How does stress affect the brain?

This research looks at the impact stress has on the brain in physiological and cognitive terms. The results published in the medical journal of the American Academy of Neurology suggest stress negatively affects memory and thinking skills | via EurekAlert

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A study published in the October 24, 2018 issue of Neurology has found that middle-aged people with high levels of a hormone called cortisol in their blood have impaired memory when compared to those with average levels of the hormone. People with high levels of the hormone also had lower brain volume than those with regular cortisol levels.

Cortisol, produced by the adrenal glands, helps the body respond to stress. It can also help reduce inflammation, control blood sugar and blood pressure, regulate metabolism and help with immune response. High cortisol levels can be caused by stress, medical conditions or medications.

In this study, researchers identified 2,231 people with an average age of 49 who were free of dementia. At the beginning of the study, each participant had a psychological exam and assessments for memory and thinking skills. Their memory and thinking skills were tested again an average of eight years later. Researchers also measured cortisol levels in the blood and then divided participants into low, middle and high groups. A total of 2,018 participants also had an MRI brain scan to measure brain volume.

After adjusting for age, sex, smoking, and body mass index, researchers found that people with high levels of cortisol had lower scores on tests of memory and thinking skills than those with normal levels of cortisol. High cortisol was also linked to lower total brain volume.

Full reference: Echouffo-Tcheugui , J. B. et al. | Circulating cortisol and cognitive and structural brain measures | Neurology | First published October 24, 2018

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Sundowning (changes in behaviour at dusk)

With the clocks going back at 2am this Sunday 28th October, Dementia UK shares some tips for preventing and managing sundowning

What is sundowning?

alarm-clock-2175342_1920Sundowning is a term used for the changes in behaviour that occur in the evening, around dusk. Some people who have been diagnosed with dementia experience a growing sense of agitation or anxiety at this time.

Sundowning symptoms might include a compelling sense that they are in the wrong place. The person with dementia might say they need to go home, even if they are home; or that they need to pick the children up, even if that is not the case. Other symptoms might include shouting or arguing, pacing, or becoming confused about who people are or what’s going on.

Tips for managing sundowning as it happens

  • Use distraction techniques: go into a different room, make a drink, have a snack, turn some music on, or go out for a walk
  • Ask the person what is the matter. Listen carefully to the response and if possible, see if you can deal with the source of their distress
  • Talk in a slow, soothing way
  • Hold the person’s hand or sit close to them and stroke their arm.

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Practical tips on preventing sundowning

  • Follow a routine during the day that contains activities the person enjoys
  • Going outside for a walk or visiting some shops is good exercise
  • Limit the person’s intake of caffeinated drinks. Consider stopping the person from drinking alcohol altogether. Caffeine-free tea, coffee and cola are available, as is alcohol-free beer and wine
  • Try and limit the person’s naps during the day to encourage them to sleep well at night instead
  • Close the curtains and turn the lights on before dusk begins, to ease the transition into nighttime
  • If possible, cover mirrors or glass doors. Reflections can be confusing for someone with dementia
  • Once you are in for the evening, speak in short sentences and give simple instructions to the person, to try and limit their confusion
  • Avoid large meals in the evening as this can disrupt sleep patterns
  • Introduce an evening routine with activities the person enjoys, such as: watching a favourite programme, listening to music, stroking a pet etc. However, try to keep television or radio stations set to something calming and relatively quiet—sudden loud noises or people shouting can be distressing for a person with dementia.

Full information leaflet: Sundowning (changes in behaviour at dusk). Understanding changes in behaviour in dementia | Dementia UK

Rise in deaths due to dementia and Alzheimer’s disease

Mortality statistics for England and Wales show that dementia and Alzheimer’s disease were the leading cause of death last year, accounting for more than one in eight of all deaths (12.7%) | Office for National Statistics

The Office for National Statistics (ONS) said that, with increases in both the size and age of the population, the number of deaths is expected to rise further. A total of 67,641 deaths were attributed to dementia and Alzheimer’s last year, up from 62,948 the previous year. Meanwhile, a better understanding of dementia and improved diagnosis is also likely to have caused increased reporting of dementia on death certificates, it added.

Full detail: Deaths registered in England and Wales (series DR): 2017

Age-friendly and inclusive volunteering: review of community contributions in later life

This review calls on charities, voluntary organisations and the public sector to do more to support and sustain the good will and effort of older volunteers | Centre for Ageing Better

old friendsThis report sets out the findings of the Review of Community Contributions in Later Life,  led by the Centre for Ageing Better in partnership with the Office for Civil Society between October 2017 and June 2018.

Making a contribution to our communities has been shown to improve our social connections, enhance our sense of purpose and self-esteem – and as a result, to increase our life satisfaction, happiness and wellbeing.

The review finds that very few people in later life make no contribution of any kind. However, some people encounter barriers to getting involved in all the ways they might want to, especially as their circumstances change.

Full document: Age-friendly and inclusive volunteering: review of community contributions in later life

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Pre-eclampsia and risk of dementia

New research suggests  pre-eclampsia is associated with an increased risk of dementia, particularly vascular dementia. | BMJ | OnMedica

New research published in the British Medical Journal has shown women who had had pre-eclampsia in at least one pregnancy to have a more than three times greater risk of vascular dementia, as well as a modestly raised risk of Alzheimer’s disease and other/non-specific dementias, than women who had never had pre-eclampsia 

The authors of a new study suggest doctors should ask women about a history of pre-eclampsia to help identify those who might benefit from screening for early signs of dementia, allowing for early clinical intervention.

Abstract
Objective: To explore associations between pre-eclampsia and later dementia, overall and by dementia subtype and timing of onset.

Design: Nationwide register based cohort study.

Setting: Denmark.

Population: All women with at least one live birth or stillbirth between 1978 and 2015.

Main outcome measure: Hazard ratios comparing dementia rates among women with and without a history of pre-eclampsia, estimated using Cox regression.

Results: The cohort consisted of 1 178 005 women with 20 352 695 person years of follow-up. Women with a history of pre-eclampsia had more than three times the risk of vascular dementia (hazard ratio 3.46, 95% confidence interval 1.97 to 6.10) later in life, compared with women with no history of pre-eclampsia. The association with vascular dementia seemed to be stronger for late onset disease (hazard ratio 6.53, 2.82 to 15.1) than for early onset disease (2.32, 1.06 to 5.06) (P=0.08). Adjustment for diabetes, hypertension, and cardiovascular disease attenuated the hazard ratios only moderately; sensitivity analyses suggested that body mass index was unlikely to explain the association with vascular dementia. In contrast, only modest associations were observed for Alzheimer’s disease (hazard ratio 1.45, 1.05 to 1.99) and other/unspecified dementia (1.40, 1.08 to 1.83).

Conclusions: Pre-eclampsia was associated with an increased risk of dementia, particularly vascular dementia. Cardiovascular disease, hypertension, and diabetes were unlikely to mediate the associations substantially, suggesting that pre-eclampsia and vascular dementia may share underlying mechanisms or susceptibility pathways. Asking about a history of pre-eclampsia could help physicians to identify women who might benefit from screening for early signs of disease, allowing for early clinical intervention.

Full reference: Basit, S. et al. | Pre-eclampsia and risk of dementia later in life: nationwide cohort study | British Medical Journal | published 17 October 2018

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Psychosocial interventions for people with dementia and anxiety or depression

Review finds psychosocial interventions to be effective at reducing symptoms of depression or anxiety in people with dementia experiencing these symptoms | Aging & Mental Health

Abstract walking-69708_1280
Objectives:
Assess the effectiveness of psychosocial interventions for depression and anxiety in people with dementia (PWD) or mild cognitive impairment (MCI).

Method:
OvidMedline, PsychInfo and Embase were searched for studies on the 5th August 2017. The efficacy of the studies was estimated using meta-analyses.

 

Results:
Eight RCTs were included. No RCTs were identified for people with MCI. Four RCTs found that psychosocial interventions (multicomponent intervention, Tai Chi, problem adaptation therapy and exercise/walking) were effective at reducing symptoms of depression in PWD who were depressed. One study (Tai Chi) found that these reductions were no longer evident at six-month follow-up. Another study, not included in the meta-analyses, found that pleasant events behaviour therapy and problem solving behaviour therapy improved depression symptoms and this effect remained significant at follow-up. Three RCTs found that psychosocial interventions (music therapy and cognitive behavioural therapy (CBT)) reduced symptoms of anxiety in PWD who were anxious. Evidence from two of these RCTs (music therapy and CBT) showed that these improvements were evident at three to six-month follow-up.

Conclusion:
The identified psychosocial interventions are effective at reducing symptoms of depression or anxiety in PWD experiencing these symptoms. This review is limited by the quality of studies, small sample sizes and the heterogeneity of the interventions, therefore high quality studies with larger sample sizes are required to test the efficacy of specific interventions such as CBT.

Full reference:  Noone, D. et al. | Meta-analysis of psychosocial interventions for people with dementia and anxiety or depressionAging & Mental Health | published online 17 Oct 2018

Memory training for adults with probable mild cognitive impairment

Graham J. McDougall, Ian M. McDonough & Michael LaRocca | Memory training for adults with probable mild cognitive impairment: a pilot study |  Aging & Mental Health | Published online: 10 Oct 2018

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Abstract
Background & Objectives:
This pilot study aimed to evaluate the efficacy of memory training and health training intervention over a 24-month period in people with probable mild cognitive impairment (MCI).

Research Design & Methods:
Based on the accepted criteria, and the neuropsychiatric measures used in the trial, MCI was defined as a subjective change in cognition, impairment in episodic memory, preservation of independence of functional abilities, and no dementia. Without a neurological assessment, laboratory tests, and psychometric evaluation combined, some of our participants may have had dementia that we were unable to detect through neuropsychological testing.

Of the 263 total participants, 39 met criteria for a diagnosis of MCI. There were 19 adults in the memory and 20 in health training conditions. Both groups received twenty hours of classroom content that included eight hours of booster sessions at three months post intervention. Hierarchical linear models (HLM) and standardized regression-based (SBR) analyses were used to test the efficacy of the intervention on immediate recall, delayed recall, subjective memory complaints, and memory self-efficacy. Age, education, depression, racial group, ethnic group, MMSE score, and baseline performance were included as covariates.

Results:
Over 24 months, the MCI group in the memory training condition showed better objective and subjective memory outcomes compared with the MCI group in the health training condition.

Conclusions:
Senior WISE Memory training delivered to individuals with MCI was able to forestall the participants’ declining cognitive ability and sustain the benefit over two years in both subjective and objective memory function.

Full detail at Aging & Mental Health