No abstract

Lewy body dementia (consisting of dementia with Lewy bodies and Parkinson's disease dementia) is a common neurodegenerative disease characterised by visual hallucinations, fluctuating attention, motor disturbances, falls, and sensitivity to antipsychotics. This combination of features presents challenges for pharmacological management. Given this, we sought to review evidence for non-pharmacological interventions with patients with Lewy body dementia and their carers. Bibliographic databases were searched using a wide range of search terms and no restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 21 studies including two randomised controlled trials with available subgroup data, seven case series, and 12 case studies. Most studies reported beneficial effects of the interventions used, though the only sizeable study was on dysphagia, showing a benefit of honey-thickened liquids. Given the heterogeneity of interventions and poor quality of the studies overall, no quantitative synthesis was possible. Overall, identified studies suggested possible benefits of non-pharmacological interventions in Lewy body dementia, but the small sample sizes and low quality of studies mean no definite recommendations can be offered. Our findings underscore the clear and urgent need for future research on this topic.

In this investigation, eight highly-trained musicians communicated emotions through composition, performance expression, or the combination of the two. In the performance condition, they performed melodies with the intention of expressing six target emotions: anger, fear, happiness, neutral, sadness, and tenderness. In the composition condition, they composed melodies to express the same six emotions. The notated compositions were then played digitally without performance expression. In the combined condition, musicians performed the melodies they composed to convey the target emotions. Forty-two listeners heard the stimuli and attempted to decode the emotions in a forced-choice paradigm. Decoding accuracy varied significantly as a function of the channel of communication. Fear was comparatively well-decoded in the composition condition whereas anger was comparatively well decoded in the performance condition. Happiness and sadness were comparatively well-decoded in all three channels of communication. A principal component analysis of cues used by musicians clarified the distinct approaches adopted in composition and performance to differentiate emotional intentions. The results confirm that composition and performance involve the manipulation of distinct cues and have different emotional capabilities.

The findings of a study by Cahn and Polich (2009) suggests that there is an effect of a meditative state on three event-related potential (ERP) brain markers of "low-level" auditory attention (i.e., acoustic representations in sensory memory) in expert meditators: the N1, the P2, and the P3a. The current study built on these findings by examining trait and state effects of meditation on the passive auditory mismatch negativity (MMN), N1, and P2 ERPs. We found that the MMN was significantly larger in meditators than non-meditators regardless of whether they were meditating or not (a trait effect), and that N1 amplitude was significantly attenuated during meditation in non-meditators but not expert meditators (an interaction between trait and state). These outcomes suggest that low-level attention is superior in long-term meditators in general. In contrast, low-level attention is reduced in non-meditators when they are asked to meditate for the first time, possibly due to auditory fatigue or cognitive overload.

Depression and a number of other psychiatric conditions can impair cognition and give the appearance of neurodegenerative disease. Collectively, this group of disorders is known as ‘pseudodementia’ and are important to identify given their potential reversibility with treatment. Despite considerable interest historically, the longitudinal outcomes of patients with pseudodementia remain unclear. We conducted a systematic review of longitudinal studies of pseudodementia. Bibliographic databases were searched using a wide range of search terms. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 18 studies with follow-up varying from several weeks to 18 years. Overall, 284 patients were studied, including 238 patients with depression, 18 with conversion disorder, 14 with psychosis, and 11 with bipolar disorder. Irrespective of diagnosis, 33% developed irreversible dementia at follow-up, 53% no longer met criteria for dementia, and 15% were lost to follow-up. Considerable variability was identified, with younger age at baseline, but not follow-up duration, associated with better outcomes. ECT and pharmacological interventions were also reported to be beneficial, though findings were limited by the poor quality of the studies. Overall, the findings suggest that pseudodementia may confer an increased risk of irreversible dementia in older patients. The findings also indicate, however, that a significant proportion improve, while many remain burdened with their psychiatric condition, independent of organic dementia. The findings support the clinical value of the construct and the need for its re-examination in light of developments in neuroimaging, genomics, other investigative tools, and trial methodology.