The use of non-pharmacological interventions for dementia behaviours in care homes

Backhouse, T. et al. (2016) Age Ageing. 45(6) pp.856-863

Background: Antipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions (NPIs) have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD.

Conclusions: There is a gap between rhetoric and practice with most NPIs in care homes used as social activities rather than as targeted interventions. If NPIs are to become viable alternatives to antipsychotic medications in care homes, further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.

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Perceptions vs. evidence:therapeutic substitutes for antipsychotics

Olivieri-Mui, B.L. et al. Aging & Mental Health. Published online: 12 Jan 2017

Objective: To compare differences between clinician perceptions of therapeutic substitutes for antipsychotics prescribed to patients with dementia in long term care (LTC) and published evidence.

 

Conclusion: Perceptions of LTC clinicians regarding substitutes for antipsychotics in LTC patients with dementia vary widely and are often discordant with published evidence.

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Dementia rates ‘higher near busy roads’

People who live near major roads have higher rates of dementia, research published in the Lancet suggests | The Lancet | BBC News

As many as 11% of dementia cases in people living within 50m of a major road could be down to traffic, a study published earlier this month suggests.

The researchers, who followed nearly two million people in Canada over 11 years, say air pollution or noisy traffic could be contributing to the brain’s decline. UK dementia experts said the findings needed probing but were “plausible”.

The study in the Lancet followed nearly two million people in the Canadian province of Ontario, between 2001 and 2012. There were 243,611 cases of dementia diagnosed during that time, but the risk was greatest in those living closest to major roads.

Compared with those living 300m away from a major road the risk was:

• 7% higher within 50m
• 4% higher between 50-100m
• 2% higher between 101-200m

The analysis suggests 7-11% of dementia cases within 50m of a major road could be caused by traffic. The researchers adjusted the data to account for other risk factors like poverty, obesity, education levels and smoking so these are unlikely to explain the link.

Full reference: Chen, Hong et al. Living near major roads and the incidence of dementia, Parkinson’s disease, and multiple sclerosis: a population-based cohort study published online 4th January 2017

Related: BBC News

Effects of smartphone-based memory training

Seo Jin Oh et. al. Effects of smartphone-based memory training for older adults with subjective memory complaints: a randomized controlled trial. Aging & Mental Health.  Published online: 10 Jan 2017

Objectives: We explored whether newly developed application (Smartphone-based brain Anti-aging and memory Reinforcement Training, SMART) improved memory performance in older adults with subjective memory complaints (SMC).

Method: A total of 53 adults (range: 50-68 years; 52.8% female) were randomized into either one of two intervention groups [SMART (n = 18) vs. Fit Brains® (n = 19)] or a wait-list group (n = 16). Participants in the intervention groups underwent 15-20 minutes of training per day, five days per week for 8 weeks. We used objective cognitive measures to evaluate changes with respect to four domains: attention, memory, working memory (WM), and response inhibition. In addition, we included self-report questionnaires to assess levels of SMC, depression, and anxiety.

Results: Total WM quotient [t(17) = 6.27, p < .001] as well as auditory-verbal WM score [t(17) = 4.45, p < .001] increased significantly in the SMART group but not in the control groups. Self-reports of memory contentment, however, increased in the Fit Brains® group only [t(18) = 2.12, p < .05).

Conclusion: Use of an 8-week smartphone-based memory training program may improve WM function in older adults. However, objective improvement in performance does not necessarily lead to decreased SMC.

NICE takes key role in new European project for faster access to Alzheimer’s disease drugs

Patients’ priorities will be brought to the fore in new Alzheimer’s project | NICE

NICE is taking part in a European project to speed up the development of new drugs to treat Alzheimer’s disease.

The ROADMAP initiative aims to establish a sustainable platform for real world evidence generation on Alzheimer’s disease.

The new project provides a unique and game-changing opportunity to gather evidence from other sources, such as electronic health records, and discover what outcomes are important to patients and carers.

Alzheimer’s disease, and the different ways it presents and progresses in different people, poses a difficulty for traditional clinical trials which do not always provide answers decision makers such as NICE would be looking for when assessing new drugs to treat the disease.

Read the full news story here

Driving and dementia: a clinical update for mental health professionals

Allan, C.L. et al. (2016) Evidence Based Mental Health. 19. pp.110-113

Most people with mild dementia can continue to drive, but dementia is progressive and many patients and clinicians will be faced with questions about driving safety in the course of their illness. Determining when this happens is a complex decision, with risks of personal and public safety needing to be weighed against individual patient benefits of driving in terms of autonomy, independence and well-being. Decisions need to make reference to cognitive abilities, as well as other factors including physical comorbidity, vision, mobility, insight and history of driving errors and accidents. Deciding to stop driving, or being required to stop driving is often difficult for patients to accept and can be a particularly problematic consequence of a dementia diagnosis. Legal frameworks help in decision-making but may not provide sufficient detail to advise individual patients. We review the current guidelines and evidence relating to driving and dementia to help clinicians answer questions about driving safety and to consider the full range of assessment tools available.

Read the full article here