A Systematic Review of Mindfulness-Based Interventions for Patients with Mild Cognitive Impairment or Dementia and Caregivers

Shim M, Tilley J.L., Im, S., Price, K., & Gonzalez, A. (2020) A Systematic Review of Mindfulness-Based Interventions for Patients with Mild Cognitive Impairment or Dementia and Caregivers| Journal of Geriatric Psychiatry and Neurology| doi:10.1177/0891988720957104

New research has analysed the evidence base for mindfulness interventions for patients with dementia, mild cognitive impairment and their carers. It has been published in the Journal of Geriatric Psychiatry and Neurology

Abstract

The aim of this article was to systematically review the quality and efficacy of the current evidence for mindfulness-based interventions (MBIs) in patients with mild cognitive impairment (MCI), patients with dementia (PwD), and their caregivers. We identified 20 randomized controlled trials (RCTs) (11 for patients, 9 for caregivers) published in the last 15 years. Evidence suggested that MBIs are highly acceptable and credible treatments for patients with MCI, PwD and caregivers. Specifically, for PwD, the results indicated that the magnitude of post-treatment effects of MBIs are in the medium to large range for psychosocial outcomes, and in the small to medium range for cognitive functioning; however, treatment effects on dementia biomarkers were mixed, ranging from small to large, depending on the outcome measure. Findings also evidenced salutary effects of MBIs for caregivers of PwD, with post-treatment effects ranging from medium to large for caregiver stress and burden and large effects for quality of life, and mixed outcomes for cognitive functioning, with effects in the small to large range. However, confidence in these findings is relatively limited due to methodological limitations, especially in terms of poor consistency in intervention strategies, outcome measures, and other key criteria across studies. To better assess the value of MBIs for these populations and optimize treatment outcomes, we recommend further research with improved study methodology (e.g., multi-method assessment, universal criterion and outcome measures, use of active control groups, larger sample sizes, long-term follow-up) to replicate current findings and enhance our understanding of underlying treatment mechanisms of MBIs.

NHS in Rotherham can request the article from the Library & Knowledge Service

Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia

Kivimäki, M. et al |2020| Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia| JAMA Network Open3|9| e2016084-e2016084

Question  Are alcohol-induced loss of consciousness and heavy weekly alcohol consumption associated with increased risk of future dementia?

Findings  In this multicohort study of 131 415 adults, a 1.2-fold excess risk of dementia was associated with heavy vs moderate alcohol consumption. Those who reported having lost consciousness due to alcohol consumption, regardless of their overall weekly consumption, had a 2-fold increased risk of dementia compared with people who had not lost consciousness and were moderate drinkers.

Meaning  The findings of this study suggest that alcohol-induced loss of consciousness is a long-term risk factor for dementia among both heavy and moderate drinkers.

Importance  Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain.

Objective  To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers.

Design, Setting, and Participants  Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131 415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020.

Exposures  Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week.

Main Outcomes and Measures  Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records.

Results  Of the 131 415 participants (mean [SD] age, 43.0 [10.4] years; 80 344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22  for greater than 21 vs 1 to 21 U/wk. Of the 96 591 participants with data on loss of consciousness, 10 004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men women during the first 10 years of follow-upa fter excluding the first 10 years of follow-up, and for early-onset and late-onset  dementia, Alzheimer disease, and dementia with features of atherosclerotic cardiovascular disease. The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate or heavy.

Conclusions and Relevance  The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.

Full article from JAMA

In the news:

Daily Mail : Passing out drunk could more than DOUBLE your risk of later developing dementia and even one drink per day raises risk by 22%, study warns

Dementia UK offers free online course for nurses on supporting families and carers

Dementia UK | September 2020 | Dementia UK offers free online course for nurses on supporting families and carers

Working with Families and Dementia: An Introduction is an open-access, six-part module produced for registered nurses by Dementia UK.

This is an online introductory course designed for registered nurses who wish to find out more about the role of an Admiral Nurse and are considering a career in Admiral Nursing. This course will also be useful to Health and Social Care professionals who wish to find out more about the complexities when supporting families living with dementia.

It has been created by Dementia UK which is the charity that supports families facing dementia through the work of Admiral Nursing.

Admiral Nurses work with families and the systems around them by taking a family and relationship focused approach (Source: Dementia UK)

Full details available from Dementia UK

Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A randomized clinical trial

Pui Kin Kor, P. Justina Yat Wah Liu, J. & Tong Chien, W. (2020) |Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A randomized clinical trial| The Gerentologist | https://doi.org/10.1093/geront/gnaa125

The latest issue of The Gerentologist features a study that examined the impact of MBCT for caregivers of people with dementia, the authors of the study report that the MBCT reduce the caregivers’ stress and promote their psychological well-being over 6-month follow-up.

Abstract

Background and Objectives

Family caregivers of people with dementia (PWD) experience high levels of stress resulting from caregiving. This study aimed to investigate the effects of a modified of Mindfulness-Based Cognitive Therapy (MBCT) for dementia caregiving

Research Design and Methods

113 family caregivers of PWD were randomized to either the intervention group, receiving the 7-session modified MBCT over 10 weeks with telephone follow-up; or the control group, receiving the brief education on dementia care and usual care. The caregiving stress (primary outcome), and various psychological outcomes of caregivers and the behavioral and psychological symptoms of dementia(BPSD) in the care-recipients were assessed and compared at baseline (T0), post-intervention (T1), and at the 6-month follow-up (T2)

Results

At both T1 and T2, the intervention group had a statistically greater improvement in stress, depression, anxiety and BPSD-related caregivers’ distress. A significant greater improvement was also demonstrated in mental health-related QoL at T2 and BPSD of the care-recipients at T1. The increased caregivers’ level of mindfulness was significantly correlated with the improvement of various psychological outcomes at T1 and T2 with correlation coefficient -0.64 to 0.43

Discussion and Implications

The modified MBCT enhanced the level of mindfulness in the caregivers and was effective to reduce the caregivers’ stress and promote their psychological well-being over 6-month follow-up. Future research is recommended to further examine its effects on the varieties of psychological and behavioural outcomes of both caregivers and care-recipients and their dyadic relationships, as well as explore its mechanism of action in facilitating dementia caregiving (Source: The Gerentologist)

This article can be requested by Rotherham NHS staff here

Guidance for carers of people with dementia

University College London | September 2020 |Guidance developed for dementia carers when dealing with COVID-19 infection

A team of researchers from University College London (UCL) have developed a decision-making guide for dementia carers, to ensure they can provide the right support and with dignity, should those they care for become infected with coronavirus.

The researchers based at Marie Curie Palliative Care Research Department at UCL, have observed the challenges to carers who can’t be with their loved one or person they support, due to visiting restrictions and having to social distance or shield themselves.

This often means that dementia carers have to make quick healthcare or legal decisions over the phone with a health professional: someone who may have no knowledge of the care and interventions the person with dementia requires.

The new guide, which was developed with families of those with dementia, is funded by an Economic and Social Research Council COVID-19 grant and supported by end of life care charity Marie Curie, Alzheimer’s Society and Dementia UK.

The tool has been designed to support carers work through situations, medical and legal jargon so they can make informed decisions quickly under stressful circumstances.

This includes do not resuscitate orders, legal issues like power of attorney, and ensuring that health and social care professionals understand what is important to the person they are caring for when that patient’s loved ones can’t be by their side.

The research team hopes that the new guide will also ease the emotional burden that families can experience and help resolve any feelings of uncertainty about the decisions they have made for their loved ones (Source: UCL).

Full press release is available from UCL

The decision aid can be downloaded here

COVID-19 and Dementia: Factors affecting patient outcomes and experience along the dementia pathway

Wessex Clinical Senate and Networks | July 2020| COVID-19 and Dementia: Factors affecting patient outcomes and experience along the dementia pathway

The COVID-19 pandemic has impacted significantly on the delivery of NHS services. We have an opportunity to learn from the rapid and necessary service transformation and consider how we recover our services.

Dementia remains a diagnosis with significant impact with a need to balance the timeliness of diagnosis with patient experience and outcomes. Covid may become endemic and our adapted ways of working may become the new normal.

Recent webinars have brought clinicians, service managers and commissioners together to consider factors affecting the dementia pathway in a Covid environment. This document aims to give an overview of factors identified that affect the pathway.

The documents are available to download from the Wessex Senate

Loneliness, but not social isolation, predicts development of dementia in older people

Older people who feel lonely and have few close relationships may have an increased chance of developing dementia. Perhaps surprisingly, being socially isolated with few or infrequent social contacts does not seem to predict dementia risk, researchers found.

This study was carried out before the coronavirus pandemic but the findings are relevant now, when the over-70s are socially isolated. It suggests that those who have supportive social relationships with relatives and carers may be protected from cognitive decline. The quality of their relationships seems to be more important than how often they meet up in person.

People who have social contact may still feel lonely. The study stresses the importance of supportive relationships for people with early stage dementia.

Full detail at National Institute for Health Research

Safeguarding adults with dementia during the COVID-19 crisis

This quick guide aims to support care providers and staff to safeguard people with dementia during the crisis | Social Care Institute for Excellence

There are increased concerns that, during the COVID-19 crisis, people may be more vulnerable to abuse or neglect. This may be a result of:

Full detail at Social Care Institute for Excellence

Dementia in care homes and COVID-19

Dementia in care homes and COVID-19 | Social Care Institute for Excellence 

This is a quick guide for carers in care homes supporting residents living with dementia during the coronavirus (COVID-19) pandemic. It discusses four clinical situations that may help to illustrate some challenges: understanding signs of COVID-19; helping residents with confusion; managing behavioural challenges; supporting residents with end-of-life care.

Full resource: Dementia in care homes and COVID-19

Caring for People with Dementia: a clinical practice guideline for the radiography workforce

Caring for People with Dementia: a clinical practice guideline for the radiography
workforce (imaging and radiotherapy) | The Society and College of Radiographers

Caring for people with Dementia: a clinical practice guideline for the radiography workforce (imaging and radiotherapy) is a comprehensive and evidence-based document. It has a set of recommendations for the whole radiographic workforce caring for people with dementia and carers when undergoing imaging and/or radiotherapy. It has been developed systematically using the best available evidence from research and expert opinion, including service users, and subjected to peer professional, lay and external review.

scor
Image source: http://www.sor.org

The guideline has recommendations for good practice for individual members of the radiographic workforce, service managers, academic institutions and the Society and College of Radiographers (SCoR).

As a whole, this guideline acts to highlight to practitioners that to offer the best service and healthcare outcomes for people with dementia and carers, care must be tailored to the needs of the invidual.

There have been minor changes to the language used in this second edition, which emphasises the ability of and need for people with dementia to continue to live well with a good quality of meaningful life.

Full document: Caring for People with Dementia: a clinical practice guideline for the radiography workforce