Objectives To perform a systematic review of reported HRs of all cause dementia, Alzheimer’s disease (AD) and vascular dementia (VaD) for late-life depression and depressive symptomatology on specific screening instruments at specific thresholds.
Results Searches yielded 121 301 articles, of which 36 (0.03%) were eligible. Included studies provided a combined sample size of 66 532 individuals including 6593 cases of dementia, 2797 cases of AD and 585 cases of VaD. The increased risk associated with depression did not significantly differ by type of dementia and ranged from 83% to 104% for diagnostic thresholds consistent with major depression. Risk associated with continuous depression symptomatology measures were consistent with those for clinical thresholds.
Conclusions Late-life depression is consistently and similarly associated with a twofold increased risk of dementia. The precise risk estimates produced in this study for specific instruments at specified thresholds will assist evidence-based medicine and inform policy on this important population health issue.
When I first came across John’s Campaign I remember thinking: “Why is this needed?” But the more I read, the more I realised that my own experience, 10 years earlier, had many similarities. My father Pag Monro – a doctor, like Dr John Gerrard, after whom the campaign is named – had vascular dementia when he was admitted to Hinchingbrooke Hospital in Huntingdon, Cambridgeshire after a fall which broke his collar bone. He was there for three months.
Had I known my father would spend so long in hospital, I would have tried to keep him at home, but hindsight is a wonderful thing. His care in hospital was always well-intentioned but not always suitable, and unfortunately he succumbed to various infections. However, I was given open access to the ward – initially to ensure that he took his medication – and I soon became a regular visitor, with some nurses even asking when my next shift was.
It is essential, I believe, for relatives and carers to have such access at all times. They should be regarded as a valuable resource who can assist nursing staff in day-to-day care. Communication and co-operation are key. Just as the patient with dementia should be seen as a person, not a medical condition, staff looking after them must have as much information as possible to ensure their care is the best it can be.
Mary Guerriero Austrom. Aging & Mental Health. Published online: 15 Dec 2015
Objectives: Describe the development of a competent workforce committed to providing patient-centered care to persons with dementia and/or depression and their caregivers; to report on qualitative analyses of our workforce’s case reports about their experiences; and to present lessons learned about developing and implementing a collaborative care community-based model using our new workforce that we call care coordinator assistants (CCAs).
Method: Sixteen CCAs were recruited and trained in person-centered care, use of mobile office, electronic medical record system, community resources, and team member support. CCAs wrote case reports quarterly that were analyzed for patient-centered care themes.
Results: Qualitative analysis of 73 cases using NVivo software identified six patient-centered care themes: (1) patient familiarity/understanding; (2) patient interest/engagement encouraged; (3) flexibility and continuity of care; (4) caregiver support/engagement; (5) effective utilization/integration of training; and (6) teamwork. Most frequently reported themes were patient familiarity – 91.8% of case reports included reference to patient familiarity, 67.1% included references to teamwork and 61.6% of case reports included the theme flexibility/continuity of care. CCAs made a mean number of 15.7 (SD = 15.6) visits, with most visits for coordination of care services, followed by home visits and phone visits to over 1200 patients in 12 months.
Discussion: Person-centered care can be effectively implemented by well-trained CCAs in the community.
Drinking 2 to 3 units of alcohol every day is linked to a reduced risk of death among people with early stage Alzheimer’s disease, finds research published in the online journal BMJ Open.
Moderate drinking has been associated with a lower risk of developing and dying from heart disease and stroke. But alcohol is known to damage brain cells, and given that dementia is a neurodegenerative disorder, drinking might be harmful in those with the condition.
The researchers therefore wanted to find out if the same potentially positive association between alcohol and a reduced risk of cardiovascular death could be applied to 321 people with early stage Alzheimer’s disease, defined as a score of 20 or less on the Mini Mental State Exam (MMSE).
The research team analysed data originally collected on 330 people with early stage dementia or Alzheimer’s disease and their primary carers from across Denmark as part of the Danish Alzheimer’s Intervention Study (DAISY).
During the monitoring period, 53 (16.5%) of those with mild Alzheimer’s disease died. Consumption of 2-3 units of alcohol every day was associated with a 77% lowered risk of death compared with a tally of 1 or fewer daily units.
Evidently Cochrane: By Sarah Chapman // December 4, 2015
In the UK, 9.9 million people are aged over 65 and it has been estimated that around 6.6% have dementia; in the over 85s, this may be as high as 50%. Dementia has been identified as a national priority in health and social care and recent guidelines have emphasized early diagnosis to help with planning and management, though ‘screening’ for dementia remains the subject of debate.
A questionnaire to identify possible dementia
Currently, less than half those with dementia will be diagnosed as having it. There are lots of different ways of assessing people for possible dementia and no clear agreement about the best way to do it. One approach is to ask someone who knows the person about changes they’ve observed and a questionnaire that is commonly used for this purpose is the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).
A team led by Dr Terry Quinn at the Cochrane Dementia and Cognitive Improvement Group has conducted a series of Cochrane reviews to find out what research can tell us about the accuracy of the IQCODE, used in different settings, for identifying possible dementia. A diagnosis of dementia can’t be made using the IQCODE alone, but this questionnaire can be used to flag up the need for further assessment or to help with a diagnosis along with other investigations.
The reviewers found that although the accuracy of the IQCODE is in a range that many would consider reasonable, in this population its use is likely to result in a large number of people being wrongly assessed as likely to have dementia and a large number of people who do have dementia being missed.
So out of a population of 100, it’s wrong for 15 of them.
Currently, there is no cure for Alzheimer’s disease. Treatments can lessen the symptoms, but scientists are looking for ways to prevent, halt or reverse the disease.
As the dementia progresses, more plaques (clumps of abnormal proteins and chemicals) form in the brain and healthy brain cells die off.
Scientists reason that preventing or removing the plaques might help, and many drug candidates are in development.
A molecule can clear Alzheimer’s plaques from the brains of mice and improve learning and memory, Korean scientists have found in early tests. But exactly how it gets rid of the abnormal build-up is not understood.
The small Nature Communications study hints at a way to tackle the disease even once its in full swing, dementia experts say. But there is no proof the same method would work in people – many more years of animal trials are needed first.
There are many things which can make it difficult for a person with dementia to live at home. Most people with dementia are older adults, which increases the likelhood of having some medical or physical conditions, such as vascular problems or frequent falls. Add on top of that reduced independence and the possible struggle to prepare a meal or dress yourself, and you have a combination of difficulties which can make it difficult to stay at home alone or with a family carer.
That’s not to say that people with dementia experience all these symptoms early on, but they do become more pronounced as the disease progresses, in some people earlier than in others (i.e. Giebel et al., 2014). Therefore, helping people with dementia live at home for longer is really important, and is picked up in the Prime Minister’s Challenge on Dementia 2020 (DH, 2015).
For some people that entails health care assistance in the home, whilst for others that means a greater focus on social care services. And for some it means both.
Professional self-management support interventions can help the carers of people with dementia cope better. Integrating psycho-education into self-management support may be particularly effective.
Reviewers from the Netherlands examined interventions to support self-management amongst the carers of people with dementia. They searched five bibliographic databases for systematic reviews available as of March 2014. Ten reviews were included. There was evidence of the effectiveness of professional self-management support interventions targeting psychological wellbeing for reducing stress and improving social outcomes. Interventions providing information were found to increase knowledge. There was limited evidence identified about techniques to cope with memory change on coping skills and mood.