Cost-effectiveness of physical activity in Alzheimer’s disease

This study explores the cost-effectiveness of a supervised moderate-to-high intensity aerobic exercise programme in people diagnosed with Alzheimer’s disease (AD) and estimate incremental cost-effectiveness ratios (ICER) using participant-reported and proxy-reported measures of health-related quality of life (HRQoL) | BMJ Open

Interventions: Control group received treatment as usual. The intervention group performed 1 hour of supervised moderate-to-high intensity aerobic exercise three times weekly for 16 weeks.

Primary and secondary outcomes measures: Different physical, functional and health measures were obtained at inclusion (baseline) and 4 and 16 weeks after. HRQoL (EuroQol-5 Dimensions-5 Levels/EQ-Visual Analogue Scale) was reported by the participants and the primary caregivers as proxy respondents. Differences in HRQOL as reported by the participant and caregiver were explored as were different values of caregiver time with respite from care tasks.

Results: The intervention cost was estimated at €608 and €496 per participant, with and without transport cost, respectively. Participants and caregivers in the intervention group reported a small, positive non-significant improvement in EQ-5D-5L and EQ-VAS after 16 weeks. The ICER was estimated at €72 000/quality-adjusted life year using participant-reported outcomes and €87000 using caregiver-reported outcomes.

Conclusions: The findings suggest that the exercise intervention is unlikely to be cost-effective within the commonly applied threshold values. The cost of the intervention might be offset by potential savings from reduction in use of health and social care.

Full reference: Sopina, E. et al. (2017) Cost-effectiveness of a randomised trial of physical activity in Alzheimer’s disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark. BMJ Open. 7:e015217.

Dementia Assessment and Referral to GPs: DeAR-GP (NICE / HIN)

Dementia and Elderly Care News

Summary

It was already known that between 75% – 89% of care home residents have dementia, but many of these persons do not receive a diagnosis. The Health Innovation Network (HIN) worked with five care homes to design the Dementia Assessment Referral to GP (DeAR-GP) tool.

DeAR-GP is a case finding tool which assists care workers in care homes to identify and support residents showing signs of dementia or confusion. The aim is to achieve better referrals to GPs or other healthcare professionals for prompt review and post-diagnostic support.

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Reference

Dementia Assessment Referral to GP (DeAR-GP). [Online]: National Institute for Health and Care Excellence (NICE) and Health Innovation Network (HIN), June 2017.

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Reference

de Waal, H. [and] Jackson, A. (2016). DeAR-GP aids referrals. Nursing Older People. May…

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Dementia training programmes for staff working in general hospitals

Anthony Scerri , Anthea Innes & Charles Scerri. Dementia training programmes for staff working in general hospital settings – a systematic review of the literature |Aging & Mental Health Vol. 21 , Iss. 8, 2017.

Objectives: Although literature describing and evaluating training programmes in hospital settings increased in recent years, there are no reviews that summarise these programmes. This review sought to address this, by collecting the current evidence on dementia training programmes directed to staff working in general hospitals.

Method: Literature from five databases were searched, based on a number of inclusion criteria. The selected studies were summarised and data was extracted and compared using narrative synthesis based on a set of pre-defined categories. Methodological quality was assessed.

Results: Fourteen peer-reviewed studies were identified with the majority being pre-test post-test investigations. No randomised controlled trials were found. Methodological quality was variable with selection bias being the major limitation. There was a great variability in the development and mode of delivery although, interdisciplinary ward based, tailor-made, short sessions using experiential and active learning were the most utilised. The majority of the studies mainly evaluated learning, with few studies evaluating changes in staff behaviour/practices and patients’ outcomes.

Conclusion: This review indicates that high quality studies are needed that especially evaluate staff behaviours and patient outcomes and their sustainability over time. It also highlights measures that could be used to develop and deliver training programmes in hospital settings.

The use of vitamin E in the treatment of mild cognitive impairment and dementia

Cochrane review finds no evidence that Vitamin E supplementation given to people with mild cognitive impairment (MCI) would help to prevent or delay the progression to dementia. Similarly, there is no evidence that Vitamin E supplementation improves cognitive function in people with MCI or dementia due to Alzheimer’s Disease. | Cochrane Database of Systematic Reviews

Vitamin E is found in a variety of foods, including vegetable oils and fats, nuts and seeds. Some animal and non-interventional studies have suggested it might have a role in the prevention or treatment of Alzheimer’s disease (AD). However, evidence has linked vitamiE with potentially serious side effects and even an increased risk of death. This review looked for evidence about the effect of vitamin E on people who had either dementia due to Alzheimer’s Disease or milder problems with memory or thinking (mild cognitive impairment).

The review concluded that from limited evidence, there was nothing to suggest that there are either benefits or harms from vitamin E supplements. As the quality of evidence was only moderate, the authors suggest further trials are needed to confirm the findings.

 Full reference: Farina, N et al. Vitamin E for Alzheimer’s dementia and mild cognitive impairment. Cochrane Database of Systematic Reviews. 2017 Apr 18;4

Earlier Diagnosis of Alzheimer’s Disease Using Saliva Test?

Pilot research indicates that a chemical in the saliva can be used to differentiate, with relatively high accuracy, between persons who are currently healthy, those with mild cognitive impairment (MCI), and others with Alzheimer’s Disease. Potentially, salivary biomarkers could offer a convenient means of screening people at high risk of developing Alzheimer’s Disease.

Full reference:   Yilmaz, A. Geddes, T. & Han, B. et al. Diagnostic biomarkers of Alzheimer’s Disease as identified in saliva using 1H NMR-based metabolomics.  Journal of Alzheimer’s Disease: May 11th 2017; 58(2): 355-359.

Related: Dementia saliva testing ‘shows early promise’ | NHS Choices

The association between an inflammatory diet, cognitive function and dementia

The Mediterranean and Dietary Approaches to Stop Hypertension diets have been associated with lower dementia risk. We evaluated dietary inflammatory potential in relation to mild cognitive impairment (MCI)/dementia risk | Alzheimer’s & Dementia

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Method: Baseline food frequency questionnaires from n = 7085 women (aged 65–79 years) were used to calculate Dietary Inflammatory Index (DII) scores that were categorized into four groups. Cognitive function was evaluated annually, and MCI and all-cause dementia cases were adjudicated centrally. Mixed effect models evaluated cognitive decline on over time; Cox models evaluated the risk of MCI or dementia across DII groups.

Results: Over an average of 9.7 years, there were 1081 incident cases of cognitive impairment. Higher DII scores were associated with greater cognitive decline and earlier onset of cognitive impairment. Adjusted hazard ratios (HRs) comparing lower (anti-inflammatory; group 1 referent) DII scores to the higher scores were group 2-HR: 1.01 (0.86–1.20); group 3-HR: 0.99 (0.82–1.18); and group 4-HR: 1.27 (1.06–1.52).

Conclusions: Diets with the highest pro-inflammatory potential were associated with higher risk of MCI or dementia.

Full reference: Hayden, K.M. et al. (2017) The association between an inflammatory diet and global cognitive function and incident dementia in older women: The Women’s Health Initiative Memory Study. Alzheimer’s & Dementia. Published online: May 19 2017

Is making music associated with better cognitive functioning?

D. Mansens, D. J. H. Deeg, and H. C. Comijs. The association between singing and/or playing a musical instrument and cognitive functions in older adults. Aging & Mental Health. Published online: 19 May 2017
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Objectives: Cognitive decline happens to everyone when aging, but to some more than others. Studies with children, adults, and professional musicians suggest that making music could be associated with better cognitive functioning. In older adults however, this association is less well investigated, which is therefore the aim of this study.

Methods: In this cross-sectional study data from 1101 participants aged 64 and older from the Longitudinal Aging Study Amsterdam were used. Multivariable linear regression analyses were performed to test the association between making music and cognitive functioning and time spent making music and cognitive functioning. ANCOVA analyses were performed to differentiate between participants who made no music, only sang, only played an instrument or both sang and played an instrument in terms of cognitive functioning.

Results: Making music was significantly positively associated with letter fluency, learning and attention/short-term memory. Time spent making music yielded no significant results. The ANCOVA analyses showed higher scores for participants who only played an instrument compared to participants who made no music on learning, working memory and processing speed. For processing speed the instrument only group also had a higher score than participants who only sang.

Discussion: Making music at least once every two weeks and especially playing a musical instrument, is associated with better attention, episodic memory and executive functions. The results suggest that making music might be a potential protective factor for cognitive decline; however, to support this notion a longitudinal study design is needed.

 

Patient and public involvement in dementia research

This paper reflects Alzheimer Europe’s position on patient and public involvement (PPI) in the context of dementia research and highlights some of the challenges and potential risks and benefits associated with such meaningful involvement. | Alzheimer Europe | Aging & Mental Health

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Alzheimer Europe is keen to promote the involvement of people with dementia in research, not only as participants but also in the context of PPI, by generating ideas for research, advising researchers, being involved in consultations and being directly involved in research activities.

Topics covered in this paper include, planning involvement, establishing roles and responsibilities, training and support, managing information and input from PPI, recognising the contribution of people with dementia involved in research in this way, promoting and protecting the rights and well-being of people with dementia, training and support, and promoting an inclusive approach and the necessary infrastructure for PPI in dementia research.

Gove, D. et al. Alzheimer Europe’s position on involving people with dementia in research through PPI (patient and public involvement) Aging & Mental Health  Published online 17 May 2017

 

Deaths from dementia set to quadruple by 2040

The number of people who will die from dementia could almost quadruple over the next 20 years, suggests a study published in BMC Medicine | Story via OnMedica

hospital-bed-315869_1280Researchers analysed mortality statistics for England and Wales from 2006 to 2014 to estimate the prevalence of palliative care need in the population.

By using explicit assumptions about change in disease prevalence over time and official mortality forecasts, they modelled palliative care need up to 2040 as well as making projections for dementia, cancer and organ failure.

They calculated that by 2040, annual deaths in England and Wales could rise by at least 25.4% from 501,424 in 2014 to 628,659 in 2040.  If age and sex-specific percentages with palliative care needs remained the same as in 2014, the number of people requiring palliative care could grow by 25% from 375,398 to 469,305 people a year.

However, if the upward trend observed from 2006 to 2014 continued, they said, the increase could be as much as 47% more people needing palliative care by 2040 in England and Wales.

In addition, disease-specific projections showed that dementia (increasing from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) would be the main drivers of the growing need.

The authors concluded: ‘Our analysis indicates that palliative care need will grow far more over the next 25 years than previously expected’.

Full reference: Etkind, S. N et al. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Medicine 2017 15:102.