Friendship and dementia

Friendship and dementia: Hints and tips on supporting friends with dementia | via Alzheimer Scotland

For people living with dementia, maintaining meaningful friendships can be a difficult task. A dementia diagnosis can turn someone’s world upside down and it’s at this time that friendship is valued the most, not only to offer comfort and support but to help to maintain an essence of normality.

In a 2017 poll  of more than 500 participants,  Alzheimer Scotland’s  ‘Friendship and Dementia’ survey highlighted some disheartening statistics:

• Two out of three people living with dementia have lost friendships following their diagnosis.
• 60% of people living with dementia felt reluctant to attend social situations after their diagnosis.
• 91% of participants felt that there was not enough public knowledge of dementia and what it’s like to live with the illness.

These findings show that more must be done to improve public understanding of attitudes towards dementia, so we are able to help friendships adapt following a diagnosis and throughout the illness. Alzheimer Scotland’s Friendship and Dementia leaflet provides hints and tips on how to provide emotional and practical support to people with dementia, at all stages of the illness. The leaflet provides tips such as:

• Find out more about dementia and how it’s likely to affect their everyday life. This will help you to support your friend and make you more prepared for changes in the months and years ahead
• Accept the person your friend is now; try not to draw comparisons with how they were before developing dementia
• Make sure to talk directly to your friend, especially in social situations.

Full article at Alzheimer Scotland

Click here to access the ‘Friendship and Dementia leaflet’.

 

Employees with early onset dementia face discrimination at work

Employees with early onset dementia face a lack of workplace support and early dismissal, with those in lower-paid jobs most affected, according to new research published in the journal, Occupational Medicine | via People Management

A new study has found ‘no real will’ among organisations to make reasonable adjustments for workers diagnosed with early onset dementia.

The study which looked into the management of employees who developed dementia between the ages of 30 and 65 years found those living with early onset dementia were not being offered reasonable changes to their roles that could have allowed them to continue working.

 

The study found reports of poor management styles in dealing with dementia, low levels of colleague support and in some cases “no real will” within organisations to find individuals suitable jobs for their remaining skills level, with many being laid off from contracts or dismissed without consultation.

It said those in low paid or manual jobs were more likely to experience an “all or nothing” response to their diagnosis from their employers and often faced dismissal quicker than those in higher paid and non-manual jobs.

Full story at People Management

Full research article: Thomson, L. et al. | Managing employees with dementia: a systematic review | Occupational Medicine | published 27 November 2018

Regular exercise improves thinking skills

Researchers in the United States have found that regular aerobic exercise may improve thinking skills in people with cognitive impairment but no dementia | Neurology | via Alzheimer’s Research UK

Researchers looked to see if people who take up aerobic exercise and follow an eating regime known as the Dietary Approaches to Stop Hypertension (DASH) over a 6-month period showed improvement in cognitive abilities.

The study participants who were cognitively impaired were split into four groups, those who took up aerobic exercise three times a week, people who kept to the diet plan, those who did both and participants who received only health education.

The volunteers who took up aerobic exercise were found to have improved executive functioning – a set of thinking skills associated with planning and controlling behaviour. This improvement was not seen in people who only took up the DASH diet or just received the health education. There were no significant improvements in memory or language abilities in any of the groups.

Full story at Alzheimer’s Research UK

Article reference: Blumenthal, J. A. et al. | Lifestyle and neurocognition in older adults with cognitive impairments | Neurology | December 2018

Having a dementia-friendly Christmas

This year, the Alzheimer’s Society Christmas message comes in the form of an animated poem, written by members of Ashford’s Dementia Support Group, who are all living with dementia.

Managing household duties as a couple

Dr Gayle Madden, Admiral Nurse Professional, talks about how couples living with dementia can work together to manage their household, to ensure the person with dementia maintains their sense of identity | via Dementia UK

When someone has dementia and needs to be cared for it is critical that they retain their sense of purpose and value in the home – for the good of the partnership and the couple’s quality of life. Research has shown that frustration, anger or aggression can be mistaken as a symptom of a person’s dementia, when they are actually expressing their upset with the changes that are occurring within their home life. 

This article provides some tips for professional and family carers to help the person with dementia feel involved in the running of the household, with their other half, so they maintain a sense of purpose and value.

Full article at Dementia UK

Regular problem solving does not protect against mental decline

The well known ‘use it or lose it’ claim has been widely accepted by healthcare professionals, but researchers in the Christmas issue of The British Medical Journal find that regularly doing problem solving activities throughout your lifetime does not prevent mental decline in later life. However, the results suggest that regularly engaging in intellectual activities boosts mental ability throughout life and provides a “higher cognitive point” from which to decline.

Abstract
Objectives:  To examine the association between intellectual engagement and cognitive ability in later life, and determine whether the maintenance of intellectual engagement will offset age related cognitive decline.

Design: Longitudinal, prospective, observational study.

Setting:  Non-clinical volunteers in late middle age (all born in 1936) living independently in northeast Scotland.

Participants:  Sample of 498 volunteers who had taken part in the Scottish Mental Health Survey of 1947, from one birth year (1936).

Main outcome measures:  Cognitive ability and trajectory of cognitive decline in later life. Typical intellectual engagement was measured by a questionnaire, and repeated cognitive measurements of information processing speed and verbal memory were obtained over a 15 year period (recording more than 1200 longitudinal data points for each cognitive test).

Results:  Intellectual engagement was significantly associated with level of cognitive performance in later life, with each point on a 24 point scale accounting for 0.97 standardised cognitive performance (IQ-like) score, for processing speed and 0.71 points for memory. Engagement in problem solving activities had the largest association with life course cognitive gains, with each point accounting for 0.43 standardised cognitive performance score, for processing speed and 0.36 points for memory. However, engagement did not influence the trajectory of age related decline in cognitive performance. Engagement in intellectual stimulating activities was associated with early life ability, with correlations between engagement and childhood ability and education being 0.35 and 0.22, respectively.

Conclusion:  These results show that self reported engagement is not associated with the trajectory of cognitive decline in late life, but is associated with the acquisition of ability during the life course. Overall, findings suggest that high performing adults engage and those that engage more being protected from relative decline.

Full reference: Staff, R. et al. | Intellectual engagement and cognitive ability in later life (the “use it or lose it” conjecture): longitudinal, prospective study | BMJ | 10 December 2018

Related:

• BMJ Newsroom: Regular problem solving does not protect against mental decline
• Alzheimer’s Society comment

Decision-making in people living with dementia

Bhatt, J et al.  | The nature of decision-making in people living with dementia: a systematic review |  Aging & Mental Health | published online 6th December 2018

Abstract
Objective: The objectives of this systematic review were to: 1) understand how people living with dementia are involved in making decisions; 2) explore the different decisional styles and domains of decision-making that people living with dementia experience and 3) identify what influences the level of decisional involvement of people living with dementia.

Methods: A systematic review of literature identified studies from Medline, PsycINFO, HAPI and CINAHL databases. Search terms related to decision-making and dementia. Qualitative and quantitative research designs were included. Appraisal of included studies was done using quality ratings. All studies focused on how decision-making took place. Extracted findings were synthesised narratively with concept mapping, conceptualisation and an exploration of connections between studies to develop an overall model of decision-making involvement

Results: Fifteen studies fully met the eligibility criteria (thirteen qualitative and two quantitative). All studies had moderate to high quality ratings. Participants were predominantly people living with dementia, Parkinson’s disease and stroke. The model of decision-making encompasses four decisional styles (managed autonomy, mutual, reductive and delegated) determined by different degrees of involvement from the person living with dementia and their supporter. The decisional style implemented was influenced by the presence or absence of background (the Freedom of Choice framework) and contextual factors (risk, relationships and resources).

Conclusion: Decision-making in dementia is complex and influenced by many factors beyond cognitive impairment alone. This review indicates that decision-making in dementia takes place through decisional styles, determined by unique levels of involvement from people living with dementia and their carers.

Monthly announcement of national dementia diagnosis rate

National dementia diagnosis rates (DDR) for November 2018 have now been published and can be found on the NHS Digital website.

This publication includes the rate of dementia diagnosis. As not everyone with dementia has a formal diagnosis, this statistic compares the number of people thought to have dementia with the number of people diagnosed with dementia, aged 65 and over.

This publication is the first to include the count of people with a diagnosis of dementia who have had a medication review in the preceding 12 months.

Key Facts

Full detail: Recorded Dementia Diagnoses – November 2018

Caregivers’ resilience in mild and moderate Alzheimer’s disease

Rachel Dias Lopes da Rosa, et al. |  Caregivers’ resilience in mild and moderate Alzheimer’s disease | Aging & Mental Health | published online: 30 Nov 2018

Objectives: To investigate the resilience of caregivers of people with mild and moderate Alzheimer’s disease (PwAD) and the related sociodemographic and clinical characteristics.

Methods: Cross-sectional assessment of dyads of PwAD and family caregivers (N = 106). Caregivers were assessed for resilience, depression, anxiety, hopelessness, quality of life, burden and cognition. PwAD were assessed for severity of dementia, cognition, neuropsychiatric symptoms, functionality, quality of life and awareness of disease.

Results: Most of the caregivers (51.1%) reported emotional problems (symptoms of anxiety, stress and depression). In both mild and moderate PwAD groups, resilience was inversely related to self-reported emotional problems. There was not a significant difference between caregivers of mild and moderate PwAD resilience.

Upon analyzing the factors related to resilience, the study found some differences between the groups of caregivers of mild and moderate PwAD. Neuropsychiatric symptoms of PwAD and caregiver’s depressive symptoms were related to resilience of caregivers of mild PwAD. In the moderate group, caregivers’ higher levels of quality of life and co-residing with PwAD were related to resilience.

Conclusion: Caregivers’ resilience is driven by different factors according to disease severity. The findings suggest that resilience allows caregivers to manage and respond positively to stressful demands of care.

Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: The Active Minds Study

Salmoirago-Blotcher, E. et al| 2018|Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: The Active Minds Study| Circulation| 138|Suppl_1| A12009-A12009.

New research studied participants with two risk factors for dementia to determine whether mindfulness training (MT) and aerobic training (AT) had an impact on their cognitive function. 

Abstract

Introduction: We conducted a pilot RCT to explore whether mindfulness training (MT), an intervention design to increase the moment-to-moment awareness of physical sensations, affective states and thoughts, alone or in combination with aerobic exercise training (AT), may improve cognitive function in individuals at risk of dementia.

Hypothesis: We hypothesized that MT and AT would improve cognitive function at the end of the intervention.

Methods: Participants with at least two risk factors for dementia were randomized to AT alone (3 sessions/week for 12 weeks), MT alone (1 session/week for 8 weeks), both interventions (MT+AT), or usual care (UC). Assessments of cognitive function including attention (Digital Symbol Substitution Test), executive function (F-A-S verbal fluency test), and episodic memory (International Shopping List Test) were conducted at baseline and end of treatment (EOT – 3 months since baseline). Scores from each measure were used to calculate a composite score (Z-scores of Attention, Verbal fluency, and Episodic memory for Non-demented adults – ZAVEN). Mixed effects longitudinal models were used to estimate intervention effects on ZAVEN scores at EOT controlling for baseline.

Results: Of the 160 screened participants, 75 were eligible and 27 were randomized. Retention rates were 96.3%. At EOT, MT alone had significantly higher ZAVEN scores compared to UC and nearly significantly higher scores compared to AT alone. Findings were driven mostly by effects of MT on executive function and episodic memory.

Conclusions: These results suggest a possible effect of MT on cognitive function in older individuals at risk of dementia. AT did not improve cognitive function and may require a longer intervention duration to show an effect. These promising findings need to be confirmed in a larger RCT.

Rotherham NHS staff can request this article here