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

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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.

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Obstructive sleep apnea treatment and dementia risk in older adults

Dunietz G.L., Chervin, R.D., Burke, J.F., Conceicao, A. S., & Braley, T.J. | 2021| Obstructive sleep apnea treatment and dementia risk in older adults| Sleep | zsab076|  https://doi.org/10.1093/sleep/zsab076

This US study from researchers at the University of Michigan studied heavy snorers to determine if this is had an impact on their risk of developing dementia. The experts found that patients who received positive airway pressure (PAP) treatment,-treatments for sleep apnea that deliver a stream of compressed air via a mask while asleep- had lower odds of being diagnosed with Alzheimer’s disease.

Abstract

Study Objectives

To examine associations between positive airway pressure (PAP) therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not otherwise specified (DNOS) in older adults.

Methods

This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65 and older, with an obstructive sleep apnea (OSA) diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes (AD [n = 1,057], DNOS [n = 378], and MCI [n = 443]) that were newly identified between 2011 and 2013. PAP treatment was defined as the presence of at least one durable medical equipment (Healthcare Common Procedure Coding System [HCPCS]) code for PAP supplies. PAP adherence was defined as at least two HCPCS codes for PAP equipment, separated by at least 1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses.

Results

In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75 years. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (odds ratio [OR] = 0.78, 95% confidence interval [95% CI]: 0.69 to 0.89; and OR = 0.69, 95% CI: 0.55 to 0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR = 0.82, 95% CI: 0.66 to 1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR = 0.65, 95% CI: 0.56 to 0.76).Conclusions

PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce the risk of subsequent dementia.

Obstructive sleep apnea treatment and dementia risk in older adults [abstract only]

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In the news Mail Online Simple snoring cure could also slash risk of dementia by more than a third, researchers say

Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT #covid19rftlks

Gathercole, R., et al. | 2021| Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT| Health Technol Assess | 25| 19| P. 1-156. doi: 10.3310/hta25190. PMID: 33755548; PMCID: PMC8020444.

A randomised controlled trial (RCT) led by a team of researchers at the University of Bristol set out to determine if assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated.

The research team report that a full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare.

Plain Language Summary

Many people with dementia living at home are recommended assistive technology and telecare to help them remain living safely and independently in the community. These devices are meant to assist and support activities such as taking medication or cooking, or to raise an alert when there is an issue, such as a fire; however, there is currently little evidence to support such claims. This trial investigated whether or not assistive technology and telecare could delay people moving into residential care and keep them any safer than alternatives, and whether or not they were cost-effective. We recruited 495 people with dementia and their unpaid caregivers, who were randomly assigned to receive either a package of assistive technology and telecare recommended by a health or social care professional or alternative support involving only basic assistive technology and telecare. We monitored the residential status, the use of health-care services and the health and well-being of participants with dementia and their caregivers over a 2-year period. Researchers also spent time with participants to see how they were living with the technology. The trial found no difference in the time that people with dementia with full assistive technology and telecare remained at home, nor any reduction in the number of safety incidents, compared with the participants who received basic assistive technology and telecare only. Full assistive technology and telecare did not increase health and social care costs. It did not improve the well-being of people with dementia or that of their caregivers. People with dementia who had full assistive technology and telecare rated their quality of life poorer than those with basic assistive technology and telecare did, but their caregivers rated their quality of life as about the same as caregivers of people with basic assistive technology and telecare. The technology sometimes averted crises but also disrupted people’s everyday lives. These results suggest that assistive technology and telecare for people with dementia provided in real-world conditions may not be as beneficial as previously claimed. The way that assistive technology and telecare services are organised bears further investigation to see how these services could be improved.

Abstract availble Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT

Paper can be read from NCBI

Feeling fearful and lonely are indicative experiences of emotional distress for people with dementia

Gruber R, Schwanda MFeeling fearful and lonely are indicative experiences of emotional distress for people with dementiaEvidence-Based Nursing 2021;24:50-51.

Mixed-methods research set out to explore the following research questions as part of a review:

How can emotional distress be characterised for individuals with dementia?

What descriptions of emotional distress exist?

What explanations for emotional distress exist?’

The review found that, besides forgetfulness, feeling fearful, lonely, worried, angry or sad are additional psychological conditions in caring for people with dementia, which should not be overlooked. Feelings of fearfulness were the most frequently experienced for people with dementia.

This Commentary is published in BMJ title Evidence-Based Nursing 

The primary paper on which this commentary is based on an earlier study Emotional distress with dementia: A systematic review using corpus‐based analysis and meta‐ethnography, which is available from the International Journal of Geriatric Psychiatry

Being overweight is linked with an increased risk of dementia in new research

Ma,Y., Ajnakina, A, Steptoe, A. & Cadar, D. | 2021 | Higher risk of dementia in English older individuals who are overweight or obese| International Journal of Epidemiology | Volume 49|z Issue 4 P 1353–1365|  https://doi.org/10.1093/ije/dyaa099

Researchers involved in The English Longitudinal Study of Ageing (ELSA) investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia; to facilitate this they tracked more than 6 500 people aged over 50 for more than a decade. For those with obesity at the outset of the study, their risk of developing the syndrome increased by a third ( 34 per cent). None of the participants had dementia at baseline.

Almost 7 per cent of participants (n equal to 453) developed dementia. When compared with a normal BMI and waist circumference ( WC ) group, the obese and high WC group had 28% higher risk of dementia.

Nearly three quarters (74 per cent) of the participants who developed dementia were overweight or obese at baseline, in comparison with 72 per cent of those who were not diagnosed with dementia by the end of the study period.

Obesity and larger waist circumference were associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health associated with a higher dementia risk across a decade follow-up period, independent of demographics, lifestyle behaviours, apolipoprotein E-ε4, hypertension and diabetes

From the various modifiable risk factors, obesity could represent a target for intervention, and these findings have significant implications for public health and dementia prevention.

Abstract

Background

Several risk factors contribute to dementia, but the role of obesity remains unclear. This study investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia in a representative sample of older English adults.

Methods

We studied 6582 participants from the English Longitudinal Study of Ageing (ELSA) who were aged more than or equal to 50 years and were dementia-free at baseline, that being either wave 1 (2002–2003) for study members who started at wave 1, or at either wave 2 (2004–2005) or 4 (2008–2009) for those who began the study as refreshment samples. Body mass index (BMI) was measured at baseline and categorized into normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (more than or equal to 30 kg/m2). Central obesity was defined as a waist circumference (WC) more than 88 cm for women and over 102 cm for men. Cumulative incidence of dementia was ascertained based on physician-diagnosed dementia, an overall score more than 3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Hospital Episodes Statistics (HES) data at every ELSA wave from baseline until wave 8 (2016–2017). Cox proportional hazards models were used to assess the association between baseline BMI levels or abdominal obesity in relation to dementia incidence during the mean follow-up period of 11 years.

Results

From the overall sample, 6.9% (n  equal to  453) of participants developed dementia during the follow-up period of maximum 15 years (2002–2017). Compared with participants with normal weight, those who were obese at baseline had an elevated risk of dementia incidence independent of sex, baseline age, apolipoprotein E-ε4 (APOE-ε4), education, physical activity, smoking and marital status. The relationship was slightly accentuated after additionally controlling for hypertension and diabetes. Women with central obesity had a 39% greater risk of dementia compared with non-central obese women . When compared with a normal BMI and WC group, the obese and high WC group had 28 per cent higher risk of dementia.

Conclusions

Our results suggest that having an increased body weight or abdominal obesity are associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health.

Primary paper is available in the International Journal of Epidemiology

The findings of this study are highlighted in a recent NIHR Signal Being overweight is linked with an increased risk of dementia in new research

Exercise & socialising might be more efficacious than medication for dementia patients with depression, reports systematic review #covid19rftlks

Watt, J. A. et al. | 2021 | Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis| BMJ | 372| n532| doi:10.1136/bmj.n532

This systematic review and network meta-analysis (NMA) compares the efficacy of drug interventions with non-drug interventions for reducing symptoms of depression in people with dementia.  The evidence showed that non-drug and multidisciplinary approaches are highly efficacious interventions from which people with dementia will derive benefit.

Non-drug approaches were associated with a meaningful reduction in symptoms of depression in people with dementia and without a diagnosis of a major depressive disorder. Drug approaches alone, however, were not more efficacious than usual care

Objective To describe the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia who experience depression as a neuropsychiatric symptom of dementia or have a diagnosis of a major depressive disorder.

Design Systematic review and meta-analysis.

Data sources Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, and grey literature between inception and 15 October 2020.

Eligibility criteria for study selection Randomised trials comparing drug or non-drug interventions with usual care or any other intervention targeting symptoms of depression in people with dementia.

Main outcome measures Pairs of reviewers screened studies, abstracted aggregate level data, and appraised risk of bias with the Cochrane risk of bias tool, which facilitated the derivation of standardised mean differences and back transformed mean differences (on the Cornell scale for depression in dementia) from bayesian random effects network meta-analyses and pairwise meta-analyses.

Results Of 22 138 citations screened, 256 studies (28 483 people with dementia) were included. Missing data posed the greatest risk to review findings. In the network meta-analysis of studies including people with dementia without a diagnosis of a major depressive disorder who were experiencing symptoms of depression (213 studies; 25 177 people with dementia; between study variance 0.23), seven interventions were associated with a greater reduction in symptoms of depression compared with usual care: cognitive stimulation (mean difference −2.93, 95% credible interval −4.35 to −1.52), cognitive stimulation combined with a cholinesterase inhibitor (−11.39, −18.38 to −3.93), massage and touch therapy (−9.03, −12.28 to −5.88), multidisciplinary care (−1.98, −3.80 to −0.16), occupational therapy (−2.59, −4.70 to −0.40), exercise combined with social interaction and cognitive stimulation (−12.37, −19.01 to −5.36), and reminiscence therapy (−2.30, −3.68 to −0.93). Except for massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction, which were more efficacious than some drug interventions, no statistically significant difference was found in the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia without a diagnosis of a major depressive disorder. Clinical and methodological heterogeneity precluded network meta-analysis of studies comparing the efficacy of interventions specifically for reducing symptoms of depression in people with dementia and a major depressive disorder (22 studies; 1829 patients).

Conclusions In this systematic review, non-drug interventions were found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder.

Full paper available from The BMJ

See also:

BMJ Opinion Social prescribing may help reduce symptoms of depression in people with dementia

In the news

iNews Exercise could be better than medication for dementia patients with depression, report claims