Marriage may help stave off dementia, study finds | Journal of Neurology Neurosurgery & Psychiatry
Researchers combining the results of 15 studies including data on more than 800,000 participants have found that lifelong singletons and widowers appear to have a heightened risk of developing dementia.
Analysis of the data showed that lifelong singletons were 42% more likely to develop dementia than those who were married, and widowers were 20% more likely to develop the condition. Part of this risk might be explained by poorer physical health among lifelong single people, suggest the researchers. Marriage may help both partners to have healthier lifestyles, including exercising more, eating a healthy diet, and smoking and drinking less, all of which have been associated with lower risk of dementia. Couples may also have more opportunities for social engagement than single people – a factor that has been linked to better health and lower dementia risk, the researchers suggest.
Heisz, J. et al. The Effects of Physical Exercise and Cognitive Training on Memory and Neurotrophic Factors. Journal of Cognitive Neuroscience, 2017; 29 (11) | story via ScienceDaily
The health advantages of high-intensity exercise are widely known but new research from McMaster University points to another major benefit: better memory.
The findings could have implications for an aging population which is grappling with the growing problem of catastrophic diseases such as dementia and Alzheimer’s.
Scientists have found that six weeks of intense exercise — short bouts of interval training over the course of 20 minutes — showed significant improvements in what is known as high-interference memory, which, for example, allows us to distinguish our car from another of the same make and model.
The findings are important because memory performance of the study participants, who were all healthy young adults, increased over a relatively short period of time, say researchers.
Hankey, G. J. | Public Health Interventions for Decreasing Dementia Risk | JAMA Neurol. Published online November 20, 2017. doi:10.1001
Dementia is projected to be the greatest global challenge for health and social care this century. Dementia is a neurocognitive syndrome specific to people with otherwise normal brain development, characterized by a decline in level of cognitive ability that compromises social functioning or activities of daily living. At present, it affects nearly 50 million people globally; the increasing life expectancy of the global population means dementia threatens to affect 75 million people by 2030 and 132 million by 2050, unless effective prevention strategies can be identified and implemented. Its impact on affected individuals, families, and caregivers, as well as the community and economy, is already substantial because of the lack of effective, disease course-modifying treatment.
This paper describes the current public health burden of dementia and the recent insights and ongoing research needs for effective, appropriate prevention.
Researchers have convincingly shown where in the brain the earliest signs of Alzheimer’s occur. Nature Communications | Story via ScienceDaily
In Alzheimer’s, the initial changes in the brain occur through retention of the protein, ?-amyloid (beta-amyloid). The process begins 10-20 years before the first symptoms become noticeable in the patient.
In Nature Communications, a research team has presented results showing where in the brain the initial accumulation of ?-amyloid occurs. It is hoped that the discovery could potentially become significant to future Alzheimer’s research while contributing to improved diagnostics.
Objectives: To examine the relative importance of different home support attributes from the perspective of carers of people with later-stage dementia.
Method: Preferences from 100 carers, recruited through carers’ organisations, were assessed with a Discrete Choice Experiment (DCE) survey, administered online and by paper questionnaire. Attributes were informed by an evidence synthesis and lay consultations. A conditional logit model was used to estimate preference weights for the attributes within a home support ‘package’.
Results: The most preferred attributes were ‘respite care, available regularly to fit your needs’ (coefficient 1.29, p = < 0.001) and ‘home care provided regularly for as long as needed’ (coefficient 0.93, p = < 0.001). Cost had a significant effect with lower cost packages preferred. Findings were similar regardless of the method of administration, with respite care considered to be the most important attribute for all carers. Carers reported that completing the DCE had been a positive experience; however, feedback was mixed overall.
Conclusions: These carer preferences concur with emerging evidence on home support interventions for dementia. Respite care, home care and training on managing difficulties provided at home are important components. Carers’ preferences revealed the daily challenges of caring for individuals with later stage dementia and the need for tailored and specialised home support.
Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants | Aging & Mental Health
Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.
Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.
Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.
Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.
This review seeks to identify primary research and use its findings to develop explanations of what characteristics of dementia-friendly initiatives in hospitals make them work, in what circumstances, and why | BMJ
Objectives To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.
Design A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.
Data sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.
Eligibility criteria Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.
Results Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.
Conclusions This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.
An evidence-based framework to support and enable directors of nursing and medical directors to achieve ‘outstanding’ care standards for those living with dementia during their stay in hospital | NHS Improvement
This framework has eight standards, and draws on learning from organisations that have achieved an ‘outstanding’ rating from the Care Quality Commission. The document integrates policy guidance and best practice with opinion from patients and carers.
The state of hospice services in England 2014 to 2017 presents findings from the Care Quality Commission’s programme of inspections.
The CQC inspected hospice services in England between October 2014 and January 2017.
The results found that Hospice care across England has the highest percentage of health and social care services that are rated outstanding (25%), and a further 70% are rated good.
The inspections found that hospice leaders and frontline staff displayed a strong commitment to providing truly person-centred, compassionate care and support to people using their services, and their loved ones. They also developed strong relationships with other services in the area.
However, the report makes the case that there is more to be done to make sure that everyone, regardless of their background or circumstances, can access high-quality end of life care. Hospice services rated as outstanding were striving to overcome such inequalities and share their expertise to drive better care in other services.
Dementia and Alzheimer’s disease remain the leading cause of death in England and Wales, accounting for 12.0% of all deaths registered in 2016, up from 11.6% in 2015, according to new Office of National Statistics (ONS) figures.
This increase is attributed by ONS to people living longer, due to improved lifestyles and medical advances. With people living longer and surviving other illnesses, the number of people developing dementia and Alzheimer disease is increasing. Improved identification and diagnosis of dementia has also contributed to the increase.
Here, the Alzheimer’s Society responds to the figures showing dementia remains the leading cause of death.