García-Casal, J. A. et al. Aging & Mental Health. Published online: 25th Jan 2016
Objectives: To estimate the efficacy of computer-based cognitive interventions for improving cognition in people with dementia (PWD).
Method: Online literature databases were searched for relevant studies. Interventions were categorised as follows: cognitive recreation, cognitive rehabilitation, cognitive stimulation or cognitive training. A systematic review, quality assessment and meta-analyses were conducted.
Results: Twelve studies were identified. Their methodological quality was acceptable according to Downs & Black criteria, the weakest methodological area being the external validity. The meta-analyses indicated cognitive interventions lead to beneficial effects on cognition in PWD (SMD −0.69; 95% CI = −1.02 to −0.37; P < 0.0001; I2 = 29%), depression (SMD 0.74; 95% CI = 0.31 to 1.17; P = 0.0008; I2 = 41%) and anxiety (SMD 0.55; 95% CI = 0.07 to 1.04;P < 0.03; I2 = 42%). They benefited significantly more from the computer-based cognitive interventions than from the non-computer-based interventions in cognition (SMD 0.48; 95% CI = 0.09 to 0.87; P = 0.02; I2 = 2%) and depression (SMD 0.96; 95% CI = 0.25 to 1.66; P = 0.008; I2 = 54%).
Conclusion: Computer-based cognitive interventions have moderate effects in cognition, depression and anxiety in PWD. No significant effects were found on activities of daily living. They led to superior results compared to non-computer-based interventions in cognition and depression. Further research is needed on cognitive recreation and cognitive stimulation. There is also a need for longer-term follow-up to examine the potential retention of treatment effects, and for the design of specific outcome measures.
Alzheimer’s Society wants to ensure that people with dementia receive the highest standards of care wherever they are: in hospital, in a care home, or in the home. Our latest report has uncovered some shocking examples of dangerous and inadequate care in hospitals throughout England.
Hospitals have a duty to be transparent and accountable to their patients, and to continually monitor and improve dementia care.
While there are notable examples of excellent care across the country, the difference from one hospital to the next is far too great and there is inconsistent understanding of the needs of people with dementia.
Our campaign is making the following recommendations to fix dementia care:
All hospitals to publish an annual statement of dementia care, which includes feedback from patients with dementia, helping to raise standards of care across the country
The regulators, Monitor and the Care Quality Commission to include standards of dementia care in their assessments
If you are a carer looking after a family member with dementia in your own home or a professional working with people with dementia, this free online course will help you better understand the person and develop the skills needed to manage their challenging behaviour. Understand and manage challenging behaviour
The symptoms of dementia vary (depending on the cause and the individual), but often include memory loss, mood changes, communication and motivation problems, a reduced ability to plan and problems with controlling their own behaviour.
Some symptoms, such as restlessness, agitation and communication difficulties, can be challenging for you as a carer, and this can cause you high levels of stress and burden.
Learn from other dementia carers and academic experts
Dr Alison Coates is a dual-trained adult and mental health nurse and has experience of working in a range of different clinical environments. She is the author of the textbook ‘Nursing Older People’ and currently works at the University of Birmingham teaching mental health nursing with a focus on older adults. Dr Chris Wagstaff has experience of working in a variety of different clinical environments over the past 25 years and has taught widely about a number of different mental health issues. Nutmeg Hallett has a background in forensic nursing, is currently undertaking PhD research investigating violence prevention in clinical settings and is a lecturer in mental health nursing.
In this course, we will use case studies to explore these challenging behaviours and find out how other carers manage them both at home and in a residential care setting. You will explore how using a person-centred approach can reduce challenging behaviours. We will cover specific interventions that can help you, particularly focusing on de-escalation skills.
This publication takes information from a variety of sources to provide a compendium of statistics about dementia in England.
It provides both new analysis and previously published statistics. New analysis includes linked mental health and mortality data, and longitudinally linked hospital data. The publication aims to be of interest to a range of audiences, including policy makers, commissioners, researchers, patients and carers.
The publication looks at five aspects of dementia care broadly aligned to national strategic aims:
Recorded dementia prevalence at 31st December 2015 is 0.755 per cent (1 person in 132). When considered alongside monthly data collected in 2014/15, this indicates a progressive increase in recorded prevalence from March 2015 (0.738) to December 2015 (0.755). After adjustments to remove spurious, ‘non-GP’ practices, shared practices and practices which decided not to participate in this extraction, the extract cohort available for collection was 7,623 practices. Of the extract cohort, data for 7,436 practices were collected, representing 97.5 per cent coverage of practices and 97.7 per cent of registered patients.
‘New research has revealed how disease-associated changes in 2 interlinked networks within the brain may play a key role in the development of the symptoms of dementia’ – via ScienceDaily
The University of Exeter Medical School led two studies, each of which moves us a step closer to understanding the onset of dementia, and potentially to paving the way for future therapies. Both studies, part-funded by Alzheimer’s Research UK, are published in the Journal of Neuroscience and involved collaboration with the University of Bristol.
Both studies shed light on how two parts of the brain’s ‘GPS’ navigation system malfunctions in dementia, and point to likely underpinning causes for loss of orientation that is commonly experienced by people living with the condition.
In the first study, the team studied a part of the brain called the entorhinal cortex. Located near the base of the brain, this region is associated with functions including memory formation and navigation, and contains so-called “grid cells.” These nerve cells fire electrical discharges in a grid-like pattern, much like the grid on an Ordnance Survey map. Paralleling the different scales employed by different maps, the grid firing patterns in the entorhinal cortex also have different scales, with cells at the top of the cortex having a more tightly packed grid pattern than those at the bottom. Scientists believe that this top-to-bottom gradient of different grid scales contributes pivotally to our sense of spatial location.
The team compared the activity in the entorhinal cortex of healthy mice and mice with dementia. They found that top-to-bottom gradients in electrical activity in the entorhinal cortex are not present in mice with dementia. Their findings suggest that the fine navigational detail, such as you would find on a large-scale map, is not correctly represented in patients with dementia.
The Alzheimer’s Society may have found further evidence of poor and variable care in a review of acute hospital care for dementia patients. Their report is based on Freedom of Information (FOI) requests, to which not all Trusts were in a position to respond; so the data could be skewed in either direction overall. It is the variation in care quality that is the main focus.
Problems detected include the prevalence of falls, night-time discharges, length of stay (delayed discharges), rates of hospital re-admissions, and anecdotal reports of “patients being treated with excessive force, not being given enough help with meals and drinks, and being left in wet or soiled sheets”.
Rosemary H Gibson et al. Dementia: January 14, 2016
Dementia-related sleep problems can be complex and challenging. Environmental interventions which resynchronise the sleep/wake cycle have been trialled with promising results for people with dementia in institutionalised settings. However, there is less research concerning community-dwelling people with dementia and their family carers.
This study involved a five-week feasibility study including timed light therapy, exercise and sleep education. Sleep and physical and mental functioning were measured at the beginning and end of the trial using objective measures, standardised questionnaires and structured participant feedback. Of 15 community-dwelling pairs who participated, nine completed the trial.
The case studies presented here reveal that it is feasible for this population to use non-pharmacological interventions, with positive outcomes. However, there are also issues that can mask benefits or prevent compliance. The options for treating dementia are limited. Environmental interventions may help manage dementia-related sleep problems and further trials would be worthwhile to improve compliance and evaluate effectiveness.