Reminiscence therapy for dementia

Woods, B.,  O’Philbin, L.Farrell, E.M.Spector, A.EOrrell, M.  | Reminiscence therapy for dementiaCochrane Database of Systematic Reviews  |  2018  | Issue 3. | DOI: 10.1002/14651858.CD001120.pub3

Cochrane Library had produced an update to a systematic review, on reminiscence therapy (RT) previously updated in 2005. RT involves the discussion of memories and past experiences with other people using tangible prompts such as photographs or music to evoke memories and stimulate conversation. It is implemented widely in a range of settings using a variety of formats (Cochrane Database of Systematic Reviews). The plain language summary is given below.

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Reminiscence therapy for dementia

Review question

We wanted to find out what effect reminiscence therapy (RT) has on people with dementia. In particular, we were interested in effects on quality of life, communication, cognition (the general ability to think and remember), mood, daily activities and relationships. We were also interested in any effects on carers.

Background

RT involves discussing events and experiences from the past. It aims to evoke memories, stimulate mental activity and improve well-being. Reminiscence is often assisted by props such as videos, pictures and objects. It can take place in a group or be done with a person on their own, when it often results in some form of life-story book being created. RT helps older people with depression. It may be suitable for people with dementia both because depression is common in dementia and because people with dementia typically have a better memory for the distant past than for recent events.

Methods

We searched for randomised, controlled trials in which RT was compared with no treatment or with a non-specific activity, such as time spent in general conversation. Our search covered all trials available up to April 2017.

Results

We found 22 trials with 1972 participants to include in the review. All the participants had dementia, mostly of mild or moderate severity. Some of the participants were living at home and some were in care homes. The length of the trials varied from four weeks to two years, and the overall amount of time spent on therapy varied from three to 39 hours. Overall, we thought most of the trials were well conducted.

Looking at all the trials together, there did not seem to be an effect of RT on the quality of life reported by the participants. However, there was probably a slight benefit of treatment in the trials done in care homes, which was not seen in the trials done in the community.

People having RT scored slightly better than the control group on tests of cognition immediately after the course of treatment, but not weeks to months later. It was not clear that the effect was large enough to be important. The effect was most evident in care home studies, which used individual RT, but not in community studies, which used group RT.

We found that group RT and RT in community settings may have a positive effect on the communication and interaction of the person with dementia immediately after the end of treatment, and probably also weeks to months later, although the effect was small.

Apart from a probable slight benefit of individual RT on scales measuring depressed mood, we found no evidence for effects of RT on other outcomes, such as agitation, ability to carry out daily activities or relationships with other people. We found no evidence of harmful effects of RT for the people with dementia themselves.

We found no effect of RT on family carers other than a suggestion that it made carers slightly more anxious in two large studies of joint reminiscence work. In this type of RT, the carers and the people with dementia were both directly involved in the reminiscence sessions.

Conclusions

We were encouraged to find that the amount and quality of research on RT for dementia has increased considerably since the last version of this review. We concluded that the effects of RT vary, depending on the way it is given and whether it takes place in care homes or the community. However, there is some evidence that RT can improve quality of life, cognition, communication and possibly mood in people with dementia in some circumstances, although all the benefits were small. More research is needed to understand these differences and to find out who is likely to benefit most from what type of RT.

The abstract and the full text systematic review is available from The Cochrane Library, alternatively it can be downloaded here

Discussing the MARQUE Study – Managing Agitation in Dementia

University College London  | MARQUE

Scientists at University College London (UCL) are involved in MARQUE (Managaing Agitation and Raising Quality of life), a five year long study taking place all over England. MARQUE aims to increase knowledge about dementia, agitation and personhood. Agitation is extremely common in people with dementia and causes distress to themselves, family carers and paid carers. Agitation is currently tackled on an individual level, not an organisation level (via UCL).

The research responds to the government’s ‘Challenge on Dementia’ and aims to

  • Build on theories of personhood in dementia to understand agitation, resilience and compassion to improve public debate and discourse.
  • Make agitation as much as a part of dementia care as risk assessment.
  • To improve and maintain quality of life in people with dementia whether at home, in a care home or in hospital.

More information about MARQUE can be found from UCL here 

A podcast has been released by Dementia Researcher, in it researchers Francesca La Frenais, and Dr Penny Rapaport from the Division of Psychiatry at UCL talk about the MARQUE Study, and how their work is helping us to understand what causes agitation. The scientists also explain how the interventions tested in this study are improving quality of life for those living with dementia, and helping carers.

MARQUE
Image source: dementiaresearcher.nihr.ac.uk

You can listen to the podcast at Dementia Reseracher

Alternatively, you can listen via SoundCloud 

Dementia Researcher |  April 2018 | Discussing the MARQUE Study – Managing Agitation in Dementia

New animation created to improve general public’s understanding of dementia

Alzheimer’s Research UK  | March 2018  | Bryan Cranston confronts misunderstanding of dementia…using an orange

A new animation created by Aardman Animations and starring Bryan Cranston, has been released as part of a campaign to address misunderstanding around dementia – using nothing more than an orange.  The animation follows a recent YouGov poll commissioned by Alzheimer’s Research UK, which asked the general public what they think dementia is and who it affects, only 23% of British adults specifically mentioned brain disease or degeneration (Alzheimer’s Research UK). 

 

The two minute film centres on an orange that gradually strips away to demonstrate how the diseases that cause dementia, most commonly Alzheimer’s, physically attack the brain. Through damage caused by the disease, the brain of a person with Alzheimer’s can weigh around 140 grams less than a healthy brain – about the weight of an orange.

Hilary Evans, Chief Executive of Alzheimer’s Research UK, said:

“Bryan Cranston’s support of our #ShareTheOrange campaign will help bring global attention to an important truth – that dementia is not an inevitability of age, but is caused by diseases that we can fight. The condition has been blighted by misconceptions for generations, and it’s now time to turn our fatalism into hope, and research holds the key to overcoming the diseases that drive the symptoms. By sharing this film and joining the millions who shared our first campaign film, we can educate and inspire around dementia, and make it our next great medical research success story. Research has made major breakthroughs in other disease areas in the past generation, and people with dementia must now benefit from the same.”

The full news item is available from Alzheimer’s Research UK 

Patient data saves lives: Dementia

Better use of data is essential to speed up diagnosis, research new treatments, plan better NHS services and monitor the safety of drugs. However, most patients feel they don’t know how their data are used in the NHS.

Understanding Patient Data have developed a series of animations to address this gap in knowledge.

Watch the video, Patient data saves lives: Dementia below:

Other titles in this series include:

  • Patient data saves lives: The bigger picture (watch)
  • Patient data saves lives: Cancer (watch)
  • Patient data saves lives: Asthma (watch)
  • Patient data saves lives: Heart attack (watch)
  • Patient data saves lives: Diabetes (watch)

For further information about how and why patient data is used, visit the UPD website: www.patientdata.org.uk

Dementia-Friendly Dentistry

The Faculty of General Dental Practice UK (FGDP(UK)) has made its guidance on the practice of dentistry for patients with dementia available free of charge online.

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The guidance covers the epidemiology of dementia and a wide range of implications for dental professionals, including patient identification, competence and referrals, communication, consent and capacity, history taking, treatment planning, care delivery, prescribing and site-specific considerations for dental practices, care homes and domiciliary practice.

The guidance can be downloaded here

How best to assess quality of life in informal carers of people with dementia

Study finds Carer well-being and support questionnaire is the most appropriate instrument to recommend for the assessment of quality of life in informal carers of people with dementia at present

feedback-3239454_1920Background
In the UK, there are currently 800 000 people living with dementia. This number is expected to double in the next 20 years. Two-thirds of people with dementia live in the community supported by informal carers. Caring for a person with dementia has adverse effects on psychological, physical, social wellbeing and quality of life. The measurement of quality of life of carers of people with dementia is increasingly of interest to health and social care practitioners and commissioners, policymakers, and carers themselves. However, there is lack of consensus on the most suitable instrument(s) for undertaking this.

Methods
A systematic review of the literature.  Searching of electronic databases (Medline, PsycINFO, CINAHL and Web of Science), reference list and citation searching of key papers was undertaken. COSMIN methodology was used to simultaneously extract data from and assess methodological quality of included studies, and make a recommendation for the instrument with the most high quality evidence for its measurement properties.

Results
Ten instruments were suitable for inclusion in this review. The Carer well-being and support questionnaire (CWS) has the best quality evidence for the greatest number of measurement of properties. The Caregiver Well-Being Scale is also worthy of consideration. There is not presently a measure which could be recommended for use in economic evaluations, however the Impact of Alzheimer’s Disease on the Caregiver questionnaire (IADCQ) could potentially be used following further investigation of its measurement properties in a representative population.

Conclusion
The CWS is the most appropriate instrument to recommend for the assessment of quality of life in informal carers of people with dementia at present. All instruments included in this review would benefit from more rigorous evaluation of their measurement properties.

Full document: Dow J, et al. |  How best to assess quality of life in informal carers of people with dementia; A systematic review of existing outcome measures. | PLoS ONE  (2018) 13(3)

 

Everyday technology use and activity involvement in mild cognitive impairment

Research findings point to a need for early support focusing on the use of everyday technology for persons with MCI

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Objectives: The aims were to describe longitudinal patterns in terms of perceived ability to use everyday technology (ET) and involvement in everyday activities over five years in older adults with mild cognitive impairment (MCI), and to examine the predictive value of these patterns regarding diagnostic outcomes.

Method: Thirty older adults diagnosed with MCI at inclusion, reported their perceived ability in using ET and involvement in everyday activities on seven occasions over five years. Individual longitudinal case plots and a pattern-oriented analysis were used to compare the participants’ distribution in earlier identified stable/ascending, fluctuating and descending patterns of functioning (year 0–2). Fisher’s exact test was used for testing the relation between pattern and diagnostic outcomes.

Results: An initial descending pattern of functioning tended to continue; none of these participants later developed a more stable pattern. More congruent trajectories of change appeared over time. Pattern affinity years 0–2 and diagnostic outcome were significantly related (p = .05), with a dementia diagnosis being more likely for those initially displaying an early descending pattern

Conclusion: These findings point to a need for early support focusing on the use of ET for persons with MCI who early after diagnosis descend in functioning.

Full reference: Annicka Hedman, Anders Kottorp & Louise Nygård | Patterns of everyday technology use and activity involvement in mild cognitive impairment: a five-year follow-up study | Aging & Mental Health, 22:5, 603-610