Dementia Bulletin13 December, 2017 | From DBTH Knowledge Library and Information Service

Marriage may lower the riskof developing dementiaNov 29, 2017 03:15PM

Marriage may help stave off dementia, study finds | Journalof Neurology Neurosurgery & Psychiatry

Researchers combining the results of 15 studies including data onmore than 800,000 participants have found that lifelong singletonsand widowers appear to have a heightened risk of developingdementia.

Analysis of the data showed that lifelong singletons were 42%more likely to develop dementia than those who were married, andwidowers were 20% more likely to develop the condition. Part ofthis risk might be explained by poorer physical health amonglifelong single people, suggest the researchers. Marriage may helpboth partners to have healthier lifestyles, including exercisingmore, eating a healthy diet, and smoking and drinking less, all ofwhich have been associated with lower risk of dementia. Couplesmay also have more opportunities for social engagement thansingle people – a factor that has been linked to better health andlower dementia risk, the researchers suggest.

Full reference: Sommerlad A, et al. | Marriage and risk ofdementia: systematic review and meta-analysis of observationalstudies | Journal of Neurology Neurosurgery & Psychiatry |published online 28 November 2017

High-intensity exerciseboosts memory, new researchsuggestsNov 24, 2017 04:12PM

Heisz, J. et al. The Effects of Physical Exercise and CognitiveTraining on Memory and Neurotrophic Factors. Journal ofCognitive Neuroscience, 2017; 29 (11) | story viaScienceDaily

The health advantages of high-intensity exercise are widely knownbut new research from McMaster University points to anothermajor benefit: better memory.

The findings could have implications for an aging population whichis grappling with the growing problem of catastrophic diseasessuch as dementia and Alzheimer’s.

Scientists have found that six weeks of intense exercise — shortbouts of interval training over the course of 20 minutes — showedsignificant improvements in what is known as high-interferencememory, which, for example, allows us to distinguish our car fromanother of the same make and model.

The findings are important because memory performance of thestudy participants, who were all healthy young adults, increasedover a relatively short period of time, say researchers.

The study is published in the Journal of Cognitive Neuroscience.

Full story at ScienceDaily

Public Health Interventionsfor Decreasing Dementia RiskNov 22, 2017 04:06PM

Hankey, G. J. | Public Health Interventions for DecreasingDementia Risk | JAMA Neurol. Published online November20, 2017. doi:10.1001

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Dementia is projected to be the greatest global challenge forhealth and social care this century. Dementia is a neurocognitivesyndrome specific to people with otherwise normal braindevelopment, characterized by a decline in level of cognitiveability that compromises social functioning or activities of dailyliving. At present, it affects nearly 50 million people globally; theincreasing life expectancy of the global population meansdementia threatens to affect 75 million people by 2030 and 132million by 2050, unless effective prevention strategies can beidentified and implemented. Its impact on affected individuals,families, and caregivers, as well as the community and economy, isalready substantial because of the lack of effective, diseasecourse-modifying treatment.

This paper describes the current public health burden of dementiaand the recent insights and ongoing research needs for effective,appropriate prevention.

Further detail at JAMA Network

New research shows wherein the brain the earliest signsof Alzheimer’s occurNov 8, 2017 02:55PM

Researchers have convincingly shown where in the brain theearliest signs of Alzheimer’s occur. Nature Communications| Story via ScienceDaily

In Alzheimer’s, the initial changes in the brain occur throughretention of the protein, ?-amyloid (beta-amyloid). The processbegins 10–20 years before the first symptoms become noticeablein the patient.

In Nature Communications, a research team has presented resultsshowing where in the brain the initial accumulation of ?-amyloidoccurs. It is hoped that the discovery could potentially becomesignificant to future Alzheimer’s research while contributing toimproved diagnostics.

Full story at ScienceDaily

Link to the research: Palmqvist, S et al. Earliest accumulation ofβ-amyloid occurs within the default-mode network andconcurrently affects brain connectivity.Nature Communications,2017; 8 (1)

Home support services inlater stage dementiaNov 8, 2017 01:48PM

Kampanellou, E at al. | Carer preferences for home supportservices in later stage dementia | Aging and Mental Health |Published online: 01 Nov 2017

Objectives: To examine the relative importance of different homesupport attributes from the perspective of carers of people withlater-stage dementia.

Method: Preferences from 100 carers, recruited through carers’

organisations, were assessed with a Discrete Choice Experiment(DCE) survey, administered online and by paper questionnaire.Attributes were informed by an evidence synthesis and layconsultations. A conditional logit model was used to estimatepreference weights for the attributes within a home support‘package’.

Results: The most preferred attributes were ‘respite care,available regularly to fit your needs’ (coefficient 1.29, p = p = Conclusions: These carer preferences concur with emergingevidence on home support interventions for dementia. Respitecare, home care and training on managing difficulties provided athome are important components. Carers’ preferences revealed thedaily challenges of caring for individuals with later stage dementiaand the need for tailored and specialised home support.

Risk factors & AlzheimersDisease: Sleep disturbance,depression and anxietyNov 1, 2017 03:05PM

Findings suggest that sleep disturbance, depression, andanxiety are associated with AD development amongcognitively asymptomatic participants | Aging & MentalHealth

Objectives: Alzheimer’s disease (AD) dementia is aneurodegenerative condition, which leads to impairments inmemory. This study predicted that sleep disturbance, depression,and anxiety increase the hazard of AD, independently and ascomorbid conditions.

Methods: Data from the National Alzheimer’s CoordinatingCenter was used to analyze evaluations of 12,083 cognitivelyasymptomatic participants. Survival analysis was used to explorethe longitudinal effect of depression, sleep disturbance, andanxiety as predictors of AD. The comorbid risk posed bydepression in the last two years coupled with sleep disturbance,lifetime depression and sleep disturbance, clinician-verifieddepression and sleep disturbance, sleep disturbance and anxiety,depression in the last two years and anxiety, lifetime depressionand anxiety, and clinician-verified depression and anxiety werealso analyzed as predictors of AD through main effects andadditive models.

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Results: Main effects models demonstrated a strong hazard of ADdevelopment for those reporting depression, sleep disturbance,and anxiety as independent symptoms. The additive effectremained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression,and anxiety are associated with AD development amongcognitively asymptomatic participants. Decreasing the threatposed by psychological symptoms may be one avenue for possiblydelaying onset of AD.

Full reference: Shanna L. Burke et al. | Psychosocial risk factorsand Alzheimer’s disease: the associative effect of depression, sleepdisturbance, and anxiety | Aging & Mental Health | Publishedonline: 27th Oct 2017

Improving the care of peopleliving with dementiaadmitted to hospitalsOct 27, 2017 12:12PM

This review seeks to identify primary research and use itsfindings to develop explanations of what characteristics ofdementia-friendly initiatives in hospitals make them work,in what circumstances, and why | BMJ

Abstract

Objectives To identify features of programmes and approaches tomake healthcare delivery in secondary healthcare settings moredementia-friendly, providing a context-relevant understanding ofhow interventions achieve outcomes for people living withdementia.

Design A realist review conducted in three phases: (1)stakeholder interviews and scoping of the literature to develop aninitial programme theory for providing effective dementia care; (2)structured retrieval and extraction of evidence; and (3) analysisand synthesis to build and refine the programme theory.

Data sources PubMed, Cumulative Index to Nursing and AlliedHealth Literature (CINAHL), Cochrane Library, NHS Evidence,Scopus and grey literature.

Eligibility criteria Studies reporting interventions andapproaches to make hospital environments moredementia-friendly. Studies not reporting patient outcomes orcontributing to the programme theory were excluded.

Results Phase 1 combined findings from 15 stakeholderinterviews and 22 publications to develop candidate programmetheories. Phases 2 and 3 identified and synthesised evidence from28 publications. Prominent context–mechanism–outcomeconfigurations were identified to explain what supporteddementia-friendly healthcare in acute settings. Staff capacity tounderstand the behaviours of people living with dementia ascommunication of an unmet need, combined with a recognitionand valuing of their role in their care, prompted changes to carepractices. Endorsement from senior management gave staffconfidence and permission to adapt working practices to providegood dementia care. Key contextual factors were the availability ofstaff and an alignment of ward priorities to value person-centred

care approaches. A preoccupation with risk generated responsesthat werelikely to restrict patient choice and increase theirdistress.

Conclusions This review suggests that strategies such asdementia awareness training alone will not improve dementia careor outcomes for patients with dementia. Instead, how staff aresupported to implement learning and resources by senior teammembers with dementia expertise is a key component forimproving care practices and patient outcomes.

Full reference: Handley M, Bunn F, Goodman C. | Dementia-friendly interventions to improve the care of peopleliving with dementia admitted to hospitals: a realist review | BMJOpen 2017; 7:e015257

See also: Dementia care in hospital: training, leadership andculture change needed | The Mental Elf

Dementia assessment andimprovement frameworkOct 18, 2017 03:23PM

An evidence-based framework to support and enabledirectors of nursing and medical directors to achieve‘outstanding’ care standards for those living with dementiaduring their stay in hospital | NHS Improvement

This framework has eight standards, and draws on learning fromorganisations that have achieved an ‘outstanding’ rating from theCare Quality Commission. The document integrates policyguidance and best practice with opinion from patients and carers.

The state of hospice servicesin England 2014 to 2017Oct 13, 2017 11:03AM

The state of hospice services in England 2014 to 2017presents findings from the Care Quality Commission’sprogramme of inspections.

The CQC inspected hospice services in England between October2014 and January 2017.

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Image source: http://www.cqc.org.uk

The results found that Hospice care across England has thehighest percentage of health and social care services that arerated outstanding (25%), and a further 70% are rated good.

The inspections found that hospice leaders and frontline staffdisplayed a strong commitment to providing truly person-centred,compassionate care and support to people using their services,and their loved ones. They also developed strong relationshipswith other services in the area.

However, the report makes the case that there is more to be doneto make sure that everyone, regardless of their background orcircumstances, can access high-quality end of life care. Hospiceservices rated as outstanding were striving to overcome suchinequalities and share their expertise to drive better care in otherservices.

Full report: The state of hospice services in England 2014 to 2017.Findings from CQC’s initial programme of comprehensiveinspections of hospice services

Dementia is still the leadingcause of death in Englandand WalesOct 13, 2017 10:49AM

Dementia and Alzheimer’s disease remain the leading cause ofdeath in England and Wales, accounting for 12.0% of all deathsregistered in 2016, up from 11.6% in 2015, according to newOffice of National Statistics (ONS) figures.

This increase is attributed by ONS to people living longer, due toimproved lifestyles and medical advances. With people livinglonger and surviving other illnesses, the number of peopledeveloping dementia and Alzheimer disease is increasing.Improved identification and diagnosis of dementia has alsocontributed to the increase.

Here, the Alzheimer’s Society responds to the figures showingdementia remains the leading cause of death.

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