Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia

Kivimäki, M. et al |2020| Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia| JAMA Network Open3|9| e2016084-e2016084

Question  Are alcohol-induced loss of consciousness and heavy weekly alcohol consumption associated with increased risk of future dementia?

Findings  In this multicohort study of 131 415 adults, a 1.2-fold excess risk of dementia was associated with heavy vs moderate alcohol consumption. Those who reported having lost consciousness due to alcohol consumption, regardless of their overall weekly consumption, had a 2-fold increased risk of dementia compared with people who had not lost consciousness and were moderate drinkers.

Meaning  The findings of this study suggest that alcohol-induced loss of consciousness is a long-term risk factor for dementia among both heavy and moderate drinkers.

Importance  Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain.

Objective  To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers.

Design, Setting, and Participants  Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131 415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020.

Exposures  Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week.

Main Outcomes and Measures  Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records.

Results  Of the 131 415 participants (mean [SD] age, 43.0 [10.4] years; 80 344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22  for greater than 21 vs 1 to 21 U/wk. Of the 96 591 participants with data on loss of consciousness, 10 004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men women during the first 10 years of follow-upa fter excluding the first 10 years of follow-up, and for early-onset and late-onset  dementia, Alzheimer disease, and dementia with features of atherosclerotic cardiovascular disease. The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate or heavy.

Conclusions and Relevance  The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.

Full article from JAMA

In the news:

Daily Mail : Passing out drunk could more than DOUBLE your risk of later developing dementia and even one drink per day raises risk by 22%, study warns

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Livingston, G., et al (2020)| Dementia prevention, intervention, and care: 2020 report of the Lancet Commission| The Lancet396|(10248)|P. 413-446.

The Lancet recently published the Lancet Commission’s 2020 report on dementia prevention, intervention and care.

Key messages

  • Three new modifiable risk factors for dementia
    • New evidence supports adding three modifiable risk factors—excessive alcohol consumption, head injury, and air pollution—to our 2017 Lancet Commission on dementia prevention, intervention, and care life-course model of nine factors (less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact).
  • Modifying 12 risk factors might prevent or delay up to 40% of dementias.
  • Be ambitious about prevention
    • Prevention is about policy and individuals. Contributions to the risk and mitigation of dementia begin early and continue throughout life, so it is never too early or too late. These actions require both public health programmes and individually tailored interventions. In addition to population strategies, policy should address high-risk groups to increase social, cognitive, and physical activity; and vascular health.
  • Specific actions for risk factors across the life course
    • Aim to maintain systolic BP of 130 mm Hg or less in midlife from around age 40 years (antihypertensive treatment for hypertension is the only known effective preventive medication for dementia).
    • Encourage use of hearing aids for hearing loss and reduce hearing loss by protection of ears from excessive noise exposure.
    • Reduce exposure to air pollution and second-hand tobacco smoke.
    • Prevent head injury.
    • Limit alcohol use, as alcohol misuse and drinking more than 21 units weekly increase the risk of dementia.
    • Avoid smoking uptake and support smoking cessation to stop smoking, as this reduces the risk of dementia even in later life.
    • Provide all children with primary and secondary education.
    • Reduce obesity and the linked condition of diabetes. Sustain midlife, and possibly later life physical activity.
    • Addressing other putative risk factors for dementia, like sleep, through lifestyle interventions, will improve general health.
  • Tackle inequality and protect people with dementia
    • Many risk factors cluster around inequalities, which occur particularly in Black, Asian, and minority ethnic groups and in vulnerable populations. Tackling these factors will involve not only health promotion but also societal action to improve the circumstances in which people live their lives. Examples include creating environments that have physical activity as a norm, reducing the population profile of blood pressure rising with age through better patterns of nutrition, and reducing potential excessive noise exposure.

Taken from the Executive Summary

Full publication is available from The Lancet

Guidance for carers of people with dementia

University College London | September 2020 |Guidance developed for dementia carers when dealing with COVID-19 infection

A team of researchers from University College London (UCL) have developed a decision-making guide for dementia carers, to ensure they can provide the right support and with dignity, should those they care for become infected with coronavirus.

The researchers based at Marie Curie Palliative Care Research Department at UCL, have observed the challenges to carers who can’t be with their loved one or person they support, due to visiting restrictions and having to social distance or shield themselves.

This often means that dementia carers have to make quick healthcare or legal decisions over the phone with a health professional: someone who may have no knowledge of the care and interventions the person with dementia requires.

The new guide, which was developed with families of those with dementia, is funded by an Economic and Social Research Council COVID-19 grant and supported by end of life care charity Marie Curie, Alzheimer’s Society and Dementia UK.

The tool has been designed to support carers work through situations, medical and legal jargon so they can make informed decisions quickly under stressful circumstances.

This includes do not resuscitate orders, legal issues like power of attorney, and ensuring that health and social care professionals understand what is important to the person they are caring for when that patient’s loved ones can’t be by their side.

The research team hopes that the new guide will also ease the emotional burden that families can experience and help resolve any feelings of uncertainty about the decisions they have made for their loved ones (Source: UCL).

Full press release is available from UCL

The decision aid can be downloaded here

COVID-19 and Dementia: Factors affecting patient outcomes and experience along the dementia pathway

Wessex Clinical Senate and Networks | July 2020| COVID-19 and Dementia: Factors affecting patient outcomes and experience along the dementia pathway

The COVID-19 pandemic has impacted significantly on the delivery of NHS services. We have an opportunity to learn from the rapid and necessary service transformation and consider how we recover our services.

Dementia remains a diagnosis with significant impact with a need to balance the timeliness of diagnosis with patient experience and outcomes. Covid may become endemic and our adapted ways of working may become the new normal.

Recent webinars have brought clinicians, service managers and commissioners together to consider factors affecting the dementia pathway in a Covid environment. This document aims to give an overview of factors identified that affect the pathway.

The documents are available to download from the Wessex Senate

Alzheimer’s Research: Progressing towards a tau blood test for Alzheimer’s disease

Alzheimer’s Research UK | July 2020 | Progressing towards a tau blood test for Alzheimer’s disease

  • Four new studies presented at the Alzheimer’s Association International Conference (AAIC) and two published papers show that levels of tau, a hallmark protein of Alzheimer’s disease, in the blood could be used to detect the disease
  • The research focuses on a specific form of tau, p-tau217
  • The new data suggests blood levels of p-tau217 can predict the development of Alzheimer’s disease before symptoms appear, track well with levels of tau in the brain and distinguish Alzheimer’s from other diseases that cause dementia

Researchers from both the US and Europe have presented data that indicates levels of a specific form of tau, one of the hallmark proteins of Alzheimer’s disease, can be measured in blood to detect the disease, even before symptoms appear. 

Full details of the studies are available from Alzheimer’s Research UK

In the news:

The Independent ‘Exciting’ results on blood test that could detect Alzheimer’s 20 years before memory falter

BBC News Alzheimer’s: ‘Promising’ blood test for early stage of disease

The Telegraph Flu jab may reduce risk of dementia by a fifth, study finds

Caring for People with Dementia: a clinical practice guideline for the radiography workforce

Caring for People with Dementia: a clinical practice guideline for the radiography
workforce (imaging and radiotherapy) | The Society and College of Radiographers

Caring for people with Dementia: a clinical practice guideline for the radiography workforce (imaging and radiotherapy) is a comprehensive and evidence-based document. It has a set of recommendations for the whole radiographic workforce caring for people with dementia and carers when undergoing imaging and/or radiotherapy. It has been developed systematically using the best available evidence from research and expert opinion, including service users, and subjected to peer professional, lay and external review.

scor
Image source: http://www.sor.org

The guideline has recommendations for good practice for individual members of the radiographic workforce, service managers, academic institutions and the Society and College of Radiographers (SCoR).

As a whole, this guideline acts to highlight to practitioners that to offer the best service and healthcare outcomes for people with dementia and carers, care must be tailored to the needs of the invidual.

There have been minor changes to the language used in this second edition, which emphasises the ability of and need for people with dementia to continue to live well with a good quality of meaningful life.

Full document: Caring for People with Dementia: a clinical practice guideline for the radiography workforce

What hinders and facilitates the implementation of nurse-led interventions in dementia care?

Karrer, M., Hirt, J., Zeller, A. et al. | What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review. | BMC Geriatrics | 20, 127 (2020)

Abstract

Background

The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care.

Methods

We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories.

Results

We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families).

Conclusions

Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.

Full article: What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review.

COVID-19: End of life care and dementia

This brief guidance was developed by Alistair Burns, National Clinical Director for Dementia at NHS England/Improvement, and has been incorporated into NHS England publications | via British Geriatrics Society

The majority of people with dementia (which is the leading cause of death in England and Wales) are aged over 70, have other long-term conditions and are frail, putting them into particularly vulnerable groups for developing complications if they are infected with COVID-19.

There are an estimated 675,000 people with dementia in England who are supported by a similar number of carers, most of whom are older people themselves. A quarter of people in acute hospitals and three quarters of residents of care homes have dementia.

This brief guidance may be useful to clinicians and planners when considering end of life care matters in people with dementia.

COVID-19: End of life care and dementia: Good practice guide.

Updated Coronavirus information for families looking after someone with dementia

Dementia UK are constantly updating the coronavirus hub on their website. Visit it to read the latest advice from dementia specialist Admiral Nurses, including the list of frequently asked questions coming through to the Dementia UK Helpline.

Coronavirus: advice for families looking after someone with dementia
The current government advice is for everyone over age 70 or with other health conditions to stay at home for up to 16 weeks. This does not specifically include people with dementia; but if the person you care for has other health considerations, or is in any way vulnerable, you might decide to follow this advice.  Full detail here

Coronavirus: questions and answers
Dementia UK have put together a list of commonly asked questions totheir Helpline, which will be updated as and when the situation develops. Full detail here

Leaflets and information
Information, blogs and ideas for people living with dementia during this time. Full detail here

Are large simple trials for dementia prevention possible?

William N Whiteley et al. | Are large simple trials for dementia prevention possible? | Age and Ageing | published 12th December 2019

  • Large simple trials have transformed care for heart attack and stroke. Lessons from these trials may be applicable to dementia prevention.
  • The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge. The reliable identification of higher risk populations is difficult but will be important.
  • Patients and families prioritise loss of function. Loss of functional abilities or clinical dementia are infrequent, but might be measured with lower variability than cognitive scores.

Abstract

New trials of dementia prevention are needed to test novel strategies and agents. Large, simple, cardiovascular trials have successfully discovered treatments with moderate but worthwhile effects to prevent heart attack and stroke. The design of these trials may hold lessons for the dementia prevention.Here we outline suitable populations, interventions and outcomes for large simple trials in dementia prevention. We consider what features are needed to maximise efficiency. Populations could be selected by age, clinical or genetic risk factors or clinical presentation. Patients and their families prioritise functional and clinical outcomes over cognitive scores and levels of biomarkers. Loss of particular functions or dementia diagnoses therefore are most meaningful to participants and potential patients and can be measured in large trials.

The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge and will need collaboration between many clinical investigators, funders and patient organisations.

Full article: Are large simple trials for dementia prevention possible?