Article of the month
The Interdem website committee selects an Interdem ‘ Publication of the month’. This is a recent scientific paper, written by Interdem members that will be put in the spotlights because of its innovative character, methodological soundness, impact, or discussion of relevant psychosocial interventions in dementia.
Pubmed will be searched for potential publications of the month and Interdem members may also send relevant new publications to the website committee (email@example.com).
Website committee members cannot vote for an article they co-authored.
For the publication of the month December, the website committee selected an article that is a bit unusual in this series, but it relates to a very important landmark of the dementia movement: Global action plan on the public health response to dementia 2017–2025. The World Health Organization (WHO) has adopted a Global Action Plan on Dementia in May 2017 and it is now published in a more accessible document, see here.
The plan includes actions for member states (all 194 countries that are member of WHO), WHO secretariat and regional and national offices as well as other stakeholders like Alzheimer associations and academic institutes. A key role for WHO is the Global Dementia Observatory that was launched this month and should serve as a data resource on prevalence, incidence and mortality on dementia and information about national plans and policies.
Many people have campaigned for dementia to become a global health priority. This WHO plan and Observatory are the result of that advocacy efforts. Interdem can contribute by promoting psycho-social research for dementia and support the work of WHO.
Reference: Global action plan on the public health response to dementia 2017–2025. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Burholt V, Windle G, Morgan DJ; CFAS Wales team.
Gerontologist. 2017 Nov 10;57(6):1020-1030. doi: 10.1093/geront/gnw125.
Published in The Gerontologist, this article draws on cognitive discrepancy theory to hypothesise a pathway from disability to loneliness in later life, whilst taking into account the mediating and moderating effects of the social environment and cognitive impairment. A model is drawn up based on cross-sectional data from a sample of 3,314 participants living in Wales. Whilst focusing on older individuals in general, this paper still holds important implications for dementia. E.g., cognitive impairment ws shown to have a greater effect on social resources than disability. The authors end by mentioning several strategies to alleviate loneliness and highlight the importance of dementia friendly communities in this context.
The paper of Pini et al (2017) has been selected as paper of the month for October.
An open access paper published in October 2017 in The Gerontologist, this paper uses an innovative methodological approach to understand the impact of caring through a needs led framework. Needs are identified and the plausibility of these needs are compared with other needs led theories. The paper highlights the importance of looking beyond the individual and considering relationships in dementia strategies.
See: Pini, S., Ingleson, E., Megson, M., Clare, L., Wright, P. and Oyebode, J.R., 2017. A needs-led framework for understanding the impact of caring for a family member with dementia. The Gerontologist. https://doi.org/10.1093/geront/gnx148
Background and Objectives
Approximately half the care for people with dementia is provided by families. It is therefore imperative that research informs ways of maintaining such care. In this study, we propose that a needs-led approach can provide a useful, novel means of conceptualizing the impact of caring on the lives of family carers. Our aim was to develop and present a needs-led framework for understanding how providing care impacts on carers’ fulfilment of needs.
Design and Methods
In this qualitative study, we conducted 42 semistructured interviews with a purposively diverse sample of family carers to generate nuanced contextualized accounts of how caring impacted on carers’ lives. Our inductive thematic analysis focused upon asking: “What need is being impacted here?” in order to generate a needs-led framework for understanding.
Nine themes were widely endorsed. Each completed the sentence: “Being a carer impacts on fulfilling my need to/for….”: Freedom; feel close to my relative; feel in control of my life; be my own person; protect my relative; share/express my thoughts and feelings; take care of myself; feel connected to the people around me; get things done.
Discussion and Implications
These needs echo those from other research areas, with relational needs emerging as particularly central. The needs-led approach offers a perspective that is able to capture both stresses and positive aspects of caregiving. We recommend that clinical interviewing using Socratic questioning to discover human needs that are being impacted by caring would provide a valuable starting point for care planning.
The website committee selected the paper of Mausbach et al. as publication of the month September. This study links a psychosocial intervention for caregivers of people with Alzheimer’s Disease (adaptive coping by engaging in pleasant activities) to a medical outcome: blood pressure. The 126 participants were followed for five years. Greater engagement in pleasant leisure activities was associated with lowered caregivers’ blood pressure over time. Participation in pleasant leisure activities may have cardiovascular health benefits for Alzheimer’s caregivers.
Reference: Mausbach BT, et al. Engagement in Pleasant Leisure Activities and Blood Pressure: A 5-Year Longitudinal Study in Alzheimer Caregivers. Psychosom Med. 2017 Sep;79(7):735-741. PMID: 28640179
For the month August, the website committee selected the report of Moniz-Cook et al., 2017 in which several INTERDEM colleagues collaborated.
The report refers to a comprehensive study regarding challenging behaviors in dementia and in care homes. It reports a conceptual overview, two systematic reviews, review of clinical guidelines, the development of an intervention, its evaluation in a cluster randomized trial with process evaluation of implementation and an observational cohort study of people with challenging behavior. Even though the trial did not show effectiveness on challenging behavior, its comprehensiveness summarizes the current state of art and gives important details and suggestions for future work.
Reference: Moniz-Cook E, Hart C, Woods B, Whitaker C, James I, Russell I, et al. Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families. Programme Grants Appl Res 2017; 5 (15).
It is available online here:
The paper of Thyrian et al., 2017 was selected as publication of the month July. This paper, published in a high impact journal, describes a large randomized clinical trial (634 people with dementia) on the safety and effectiveness of dementia care management compared to care as usual. It shows that dementia care management is a safe intervention that significantly reduces neuropsychiatric symptoms and caregiver burden. Furthermore it increased the use of antidementia drugs compared with care as usual. The authors argue that dementia care management should be incorporated in routine care.
See for further reading: http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2645498http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2645498
The paper of Van der Roest et al. 2017 has been selected as paper of the month June.
This paper is a review on electronic assistive technology (AT) devices designed to support people with dementia. Aim of the review was to assess the efficacy of AT for memory support in people with dementia in terms of daily performance of personal and instrumental activities of daily living (ADL), level of dependency, and admission to long-term care. The results showed a lack of high-quality evidence to determine whether AT is effective in supporting people with dementia to manage their memory problems.
Cochrane Database Syst Rev. 2017 Jun 11;6:CD009627. doi: 10.1002/14651858.CD009627.pub2.
Assistive technology for memory support in dementia.
Van der Roest HG1, Wenborn J, Pastink C, Dröes RM, Orrell M.
The paper of Sampson et al. 2017, has been selected as publication of the month.
Improving the care of people with dementia in general hospitals: evaluation of a whole-system train-the-trainer model. Sampson EL, Vickerstaff V, Lietz S, Orrell M. Int Psychogeriatr. 2017 Apr;29(4):605-614. doi: 10.1017/S1041610216002222. Epub 2016 Dec 21.
This article describes a “train-the-trainer” model which was implemented across eight acute hospital trusts in London in response to concerns about the quality of care that people with dementia receive during hospital admission. 2,020 hospital staff professionals were trained and the impact of training was evaluated using mixed methods. There was a significant improvement in staffs’ sense of competence in dementia care and the quality of interactions with patients. More hospitals adopted person-centered tools and pathways. Staff training can be considered an important step towards improving hospital outcomes for people with dementia.
The paper of Wilson et al. 2017, has been selected as publication of the month. The paper describes their systematic review on psychosocial interventions targeted at reducing grief symptoms among family caregivers of people with dementia. It shows how important it is to implement psychosocial interventions for caregivers when the person with dementia is still alive in order to prevent caregivers’ complicated grief. In fact, it seems that a combination of cognitive skills training and behavioral oriented interventions to improve the well-being of the carer and care recipient is effective in supporting the family caregivers once the person with dementia has passed away.
JBI Database System Rev Implement Rep. 2017 Mar;15(3):809-839. doi: 10.11124/JBISRIR-2016-003017.
Effectiveness of psychosocial interventions in reducing grief experienced by family carers of people with dementia: a systematic review. Wilson S, Toye C, Aoun S, Slatyer S, Moyle W, Beattie E.
To synthesize the existing evidence regarding the impact of psychosocial interventions to assist adjustment to grief, pre- and post-bereavement, for family carers of people with dementia.
INCLUSION CRITERIA TYPES OF PARTICIPANTS:
Family carers of older persons with dementia (>65 years).
TYPES OF INTERVENTIONS:
Psychosocial interventions in health and social care facilities, and community settings designed to assist family carers adjust to grief during the dementia trajectory and/or following death.
No treatment, standard care or treatment as usual, or an alternative intervention.
TYPES OF STUDIES:
Experimental and epidemiological study designs.
Grief in family carers including anticipatory, complicated and prolonged grief disorder measured with validated instruments.
A three-step strategy sought to identify both published and unpublished studies from 1995.
Assessed by two independent reviewers using standardized critical appraisal tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).
The standardized data extraction tool from JBI-MAStARI was used by two reviewers independently.
Statistical pooling of results was not possible due to the heterogeneity of the interventions and the outcome measures.
Data were extracted from three studies. Study designs were a randomized controlled trial; a pre-test, multiple post-test quasi-experimental; and a single group, repeated measures. The interventions were multi-component, had durations of nine to 26 weeks and were delivered while care recipients were alive. All studies were undertaken in the United States. There were 327 family carers, of which 197 received a psychosocial intervention. Family carers were predominantly female (84.7%), Caucasian (73.4%) and caring for their spouse (44.3%). All care recipients had dementia; 68.5% had Alzheimer’s disease. Two studies measured anticipatory grief, and the third study reported normal and complicated grief.Moderate benefits to anticipatory grief were evident upon completion of the “Easing the Way” intervention (effect size -0.43, P = 0.03). After controlling for research design and control variables, for every hour increase in the interventions focusing on family carers’ cognitive skills, there were associated decreases in carers’ normal grief (parameter estimate [PE] = -0.81, P = 0.02) and complicated grief (PE = -0.87, P = 0.03). For every hour increase in the interventions focusing on carer behavior, there was an associated decrease in carers’ complicated grief (PE = -1.32, P = 0.04). For every hour increase in the interventions focusing on care recipient behavior, there was an associated decrease in carers’ complicated grief (PE = -2.91, P = 0.04).
There is little evidence upon which to base practice with regard to interventions to reduce any aspects of grief. Findings suggest that different pre-death interventions might be warranted depending upon a family carer’s unique clinical presentation and combination of risk factors.Cognitive skills training provided while the care recipient is alive may positively impact normal and complicated grief following the death of the care recipient. When the cognitive skills training is provided in conjunction with behaviorally oriented interventions that improve the wellbeing of the carer and care recipient, carers’ complicated grief symptoms may be reduced.
The paper of Toot et al. 2017, has been selected as publication of the month. The paper describes their systematic review on causes of nursing home admission of people with dementia. They focus on factors that are responsive to interventions, such as cognitive functioning, behavior and psychological problems, carer related issues, environmental factors, functional status and physical health. Based on their results especially cognitive enhancement strategies, assessment and management of behavior and psychological challenges, and carer education and support are recommended to delay nursing home placement.
See: Toot S, Swinson T, Devine M, Challis D, Orrell M. Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis. Int Psychogeriatr. 2017 Feb;29(2):195-208. doi: 10.1017/S1041610216001654. PubMed
Up to half of people with dementia in high income countries live in nursing homes and more than two-thirds of care home residents have dementia. Fewer than half of these residents report good quality of life and most older people are anxious about the prospect of moving into a nursing home. Robust evidence is needed as to the causes of admission to nursing homes, particularly where these risk factors are modifiable.
We conducted a systematic literature search to identify controlled comparison studies in which the primary outcome was admission to nursing home of older adults with dementia. Identified studies were assessed for validity and 26 (17 cohort and 9 case-control) were included. Qualitative and quantitative analyses were conducted, including meta-analysis of 15 studies.
Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of our meta-analyses demonstrated impairments in activities of daily living as a significant risk. The effects of community support services were unclear, with both high and low levels of service use leading to nursing home placement. There was an association between caregiver burden and risk of institutionalization, but findings with regard to caregiver depression varied, as did physical health associations, with some studies showing an increased risk of nursing home placement following hip fracture, reduced mobility, and multiple comorbidities.
We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.
A synthesis of the evidence on peer research with potentially vulnerable adults: how this relates to dementia. Di Lorito C, Birt L, Poland F, Csipke E, Gove D, Diaz-Ponce A, Orrell M. Int J Geriatr Psychiatry. 2017 Jan;32(1):58-67. doi: 10.1002/gps.4577. Review.
Peer research, co-research, or participatory research, is an innovative form of PPI where people living with dementia undertake research activities such as data collection alongside academics. Co-research with this group of service users has been attracting scientific interest, yet it appears that due to stigmatising preconceptions, studies are still scarce. This review draws on participatory research with different populations (also included mental health, learning disabilities and geriatric populations) in order to develop a model of good practice. The EWGPWD was consulted during the review process in order to create an overview of potential benefits as well as challenges of peer research, and pragmatic considerations to be addressed. Although there is a need for more high-quality data, this paper challenges traditional views on the role of people with dementia in research, and provides a nuanced view not only the practical but also the ethical implications of this research method.
Claudia Cooper, Rebecca Lodwick, Kate Walters, Rosalind Raine, Jill Manthorpe, Steve Iliffe, Irene Petersen; Inequalities in receipt of mental and physical healthcare in people with dementia in the UK. Age Ageing 2016 1-8. doi: 10.1093/ageing/afw208 is the article of the month (READ)
Fair access to mental an physical healthcare is of great important to people with dementia, as they have high rates of physical ill health and neuropsychiatric symptoms. This study investigated whether there are inequalities by deprivation or gender in healthcare received by people with dementia and compared health care received by people with and without dementia. It studied primary care records of 68,061 community dwelling dementia patients and 259,337 people without dementia. Compared with the control population, people with dementia had fewer primary care consultations and were less likely to have weight and blood pressure monitored annually, despite the association of dementia with vascular risk factors, frailty and malnutrition. Furthermore, women with dementia were more likely to receive psychotropic medications than men, which may negatively impact their physical health. Interventions to improve access to healthcare and reduce psychotropic use in people with dementia, especially women, could benefit people with dementia, their families and society by enabling them to live well with dementia for longer.
The paper of Dröes et al., has been selected as publication of the month. The paper discusses the concept of social health, which acknowledges the people with dementia’s remaining capacities to fulfil potentials and obligations, to manage life and to participate in social activities. Furthermore, effective interventions in these domains are described as well as recommendations for research and practice.
Social health and dementia: a European consensus on the operationalization of the concept and directions for research and practice.
Dröes RM, Chattat R, Diaz A, Gove D, Graff M, Murphy K, Verbeek H, Vernooij-Dassen M, Clare L, Johannessen A, Roes M, Verhey F, Charras K, The Interdem Social Health Taskforce.
Aging Ment Health. 2016 Nov 21:1-14. [Epub ahead of print]
The website committee selected the publication of Zeisel et al. as publication of the month. This article introduces the terminology “Ecopsychosocial interventions” to describe a broad range of interventions that fall into this category. It can replace the term that is now often used and that describes what it is not, namely nonpharmacological interventions. The authors urge and welcome the professional community’s adoption of the new recommended terminology as well as ongoing debate about it and study of topics included in the overall term, especially contextual issues and environmental design.
Zeisel J, Reisberg B, Whitehouse P, Woods R, Verheul A. Ecopsychosocial Interventions in Cognitive Decline and Dementia: A New Terminology and a New Paradigm. Am J Alzheimers Dis Other Demen. 2016 Sep;31(6):502-7. doi: 10.1177/1533317516650806.
Dementia is a major medical and social scourge. Neither pharmacological nor nonpharmacological interventions and treatments have received sufficient funding to be meaningful in combatting this tsunami. Because the term-“nonpharmacological”-refers to what these interventions are not, rather than what they are, nonpharmacological treatments face a special set of challenges to be recognized, accepted, funded, and implemented. In some ways, the current situation is analogous to using the term “nonhate” to mean “love.” This article presents a carefully reasoned argument for using the terminology “ecopsychosocial” to describe the full range of approaches and interventions that fall into this category. These include interventions such as educational efforts with care partners, social support programs for individuals with various levels of dementia, efforts to improve community awareness of dementia, an intergenerational school where persons with dementia teach young children, and the design of residential and community settings that improve functioning and can reduce behavioral symptoms of dementia. The proposed terminology relates to the nature of the interventions themselves, rather than their outcomes, and reflects the broadest range of interventions possible under the present rubric-nonpharmacological. The goal of this new label is to be better able to compare interventions and their outcomes and to be able to see the connections between data sets presently not seen as fitting together, thereby encouraging greater focus on developing new ecopsychosocial interventions and approaches that can improve the lives of those with dementia, their care partners, and the broader society.
The website committee selected the publication of Stevnsborg L et al. as publication of the month. This study addresses the issue of inequalities of access to treatment and care for immigrants with dementia. A large nationwide register-based study was conducted in the elderly population with dementia in Denmark in 2012 (n = 34,877). Indeed some worrisome differences in access were found and further research on barriers to access to suitable healthcare is needed.
See: Stevnsborg L, Jensen-Dahm C, Nielsen TR, Gasse C, Waldemar G. Inequalities in Access to Treatment and Care for Patients with Dementia and Immigrant Background: A Danish Nationwide Study. J Alzheimers Dis. 2016 Sep 6;54(2):505-14. doi: 10.3233/JAD-160124. PubMed PMID: 27567820.
Background: Previous studies demonstrated lower quality diagnostic assessment of dementia in immigrant populations, but knowledge about the quality of treatment and care for dementia is still lacking.
Objective: To conduct a nationwide registry-based study to determine whether inequality exists regarding access to anti-dementia treatment and care between immigrant and Danish-born patients with dementia.
Methods: A cross-sectional register-based study was conducted in the entire elderly (60≥years) population with dementia in Denmark in 2012 (n = 34,877). The use of anti-dementia drugs and residency in a nursing home were compared among Danish-born and Western and non-Western immigrants with dementia. Logistic regression analysis was done with adjustment for age, sex, comorbidity, marital status, basis of inclusion, and time since dementia diagnosis.
Results: Immigrant background was associated with a significantly lower likelihood of receiving anti-dementia drug therapy (odds ratio (OR) [95% confidence interval (CI)]): non-Western = 0.70 [0.56-0.87]; Western = 0.74 [0.63-0.87]). No significant differences were found in type or amount of anti-dementia medication dispensed between the population groups (proxy measure for adherence). Non-Western immigrants were significantly less likely to live in a nursing home (0.52 [0.41-0.65]).
Conclusion: This nationwide registry-based study indicated a worrisome difference in access to anti-dementia treatment and care for dementia patients with an immigrant background, but similar levels of adherence compared with the Danish-born population. Further research is necessary to pinpoint barriers to access to suitable healthcare among elderly immigrants with dementia but also to identify and develop culturally sensitive methods for their treatment and care.
July - August 2016
The website committee selected the publication of Nelleke van ‘t Leven et al. as publication of the month. This study addresses the important topic of how interventions can deliver a person-centred approach. It examined how three specific multiple-component, activating dyadic interventions fitted needs, characteristics, and preferences of both the people with dementia and their informal caregivers. These interventions included the Pleasant Events Program, the Exercise and Support Intervention for People with Dementia and Their Caregivers, and Occupational Therapy. Results showed that five factors influenced the dyad’s ‘fit’ for these interventions: timing, need for activity, lifestyle, apart-or-together and meaning of (lost) activity.
See: Van’t Leven N, de Lange J, Prick AE, Pot AM . How do activating interventions fit the personal needs, characteristics and preferences of people with dementia living in the community and their informal caregivers? Dementia (London). 2016 Aug 10. pii: 1471301216662378. [Epub ahead of print]
The publication of the month June, selected by the website committee, is Sobol et al. In this article results of a large RCT are described in which supervised aerobic exercises were compared to care as usual in community-dwelling persons with mild Alzheimer’s disease. Positive effects were shown on fitness, exercise self-efficacy, single-task physical performance and dual-task performance.
See: Sobol NA, Hoffmann K, Frederiksen KS, Vogel A, Vestergaard K, Brændgaard H, Gottrup H, Lolk A, Wermuth L, Jakobsen S, Laugesen L, Gergelyffy R, Høgh P, Bjerregaard E, Siersma V, Andersen BB, Johannsen P, Waldemar G, Hasselbalch SG, Beyer N. Effect of aerobic exercise on physical performance in patients with Alzheimer’s disease. Alzheimers Dement. 2016 Jun 23. pii: S1552-5260(15)30002-9. doi: 10.1016/j.jalz.2016.05.004. [Epub ahead of print] PubMed PMID: 27344641.
The website committee selected the publication of Wiskerke et al. as publication of the month. The paper discusses a rather new theme: how to deal with new relationships or sexual intimacy of persons with dementia whilst still married to another person? Results of qualitative interviews with relatives and staff are discussed.
See: Wiskerke E, Manthorpe J. New relationships and intimacy in long-term care: The views of relatives of residents with dementia and care home staff. Dementia (London). 2016 May 6. pii: 1471301216647814. [Epub ahead of print] PubMed PMID:
This time the website committee selected the publication of Laakkonen et al, as publication of the month April. This is a well-designed study about effects of self-management groups for informal caregivers and for persons with dementia. It addresses the important topic of promoting empowerment and problem solving skills in dementia.
See: Laakkonen ML, Kautiainen H, Hölttä E, Savikko N, Tilvis RS, Strandberg TE, Pitkälä KH. Effects of Self-Management Groups for People with Dementia and Their Spouses-Randomized Controlled Trial. J Am Geriatr Soc. 2016 Apr;64(4):752-60.
doi: 10.1111/jgs.14055. Epub 2016 Apr 5. PubMed PMID: 27060101
The website committee selected the publication of Lawrence V. et al. as publication of the month. A large qualitative study was conducted with focus group discussion in sixteen care homes. It stresses relevant factors to consider when trying to implement psychosocial interventions in care homes.
See: Lawrence V, Fossey J, Ballard C, Ferreira N, Murray J. Helping staff to implement psychosocial interventions in care homes: augmenting existing practices and meeting needs for support. Int J Geriatr Psychiatry. 2016 Mar;31(3):284-93.
doi: 10.1002/gps.4322. Epub 2015 Jul 20. PubMed PMID: 26192078
You can find it HERE
The website committee selected the publication of Alieske Dam et al. as publication of the month. A thorough systematic review was performed on a relevant topic: social support interventions to improve well-being in caregivers. Multi-component interventions were most effective on caregiver social support and well-being.
See: Dam AE, de Vugt ME, Klinkenberg IP, Verhey FR, van Boxtel MP. A systematic review of social support interventions for caregivers of people with dementia: Are they doing what they promise? Maturitas. 2016 Mar; 85: 117-30. doi:
10.1016/j.maturitas.2015.12.008. Epub 2016 Jan 4.
You can find it at: http://www.maturitas.org/article/S0378-5122(15)30092-X/abstract
The website committee selected the article of Clive Ballard et al. as publication of the month.
This high-impact article describes results of a cluster-randomized factorial controlled trial in 16 U.K nursing homes showing that worsening of neuropsychiatric symptomatology after reduction of antipsychotic medication use in long-term care settings can be mitigated by concomitant delivery of an nonpharmacological intervention aimed at improving resident interactions.
See: Ballard C, Orrell M, YongZhong S, Moniz-Cook E, Stafford J, Whittaker R, Woods B, Corbett A, Garrod L, Khan Z, Woodward-Carlton B, Wenborn J, Fossey J. Impact of Antipsychotic Review and Nonpharmacological Intervention on Antipsychotic Use, Neuropsychiatric Symptoms, and Mortality in People With Dementia Living in Nursing Homes: A Factorial Cluster-Randomized Controlled Trial by the Well-Being and Health for People With Dementia (WHELD) Program. Am J Psychiatry. 2015 Nov 20:appiajp201515010130. [Epub ahead of print] PubMed PMID: 2658540
The website committee selected the publication of Alexandra König et al. as publication of the month. The article describes an innovative way of assessing autonomy in persons with dementia by using a video event monitoring system. It was tested among 49 participants and results show that this technology may improve autonomy assessment in an unbiased way.
See: König A, Sacco G, Bensadoun G, Bremond F, David R, Verhey F, Aalten P, Robert P, Manera V. Ecological Assessment of Autonomy in Instrumental Activities of Daily Living in Dementia Patients by the Means of an Automatic Video Monitoring System. Front Aging Neurosci. 2015 Jun 9;7:110.