Impact of functional alterations on quality of life in patients with Alzheimer’s disease

Aging & Mental Health. 2016 Jan 8:1-6

Aim: To identify factors associated with health-related quality of life (HRQoL) as assessed by the Dementia Quality of Life (DQoL) in patients with Alzheimer’s disease (AD), focusing particularly on functional alterations.

Methods: Cross-sectional multicenter study in subjects aged 65 years or older with mild to moderate AD. HRQoL was measured using the DQoL (five domains: self-esteem, positive affect/humor, negative affect, feeling of belonging, and sense of esthetics). Functional alterations were assessed based on activities of daily living (ADLs) and instrumental activities of daily living (IADLs). We also recorded socio-demographic characteristics of the patient and their carer, and comprehensive geriatric assessment including MMSE and psycho-behavioral data (Neuropsychiatric Inventory, Cornell depression score). Factors associated with each domain of the DQol were identified by multivariate linear regression.

Results: In total, 123 subjects were included (mean age 82 ± 6 years, 64% women). Two of the five domains of the DQoL were significantly associated with factors based on functional evaluation. The ability to transfer within the home and the ability to use the telephone were associated with an increase in HRQoL in the ‘self-esteem’ domain (p = 0.02 and 0.05, respectively). Ability to get dressed without assistance was associated with lower HRQoL in the ‘negative affect’ domain (p = 0.0007).

Conclusion: Alterations in functional capacity have a significant effect on HRQoL in several domains of the DQoL.

Full reference: Barbe, C et al.  Aging & Mental Health.  Impact of functional alterations on quality of life in patients with Alzheimer’s disease. 2016 Jan 8:1-6. [Epub ahead of print]

How people come to recognise a problem and seek medical help for a person showing early signs of dementia

Dementia published online January 12, 2016

Evidence suggests that there is usually a long delay between noticing first signs of dementia and seeking medical help.The authors  conducted a systematic review of what people experience and how they make decisions during this time.

People with dementia mainly report experiencing memory lapses, while carers focus on more subtle changes in personality. People respond to these changes in one of three ways: 1) they discount them as normal; 2) they reserve judgement as to their cause and significance, or 3) they misattribute them.

Pivotal events can finally trigger help seeking. Active reflection and seeking of further evidence may lead to earlier recognition of the possibility of dementia and the need to seek help; it also reduces the risk of a pivotal event.

Public education should aim to improve recognition of more subtle signs and to encourage repeated evaluation and reflection.

Read the full paper: Perry-Young, L et al.  How people come to recognise a problem and seek medical help for a person showing early signs of dementia: A systematic review and meta-ethnography. Dementia. Published online before print January 12, 2016

Dementia and the importance of local data

PHE Blog

The Alzheimer’s Society estimates that in 2013 the number of people with dementia in England was 686,000. Without public health intervention this has been forecast to increase by 40% by 2025.

Dementia may be affecting 108,700 people in the country aged between 65 and 74. The annual cost of this to society in the UK is estimated to be £26.3 billion, an average cost of £32,250 per person each year.

Although advances have been made, research for dementia remains a challenge and falls behind other non-communicable diseases like cancer.

PHE’s National Dementia Intelligence network (DIN) has launched the first dementia profile on Fingertips. We have, for the first time, created a tool that enables bespoke comparison and benchmarking for local authorities and CCG’s against other areas in England using one, easily accessible online platform – Fingertips.

view profile data

By this we mean looking at local risk factors such as smoking prevalence; looking at local outcome such as mortality rates for people with dementia; and looking at clinical need such as the diagnosis process, service utilisation and quality of life.

While the data will highlight variation, it’s important to remember that there will be a number of reasons why some areas may appear to be ‘better’ or ‘worse’ than others.

dementia prevalance
Image source: 


View the full blog post via PHE

Access Fingertips

Dementia in the Family: The impact on carers

impact on carers.pngThis report explores the experiences of people who are caring for family members with dementia, highlighting the heavy toll the condition can take on family carers. Dementia in the Family: The impact on carers shines a spotlight on the daily realities for these people, which are shared by many of the 700,000 people in the UK who are caring for a loved one with dementia.

In-depth interviews with the carers reveal how dementia changes family relationships, leaves people socially isolated, and affects both the health and finances of family carers. All too often, family carers sacrifice their own well-being to ensure their loved one has the best care possible. Their experiences underline the urgent need for research to defeat dementia.

impact on carers2

Image source: Alzheimer’s Research UK


Read the full report here

The reciprocal relationship between participation in leisure activities and cognitive functioning: the moderating effect of self-rated literacy level

Lifshitz-Vahava, H. et al. Aging & Mental Health: Published online: 08 Jan 2016



Objective: Participation in leisure activities is beneficial for cognitive functioning of older adults, but it is less known whether it is also beneficial for those with low basic cognitive level. This study examined the reciprocal relationship between participating in leisure activities and cognitive functioning among low and higher literacy level older adults.

Method: Respondents aged 60 years and older who participated in both first waves (2005–2006 and 2009–2010) of the Israeli component of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) were divided into low (n = 139) and higher literacy level respondents (n = 714). They reported participation in leisure activities and completed measures of cognitive functioning at both waves.

Results: Cross-lagged models showed that participation in leisure activities predicted higher cognitive functioning four years later only among older adults with low literacy level. On the other hand, cognitive functioning predicted more participation in leisure activities four years later only among higher literacy level older adults.

Conclusions: Participating in leisure activities may be especially beneficial to cognitive functioning among older adults with low literacy level, as their initial low cognitive level allows more room for cognitive improvement than among higher literacy level older adults. Public efforts aimed at increasing participation in leisure activities may therefore target particularly older adults with low basic cognitive level.

Read the full abstract here

Policy Paper – Dementia: post-diagnostic care and support

dementia pd
Image source:

Joint declaration across government, health, social care and the third sector to deliver better quality services to people with dementia.

This declaration sets out:

  • our shared commitment to joint action across government, health, social care, the third sector and all other relevant partners
  • our ambition to deliver better quality post-diagnostic care
  • the need to deliver integrated and effective services that meet the needs of people with dementia and their families and carer

Read the full paper here

Use of anticholinergic drugs does not increase risk for dementia in Parkinson’s disease patients

Yarnell, A. et al.  Journal of Parkinson’s Disease, vol. 5, no. 4, pp. 743-747, 2015

Recent evidence has shown a greater risk of dementia, in particular Alzheimer’s disease (AD), in individuals using anticholinergic medications regularly. These drugs are widely used by older adults to treat bladder dysfunction, mood, and pain, and many of them are available without prescription.

Since these drugs are often used to treat both motor symptoms and non-motor symptoms in patients with Parkinson’s Disease (PD), there is concern for increased risk of dementia.

Contrary to expectations, a study has determined that the cognitive performance of PD patients taking anticholinergic medications did not differ from those who did not.

Read the article abstract here

Read the full commentary via ScienceDaily 

The Frailty Fulcrum

Latest Health News

NHS England

The concept of frailty as a long-term condition brings with it the opportunity to adopt a much more proactive, person-centred, community-based approach to care.

Achieving this requires a new approach to care, particularly through supporting self-care.  This new approach will be enabled through a wider awareness of frailty and a greater shared understanding of the condition.

The ‘frailty fulcrum’ is an animated model for frailty that has been developed with these opportunities in mind. This model aims to provide a ‘common language’ for frailty that can be shared between individuals, carers and professionals.  It offers an interpretation of frailty that is meaningful, relevant and sustainable for people living with the condition, throughout their journeys of care.


The frailty fulcrum highlights the multi-dimensional nature of frailty.  It considers the many different aspects of our lives that contribute to our overall wellbeing through a series of domains. The domains identified…

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