Why modern life is making dementia in your 40s more likely

From background radiation to chemicals in the food chain, environmental changes are contributing to a rapid global rise in neurological disease

brain mri

My interest in neurological disease was triggered by a second friend dying ofmotor neurone disease (MND), which in purely statistical terms was exceptional. It is suggested there is an incidence of about one in 50,000 who are affected by MND and most die. No one knows 50,000 people, so was it a statistical fluke?

This raised the question of whether there were increases not only in MND, but in neurological disorders as a whole, including the dementias. Using World Health Organisation mortality data, which – while not perfect – is the best information available as it is collated in a standard and uniform way, myself and colleagues at the faculty of health and social sciences at Bournemouth University set out to investigate this.

Our first study, focusing on the changing pattern of neurological deaths from 1979 up to 1997, found that dementias were starting 10 years earlier – affecting more people in their 40s and 50s – and that there was a noticeable increase in neurological deaths in people up to the age of 74. In a follow-up study, taking us to 2010 and across 21 western countries, these increases were confirmed.

The results were controversial. As one newspaper headline reported: “Modern living leads to brain disease”, which in a somewhat simplistic way reflected what our research uncovered about the impact of the changing environment in which we live on our neurological health.

Read the full article via Why modern life is making dementia in your 40s more likely | Colin Pritchard | Comment is free | The Guardian.

Qualitative studies of psychosocial interventions for dementia: a systematic review

Objectives: Whilst a range of psychosocial interventions are used for people with dementia, there lacks evidence for the processes which underpin them. Systematic reviews focus on quantitative studies and there is a lack of qualitative reviews in the area. The review aimed to address this gap by exploring what existing qualitative studies reveal about the implementation, effects and processes of psychosocial interventions for dementia.

Method: A systematic literature search was conducted, identifying 363 studies. Sixteen studies were found to meet the inclusion criteria and assessed for quality using pre-specified criteria. Thematic analysis was used to synthesise the findings.

Results: There were 10 descriptive themes. Despite the diversity of the psychosocial interventions, there were common themes in relation to (1) contextual and individual factors affecting implementation (2) perceived impact of the interventions and (3) the processes active in achieving these effects. Study quality was adequate but variable.

Conclusion: Common processes may underlie different psychosocial interventions for dementia. The synthesis of qualitative findings can offer insight into what makes interventions ‘work’ and factors which may facilitate or impede their use.

Reference: Dugmore, O, Orrell, M & Spector, A. Qualitative studies of psychosocial interventions for dementia: a systematic review. Aging & Mental Health Volume 19, Issue 11, 2015 pages 955-967

Advance care planning and palliative medicine in advanced dementia: a literature review

Advance care planning is a targeted intervention that promotes autonomy for end-of-life decisions. It is particularly important in dementia where the illness impairs individuals’ decision-making abilities. Patients with advancing dementia experience significant comorbidities such as malnutrition and dehydration. They may have no advance care plan (ACP) in place and this can pose difficult management questions for their families and attending physicians concerning palliation and end-of-life care.

This narrative review aims to assess the factors that affect the clinical use of advanced care planning and palliative care interventions in patients with dementia, and to help guide future primary research, systematic reviews and service development in the UK.

Fulll text available at The British Journal of Psychiatry

Advance care planning and palliative medicine in advanced dementia: a literature review. ,

Expert views on the factors enabling good end of life care for people with dementia: a qualitative study

BMC Palliative Care 2015, 14:32

Background
Dementia, of all long term illnesses, accounts for the greatest chronic disease burden, and the number of people with age-related diseases like dementia is predicted to double by 2040. People with advanced dementia experience similar symptoms to those dying with cancer yet professional carers find prognostication difficult and struggle to meet palliative care needs, with physical symptoms undetected and untreated. While elements of good practice in this area have been identified in theory, the factors which enable such good practice to be implemented in real world practice need to be better understood. The aim of this study was to determine expert views on the key factors influencing good practice in end of life care for people with dementia.

Methods
Semi-structured telephone and face-to-face interviews with topic guide, verbatim transcription and thematic analysis. Interviews were conducted with experts in dementia care and/or palliative care in England (n = 30).

Results
Four key factors influencing good practice in end of life care for people with dementia were identified from the expert interviews: leadership and management of care, integrating clinical expertise, continuity of care, and use of guidelines.

Conclusions
The relationships between the four key factors are important. Leadership and management of care have implications for the successful implementation of guidelines, while the appropriate and timely use of clinical expertise could prevent hospitalisation and ensure continuity of care. A lack of integration across health and social care can undermine continuity of care. Further work is needed to understand how existing guidelines and tools contribute to good practice.

Disclaimer
This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Grant Reference Number RP-PG-0611-20005). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

via BMC Palliative Care | Abstract | Expert views on the factors enabling good end of life care for people with dementia: a qualitative study.

Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study

BMC Geriatrics 2015, 15:90

Background
General practitioners (GPs) are in best position to suspect dementia. Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) are widely used. Additional neurological tests may increase the accuracy of diagnosis. We aimed to evaluate diagnostic ability to detect dementia with a Short Smell Test (SST) and Palmo-Mental Reflex (PMR) in patients whose MMSE and CDT are normal, but who show signs of cognitive dysfunction.

Methods
This was a 3.5-year cross-sectional observational study in the Memory Clinic of the University Department of Geriatrics in Bern, Switzerland. Participating patients with normal MMSE (>26 points) and CDT (>5 points) were referred by GPs because they suspected dementia. All were examined according to a standardized protocol. Diagnosis of dementia was based on DSM-IV TR criteria. We used SST and PMR to determine if they accurately detected dementia.

Results
In our cohort, 154 patients suspected of dementia had normal MMSE and CDT test results. Of these, 17 (11 %) were demented. If SST or PMR were abnormal, sensitivity was 71 % (95 % CI 44–90 %), and specificity 64 % (95 % CI 55–72 %) for detecting dementia. If both tests were abnormal, sensitivity was 24 % (95 % CI 7–50 %), but specificity increased to 93 % (95 % CI 88–97 %).

Conclusion
Patients suspected of dementia, but with normal MMSE and CDT results, may benefit if SST and PMR are added as diagnostic tools. If both SST and PMR are abnormal, this is a red flag to investigate these patients further, even though their negative neuropsychological screening results.

via BMC Geriatrics | Full text | Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study.