How your driving might reveal early signs of Alzheimer’s

Bayat, S., et al| 2021 | GPS driving: a digital biomarker for preclinical Alzheimer disease| Alz Res Therapy| 13 | 115. https://doi.org/10.1186/s13195-021-00852-1

A study of drivers over the age 65 tracked them using GPS to investigate the driving performance and driving space of older adults with and without preclinical Alzheimer’s Disease (AD ) . From the GPS tracking the researchers the top five most important features consisted of two features describing driving performance (average jerk and over speeding) and three features describing driving space (total number of night trips, radius of gyration, and number of trips shorter than 1 mile.) The researchers’ findings suggest that driving may serve as an effective and accurate digital biomarker for identifying preclinical AD among older adults

Abstract

Background

Alzheimer disease (AD) is the most common cause of dementia. Preclinical AD is the period during which early AD brain changes are present but cognitive symptoms have not yet manifest. The presence of AD brain changes can be ascertained by molecular biomarkers obtained via imaging and lumbar puncture. However, the use of these methods is limited by cost, acceptability, and availability. The preclinical stage of AD may have a subtle functional signature, which can impact complex behaviours such as driving. The objective of the present study was to evaluate the ability of in-vehicle GPS data loggers to distinguish cognitively normal older drivers with preclinical AD from those without preclinical AD using machine learning methods.

Methods

We followed naturalistic driving in cognitively normal older drivers for 1 year with a commercial in-vehicle GPS data logger. The cohort included n equal to 64 individuals with and n equal to 75 without preclinical AD, as determined by cerebrospinal fluid biomarkers. Four Random Forest (RF) models were trained to detect preclinical AD. RF Gini index was used to identify the strongest predictors of preclinical AD.

Results

The F1 score of the RF models for identifying preclinical AD was 0.85 using APOE ε4 status and age only, 0.82 using GPS-based driving indicators only, 0.88 using age and driving indicators, and 0.91 using age, APOE ε4 status, and driving. The area under the receiver operating curve for the final model was 0.96.

Conclusion

The findings suggest that GPS driving may serve as an effective and accurate digital biomarker for identifying preclinical AD among older adults.

GPS driving: a digital biomarker for preclinical Alzheimer disease [primary paper]

BBC News also highlight these research findings in the article: How your driving might reveal early signs of Alzheimer’s

Dementia podcast

Dementia Researcher Cochrane Dementia and Cognitive Improvement Group | 7 June 2021 | Cochrane Dementia and Cognitive Improvement Group

Cochrane’s dementia podcast is produced in association with Alzheimer’s Research UK and Alzheimer’s Society. In this edition of the biweekly podcast Dr Anna Volkmer talks with the joint co-ordinating editors of the Cochrane Dementia Group. This bring together panels of early career researchers and other dementia experts to discuss their research and career topics to support other early career researchers. The podcast covers research investigating Alzheimer’s and other dementias, exploring prevention, diagnosis, treatments, care and how they’re working to better understand the disease and the brain.

The latest edition of the podcast is available on SoundCloud

See Cochrane for full details

More information about Cochrane Dementia and Cognitive Improvement

US approves first new Alzheimer’s drug in 20 years

via BBC News | US approves first new Alzheimer’s drug in 20 years

The first new treatment for Alzheimer’s disease for nearly 20 years has been approved by regulators in the United States, paving the way for its use in the UK.

Aducanumab targets the underlying cause of Alzheimer’s, the most common form of dementia, rather than its symptoms.

At least 100,000 people in the UK with a mild form of the disease could be suitable for the drug.

But approval from the UK regulator could take more than a year.

Charities have welcomed the news (Source: BBC News)

Full story from BBC News

Using Zoom could help older people avoid dementia, study reveals

Rafnsson, S.B., Maharani, A. & Tampubolon, G. | 2021| Social Contact Mode and 15-Year Episodic Memory Trajectories in Older Adults With and Without Hearing Loss: Findings From the English Longitudinal Study of Ageing | The Journals of Gerontology: Series B| gbab029| https://doi.org/10.1093/geronb/gbab029

The findings of a longitudinal study add new evidence to the body of research on social networks and cognition in later life, they indicate that social interactions through online communication such as Zoom or Skype may help older adults, sustain, and benefit cognitively from, personal relationships. This was particularly apparent for older people living with hearing loss. The researchers used data from ELSA sought to determine whether frequent offline social interactions, as compared to infrequent contact, were independently and longitudinally associated with episodic memory.

Abstract

Objectives

Frequent social contact benefits cognition in later life although evidence is lacking on the potential relevance of the modes chosen by older adults, including those living with hearing loss, for interacting with others in their social network.

Method

11 418 participants in the English Longitudinal Study of Ageing provided baseline information on hearing status and social contact mode and frequency of use. Multilevel growth curve models compared episodic memory (immediate and delayed recall) at baseline and longitudinally in participants who interacted frequently (offline only or offline and online combined), compared to infrequently, with others in their social network.

Results

Frequent offline (B equal to 0.23; SE  equal to 0.09) and combined offline and online (B equal to 0.71; SE  equal to 0.09) social interactions predicted better episodic memory after adjustment for multiple confounders. We observed positive, longitudinal associations between combined offline and online interactions and episodic memory in participants without hearing loss (B  equal to 0.50, SE  equal to 0.11) but not with strictly offline interactions (B equal to 0.01, SE  equal to 0.11). In those with hearing loss, episodic memory was positively related to both modes of engagement (offline only: B  equal to 0.79, SE  equal to 0.20; combined online and offline: B  equal to 1.27, SE  equal to 0.20). Sensitivity analyses confirmed the robustness of these findings.

Discussion

Supplementing conventional social interactions with online communication modes may help older adults, especially those living with hearing loss, sustain, and benefit cognitively from, personal relationships.

Paper Social Contact Mode and 15-Year Episodic Memory Trajectories in Older Adults With and Without Hearing Loss: Findings From the English Longitudinal Study of Ageing

In the news:

The Guardian Using Zoom could help older people avoid dementia, study reveals

Alzheimer’s Society: Emergency admissions from dementia care failures soaring, and worse to come

Alzheimer’s Society | 17 May 2021 | Emergency admissions from dementia care failures soaring, and worse to come warns charity

Emergency admissions for patients with a diagnosis of dementia have increased by more than a quarter during the last four years, reports the Alzheimer’s Society. The findings of an investigation commissioned by the charity show that people with dementia were being rushed to hospital each year, up 27%, because inadequate social care left them unprotected from infections, falls and dehydration. 

The investigation was based on freedom of information (FOIs) to NHS Trusts, found a 27 per cent rise between 2015 – 2019 of people with dementia sped to hospitals with avoidable emergencies. And in 2019, nearly two thirds (65 per cent) of all emergency admissions of people with dementia were for avoidable illnesses and injuries caused by failures in care. The charity says that while an increase in the number of people with dementia has contributed in part to the rise in avoidable admissions, much of the increase is thought to be due to cuts in spending on adult social care piling pressure on A&E and ambulance services.

Full details are available from the Alzheimer’s Society

In the news:

Guardian Social care cuts mean thousands with dementia taken to A&E, charity says

Alzheimer’s Society: Cure the Care System

Alzheimer’s Society | nd | Cure the care system

This week -17-23 May 2021- is Dementia Action Week. The Alzheimer’s Society is calling on the Government to cure the care system now. The charity has produced a short film, showing the impact the broken social care system has on carers. Without support, dementia claims more than one life.

The Cure the Care system campaign highlights the broken social care system means that in the UK, nearly 1 million people with dementia and their families are struggling to get the support and care that they need and deserve.  

Decades of underfunding and neglect have led to a care system that’s difficult to access, costly, inadequate and deeply unfair. The coronavirus pandemic has exposed these problems like never before. 

Until things change, a dementia diagnosis will continue to claim more than one life, as families facing dementia feel its destructive effects.   The charity underlines that it doesn’t have to be this way.

With the right support people with dementia can live a good quality of life, doing what matters most to them for as long as possible (Source: Alzheimer’s Society).

There are also a range of resources including the poster below

Poster from the charity’s Cure the Care System campaign shows a photograph of a man and the text ” My wife has dementia I’m forgetting who I am”

Further details are available from The Alzheimer’s Society

Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital

Hapca, R. E. et al | 2021| Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study | NIHR | Health Services and Delivery Research| Vol. 9 | Issue 8 | Published in April 2021 | https://doi.org/10.3310/hsdr09080

Researchers’ analysis of hospital records indicates that a third of people aged 65 or over admitted to hospital had confusion and that they had higher mortality and had longer hospital stays than those without confusion.

Adopting a mixed-methods approach, the researchers behind this study carried out this piece of research in four ways:

  1. all available research publications were reviewed.
  2. hospital records were analysed to calculate the health-care outcomes (e.g. mortality, length of stay and re-admission).
  3. The hospital costs of patients with and of those without confusion were compared.
  4. The researchers surveyed people with confusion who had been patients in hospital and their families to see what was important to them.

From the research publications, they found that there is overlap between the conditions that cause confusion and there is no agreement on how to test for and define these conditions.

The analysis showed that patients with confusion had an overall higher cost for their hospital admission than patients without confusion; however, this was because they stayed in hospital longer. Their daily cost was lower.

When surveyed, patients and their families told the research team that they expect the patient to leave the hospital in the same or a better condition than they were in on admission. Failing that, they expect patients to have a satisfactory experience of their hospital stay.

These findings will be used to inform the development of a standardised management plan to improve the identified outcomes and, therefore, the quality of care. This will be evaluated in a future study.

Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study

Family carers’ narratives of the financial consequences of young onset dementia

Bayly, M., O’Connell, M. E., Kortzman, A., Peacock, S., Morgan, D. G. & Kirk, A. | 2021| Family carers’ narratives of the financial consequences of young onset dementia | Dementia | https://doi.org/10.1177/14713012211009341

This study takes a qualitative approach to explore how family carers of persons with young onset dementia understand their experiences (n equal to 8), with a focus on financial consequences and how they may be ameliorated by support

Abstract

Individuals with young onset dementia and their families face unique challenges, such as disruptions to their life cycle and relationships and a dearth of appropriate supports. Financial consequences have also been noted in the literature yet have not been explored in-depth. The purpose of this research was to qualitatively explore carers’ experiences of financial consequences resulting from the young onset dementia of a family member and how these consequences may be managed. Eight carers (7 women and 1 man) provided a written online narrative about their journey with young onset dementia and any financial consequences experienced, with open-ended prompts to elicit details not yet shared. Narratives were inductively coded and analyzed using a thematic narrative approach. Carers described a voluntary or involuntary end to employment for the person with young onset dementia around the time of diagnosis. This engendered ongoing and anticipated financial consequences, combined with the need for carers to balance employment with the provision of care (which often meant early retirement for spousal carers). Common themes were tension between the needs to provide care and earn income, altered financial prospects, costs of care, and lack of available and accessible supports to ameliorate financial consequences. Findings illustrate the reality of financial consequences across the trajectory of young onset dementia. These consequences may manifest differently for spousal and child carers and are not being adequately addressed by existing supports.

Full paper available from Dementia

The Effect of Cognitive Intervention on Cognitive Function in Older Adults With Alzheimer’s Disease: A Systematic Review and Meta-Analysis

Wang, Y-Y et al | 2021 | The Effect of Cognitive Intervention on Cognitive Function in Older Adults With Alzheimer’s Disease: A Systematic Review and Meta-Analysis | Neuropsychology Review 2021 | April 24 |

Abstract

Cognitive intervention includes cognitive stimulation, cognitive training, and cognitive rehabilitation. This systematic review was performed to re-assess the efficacy of cognitive intervention for the patients with Alzheimer’s disease (AD). Twenty studies (2012 participants) were eventually included. For global cognitive function, the combined mean difference (MD) in eight studies was 1.67 for the short term. The pooled standardized mean difference (SMD) of six RCTs was 1.61 for the medium term. The pooled SMD of seven studies was 0.79 for the long term. For depression, the pooled SMD of two trials was -0.48 for the short term. Cognitive training may show obvious improvements in global cognitive function whether after short, medium, or long-term interventions and in depression after short term intervention. However, the positive effect of the intervention on general cognitive function or depression did not seem to persist after intervention ended. There is still a lack of reliable and consistent conclusions relevant to the effect of cognitive stimulation and cognitive rehabilitation on observed outcomes, cognitive training for memory or other non-cognitive outcomes. PROSPERO registration number: CRD42019121768.The Effect of Cognitive Intervention on Cognitive Function in Older Adults With Alzheimer’s Disease: A Systematic Review and Meta-Analysis

Abstract available from the journal Neuropsychology Review 2021

Rotherham NHS staff? Why not request a copy of the article from the Library

Improving medicine concordance in a patient with Parkinson’s and dementia: a case study

Soper, C. | 2021|  Improving medicine concordance in a patient with Parkinson’s and dementia: a case study | Nursing Older People | doi: 10.7748/nop.2021.e1301

This article has been written by Claire Soper, Community Parkinson’s nurse specialist, community nursing, Royal Devon and Exeter NHS Foundation Trust, Exeter, England. It has been written for nurses to support, with the express purpose of improving knowledge of the role of antiparkinsonian medicines in controlling symptoms; supporting better understanding as to why medicines concordance can be challenging for people with Parkinson’s and dementia, and to outline the benefits of multidisciplinary working in people with Parkinson’s and dementia.

Parkinson’s is a progressive neurological condition characterised by a range of debilitating motor and non-motor symptoms and often leading to the development of Parkinson’s dementia. People with Parkinson’s need to take antiparkinsonian medicines at frequent and regular intervals to control their symptoms. However, concordance with medicines is often suboptimal, with some people taking excessive doses to alleviate their symptoms or forgetting to take their medicines. For people with Parkinson’s living at home, monitoring and support from a community Parkinson’s nurse specialist (CPNS), in coordination with local services, can assist them in managing their medicines and enable them to remain safely in their own home.

The full text of this article discusses the case of one patient and the interventions provided to her over a six-month period by the CPNS, alongside the community multidisciplinary team, to improve her medicine concordance and ensure her safety.

Rotherham NHS staff can request this article from us