A treatment for sleep disorders in dementia?

This paper investigates the feasibility and acceptability of a six-session non-pharmacological therapy for people with dementia who have disturbed sleep.  The authors conclude that the ‘DREAMS-START’ intervention for sleep disorders in dementia is both feasible and acceptable | International Psychogeriatrics | via The Mental Elf

In people with dementia, symptoms such as agitation and inappropriate behaviour are fairly well known for being difficult to cope with. What is less well known is that people with dementia often sleep badly. They may wander, putting themselves at risk, and being awake at night then tends to make them sleepy during the day. This sleep disruption can cause a lot of stress for their carers.

Available treatments for this problem do not appear to be very effective. The current study tests a new intervention called DREAMS-START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), which is delivered to carers over six sessions to help them cope with and improve sleep problems.

Abstract

Background:40% of people with dementia have disturbed sleep but there are currently no known effective treatments. Studies of sleep hygiene and light therapy have not been powered to indicate feasibility and acceptability and have shown 40–50% retention. We tested the feasibility and acceptability of a six-session manualized evidence-based non-pharmacological therapy; Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS-START) for sleep disturbance in people with dementia.

Methods:

We conducted a parallel, two-armed, single-blind randomized trial and randomized 2:1 to intervention: Treatment as Usual. Eligible participants had dementia and sleep disturbances and a family carer and were recruited from two London memory services and Join Dementia Research. Participants wore an actiwatch for two weeks pre-randomization. Trained, clinically supervised psychology graduates delivered DREAMS-START to carers randomized to intervention; covering Understanding sleep and dementia; Making a plan (incorporating actiwatch information, light exposure using a light box); Daytime activity and routine; Difficult night-time behaviors; Taking care of your own (carer’s) sleep; and What works? Strategies for the future. Carers kept their manual, light box, and relaxation recordings post-intervention. Outcome assessment was masked to allocation. The co-primary outcomes were feasibility and acceptability.

Results:

In total, 63 out of 95 eligible referrals consented  62 were randomized, and 37 out of 42  adhered to the intervention.

Conclusions:

DREAM-START for sleep disorders in dementia is feasible and acceptable.

Full document: Livingston, G. et al. | DREAMS-START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people with dementia and sleep disturbances: a single-blind feasibility and acceptability randomized controlled trial

Full commentary: Sleep problems in dementia: a promising treatment? | The Mental Elf

Dementia 2020 challenge: progress review

This document summarises the views of stakeholders on the progress of the challenge on dementia so far and sets out actions for the final 2 years of the challenge | Department of Health and Social Care

In 2015, the Dementia 2020 Challenge was launched. The Challenge aims to
make England, by 2020, the best country in the world for dementia care, support,
research and awareness. The Challenge identified 18 key commitments under four
themes: Dementia Awareness; Health and Care Delivery; Risk Reduction; and
Research and Funding.

Since then, significant progress has been made. The Dementia Diagnosis Rate is
above the Challenge’s target of 66.7%. There are now 2.78 million Dementia
Friends and 412 Communities have committed to becoming Dementia Friendly in
England and Wales (as of January 2019), and over one million NHS staff have
attended dementia awareness raising sessions.

During 2018, stakeholders from the health and social care system, and the charitable sector, were asked to comment on the progress of the actions set out in the Challenge on dementia 2020 implementation plan and what else needed to be done to complete them.

This report summarises the responses and sets out revised actions for 2018 to 2020.

Full report: Dementia 2020 Challenge: 2018 Review Phase 1

Updated advice on eating and drinking for a person with dementia

Helping a person with dementia to maintain a healthy diet can be difficult for the people caring for them. This newly updated leaflet from Dementia UK aims to provide some positive tips on ways to help.

People with dementia may experience problems with eating and drinking. There are many reasons this might happen. They might:

• forget to eat or drink
• experience difficulties preparing food or drinks
• have difficulty recognising food items
• have a change in appetite or taste

Eating a healthy and balanced diet is important for a person’s physical and mental health. Not eating and drinking enough can increase the risk of dehydration, weight loss, a urinary tract infection and constipation. These health problems can be particularly problematic for someone with dementia as they can increase confusion and the risks of delirium, and sometimes make the symptoms of dementia worse.

This leaflet aims to provide some positive tips on ways to help including:

• Setting the scene for mealtimes: A familiar, sociable environment can help a person with dementia to feel more comfortable eating and drinking
• Encouraging a person with dementia to eat: Involve the person by asking them what they would like to eat. If they struggle to decide, you could give them two options of simple things you know they like and can manage. If appropriate, you could involve them in the food preparation
• Encouraging a person with dementia to drink: A person with dementia may not always be able to recognise when they are thirsty, or they might not be able to communicate their thirst. But nevertheless, it is recommended to aim for about eight glasses of fluid per day
• Stocking up and storing food: A person with dementia might need help keeping track of what food they have at home and storing food safely
• Weight gain or weight loss: Some of the eating and drinking issues associated with dementia can lead to weight loss. Pureed food is less nutritious, and people with dementia are at risk of malnutrition.

Full leaflet: Eating and Drinking. Staying well with dementia | Dementia UK

Top film suggestions for people with dementia

Dementia UK has put together a list of film recommendations for people living with demenntia. The list is focussed around films which have music, interactivity and simple plotlines at their heart.

The ability of the arts to help families stay together in the face of dementia has been recognised by Dementia UK’s specialist dementia nurses. Dr. Hilda Hayo, CEO and Chief Admiral Nurse at Dementia UK, said:

“There are certain film genres or styles which can be appealing to someone with dementia. This can include films which do not have complex story lines and films where there is a strong action, comedic or musical element. We are seeing more and more screenings of films to cater for people with dementia and their families. Some of our very own specialist dementia Admiral Nurses have been involved in bringing these screenings to local communities for example. They undoubtedly help to elevate a person with dementia’s mood, helping them stay engaged and connected to their families and wider society.”

Included in the list of recommended films are:

Mamma Mia

What marks Mamma Mia out is the fact that it’s so interactive. People of all ages regularly sing along to the tunes of Abba helping to connect people with dementia. Music and songs can bring out strong feelings in someone with dementia too. Other similar recommendations include The Sound of Music, My Fair Lady and South Pacific.

Laurel and Hardy

Many people diagnosed with dementia grew up with the slapstick routines of Laurel and Hardy allowing many to reminisce. Their comedic routines can bring enjoyment and distraction. Films like this are also great to share with the wider family. They can even help to provide invaluable connection between children and grandparents with dementia. Other similar recommendations include Mr Bean.

Top Gun

This may be a suitable choice for younger people diagnosed with dementia. Top Gun’s straightforward plotline can help to hold a person with dementia’s attention. Other similar recommendations for younger people with dementia include Ghost and Pretty Woman.

Full story at Dementia UK

Staying fit and mentally active linked with reduced dementia risk

Researchers in Sweden have found that women who exercise and stay cognitively active during midlife have a reduced risk of dementia in older age | Neurology | via Alzheimer’s Research UK

In 1968, Swedish researchers began studying a group of 800 women in midlife, between the ages of 38 and 54, and measured the amount of time they spent doing cognitively stimulating activities, including reading books and writing. The team also recorded how much physical activity the women did including walking, and intense training like swimming.

The team followed the volunteers until 2012 to see if they went onto develop dementia. They found that those who were more engaged in physical activity and spent more time doing cognitive tasks had a lower risk of developing the condition.

Abstract
Objective:  To investigate whether cognitive and physical activities in midlife are associated with reduced risk of dementia and dementia subtypes in women followed for 44 years.

Methods:  A population-based sample of 800 women aged 38–54 years (mean age 47 years) was followed from 1968 to 2012. Cognitive (artistic, intellectual, manual, religious, and club) and physical activity were assessed at baseline. During follow-up, dementia, Alzheimer disease, vascular dementia, mixed dementia, and dementia with cerebrovascular disease were diagnosed according to established criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. Cox regression models were used with adjustment for age, education, socioeconomic status, hypertension, body mass index, cigarette smoking, diabetes mellitus, angina pectoris, stress, and major depression.

Results:  We found that cognitive activity in midlife was associated with a reduced risk of total dementia and Alzheimer disease during follow-up. Physical activity in midlife was associated with a reduced risk of mixed dementia and dementia with cerebrovascular disease. The results were similar after excluding those who developed dementia before 1990, except that physical activity was then also associated with reduced risk of total dementia.

Conclusion: Our findings suggests that midlife cognitive and physical activities are independently associated with reduced risk of dementia and dementia subtypes. The results indicate that these midlife activities may have a role in preserving cognitive health in old age.

Full story at Alzheimer’s Research UK

Full reference: Najar, J. et al. | Cognitive and physical activity and dementia. A 44-year longitudinal population study of women | Neurology | First published February 20, 2019

 

Using technology enabled care to support cognition in early onset dementia

NHS England | January 2019 | Using technology enabled care to support cognition in early onset dementia

A recent case study on NHS England’s Atlas of Shared Learning spotlights how the Nurse Manager in the Mental Health and Vascular Wellbeing Team at North Staffordshire Combined Healthcare NHS Trust (NSCHT) led a programme of work to introduce a digital application (app) into the care and treatment plans for service users at high risk of developing mild cognitive impairment (MCI).

The app was designed to digitally link the nursing and medical staff with the service user, enabling care closer to home, empowering service users, families and carers to have greater control and input into planning their treatment and care and improving service user experience and outcomes.

Full story at NHS England

Dementia Commissioning Know How

Yorkshire & the Humber Clinical Networks | February 2019| Dementia Commissioning Know How

The resource is primarily intended to support CCGs who are endeavouring to improve
dementia care services and are striving to meet the national ambitions. It will also be of
interest to STPs in helping to clarify work which will add value for dementia care
services.

The tool covers the dementia care pathway and advocates a systematic, standardised
approach to investigating and enhancing the attributes and processes that positively
impact effective commissioning of dementia care services.

After working through the document, commissioners should be able to identify and
develop, or enhance, the abilities and processes that need to be in place in order to
successfully deliver commissioning of high quality dementia care services including:
• Strategic and leadership qualities and abilities
• Awareness of current performance
• Collaborative working with service providers
• Use of appropriate levers and incentives
• Accuracy and use of data in monitoring and reporting
• Resources to address any gaps or improvements required
• Futureproofing knowhow (Source: Yorkshire & the Humber Clinical Networks)

Dementia Commissioning Know How

Psychosocial risk factors and Alzheimer’s disease

New study predicts that sleep disturbance, depression, and anxiety increase the hazard of Alzheimer’s disease | Aging & Mental Health

Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Burke, S. L. et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety | Aging & Mental Health | 2018 Vol. 22, issue 12 | p 1577-1584 |  DOI: 10.1080/13607863.2017.1387760

Older patients spared dementia and falls by NHS tech roll-out

Digital checks that can prevent dementia and falls in older people are among a range of tools being made available in hospitals across the country, as part of the NHS Long Term Plan | Via NHS England

One in eight hospital patients is affected by delirium, which can make people unsteady on their feet, increases the risk of developing dementia and can result in longer hospital stays or admission to a care home.

However, these problems can be avoided through timely and effective care, with a scheme in Salford increasing the number of patients correctly diagnosed with delirium by 34%, through the introduction of screening for all over-65s who are admitted to hospital. Doctors and nurses run through a symptoms checklist on a mobile computer or handheld device.

The new electronic assessment tool for delirium has increased screening of over 65-year-olds on admission to hospital and has increased assessment of those who become newly confused when they are in hospital, with the number of identified cases per year having risen by 34% and the length of stay for these patients has reduced by 11%, saving an estimated £1.7m in the first year. Readmissions for delirium patients has also reduced from 15% to 13% saving an estimated £101,000 for the same period.

The scheme is just one of a series that is being rolled out across the country through the adoption of toolkits, known as blueprints, that allow any NHS hospital to implement improvements quicker and more easily to transform care and improve services for patients and staff.

Full detail at NHS England

Record £3.7m research grant to ‘transform’ palliative care for dementia

Researchers in London are aspiring to create a “step-change” in dementia care through an innovative study funded by a record-breaking grant | Nursing Times | The Carer

The largest ever research grant to improve palliative and end of life care for people with dementia and their carers in the UK (£3.7m) has been awarded to researchers at the Marie Curie Palliative Care Research Department, UCL, and the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Kings College London.

The grant will be used to fund research to help understand the current and future needs for dementia palliative care, how people with dementia move through the health and social care system and develop new ways to deliver these vital services. The research is one of four collaborative projects being funded by the ESRC-NIHR Dementia Research Initiative 2018, which aims to improve the lives of people living with dementia across the UK.

The team’s Empowering Better End of Life Dementia Care Programme (EMBED-Care) will develop new ways of supporting patients with advanced dementia, where they live and receive care. The terminal illness charity, Marie Curie, provides core funding to the Marie Curie Palliative Care Research Department, UCL, which includes posts dedicated to improving the evidence base for palliative and end of life dementia care. Determining a person’s palliative care needs, then initiating and delivering this care for patients with dementia was one of the research gaps identified by the Palliative and end of life care Priority Setting Partnership with the James Lind Alliance.

Full story: £3.7m Research Grant Set To Improve Care For People With Dementia | The Carer