New person-centred service being developed by Alzheimer’s Society

Alzheimer’s Society | September 2018 | Keeping connected: The right support at the right time

Dementia Connect, is a new service being developed  by the Alzheimer’s Society to keep in touch with and support people affected by dementia. The service, currently available in Penine Lancashire- where it is being piloted- involves specialist dementia advisers assessing and addressing the needs of people who either contact the service themselves or who are referred to Dementia Connect.

 

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The new service provides a combination of  face-to-face support with telephone and online advice, so people can access the help that they need, when they need it. It is part of The Alzheimer’s Society  strategy New Deal on Dementia,  which aims by 2022,  for everyone affected by the condition to be offered information, advice and support (Source: Alzheimer’s Society).

Full details and to read about the impact of the service on  people affected by dementia visit Alzheimer’s Society 

Are noise and air pollution related to the incidence of dementia? A cohort study in London

Carey IMAnderson HRAtkinson RW, et al| 2018 | Are noise and air pollution related to the incidence of dementia? A cohort study in London, England |

A new article published  in the BMJ Open investigated an association between dementia and air and noise pollution in London. The cohort study included 75  Greater London Practices and involved patients with no recorded history of dementia. 

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Abstract

Objective To investigate whether the incidence of dementia is related to residential levels of air and noise pollution in London.

Design Retrospective cohort study using primary care data.

Setting 75 Greater London practices.

Participants 130 978 adults aged 50–79 years registered with their general practices on 1 January 2005, with no recorded history of dementia or care home residence.

Primary and secondary outcome measures A first recorded diagnosis of dementia and, where specified, subgroups of Alzheimer’s disease and vascular dementia during 2005–2013. The average annual concentrations during 2004 of nitrogen dioxide (NO2), particulate matter with a median aerodynamic diameter less than or equal to2.5 µm (PM2.5) and ozone (O3) were estimated at 20×20 m resolution from dispersion models. Traffic intensity, distance from major road and night-time noise levels (Lnight) were estimated at the postcode level. All exposure measures were linked anonymously to clinical data via residential postcode. HRs from Cox models were adjusted for age, sex, ethnicity, smoking and body mass index, with further adjustments explored for area deprivation and comorbidity.

Results 2181 subjects (1.7%) received an incident diagnosis of dementia (39% mentioning Alzheimer’s disease, 29% vascular dementia). There was a positive exposure response relationship between dementia and all measures of air pollution except O3, which was not readily explained by further adjustment. Adults living in areas with the highest fifth of NO2 concentration  versus the lowest fifth  were at a higher risk of dementia. Increases in dementia risk were also observed with PM2.5, PM2.5 specifically from primary traffic sources only and Lnight, but only NO2 and PM2.5 remained statistically significant in multipollutant models. Associations were more consistent for Alzheimer’s disease than vascular dementia.

Conclusions We have found evidence of a positive association between residential levels of air pollution across London and being diagnosed with dementia, which is unexplained by known confounding factors.

Read the full article at BMJ Open 

Related:

OnMedica Air pollution may be linked to heightened dementia risk

Could dementia cafés be a new type of community resource for dementia care?

Takechi H, et al.A Dementia Café as a Bridgehead for Community-Inclusive Care: Qualitative Analysis of Observations by On-the-Job Training Participants in a Dementia Café. | Dementia & Geriatric Cognitive Disorders | 2018 | Vol. 46 p.128-139

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Background/Aims: Dementia cafés are becoming widespread as a new approach to dementia care, but their operational procedures and significance have not been adequately studied.

Methods: On-the-job training (OJT) for professionals planning to operate a dementia café in the future was conducted in a pioneering dementia café in Japan. The reports of OJT trainees’ observations and learning were analyzed qualitatively.

Results: Reports could be summarized in up to 9 themes: 2 related to the atmosphere and significance of the café, 3 related to the guests, such as people with dementia and their families, and 4 related to the café staff.

Discussion: The results of the present study identified the elements that make up dementia cafés and their significance and suggest that dementia cafés could be a new type of community resource for dementia care in the future.

More detail at Dementia & Geriatric Cognitive Disorders

Antidepressants for treating depression in dementia

Dudas,  R., Malouf,  R., McCleery,  J., & Dening,  T.| 2018|  Antidepressants for treating depression in dementia| Cochrane Database of Systematic Reviews 2018 | Issue 8| Art. No.: CD003944|  DOI: 10.1002/14651858.CD003944.pub2.

A new review from Cochrane looks at the efficacy of antidepressants in treating depression in dementia. This study updates an earlier version, first published in 2002. 

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Plain language summary

Antidepressants for treating depression in dementia

Review question

We reviewed the evidence about the effect of antidepressants on depression in people with dementia.

Background

Depression can be hard to recognise in people with dementia, but there is evidence that it is common and associated with increased disability, poorer quality of life, and shorter life expectancy. Many people with dementia are prescribed antidepressants to treat depression, but there is uncertainty about how effective this is.

Study characteristics

We found ten studies with 1592 people to include in the review. On average, the studies lasted only 12 weeks, although one study ran for nine months. Each of them used a set of formal criteria to diagnose both depression and dementia and compared an antidepressant against a dummy pill (placebo).

The older studies used more old‐fashioned antidepressants (imipramine, clomipramine, and moclobemide) and the newer studies used more modern ones, such as venlafaxine, mirtazapine and so‐called SSRI antidepressants (sertraline, fluoxetine, citalopram and escitalopram).

The people taking part in the studies had an average age of 75 and they had mild or moderate dementia. With the exception of two studies, they were being treated as outpatients.

Key results

We found that there was little or no difference in scores on depression rating scales between people treated with antidepressants and those treated with placebo for 12 weeks. The evidence to support this finding was of high quality, which suggests that further research is unlikely to find a different result. There was probably also little or no difference after six to nine months of treatment.

Another way to assess the effect of antidepressants is to count the number of people in the antidepressant and placebo groups who show significant clinical improvement (response) or who recover from depression (remission). There was low‐quality evidence on the number of people showing a significant clinical improvement and the result was imprecise so we were unable to be sure of any effect on this measure. People taking an antidepressant were probably more likely to recover from depression than were those taking placebo (antidepressant: 40%, placebo: 21.7%). There was moderate‐quality evidence for this finding, so it is possible that further research could find a different result.

We found that antidepressants did not affect the ability to manage daily activities and probably had little or no effect on a test of cognitive function (which includes attention, memory, and language).

People taking an antidepressant were probably more likely to drop out of treatment and to have at least one unwanted side effect.

Quality of the evidence

The quality of the evidence varied, mainly due to poorly conducted studies and problems with the relevance of the outcome measures used. This should be taken into consideration when interpreting the different results on depression rating scales and recovery rates, as evidence was of a higher quality for the former than for the latter.

Another major problem is that side effects are very rarely well‐reported in studies.

Therefore, further research will still be useful to reach conclusions that are more reliable and can better help doctors and patients to know what works for whom.

The full paper is available from the Cochrane 

A summary including the abstract and  plain language summary is here 

Dementia patients “suffering in silence”

University College London | September 2018 | Dementia patients “suffering in silence”

A new study from University College London (UCL) reports that one-third of patients with dementia who may also experience delirium (a state of acute confusion) are frequently unable to express that they are in pain.  The study has originality, as it is the first of its kind  in a hospital context. It has been funded by the Alzheimer’s Society and Bupa Foundation, and supported by the terminal illness charity Marie Curie. The research was conducted in two acute hospitals in the UK and followed more than 200 patients over the age of 70 (via UCL).

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At the outset the researchers asked patients if they were in pain. If the patient was then unable to communicate, researchers assessed people for signs of pain in their facial expression and body language. They recorded the number of people who were unable to communicate that they were in pain, and measured delirium with a standard confusion assessment method.

The researchers found that almost half (49%)  of the participants experienced pain at rest, while a quarter (25%)  experienced pain during activity. A little over a  third (35%) of participants who were delirious and unable to self-report pain,  of these patients 33%  experienced pain at rest, and 56% experienced pain during activity.

The odds of being delirious were 3.26 times higher in participants experiencing pain at rest.

Senior Author Dr Liz Samson from the Marie Curie Palliative Care Research Department, UCL Psychiatry says, ” In the UK, almost half of people admitted to hospital over the age of 70 will have dementia. We know that they are a high-risk group for delirium and yet delirium is often under treated.”  She elaborated, “It’s deeply troubling to think that this vulnerable group of patients are suffering in silence, unable to tell healthcare professionals that they are in pain.” (Source: UCL)

Read the full story at UCL

The research findings have now been published in the journal  Age and Ageing, where the full article can be read

Forecasting the care needs of the older population in England

This study estimates that, in the next 20 years, the English population aged 65 years or over will see increases in the number of individuals who are independent but also in those with complex care needs. This increase is due to more individuals reaching 85 years or older who have higher levels of dependency, dementia and comorbidity.

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Background
Existing models for forecasting future care needs are limited in the risk factors included and in the assumptions made about incoming cohorts. We estimated the numbers of people aged 65 years or older in England and the years lived in older age requiring care at different intensities between 2015 and 2035 from the Population Ageing and Care Simulation (PACSim) model.
Methods
PACSim, a dynamic microsimulation model, combined three studies (Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II) to simulate individuals’ sociodemographic factors, health behaviours, 12 chronic diseases and geriatric conditions, and dependency (categorised as high [24-h care], medium [daily care], or low [less than daily] dependency; or independent). Transition probabilities for each characteristic were estimated by modelling state changes from baseline to 2-year follow-up. Years in dependency states were calculated by Sullivan’s method.
Findings
Between 2015 and 2035 in England, both the prevalence of and numbers of people with dependency will fall for young-old adults (65–74 years). For very old adults (≥85 years), numbers with low dependency will increase by 148·0% (range from ten simulations 140·0–152·0) and with high dependency will almost double (increase of 91·8%, range 87·3–94·1) although prevalence will change little. Older adults with medium or high dependency and dementia will be more likely to have at least two other concurrent conditions (increasing from 58·8% in 2015 to 81·2% in 2035). Men aged 65 years will see a compression of dependency with 4·2 years (range 3·9–4·2) of independence gained compared with life expectancy gains of 3·5 years (3·1–4·1). Women aged 65 years will experience an expansion of mainly low dependency, with 3·0 years (3·0–3·6) gained in life expectancy compared with 1·4 years (1·2–1·4) with low dependency and 0·7 years (0·6–0·8) with high dependency.

Interpretation
In the next 20 years, the English population aged 65 years or over will see increases in the number of individuals who are independent but also in those with complex care needs. This increase is due to more individuals reaching 85 years or older who have higher levels of dependency, dementia, and comorbidity. Health and social care services must adapt to the complex care needs of an increasing older population.

Full paper: Forecasting the care needs of the older population in England over the next 20 years | The Lancet Public Health

Stroke and dementia risk

Kuzma, E. et al. | Stroke and dementia risk: A systematic review and meta-analysis | Alzheimer’s & Dementia | 2018

This study analysed data on stroke and dementia risk from 3.2 million people across the world. The link between stroke and dementia persisted even after taking into account other dementia risk factors such as blood pressure, diabetes and cardiovascular disease. Their findings give the strongest evidence to date that having a stroke significantly increases the risk of dementia.

Introduction
Stroke is an established risk factor for all-cause dementia, though meta-analyses are needed to quantify this risk.

Methods
We searched Medline, PsycINFO, and Embase for studies assessing prevalent or incident stroke versus a no-stroke comparison group and the risk of all-cause dementia. Random effects meta-analysis was used to pool adjusted estimates across studies, and meta-regression was used to investigate potential effect modifiers.

Results
We identified 36 studies of prevalent stroke (1.9 million participants) and 12 studies of incident stroke (1.3 million participants). For prevalent stroke, the pooled hazard ratio for all-cause dementia was 1.69 (95% confidence interval: 1.49–1.92; P < .00001; I2 = 87%). For incident stroke, the pooled risk ratio was 2.18 (95% confidence interval: 1.90–2.50; P < .00001; I2 = 88%). Study characteristics did not modify these associations, with the exception of sex which explained 50.2% of between-study heterogeneity for prevalent stroke.

Discussion
Stroke is a strong, independent, and potentially modifiable risk factor for all-cause dementia.

Full document available here

See also: Stroke doubles dementia risk, concludes large-scale study | ScienceDaily