Should we rethink of causes of dementia?

ScienceDaily. Published online: 12 May 2016.

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Image source: Nephron // CC BY-SA 3.0

University of Adelaide researchers have developed a new theory for the causes of dementia and other neurodegenerative diseases, involving an out-of-control immune system.

Published in the journal Frontiers in Neuroscience, the researchers have assembled strong evidence that the neurological decline common to these diseases is caused by ‘auto-inflammation’, where the body’s own immune system develops a persistent inflammatory response and causes brain cells to die.

Previously, researchers have focused on the role of protein deposits called amyloid plaques that lodge in the brain of Alzheimer’s affected people. But it is now clear that this is an inadequate explanation for Alzheimer’s Disease.

There are many distinct forms of neurodegeneration including Alzheimer’s, Parkinson’s and Huntington’s Diseases. These conditions are distinguished by the different types of brain nerve cells that are first affected and by the symptoms that first appear. However, as all of these diseases progress, they become more similar.

Read the full commentary here

Read the original research abstract here

 

Prevalence of dementia subtypes in U.S. Medicare fee-for-service beneficiaries, 2011–2013

Goodman, R.A. et al.Alzheimer’s & Dementia. Published online: 10 May 2016

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Image source: Stephen Magrath – Wellcome Images // CC BY-NC-ND 4.0

Highlights

  • Rapid growth of the older adult population requires greater epidemiologic characterization of dementia.
  • We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk U.S. population by analyzing Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011–2013 and age ≥68 years as of December 31, 2013 (n = 21.6 million).
  • Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype.
  • Dementia not otherwise specified was the most common diagnosis (present in 92.9%); the most common subtype was Alzheimer’s (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%).
  • This study, the first to document concurrent prevalence of primary dementia subtypes among this U.S. population, provides findings that can assist in prioritizing dementia research, clinical services, and caregiving resources.

Read the abstract here

The use of the truth and deception in dementia care amongst general hospital staff

Turner, A. et al. Aging & Mental Health. Published online: 4 May 2016

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Objectives: Deceptive practice has been shown to be endemic in long-term care settings. However, little is known about the use of deception in dementia care within general hospitals and staff attitudes towards this practice. This study aimed to develop understanding of the experiences of general hospital staff and explore their decision-making processes when choosing whether to tell the truth or deceive a patient with dementia.
Method: This qualitative study drew upon a constructivist grounded theory approach to analyse data gathered from semi-structured interviews with a range of hospital staff. A model, grounded in participant experiences, was developed to describe their decision-making processes.
Findings: Participants identified particular triggers that set in motion the need for a response. Various mediating factors influenced how staff chose to respond to these triggers. Overall, hospital staff were reluctant to either tell the truth or to lie to patients. Instead, ‘distracting’ or ‘passing the buck’ to another member of staff were preferred strategies. The issue of how truth and deception are defined was identified.
Conclusion: The study adds to the growing research regarding the use of lies in dementia care by considering the decision-making processes for staff in general hospitals. Various factors influence how staff choose to respond to patients with dementia and whether deception is used. Similarities and differences with long-term dementia care settings are discussed. Clinical and research implications include: opening up the topic for further debate, implementing staff training about communication and evaluating the impact of these processes.
Read the abstract here

 

Dementia care in care homes

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image source: http://www.alzheimers.org.uk

The Alzheimer’s Society has published Fix dementia care:  NHS and care homes.

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image source: http://www.alzheimers.org.uk

This report marks the second phase of an Alzheimer’s Society campaign looking at the experiences of people with dementia in a range of health and care settings.  It contains the results of a survey of care home managers and the voices of people with dementia, their families and carers.  The report sets out recommendations for the government and NHS to improve the experiences of people with dementia in care homes.

Additional link: RCGP press release

 

Mobile game to help dementia research

Sea Hero Quest will provide data that will help researchers better understand how diseases like Alzheimer’s affect the brain.

Sea Hero Quest follows the story of a young man who sails the ocean recovering his father’s lost memories. Rather than being given points on a map to follow, players must navigate the world themselves using methods that test their memory and orientations skills. Understanding how people navigate 3D environments is important because the skill is often one of the first lost by people who have dementia.

By playing Sea Hero Quest, researchers hope to create a database of anonymous data about how the healthy human brain navigates, which will then help them determine what causes navigational cognition to go wrong for people suffering from the disease. The more people who play the game, the more valuable data will be created which can then be used by researchers.

The free game was developed by the charity, researchers from University College London and the University of East Anglia, with the backing of communications giant Deutsche Telekom.

Sea Hero Quest is available to dowmload now for Android and iOS.

Related: BBC News Mobile game Sea Hero Quest ‘helps dementia research’ 

Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review

Feast, A. et al. The British Journal of Psychiatry. May 2016, 208 (5) 429-434

Background: Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative’s behaviours contribute to the success of support programmes.

Aims: To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered.

Method: A systematic review and meta-ethnographic synthesis was conducted of high-quality quantitative and qualitative studies between 1980 and 2012.

Results: We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in ‘feeling bereft’; and perceptions of transgressions against social norms associated with ‘misunderstandings about behaviour’ in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging.

Conclusions: Family carers’ perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their ‘personhood’. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers.

Read the abstract here

Visual cortical excitability in dementia with Lewy bodies

Taylor, J-P. et al. The British Journal of Psychiatry. May 2016, 208 (5) 497-498

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Image source: Dianne Harris – Wellcome Images // CC BY-NC-ND 4.0

Alterations in the visual system may underlie visual hallucinations in dementia with Lewy bodies (DLB). However, cortical excitability as measured by transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) activation of lower visual areas (V1–3) to visual stimuli appear normal in DLB. We explored the relationship between TMS-determined phosphene threshold and fMRI-related visual activation and found a positive relationship between the two in controls but a negative one in DLB. This double dissociation suggests a loss of inhibition in the visual system in DLB, which may predispose individuals to visual dysfunction and visual hallucinations.

Read the abstract here