A critical literature review of the effectiveness of various instruments in the diagnosis of dementia in adults with intellectual disabilities

Elliott-King, J. et al. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring. Published online: 29 June 2016

Image source: Charles Hamm – Wikipedia // CC BY 3.0

Currently, there is no consensus on dementia diagnostics in adults with intellectual disabilities (IDs). There are three types of assessments available: direct cognitive tests, test batteries, and informant reports.

A systematic literature search was conducted in four databases yielding 9840 records. Relevant studies were identified and selected using predefined inclusion and exclusion criteria and then coded and classified according to assessment type. This was completed by two independent researchers, with a third consulted when discrepancies arose. The review collates diagnostic instruments and presents strengths and weaknesses.

Overall 47 studies met the search criteria, and 43 instruments were extracted from the selected studies. Of which, 10 instruments were classified as test batteries, 23 were classified as direct cognitive tests, and the remaining 10 were informant reports.

This review can recommend that test batteries can offer the most practical and efficient method for dementia diagnosis in individuals with ID.

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Psychosocial interventions for people with dementia: An overview and commentary on recent developments

Oyebode, J.R. & Parveen, S. Dementia. Published online: 4 July 2016

Image source: Bill McConkey – Wellcome Images // CC BY-NC-ND 4.0

An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning, activities of daily living, behaviour and mood of people with dementia. Our aim here is to provide an up-to-date overview of research into psychosocial interventions and their impact on psychosocial outcomes.

We focused on randomised controlled trials, controlled studies and reviews published between October 2008 and August 2015, since the earlier review. The search of PsychInfo, Medline and the Cochrane database of systematic reviews yielded 61 relevant articles, organised into four themes echoing key phases of the care pathway: Living at home with dementia (five reviews, eight studies), carer interventions (three reviews, four studies), interventions in residential care (16 reviews, 12 studies) and end-of-life care (three reviews, two studies), along with an additional group spanning community and institutional settings (six reviews, two studies).

Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes; physical therapies, cognitive training and modified cognitive behaviour therapy also had a range of benefits. There was more limited evidence of positive benefits for people with dementia through interventions with family carers. Thirty-two articles focused on the management of ‘behavioural symptoms’ through a range of interventions all of which had some evidence of benefit. Also a range of multi-component and specific interventions had benefits for cognitive, emotional and behavioural well-being of people with dementia in residential settings, as well as for quality of life. Overall, interventions tended to be short term with impact only measured in the short term.

We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care. Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia.

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A qualitative study on becoming cared for in Alzheimer’s disease: the effects to women’s sense of identity

Borely, G. & Hardy, S. Aging & Mental Health. Published online: 29 Jun 2016

B0007022 City life
Image source: Marina Caruso – Wellcome Images // CC BY-NC-ND 4.0

Objective: To explore the lived experience of becoming cared for and the impact this has on the identity and sense of self of women with Alzheimer’s disease.

Method: Eight women with mild-to-moderate Alzheimer’s disease were interviewed in Northamptonshire, England, on two separate occasions about their experiences relating to needing assistance with instrumental activities of daily living (IADL) tasks. Interpretative phenomenological analysis was the approach used to underpin this research.

Results: Changes in the women’s identity affected by the increased need for assistance with IADL tasks were expressed in terms of: who I am; unhappy being me; fighting to remain me; I’m not the same, but it doesn’t worry me; and acceptance and contentment.

Conclusion: This study offers an alternative perspective to the view that all women with Alzheimer’s disease experience becoming cared for as a negative event in their lives. Some factors universally perceived as being a result of Alzheimer’s disease may be a normal part of the life course.

Read the abstract here