Dementia risk factors

Alzheimer’s Disease International| nd| Dementia risk factors

Alzheimer’s Disease International is highlighting a new infographic which shows the 12 risk factors for dementia, it is available to download from Alzheimer’s Disease International.

Image source: alz.co.uk

The infographic is taken from a paper published in The Lanet, where it is available to download

Related:

Age UK report: The impact of COVID-19 to date on older people’s mental and physical health

Age UK | October 2020 | The impact of COVID-19 to date on older people’s
mental and physical health

Carers, families, and friends of people living with dementia have told Age UK that they have seen rapid deterioration in their loved one’s cognitive function, which has affected memory, sleep, mood, and behaviour. They explained how hard it has been to help someone with dementia to understand why they cannot do the things they enjoy or see the people they love

Full details are available in Age UK’s report The impact of COVID-19 to date on older people’s mental and physical health

See also:

Age UK Age UK research lays bare the drastic impact of the pandemic on our older population’s health and morale

Guidance for health professionals supporting groups with specific complex needs who are or have been shielding

This document is aimed at psychologists and other health professionals supporting adults who are or have been subject to shielding, who have additional complex needs or considerations, including adults with learning/intellectual disabilities, autism spectrum conditions, and/or those living with dementia | The British Psychological Society

The considerations may also be relevant for those living with long term health conditions and their families. People living with these conditions often live with hidden disabilities and the difficulties they face can consequently be less obvious to services and society due to Covid-19.

The guidance specifically focusses on those in the ‘high’ risk category defined by the UK government but recognises that many people not officially in the ‘high risk’ category may have been shielding and therefore may face similar challenges, especially those shielding others, or those in ‘moderate risk’ categories.

Full guidance: Guidance for health professionals supporting groups with specific complex needs who are or have been shielding

A new dawn of preventing dementia by preventing cerebrovascular diseases

This analysis from the BMJ discusses the relation between cerebrovascular diseases and impairment of cognition, with an emphasis on a chance to prevent dementia by preventing cerebrovascular diseases | BMJ 2020; 371:m3692

Cerebrovascular diseases and dementia are two leading contributors to impairment of brain health and neurological disability in older people. The prevalence of these two neurological disorders has increased in recent years as the population has aged and grown.

Globally, an estimated 42.4 million cases of stroke occurred in 2015, and approximately 50 million cases of dementia (including Alzheimer’s disease, vascular dementia, and other dementias) occurred in 2018. Strategies for preventing and treating stroke have progressed substantially in recent years, but no effective treatment yet exists for Alzheimer’s disease.

Recent studies have shown that many vascular risk factors and unfavourable lifestyle factors are shared predictors of stroke and dementia, and incident cerebrovascular diseases may precipitate a decline in cognitive function or dementia. This suggests that some cognitive impairment and dementia might be prevented by preventing cerebrovascular diseases.

Full analysis: A new dawn of preventing dementia by preventing cerebrovascular diseases

Prevalence, management, and outcomes of SARS-CoV-2 infections in older people and those with dementia in mental health wards in London, UK

The Lancet Psychiatry | 5th October 2020

People living in group situations or with dementia are more vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older people and those with multimorbidity have higher mortality if they become infected than the general population. However, no systematic study exists of COVID-19-related outcomes in older inpatients in psychiatric units, who comprise people from these high-risk groups.

The authors aimed to describe the period prevalence, demographics, symptoms (and asymptomatic cases), management, and survival outcomes of COVID-19 in the older inpatient psychiatric population and people with young-onset dementia in five National Health Service Trusts in London, UK, from March 1 to April 30, 2020.

The study found that patients in psychiatric inpatient settings who were admitted without known SARS-CoV-2 infection had a high risk of infection with SARS-CoV-2 compared with those in the community and had a higher proportion of deaths from COVID-19 than in the community.

Implementation of the long-standing policy of parity of esteem for mental health and planning for future COVID-19 waves in psychiatric hospitals is urgent.

Full paper: Prevalence, management, and outcomes of SARS-CoV-2 infections in older people and those with dementia in mental health wards in London, UK: a retrospective observational study

NICE impact end of life care for adults

NICE| October 2020| NICE impact end of life care for adults

Many people are unable to access all the support they need at the end of their life.

NICE impact end of life care for adults, is a new report from NICE which highlights progress made by the health and care system in implementing NICE guidance on end of life care. This publication highlights how the quality of care can be variable depending on location, social and cultural background, and diagnosis.

Many people are unable to access support at the end of life. We need to understand and strengthen the impact of NICE guidance on people’s experience of end of life care

.Julie Pearce (chief nurse and executive director of caring services) and Dr Sarah Holmes (medical director, service transformation and innovation).

The report makes some of the following key points:

Care of people approaching the end of life

  • Care at the end of life should be identified in a timely way.  If identification is effective and timely, this can allow people, and those important to them, to make decisions about their care. 
  • NICE’s quality standard on end of life care for adults says that the opportunity to develop a personalised care plan should be part of a comprehensive holistic assessment for people approaching the end of life.
  •  90% of people did not have a care plan in place on arrival at their final hospital admission
  • People with conditions such as dementia, which are not always recognised as life-limiting, often face an additional barrier to dying in their preferred place. This is because certain care settings, for example hospices, are not always offered as an option for them.
  • Healthcare professionals did not always consider the communication needs of people with dementia and sometimes assumed that the person with dementia lacked capacity

NICE impact end of life care for adults [news release]

Summary of the report available from NICE

NICE impact end of life care for adults (PDF) [report]

Worst hit: dementia during coronavirus #covid19rftlks

Alzheimer’s Society| September 2020| Worst hit: dementia during coronavirus

A new report from the Alzheimer’s Society spotlights the impact of the pandemic on family and friends caring for a loved one with dementia. Worst hit: dementia during coronavirus reveals that 92 million extra hours of care have been given in response to what the report terms, the ‘double whammy of lockdown making dementia symptoms worse, and the chronically underfunded social care system leaving them nowhere else to turn.’

Almost half (45%) of those caregivers surveyed by the charity, felt the level of care their loved one with dementia needed was more than they could give. Half of carers have spent more than 100 hours a week looking after or helping the person they care for since 23 March.

Image is a poster taken from the publication, it states key statistics from the report

Alzheimer’s Society Worst hit: dementia during coronavirus

Alzheimer’s Society press release ‘Exhausted’ family and friends spent 92 million extra hours caring for loved ones with dementia since lockdown

A Systematic Review of Mindfulness-Based Interventions for Patients with Mild Cognitive Impairment or Dementia and Caregivers

Shim M, Tilley J.L., Im, S., Price, K., & Gonzalez, A. (2020) A Systematic Review of Mindfulness-Based Interventions for Patients with Mild Cognitive Impairment or Dementia and Caregivers| Journal of Geriatric Psychiatry and Neurology| doi:10.1177/0891988720957104

New research has analysed the evidence base for mindfulness interventions for patients with dementia, mild cognitive impairment and their carers. It has been published in the Journal of Geriatric Psychiatry and Neurology

Abstract

The aim of this article was to systematically review the quality and efficacy of the current evidence for mindfulness-based interventions (MBIs) in patients with mild cognitive impairment (MCI), patients with dementia (PwD), and their caregivers. We identified 20 randomized controlled trials (RCTs) (11 for patients, 9 for caregivers) published in the last 15 years. Evidence suggested that MBIs are highly acceptable and credible treatments for patients with MCI, PwD and caregivers. Specifically, for PwD, the results indicated that the magnitude of post-treatment effects of MBIs are in the medium to large range for psychosocial outcomes, and in the small to medium range for cognitive functioning; however, treatment effects on dementia biomarkers were mixed, ranging from small to large, depending on the outcome measure. Findings also evidenced salutary effects of MBIs for caregivers of PwD, with post-treatment effects ranging from medium to large for caregiver stress and burden and large effects for quality of life, and mixed outcomes for cognitive functioning, with effects in the small to large range. However, confidence in these findings is relatively limited due to methodological limitations, especially in terms of poor consistency in intervention strategies, outcome measures, and other key criteria across studies. To better assess the value of MBIs for these populations and optimize treatment outcomes, we recommend further research with improved study methodology (e.g., multi-method assessment, universal criterion and outcome measures, use of active control groups, larger sample sizes, long-term follow-up) to replicate current findings and enhance our understanding of underlying treatment mechanisms of MBIs.

NHS in Rotherham can request the article from the Library & Knowledge Service

Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia

Kivimäki, M. et al |2020| Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia| JAMA Network Open3|9| e2016084-e2016084

Question  Are alcohol-induced loss of consciousness and heavy weekly alcohol consumption associated with increased risk of future dementia?

Findings  In this multicohort study of 131 415 adults, a 1.2-fold excess risk of dementia was associated with heavy vs moderate alcohol consumption. Those who reported having lost consciousness due to alcohol consumption, regardless of their overall weekly consumption, had a 2-fold increased risk of dementia compared with people who had not lost consciousness and were moderate drinkers.

Meaning  The findings of this study suggest that alcohol-induced loss of consciousness is a long-term risk factor for dementia among both heavy and moderate drinkers.

Importance  Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain.

Objective  To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers.

Design, Setting, and Participants  Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131 415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020.

Exposures  Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week.

Main Outcomes and Measures  Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records.

Results  Of the 131 415 participants (mean [SD] age, 43.0 [10.4] years; 80 344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22  for greater than 21 vs 1 to 21 U/wk. Of the 96 591 participants with data on loss of consciousness, 10 004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men women during the first 10 years of follow-upa fter excluding the first 10 years of follow-up, and for early-onset and late-onset  dementia, Alzheimer disease, and dementia with features of atherosclerotic cardiovascular disease. The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate or heavy.

Conclusions and Relevance  The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.

Full article from JAMA

In the news:

Daily Mail : Passing out drunk could more than DOUBLE your risk of later developing dementia and even one drink per day raises risk by 22%, study warns

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Livingston, G., et al (2020)| Dementia prevention, intervention, and care: 2020 report of the Lancet Commission| The Lancet396|(10248)|P. 413-446.

The Lancet recently published the Lancet Commission’s 2020 report on dementia prevention, intervention and care.

Key messages

  • Three new modifiable risk factors for dementia
    • New evidence supports adding three modifiable risk factors—excessive alcohol consumption, head injury, and air pollution—to our 2017 Lancet Commission on dementia prevention, intervention, and care life-course model of nine factors (less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact).
  • Modifying 12 risk factors might prevent or delay up to 40% of dementias.
  • Be ambitious about prevention
    • Prevention is about policy and individuals. Contributions to the risk and mitigation of dementia begin early and continue throughout life, so it is never too early or too late. These actions require both public health programmes and individually tailored interventions. In addition to population strategies, policy should address high-risk groups to increase social, cognitive, and physical activity; and vascular health.
  • Specific actions for risk factors across the life course
    • Aim to maintain systolic BP of 130 mm Hg or less in midlife from around age 40 years (antihypertensive treatment for hypertension is the only known effective preventive medication for dementia).
    • Encourage use of hearing aids for hearing loss and reduce hearing loss by protection of ears from excessive noise exposure.
    • Reduce exposure to air pollution and second-hand tobacco smoke.
    • Prevent head injury.
    • Limit alcohol use, as alcohol misuse and drinking more than 21 units weekly increase the risk of dementia.
    • Avoid smoking uptake and support smoking cessation to stop smoking, as this reduces the risk of dementia even in later life.
    • Provide all children with primary and secondary education.
    • Reduce obesity and the linked condition of diabetes. Sustain midlife, and possibly later life physical activity.
    • Addressing other putative risk factors for dementia, like sleep, through lifestyle interventions, will improve general health.
  • Tackle inequality and protect people with dementia
    • Many risk factors cluster around inequalities, which occur particularly in Black, Asian, and minority ethnic groups and in vulnerable populations. Tackling these factors will involve not only health promotion but also societal action to improve the circumstances in which people live their lives. Examples include creating environments that have physical activity as a norm, reducing the population profile of blood pressure rising with age through better patterns of nutrition, and reducing potential excessive noise exposure.

Taken from the Executive Summary

Full publication is available from The Lancet