Visual Avoidance in Dementia Patients and Distress in Caregivers

Otero, M.C. & Levenson, R.W. (2017) Dementia & Geriatric Cognitive Disorders. 43(5-6) pp. 247-258

Caring for a spouse with dementia can lead to increased health problems in caregivers. The present study examined whether patient deficits in visual avoidance, a common form of emotion regulation, are related to greater psychological distress in caregivers.

Lower use of visual avoidance by patients was associated with greater psychological distress in their caregivers. This relationship was partially mediated by patient overall emotional functioning (as reported by caregivers), such that patients with less visual avoidance were seen as having worse emotional functioning, which in turn related to greater caregiver psychological distress.

Dementia diagnosis moderated this effect, with diminished patient visual avoidance particularly detrimental to psychological distress of bvFTD caregivers. Findings suggest that the use of visual avoidance may serve as a marker of overall emotional functioning in patients and that preservation of this emotion regulatory behavior may help reduce the negative effects of caregiving.

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Common sedatives linked to increased risk of pneumonia in people with Alzheimer’s disease

Commonly used sedatives called benzodiazepines are associated with an increased risk of pneumonia when used in people with Alzheimer disease, according to a study published in CMAJ (Canadian Medical Association Journal) | ScienceDaily

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Image source: FedEx – Flickr // CC BY-NC-ND 2.0

Dementia, of which 60%-70% of cases are Alzheimer disease, is a risk factor for pneumonia, and many people with dementia are prescribed benzodiazepines and non- benzodiazepines (called Z-drugs), both of which have sedative effects.

To determine if there is a link between these drugs and pneumonia, Finnish researchers looked at data from national registries on 49 484 adults living in the community diagnosed with Alzheimer disease between 2005 and 2011 in Finland. The mean age of participants was 80 years and almost two-thirds (62.7%) were women. They matched 5232 patients taking benzodiazepines and 3269 patients taking Z-drugs with the remainder not taking either drug.

They found that benzodiazepines were linked to a 30% increased risk of pneumonia in patients with Alzheimer disease, and the risk was highest at the start of treatment (during the first 30 days).

Read the commentary article here

The original research article is available here

Care in hospitalized patients with dementia

Patira, R. et al. Aging & Mental Health | Published online: 22 March 2017

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Background: Hospitalization is an opportunity to address various aspects related to management of dementia, including the goals of care to avoid futile care. We studied the prevalence of these factors when patients with dementia are hospitalized.

Results: In patients with dementia, co-morbidities and vascular disease burden were frequent. When these patients were hospitalized, use of psychotropic medications, invasive procedures, and multi-specialty consultations was common. Tests of mental status, screening for reversible causes, and use of FDA-approved medications for dementia is less common. Despite the lack of advance directives, goals of care were infrequently discussed. When goals of care were discussed, proxy decision-maker preferred palliative care and long-term institutionalization on discharge.

Conclusion: Goals of care and other aspects of management are not fully addressed in hospitalized patients with dementia.

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Environmental factors and emergency hospital admissions due to Alzheimer’s disease

Culqui, D.R. et al. (2017) Science of The Total Environment. 592(15) pp. 451–457

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Highlights:

  • Alzheimer’s disease (AD) is the most common cause of dementia among older adults
  • Air pollutants may be risk factors regarding the decompensation of AD
  • PM2.5 concentrations are associated with the development and the exacerbation of AD
  • Heat waves can exacerbate Alzheimer’s hospital admissions
  • More epidemiologic studies will be needed to confirm the relation between AD and environmental factors

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The midlife cognitive profiles of adults at high risk of late-onset Alzheimer’s disease

Ritchie, K. et al. Alzheimer’s & Dementia. Published online 30 March 2017

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Introduction: Although biomarker studies of late-onset Alzheimer’s disease suggest pathology to be present decades before diagnosis, little is known about cognitive performance at this stage.

Discussion: Middle-aged adults at risk of dementia show evidence of poorer cognitive performance, principally in visuospatial functions.

Read the full abstract here