Touchscreen interventions and the well-being of people with dementia and caregivers

This article reviews touchscreen-based interventions designed to be used by people with dementia (PWD), with a specific focus in assessing their impact on well-being | International Psychogeriatrics

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Dementia can have significant detrimental impacts on the well-being of those with the disease and their carers. A range of computer-based interventions, including touchscreen-based interventions have been researched for use with this population in the hope that they might improve psychological well-being.

The data bases, PsycInfo, ASSIA, Medline, CINAHL, and Cochrane Reviews were searched for touchscreen-based interventions designed to be used by PWD with reported psychological well-being outcomes. Methodological quality was assessed using Pluye and Hong’s (2014) Mixed Methods Appraisal Tool (MMAT) checklist.

Sixteen papers were eligible. They covered 14 methodologically diverse interventions. Interventions were reported to be beneficial in relation to mental health, social interaction, and sense of mastery. Touchscreen interventions also reportedly benefit informal carers in relation to their perceived burden and the quality of their relationships with the people they care for. Key aspects included the user interface, provision of support, learning style, tailored content, appropriate challenge, ergonomics, and users’ dementia progression.

Whilst much of the existing research is relatively small-scale, the findings tentatively suggest that touchscreen-based interventions can improve the psychological well-being of PWD, and possibilities for more rigorous future research are suggested.

Full reference: Tyack, C & Cami, P.M. (2017) Touchscreen interventions and the well-being of people with dementia and caregivers: a systematic review. International Psychogeriatrics. Vol. 29 (Issue 8) pp. 1261-1280

Neuropsychiatric signs and symptoms of Alzheimer’s disease: New treatment paradigms

Neuropsychiatric symptoms (NPSs) are hallmarks of Alzheimer’s disease (AD), causing substantial distress for both people with dementia and their caregivers, and contributing to early institutionalization | Alzheimer’s & Dementia: Translational Research & Clinical Interventions

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Image source: Florence Winterflood – Wellcome Images // CC BY 4.0

Image shows an artistic interpretation of Alzheimer’s Disease.

They are among the earliest signs and symptoms of neurocognitive disorders and incipient cognitive decline, yet are under-recognized and often challenging to treat. With this in mind, the Alzheimer’s Association convened a Research Roundtable in May 2016, bringing together experts from academia, industry, and regulatory agencies to discuss the latest understanding of NPSs and review the development of therapeutics and biomarkers of NPSs in AD. This review will explore the neurobiology of NPSs in AD and specific symptoms common in AD such as psychosis, agitation, apathy, depression, and sleep disturbances. In addition, clinical trial designs for NPSs in AD and regulatory considerations will be discussed.

Full reference: Lanctôt, K.L. et al. (2017) Neuropsychiatric signs and symptoms of Alzheimer’s disease: New treatment paradigms. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. Published online: 5th August 2017

Predicting progression to dementia in persons with mild cognitive impairment using cerebrospinal fluid markers

This study aimed to determine the added value of cerebrospinal fluid (CSF) to clinical and imaging tests to predict progression from mild cognitive impairment (MCI) to any type of dementia | Alzheimer’s & Dementia

Methods: The risk of progression to dementia was estimated using two logistic regression models based on 250 MCI participants: the first included standard clinical measures (demographic, clinical, and imaging test information) without CSF biomarkers, and the second included standard clinical measures with CSF biomarkers.

Results: Adding CSF improved predictive accuracy with 0.11 (scale from 0–1). Of all participants, 136 (54%) had a change in risk score of 0.10 or higher (which was considered clinically relevant), of whom in 101, it was in agreement with their dementia status at follow-up.

Discussion: An individual person’s risk of progression from MCI to dementia can be improved by relying on CSF biomarkers in addition to recommended clinical and imaging tests for usual care.

Full reference: Handels, R.L.H. et al. (2017) Predicting progression to dementia in persons with mild cognitive impairment using cerebrospinal fluid markers. Alzheimer’s & Dementia. Vol. 13 (Issue 8) pp. 903–912

A comprehensive approach to reablement in dementia

As society grapples with an aging population and increasing prevalence of disability, “reablement” as a means of maximizing functional ability in older people is emerging as a potential strategy to help promote independence | Alzheimer’s & Dementia

This article presents a comprehensive reablement approach across seven domains for the person living with mild-to-moderate dementia. Domains include assessment and medical management, cognitive disability, physical function, acute injury or illness, assistive technology, supportive care, and caregiver support.

In the absence of a cure or ability to significantly modify the course of the disease, the message for policy makers, practitioners, families, and persons with dementia needs to be “living well with dementia”, with a focus on maintaining function for as long as possible, regaining lost function when there is the potential to do so, and adapting to lost function that cannot be regained. Service delivery and care of persons with dementia must be reoriented such that evidence-based reablement approaches are integrated into routine care across all sectors.

Full reference: Poulos, C.J. et al. (2017) A comprehensive approach to reablement in dementia. Alzheimer’s & Dementia. Published online: 28 July 2017

 

Implementation guide and resource pack for dementia care

NHS England has published a new dementia guide that sets out what good quality assessment, diagnosis and care looks like in relation to formal guidance, in addition to the views and expectations of people living with dementia and their carers.

The guide is shaped by the framework set by the NHS Mandate and has two clear requirements to enhance dementia care, through:

increasing the number of people being diagnosed with dementia, and starting treatment, within six weeks from referral; and
improving the quality of post-diagnostic treatment and support for people with dementia and their carers.
This guide is support by:

Good care planning guide for dementia
RightCare dementia pathway scenario

Dementia in older age: barriers to primary prevention and factors

Evidence review showing that changing some behaviours in midlife can reduce the chances of getting dementia in older age | PHE

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These documents help commissioners and researchers make decisions about prioritisation of primary prevention measures relevant to dementia.

This review, by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and Political Science (2016), shows that there is evidence that the risk of dementia is increased by:

  • physical inactivity
  • current smoking
  • diabetes
  • hypertension in mid-life
  • obesity in mid-life and depression

It also shows that mental activity can reduce the risk of dementia.

To promote primary prevention of dementia, it is important to understand both the barriers to primary prevention and factors which facilitate primary prevention.

Read the full overview here

Increased risk of dementia in patients who experience delirium after surgery

This study finds those who developed postoperative delirium were three times more likely to suffer permanent cognitive impairment or dementia | ScienceDaily

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Over a ten year period, patients over the age of 65 enrolled at the Mayo Clinic Study of Ageing in Olmsted County Minnesota who were exposed to general anesthesia were included in an investigation involving over two 2000 patients. Their cognitive status was evaluated in regular 15 month periods before and after surgery by neuropsychologic testing and clinical assessment. Out of 2014 patients, 1667 were deemed to be cognitively normal before surgery. Of the 1152 patients who returned for follow-up cognitive evaluation, 109 (9.5%) had developed mild cognitive impairment (pre-dementia) or dementia, and those who had suffered postoperative delirium were three times more likely to be subsequently diagnosed with permanent cognitive decline or dementia. This research is the first to focus on the association between delirium and long-term cognitive decline in patients with normal mental capacity before surgery.

While previous studies have highlighted cognitive decline in the elderly following postoperative delirium, no others have involved such a detailed neuro-cognitive assessment identifying those with normal pre-operative cognitive abilities who go on to develop dementia. In conclusion, researchers believe that postoperative delirium could be a warning sign of future permanent cognitive impairment (dementia) in patients who at the time of surgery were still just above the threshold for registering cognitive decline. Alternatively, postoperative delirium could itself produce injury, which per se accelerates the trajectory of decline into dementia.