This new profiling tool aims to help enable a major change in the way dementia data will be used at a local level. It will allow users to create a bespoke comparison between local authorities and CCGs in England and shares key information such as the number of people who have dementia, broken down by area and age; the number of people who have received an NHS health check; the number of people who have depression; emergency hospital admission numbers; and where people with dementia die.
This report, from the Deloitte UK Centre for Health Solutions in collaboration with the Alzheimer’s Society, summarises the emerging consensus and outcomes developed from a series of events and initiatives which aimed to collect the views of people interested in improving services for people with dementia and their carers. The “Dementia Today and Tomorrow” report:
- Evaluates progress made since the National Dementia Strategy (2009) and Prime Minister’s Dementia Challenge (2012).
- Identifies issues and challenges remaining.
- Considers aims and targets for the next five years.
- Discusses what good dementia care and support should look like by 2020.
Objective: The aim of this study was to investigate whether the use of fish oil supplements (FOSs) is associated with concomitant reduction in cognitive decline and brain atrophy in older adults.
Methods: We conducted a retrospective cohort study to examine the relationship between FOS use during the Alzheimer’s Disease Neuroimaging Initiative and indicators of cognitive decline. Older adults (229 cognitively normal individuals, 397 patients with mild cognitive impairment, and 193 patients with Alzheimer’s disease) were assessed with neuropsychological tests and brain magnetic resonance imaging every 6 months. Primary outcomes included (1) global cognitive status and (2) cerebral cortex gray matter and hippocampus and ventricular volumes.
Results: FOS use during follow-up was associated with significantly lower mean cognitive subscale of the Alzheimer’s Disease Assessment Scale and higher Mini-Mental State Examination scores among those with normal cognition. Associations between FOS use and the outcomes were observed only in APOE ε4–negative participants. FOS use during the study was also associated with less atrophy in one or more brain regions of interest.
Objective: Dementia has a multifactorial etiology, but the importance of individual health and lifestyle related risk factors is often uncertain or based on few studies. The goal of this paper is to identify the major modifiable risk factors for dementia as a first step in developing an effective preventive strategy and promoting healthy late life cognitive functioning.
Methods: A mixed-method approach combined findings from a systematic literature review and a Delphi consensus study. The literature search was conducted in PubMed and updated an earlier review by the United States National Institutes of Health from 2010. We reviewed the available evidence from observational epidemiological studies. The online Delphi study asked eight international experts to rank and weigh each risk factor for its importance for dementia prevention.
Results: Out of 3127 abstracts, 291 were included in the review. There was good agreement between modifiable risk factors identified in the literature review and risk factors named spontaneously by experts. After triangulation of both methods and re-weighting by experts, strongest support was found for depression, (midlife) hypertension, physical inactivity, diabetes, (midlife) obesity, hyperlipidemia, and smoking, while more research is needed for coronary heart disease, renal dysfunction, diet, and cognitive activity.
Conclusions: Findings provide good support for several somatic and lifestyle factors and will be used to inform the design of a new multicenter trial into dementia prevention.
One in four inpatients in general hospitals has dementia care needs, and faces worse outcomes if these needs go unrecognised. One large NHS trust has introduced an enhanced dementia care role for healthcare assistants, offering training in how to recognise dementia and providing oneto-one support. This article outlines the content of the training and its impact on practice and teamwork at the trust.
Goodwin C (2015) Enhancing healthcare assistants’ dementia role. Nursing Times; 111: 9, 21-23.
Objective: Public health campaigns encouraging early help seeking have increased rates of mild cognitive impairment (MCI) diagnosis in Western countries, but we know little about how to treat or predict dementia outcomes in persons with the condition.
Method: The authors searched electronic databases and references for longitudinal studies reporting potentially modifiable risk factors for incident dementia after MCI. Two authors independently evaluated study quality using a checklist. Meta-analyses were conducted of three or more studies.
Results: There were 76 eligible articles. Diabetes and prediabetes increased risk of conversion from amnestic MCI to Alzheimer’s dementia; risk in treated versus untreated diabetes was lower in one study. Diabetes was also associated with increased risk of conversion from any-type or nonamnestic MCI to all-cause dementia. Metabolic syndrome and prediabetes predicted all-cause dementia in people with amnestic and any-type MCI, respectively. Mediterranean diet decreased the risk of conversion to Alzheimer’s dementia. The presence of neuropsychiatric symptoms or lower serum folate levels predicted conversion from any-type MCI to all-cause dementia, but less formal education did not. Depressive symptoms predicted conversion from any-type MCI to allcause dementia in epidemiological but not clinical studies.
Conclusions: Diabetes increased the risk of conversion to dementia. Other prognostic factors that are potentially manageable are prediabetes and the metabolic syndrome, neuropsychiatric symptoms, and low dietary folate. Dietary interventions and interventions to reduce neuropsychiatric symptoms, including depression, that increase risk of conversion to dementia may decrease new incidence of dementia.
Reference: Cooper, C et al. Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. American Journal of Psychiatry, 2015; appi.ajp.2014.1 DOI: 10.1176/appi.ajp.2014.14070878
This study delved into the underlying consensus among English-speaking dementia experts concerning contemporary knowledge about dementia. Delphi experts have identified 36 statements about dementia deemed to be “essential” to understanding the condition. These statements are primarily about care for people with dementia and their carers, but also relate to dementia characteristics, symptoms and progression, diagnosis and assessment, and treatment and prevention.
Annear, MJ. Toye, C. [and] McInerney, F. [et al] (2015). What should we know about dementia in the 21st Century? A Delphi consensus study. BMC Geriatrics, February 6th2015, Vol.15(1), 5. pp.1- 26.
Data on dementia diagnosis rates from April 2014 to January 2015 have been published, in support of the Dementia Strategy (2009) and David Cameron’s Dementia Challenge. NHS England is committed to increasing dementia diagnosis rates in England by March 2015, with the target of two-thirds of people with dementia receiving a formal diagnosis.
This analysis from the Health and Social Care Information Centre (HSCIC) examines Quality Outcomes Framework (QOF) recorded dementia diagnoses between April 2014 and January 2015.
The “Join Dementia Research” website assists people with dementia to learn about, and become involved in, dementia research. A new enhancement to this service allows people with dementia (or their families / carers for example, acting on their behalf) to register an interest in participating in research studies. This is hoped to remove barriers to public and patient engagement in research trials, while helping researchers find suitable participants as and when required.
Reference: Scheme launches to help people take part in dementia research. London: Department of Health / Dementia Challenge, February 24th 2015.
Persons concerned about integrated care and public health are invited to consider population health as a broader, all-encompassing, construct for addressing local public health and a broad range of socio-economic determinants of health inequalities.
Reference: Alderwick, H. Ham, C. and Buck, D. (2015). Population health systems: going beyond integrated care. London: The King’s Fund, January 22nd 2015.