New leads on treating dementia and Alzheimer’s

A new research study provides an explanation for why clinical trials of drugs reducing proteins in the brain that were thought to cause dementia and Alzheimer’s have failed. The study has opened the way for potential new treatments with existing drugs | Human Molecular Genetics | via ScienceDaily

In an article in the journal, Human Molecular Genetics,  researchers assembled evidence from a wide range of human studies and animal models of dementia-related diseases to show that inflammation is a major cause, not just a consequence. The new work turns previous thinking around. The genetic linkages imply that the inflammation comes first — and the tissue damage second.

Project leader Professor Robert Richards explains that by reducing some elements of inflammation, it may be possible to reduce dementia symptoms:

“With this new understanding of the disease, we now need to test existing anti-inflammatory drugs for their effectiveness in treating dementia,” he says.

Full story at ScienceDaily

Journal reference: Robert I Richards, Sarah A Robertson, Daniel L Kastner |  Neurodegenerative diseases have genetic hallmarks of autoinflammatory disease | Human Molecular Genetics |  April 2018

 

UCL researchers: Anxiety in mid-life might be linked to dementia in later life

University College London | May 2018 | Mid-life anxiety may be linked to later life dementia

A new research paper published in the BMJ Open analysed studies looking at the association between mid-life anxiety, depression, and the development of dementia. The researchers from University College London (UCL) and the University of Southampton  searched databases for published studies. While only four out of over 3500 studies  met their criteria for inclusion this was equivalent to nearly 30000 people.  They suggest that an abnormal stress response, experienced in moderate to severe anxiety, may increase brain cell ageing and degenerative changes in the central nervous system, so increasing vulnerability to dementia. For this reason they  suggest that anxiety should be considered by doctors as a risk factor for dementia.  Currently, it remains unclear if treatment for anxiety could potentially curb dementia (via UCL).

 

Abstract

Objectives Anxiety is an increasingly recognised predictor of cognitive deterioration in older adults and in those with mild cognitive impairment. Often believed to be a prodromal feature of neurodegenerative disease, anxiety may also be an independent risk factor for dementia, operationally defined here as preceding dementia diagnosis by more than or equal to 10 years.

Design A systematic review of the literature on anxiety diagnosis and long-term risk for dementia was performed following published guidelines.

Setting and participants Medline, PsycINFO and Embase were searched for peer-reviewed journals until 8 March 2017. Publications reporting HR/OR for all-cause dementia based on clinical criteria from prospective cohort or case–control studies were selected. Included studies measured clinically significant anxiety in isolation or after controlling for symptoms of depression, and reported a mean interval between anxiety assessment and dementia diagnosis of at least 10 years. Methodological quality assessments were performed using the Newcastle-Ottawa Scale.

Outcome measure HR/OR for all-cause dementia.

Results Searches yielded 3510 articles, of which 4 (0.02%) were eligible. The studies had a combined sample size of 29 819, and all studies found a positive association between clinically significant anxiety and future dementia. Due to the heterogeneity between studies, a meta-analysis was not conducted.

Conclusions Clinically significant anxiety in midlife was associated with an increased risk of dementia over an interval of at least 10 years. These findings indicate that anxiety may be a risk factor for late-life dementia, excluding anxiety that is related to prodromal cognitive decline. With increasing focus on identifying modifiable risk factors for dementia, more high-quality prospective studies are required to clarify whether clinical anxiety is a risk factor for dementia, separate from a prodromal symptom.

Full reference:

Gimson A, Schlosser M, Huntley JD, et al | Support for midlife anxiety diagnosis as an independent risk factor for dementia: a systematic review| BMJ  Open |  2018| 8|e019399| doi: 10.1136/bmjopen-2017-019399

iSPACE – dementia friendly GP surgeries

iSPACE is helping surgeries improve support for patients with dementia and their carers | AHSN

iSPACE is a quality improvement and innovation programme delivered in GP surgeries in all parts of Hampshire, Dorset, Isle of Wight and south Wiltshire. The aim of iSPACE is to improve the pathway of patients with dementia and their carers through primary care.

The key to the spread of iSPACE is the engagement of staff teams and a recognition that people with dementia need a more personalised care plan and access to resources to help them and their carers to better manage the pathway.

Wessex Academic Health Science Network (AHSN) worked with Alzheimers charities, clinical commissioning groups (CCGs), Public Health England (PHE), Health Education England (HEE) and companies providing dementia services both within and outside the NHS to deliver this project. The AHSN delivered the project into 153 GP surgeries providing training, access to resources, meetings to encourage progress and physical resources such as funding for environmental changes and literature.

Patients reported feeling more supported by their surgery; carers reported a greater understanding of dementia from the surgery team and seeing the same clinician at each appointment. Dementia diagnosis rates increased (15.9% for people aged over 65), care planning increased by 26% for face to face reviews and 80% of surgeries now have a dementia noticeboard.

Full detail at The AHSN Network

Eating and drinking for a person with dementia

Helping a person with dementia to maintain a healthy diet can be difficult
for the people caring for them. This leaflet aims to provide some positive
tips on ways to help | Dementia UK

People with dementia may experience problems with eating and drinking.
There are many reasons this might happen. They might:

• forget to eat
• experience difficulties preparing food
• have difficulty recognising food items
• have a change in appetite or taste

Image source: http://www.dementiauk.org

Eating a healthy and balanced diet is important for a person’s physical and mental health. Not eating and drinking enough can increase the risk of dehydration, weight loss, a urinary tract infection and constipation. These health problems can be particularly problematic for someone with dementia as they can increase confusion and the risks of delirium, and sometimes make the symptoms of dementia worse.

This leaflet from Dementia UK provides useful tips on the following:

• Setting the scene for mealtimes
• Encouraging a person with dementia to eat
• Encouraging a person with dementia to drink
• Stocking up and storing food
• Weight gain or weight loss
• Swallowing

Full resource: Eating and drinking: Staying well with dementia

Related:   ‘Eating and Drinking Well: Supporting People Living with Dementia’ |Bournemouth University

Growing Older with Learning Disabilities

This new guideline from NICE aims to ensure that people with learning disabilities are given the help they need to access a range of services as they grow older, so they can live healthy and fulfilled lives. It covers identifying changing needs, planning for the future, and delivering services including health, social care and housing.

This guideline includes recommendations on:

• overarching principles
• organising and delivering services
• identifying and assessing care and support needs
• planning and reviewing care and support
• identifying and managing health needs
• end of life care
• staff skills and expertise

The guideline was developed by the NICE Collaborating Centre for Social Care, a partnership which was led by SCIE.

Full guideline: Care and support of people growing older with learning disabilities

See also: NICE interactive flowchart – Care and support of people growing older with learning disabilities

 

When do problems with memory and decision-making affect older adults’ ability to drive?

Study finds lower levels of cognitive function were linked to a higher risk of motor vehicle crashes | Journal of the American Geriatrics Society | via ScienceDaily

A team of researchers designed a study to learn more about cognitive health and older drivers’ crash risks. The study focused on links between levels of cognitive function and crash risk among older drivers without dementia. They also assessed the link between changes in cognitive function over time and later risks of crashes.

Researchers followed 2,615 participants for an average of 6.7 years, and looked at motor vehicle crashes involving participants. For older licensed drivers without dementia, lower levels of cognitive function were linked to a higher risk of motor vehicle crashes. Depression also was linked to a higher risk for crashes in older licensed drivers without dementia.

The researchers noted that, unfortunately, there is not yet a widely accepted specific clinical exam, procedure, or lab test that can evaluate driving and crash risk related to cognitive function. The researchers concluded that older drivers with lower levels of cognitive function were somewhat more likely to be involved in a crash.

Full story at ScienceDaily

Full reference: Fraade-Blanar, L.A. et al. |  Cognitive Decline and Older Driver Crash Risk. Journal of the American Geriatrics Society | published online 17 April 2018

Dementia 2020 Engagement Panel

The Opinion Research Service (ORS) has opened the Dementia 2020 Engagement Panel on behalf of the Department of Health.

The aim is to gain a better understanding of the experiences and needs of people living with dementia, in order to shape policies to better deliver the commitments of the Dementia 2020 Implementation Plan.

The two-year consultation focuses in particular on people who have received the diagnosis in the past two years (since January 2015), but those with a diagnosis of more than two years can also take part, as can carers.

More information can be found here.

Image source: http://www.ors.org.uk

MindEd for older people

MindEd for Families has launched MindEd for Older People which is a free web-based resource providing information about mental health issues for older people and their families.  The resource is supported by NHS England in partnership with Health Education England.

Hospitals do not recognise dementia in a third of patients admitted with other conditions

Hospitals fail to recognise dementia in a third of patients who have already had the condition diagnosed if they are admitted to hospital for a different reason | Alzheimer’s and Dementia | via BMJ

Researchers reviewed data on 21 387 patients aged over 65 who had been assessed at South London and Maudsley NHS Foundation Trust memory clinics from 2008 to 2006. A total of 8246 people had dementia diagnosed and were then admitted to general hospitals 37 329 times after their diagnosis.

The results, published in Alzheimer’s and Dementia, showed that 6429 patients (78%) had a dementia diagnosis recorded at some point in their hospital records. The proportion of all individual hospital records that included dementia was 50.3% and, among the 26 894 non-elective hospital admissions, the proportion was 63.3%.

Hospitals were more likely to miss dementia in patients who were younger, single, had more physical illness, had better cognitive function and less agitation or activity of daily living impairment, or were from an ethnic minority group.

Full story at BMJ

Full article: Sommerlad A, et al. | Accuracy of general hospital dementia diagnoses in England: sensitivity, specificity, and predictors of diagnostic accuracy 2008-2016 | Alzheimer’s and Dementia | published online 24 April 2018

Recorded Dementia Diagnoses March 2018

Number of people diagnosed with Dementia according to GP records up to the 31 March 2018

This publication presents at England level: recorded prevalence and how this compares with research based studies at different ages, and how prevalence differs at different ages depending on comorbidity; CCG level: the rate of emergency hospital admissions for dementia per person recorded with a dementia diagnosis.

Key Facts:

• Recorded dementia prevalence at 31 March 2018 was 0.765 per cent (1 person in 131). When considered alongside monthly data previously collected, this indicates a decrease in recorded prevalence from March 2017 (0.766) to March 2018 (0.765).
• The number of people over 65 with dementia was estimated to be 645,507. Of these, 67.5 per cent have a coded dementia diagnosis recorded.
• 9.3 per cent of patients with a recorded dementia diagnosis were prescribed antipsychotic medication in the 6 weeks to 31 March 2018.

Full document available via NHS Digital