Observational cohort study: deprivation and access to anti-dementia drugs in the UK

Cooper, C. et al. Age Ageing (2015). 

Background: UK National Dementia Strategies prioritise fair access to dementia treatments for the whole population. We investigated for the first time inequalities in NHS national dementia prescribing and how they have varied between UK countries and over time.

Method: we investigated the association between Townsend deprivation score and anti-dementia drug prescribing in 77,045 dementia patients from UK primary care records from 2002 to 2013.

Results: we included 77,045 patients with recorded dementia diagnosis or anti-dementia drug prescription. Least deprived patients were 25% more likely to be initiated on anti-dementia drugs than the most deprived (adjusted incidence rate ratio 1.25, 95% confidence interval 1.19–1.31). This was driven by data from English practices where prescribing rates were consistently lower in more deprived patients compared with Scotland, Northern Ireland and Wales, where prescribing was not related to deprivation quintile. Compared with English practices, anti-dementia medication was prescribed more often in Northern Irish (1.81, 1.41–2.34) and less in Welsh practices (0.68, 0.55–0.82), with a trend towards more prescribing in Scottish practices (1.14, 0.98–1.32). Drug initiation rates were also higher in younger people and men.

Conclusion: four years after the English National Dementia Strategy, there is no evidence that the Strategy’s key objective of reducing treatment inequalities is being achieved. Higher overall anti-dementia drug prescribing in Scottish and Northern Irish practices, and differing clinical guidelines in Scotland from other UK countries might explain greater equality in prescribing in these countries. Strategies to offer treatment to more deprived people with dementia in England are needed.

Phenolic Acids, Flavonoids, Champagne Consumption and Dementia Risk Reduction (NHS Choices / Antioxidants and Redox Signaling)

Dementia and Elderly Care News

Summary

Over-interpretation of a recent (2013) piece of animal-based research led some press commentators to insinuate that champagne / white wine consumption might have a role in reducing the risk of dementia in humans. The following NHS ChoicesBehind the Headlines critical appraisal offers a due sense of perspective and reminds readers that it probably won’t.

Full Text Link

Reference

No hard evidence champagne can prevent dementia. London: NHS Choices Behind the Headlines, November 9th 2015.

This relates to:

Full Text Link(Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Corona, G. Vauzour, D. [and] Hercelin, J. [et al] (2013). Phenolic acid intake, delivered via moderate champagne wine consumption, improves spatial working memory via the modulation of hippocampal and cortical protein expression / activation. Antioxidants and Redox Signaling. November 10th 2013, Vol.19(14), pp.1676-89. (Click here to view the PubMed…

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Dementia research institute

The UK’s first dementia research institute is set to receive up to £150m to tackle the disease.

Led by the Medical Research Council, the institute will bring together world-leading experts, universities and organisations to drive forward research and innovation in fighting dementia. The disease affects an estimated 850,000 in Britain, a figure that’s expected to double in the next 20 years.

The institute will have a central UK hub, with links to universities across the country and will build on the centres of excellence in dementia already operating across the UK.

Can higher educational attainment help lower dementia risk?

Posted by Raluca Lucacel for the Mental Elf

study

We do not know much about the direct causes of dementia, but the evidence for possible causal associations includes (Prince et al., World Alzheimer Report 2015):

  • Low education
  • Hypertension
  • Smoking
  • Diabetes

Knowing the risk factors and acting upon the modifiable ones can lower the incidence of the disease. Our level of education is one of the most accepted risk factors in epidemiological studies for dementia. This factor is a modifiable one, so knowing more about how it influences the disease and acting upon it can lead to lower incidence levels and improved quality of life.

An explorative meta-analysis was conducted in order to find out whether a dose-response relation exists between education and dementia risk (Xu et al, 2015).

This paper presents important modifiable factors for reducing the risk of dementia. Many people consider that everyone gets dementia if they live long enough, but this is not true. Dementia is not a normal part of the ageing process and the more we know about the risk factors of the disease, the more we can do to help prevent it from occurring. – See more at: http://www.nationalelfservice.net/mental-health/dementia/can-higher-educational-attainment-help-lower-dementia-risk/#sthash.o1uC2cDQ.dpuf

via Can higher educational attainment help lower dementia risk?.

Dementia – Immediate Post Diagnosis Support Guidance — London Strategic Clinical Networks

Latest Health News

Released: 17.09.2015 | Dementia

living well with dementia

The living well with dementia workstream has created guidance for professionals to support people with dementia and carers immediately following diagnosis. The guidance covers prognosis, mediations, assessing carers needs, signposting, post diagnosis support, information on services available, and signposts the reader to further information.

This guidance has been produced primarily for professionals working with people with dementia in health and social care settings; however it may also be useful to commissioners.

All support should be tailored to the individual’s needs and wishes in order to provide a personalised approach.Not all information below will be appropriate for everyone and it is the diagnosing clinician’s decision what to discuss. It is unlikely that all topics will be covered in one meeting; it is anticipated that support will be offered over a series of meetings as necessary.

All areas should use these indicators as a guide to ensure that…

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Interventions in supporting self-management of informal caregivers: Systematic Review

Informal caregivers of people with dementia face the challenge of  managing the consequences of dementia in daily life. This meta-review makes an attempt to synthesize evidence from previous systematic reviews about professional self-management support interventions for this group.

Full reference: Huis in het Veld, J et al. The effectiveness of interventions in supporting self-management of informal caregivers of people with dementia; a systematic meta reviewBMC Geriatrics 2015, 15:147

Improving the clinical detection of Lewy body dementia with the Lewy body composite risk score

Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. Volume 1, Issue 3, September 2015, Pages 316–324

Introduction

Dementia with Lewy bodies (DLB) is a challenge to diagnose, particularly outside of expert centers with long delays in diagnosis leading to significant burden to patients and caregivers. Although consensus criteria have excellent specificity, there is no standardized way to assess symptoms reducing sensitivity. We developed the Lewy body composite risk score (LBCRS) from autopsy-verified cases to improve the ability to detect DLB in clinic and research populations.

Methods

The LBCRS was tested in a consecutive series of 256 patients compared with the clinical dementia rating and gold standard measures of cognition, motor symptoms, function, and behavior. Psychometric properties including floor and ceiling effects; concurrent, construct, and known-groups validity; and internal consistency of the LBCRS were determined. Receiver operator characteristic (ROC) curves assessed the ability of LBCRS to differentiate (1) DLB from Alzheimer’s disease (AD), (b) DLB from all dementia, and (c) mild cognitive impairment (MCI) due to DLB from MCI due to AD. The LBCRS was completed independent of the clinical evaluation.

Results

Mean LBCRS scores were significantly different between DLB and AD (6.1 ± 2.0 vs. 2.4 ± 1.3, P < .001) and between MCI-DLB versus MCI-AD (3.2 ± 0.9 vs. 1.0 ± 0.8, P < .001). The LBCRS was able to discriminate DLB from other causes of dementia. Using a cutoff score of 3, areas under ROC for DLB versus AD = 0.93 (0.89–0.98) and for MCI-DLB versus MCI-AD = 0.96 (0.91–1.0).

Discussion

The LBCRS increases diagnostic probability that Lewy body pathology is contributing to the dementia syndrome and should improve clinical detection and enrollment for clinical trials.

via Improving the clinical detection of Lewy body dementia with the Lewy body composite risk score.

Dementia: through the eyes of women | JRF

Nada Savitch, Emily Abbott, Gillian Parker, Helen Cadbury, Eloise Ross and Katherine Ludwin for the Joseph Rowntree  Foundation (JRF)

Dementia disproportionately affects women, but their experiences and voices are missing from research and literature. This project aimed to inspire people to think differently about women and dementia by using stories and reflections from individual women to inform the debate in a unique, inspiring and insightful way.

dementia women report
The report shows:

  • there is often resistance to talking about dementia as a women’s issue;
  • research needs to focus on the voices, experiences and perceptions of women affected by dementia;
  • service provision needs to reflect the needs, skills and attributes of women with dementia, female carers and the female care workforce;
  • the way women experience dementia is affected by gender, but also by many other factors including education, ethnicity, sexuality, class, age, and disability.

via Dementia: through the eyes of women | JRF.