An evaluation of Snoezelen® compared to ‘common best practice’ for allaying the symptoms of wandering and restlessness among residents with dementia in aged care facilities

Geriatric Nursing: DOI: http://dx.doi.org/10.1016/j.gerinurse.2015.07.005

Snoezelen has become an increasingly popular therapy in residential aged care facilities in Australia and elsewhere, despite no conclusive evidence of its clinical efficacy.

This paper reports on an evaluation of the use of Snoezelen compared to ‘common best practice’ for allaying the dementia related behaviors of wandering and restlessness in two residential aged care facilities in Victoria, Australia.

Sixteen residents had their behavior and responses to Snoezelen or ‘common best practice’ observed and recorded over three time periods.

The Wilcoxon signed-rank test showed there was a significant improvement in behaviors immediately after the intervention and after 60 min. However, no significant differences were found between residents receiving Snoezelen and ‘common best practice’ interventions for the reduction of the dementia related behaviors.

via An evaluation of Snoezelen® compared to ‘common best practice’ for allaying the symptoms of wandering and restlessness among residents with dementia in aged care facilities – Geriatric Nursing.

Global Impact of Dementia: World Alzheimer Report 2015

The World Alzheimer Report 2015: ‘The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends’, released this month, has found that there are currently around 46.8 million people living with dementia around the world, with numbers projected to nearly double every 20 years, increasing to 74.7 million by 2030 and 131.5 million by 2050. There are over 9.9 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds.

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The report shows that the current annual societal and economic cost of dementia is US $818 billion, and it is expected to become a trillion dollar disease in just three years’ time. The findings show that the cost of dementia has increased by 35% since the 2010 World Alzheimer Report.

Research claims the number of people with dementia could be stabilising

Research published today (Friday 21 August) in The Lancet Neurology journal indicates that the number of people with dementia in some Western European countries is stabilising.

The reason(s) why rates of dementia may be levelling-off, or even falling, is not certain; but improvements in general wellbeing and ongoing work towards the reduction of risk factors for dementia (which include diabetes, cardiovascular disease, stroke, hypertension, depression, low educational attainment, smoking, obesity and physical inactivity) have been suggested.

According to the researchers, although the decrease in dementia occurrence is a positive sign, dementia care will remain a crucial challenge for many years because of population ageing.

Reference: Wu, Y-T. Fratiglioni, L.  Matthews, FE. [et al] (2015). Dementia in western Europe: epidemiological evidence and implications for policy making. Lancet Neurology. Published online August 20th 2015.

Related: Dementia levels ‘are stabilising’.  BBC Health News, August 21st 2015.

Depression as a risk factor for cognitive impairment in later life: the Health In Men cohort study

International Journal of Geriatric Psychiatry: Article first published online 17 AUG 2015

Background
Depression is an established risk factor for dementia in later life, but it is unclear if this relationship is causal. This study aimed to determine if clinically significant depressive symptoms are likely to be causally related to cognitive impairment in later life.

Methods
Observational cohort study of 4568 men aged 70–89 years living in Perth, Western Australia, who were free of cognitive impairment at the beginning of follow-up. Current clinically significant depressive symptoms were defined by a score of 7 or more on the Geriatric Depression Scale 15 items. Past depression was ascertained via electronic medical records, by self-report or use of antidepressants. A score of 27 or less on the Telephone Interview for Cognitive Status modified or a recorded diagnosis of dementia in electronic medical records established the presence of cognitive impairment.

Results
During the 5-year follow-up, 534 men developed cognitive impairment, 811 died and 1455 were lost. The presence of clinically significant depressive symptoms at study entry was associated with increased risk rate (RR) of cognitive impairment (RR = 2.59, 95% confidence interval: 95%CI = 1.57–4.27), death (RR = 5.07, 95%CI = 3.32–7.75) and loss to follow-up (RR = 2.03, 95%CI = 1.32–3.13). These associations remained statistically significant after adjustment for age, country of birth, education, smoking history, and prevalence hypertension, diabetes, coronary heart disease and stroke. History of past clinically significant depressive symptoms was not associated with incident cognitive impairment (RR = 1.09, 95%CI = 0.78–1.52).

Conclusions
The lack of association between past depression and cognitive impairment suggests that the link between depression and cognitive impairment is not causal and that the presence of clinically significant depressive symptoms in later life may herald the onset of cognitive impairment in at least some people.

via Depression as a risk factor for cognitive impairment in later life: the Health In Men cohort study – Almeida – 2015 – International Journal of Geriatric Psychiatry – Wiley Online Library.

Government boosted in drive to cure dementia after 60% rise in volunteers

Number of research participants soared to 22,000 during last year as Downing Street aims to find a cure or disease modifying therapy by 2025

The government’s ambition to find a cure for dementia by 2025 has been boosted by a big rise in people volunteering to take part in groundbreaking research studies.

During the last year, almost 22,000 people have taken part in research studies to tackle the condition – a 60% rise – according to figures from the National Institute for HealthResearch.

The increased participation in 100 dementia research projects across the UK will boost scientists in their bid to find new treatments to prevent, treat and eventually cure the illness.

Research projects include testing whether antibiotics slow cognitive decline, investigating the role of the immune system in dementia, identifying genetic risk factors and improving end of life care for people with dementia.

George Freeman, minister for life sciences, said: “Dementia is a devastating condition that can have a significant impact on the lives of those affected and their families.

“Volunteers are essential to our battle against the disease and I’m delighted that so many people – with and without dementia – are coming forward to participate in ground-breaking new trials.

“There is still a long way to go, but with their help we hope to find a cure or disease modifying therapy by 2025. The race is on.”

via Government boosted in drive to cure dementia after 60% rise in volunteers | Society | The Guardian.

TREATMENT FOR DEMENTIA, LEARNING FROM BREAKTHROUGHS FOR OTHER CONDITIONS

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This project analysed breakthroughs in the treatment of four selected conditions of ill health and seeks to identify potentially transferable lessons for the dementia context. Using evidence review and key informant interviews the authors sought to identify the series of ‘events’ that eventually led to a given breakthrough, and the key milestones in the process that have helped improve understanding and potential for treatment.

Reference: Taylor, J. et al. Treatment for dementia: Learning from breakthroughs for other conditions. Santa Monica, CA: RAND Corporation, 2015.

Marked gender differences in progression of mild cognitive impairment over 8 years

Available online 21 July 2015

Introduction

This study examined whether, among subjects with mild cognitive impairment (MCI), women progressed at faster rates than men.

Methods

We examine longitudinal rates of change from baseline in 398 MCI subjects (141 females and 257 males) in the Alzheimer’s Disease Neuroimaging Initiative-1, followed for up to 8 years (mean, 4.1 ± 2.5 years) using mixed-effects models incorporating all follow-ups (mean, 8 ± 4 visits).

Results

Women progressed at faster rates than men on the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog; P = .001) and clinical dementia rating-sum of boxes (CDR-SB; P = .003). Quadratic fit for change over time was significant for both ADAS-Cog (P = .001) and CDR-SB (P = .004), and the additional acceleration in women was 100% for ADAS-Cog and 143% for CDR-SB. The variability of change was greater in women. The gender effect was greater in ApoE4 carriers.

Discussion

Women with MCI have greater longitudinal rates of cognitive and functional progression than men. Studies to confirm and uncover potential mechanisms appear to be warranted.

via Marked gender differences in progression of mild cognitive impairment over 8 years.

Is late-onset Alzheimer’s disease really a disease of midlife?

Alzheimer’s & Dementia: Available online 26 July 2015

Introduction

Increasing evidence suggests that Alzheimer’s disease (AD) may begin decades before evidence of dementia, indicating that it may be a disorder of midlife rather than old age.

Methods

In the absence of long-term prospective studies from early adulthood specifically designed to address this question, a group of international experts examined evidence presently available from previous clinical and population studies to provide an evidence-based opinion as to whether such a change in conceptualization may be justified.

Results

Although still lacking confirmation from dedicated prospective biomarker studies, there is already considerable evidence to suggest both risk factor exposure and brain changes may be already present in midlife.

Discussion

Current evidence suggests (1) that a change in clinical approach notably involving promotion of cardiovascular health in persons with a family history of AD may considerably reduce disease risk and (2) that the development of biomarkers at this early stage will lead to the possibility of clinical trials at a much earlier stage.

via Is late-onset Alzheimer’s disease really a disease of midlife?.

Living with younger onset dementia by BMJ talk medicine | Free Listening on SoundCloud

BMJ talk medicine

EBN associate editor Gary Mitchell caught up with Kate Swaffer in London earlier this month to discuss her upcoming book, what it is like to live with dementia, and the current areas for development within healthcare systems and society.

Kate’s book, “what the hell happened to my brain?” is to be released later this year with Jessica Kingsley Publishers. If you are interested in finding out more about Kate’s work check out her webpage and regular blog series here: kateswaffer.com/

via Living with younger onset dementia by BMJ talk medicine | Free Listening on SoundCloud.