Clinically effective, safe treatment of sleep disturbances in dementia remains an unresolved challenge. Given the importance of sleep and the many consequences of its disruption, well designed controlled trials are needed to determine acceptable and cost-effective treatment strategies that work for sleep disturbances.
Background It has been estimated that between 25% and 40% of people living with dementia suffer from sleep disturbances, and there are currently no known effective treatments. Sleep disturbances may be the direct result of dementia or due to other comorbidities, such as pain and limited mobility. If carers’ sleep is also disturbed, carers too can become tired and stressed, and this sometimes results in the breakdown of care in the home. Objectives To design an evidence-based manualised non-pharmacological therapy for sleep disturbances and test it for feasibility and acceptability. Design A single-blind, randomised, parallel-group feasibility trial, with participants randomised 2 : 1 to intervention or treatment as usual (TAU). Setting Five memory services in two London NHS trusts and Join Dementia Research (JDR). Participants The study recruited people with dementia and sleep disturbances (who scored ≥ 4 on at least one question on the Sleep Disorders Inventory) and their primary family carers. Intervention All participants were given an Actiwatch (CamNtech Ltd, Cambridge, UK) to wear to record their sleep patterns for 2 weeks before randomisation. The intervention group received Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS START). This was designed as a six-session, manual-based intervention for carers of people with dementia, delivered by trained and clinically supervised psychology graduates, based on evidence about managing sleep disturbance in people with dementia. It uses the structure of a previous manual-based treatment, STrAtegies for RelaTives (START). Family carers were consulted about structure, content and design. Sessions were interactive, and each involved techniques, tasks to practise between sessions, relaxation and a recapitulation on the previous session. The sessions covered understanding sleep and dementia, making a plan (incorporating information from Actiwatch read-outs and a light box to increase light), daytime activity and routine, difficult night-time behaviours, taking care of your own (carer’s) sleep and using the strategies in the future. Carers kept their own manual, light box and relaxation recordings post intervention. Randomisation and blinding A statistician created an electronic randomisation list, stratified by site, using random permuted blocks. Those assessing the outcome were blinded to allocation; participants were not blinded. Main outcome measures Outcomes were assessed at 3 months. (1) Feasibility, defined as the percentage of eligible people who consented to the study recruitment, with an expected value of 50% [95% confidence interval (CI) 41% to 59%]. (2) Acceptability, defined as the percentage of intervention group participants attending ≥ 4 intervention sessions, with an expected value of 75% (95% CI 59% to 87%). The predetermined criterion for progression to the main trial was acceptability of ≥ 70%. Results Of 95 eligible patients referred, 63 (66%, 95% CI 56% to 76%) consented between 4 August 2016 and 24 March 2017: 61 from memory clinics and two from JDR. Of these, 62 participants (65%, 95% CI 55% to 75%) were randomised: 42 to the intervention arm and 20 to the TAU arm. Thirty-seven out of 42 participants (88%, 95% CI 75% to 96%) adhered to the intervention. Conclusions The results show that the randomised controlled trial is feasible and that the intervention is acceptable. A higher than expected proportion of eligible patients referred consented to the study and adhered to the intervention. Limitations Participants were not blinded and were recruited only in London. Future work The results of this trial indicate that a future efficacy trial is warranted. Trial registration Current Controlled Trials ISCTRN36983298. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 71. See the NIHR Journals Library website for further project information. Funding was also provided by Camden and Islington NHS Foundation Trust and Barnet, Enfield and Haringey Mental Health NHS Trust to pay for excess treatment costs from therapist training and supervision and intervention delivery.
We need collective action to tackle global warming. However, research shows that people switch off from being concerned about the environment because they are often too busy, or fail to appreciate their ability to make a difference. An alternative approach is to run campaigns that are able to engage large numbers of people and engender feelings of concern and empowerment. This could then kick-start a range of pro-environmental habits. We present the development and evaluation of a playful installation that aimed to attract attention, and stimulate discussion about environmental issues amongst university staff and students. The first prototype was shown to successfully attract people to engage and interact with the installation. The second prototype was deployed in-the-wild, over the course of a week. We evaluated the extent to which the installation was successful at attracting attention, and in encouraging people to interact with it, to reflect on their habits and to discuss environmental issues with others. We found the Green Ball Kiosk was a fun way to raise discussions about green issues, to encourage the adoption of new environmentally friendly behaviours and to prompt people to maintain existing ones. We suggest that interactive installations such as this can be effective at promoting awareness and generating a 'social buzz' about environmental topics when exhibited as a temporary installation.
Emotion recognition is vital for social interactions, and atypical (or biased) emotion recognition has been linked to mental health disorders including depression and anxiety. However, biases in emotion recognition vary across studies, and it is unclear whether this reflects genuine group differences in psychological processes underlying emotion recognition or differences in methodologies. One common method to measure biases in emotion recognition involves morphing a face between two emotional expressions in different ratios and asking participants to categorise the faces as belonging to one of the two emotion categories (‘direct-morphing’ method). However, this method creates morphed faces that are not ecologically valid. Alternatively, faces may be morphed through a neutral expression (‘morphing-through-neutral’ method), which is more ecologically valid since emotional expressions usually start from a neutral face. To compare these two approaches, we measured emotion recognition biases using two morphing techniques in 136 participants who also completed measures of anxiety (GAD-7) and depression (PHQ-9). Biases obtained using the two methods differed significantly: In the direct-morphing method, participants perceived the central 50% happy/50% angry face as slightly happy, whereas in the morphing-through-neutral method the neutral face was seen as angry. There were no associations between biases and depression or anxiety scores for either morphing method. This study is the first to directly compare emotion recognition biases obtained using two different morphing methods and is a first step towards reconciling discrepancies in the literature.
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