Alzheimer’s study to look at gut health link

University of Aberdeen | December 2018 | Alzheimer’s study to look at gut health link

A new study led by experts at the University of Aberdeen will recruit patients in the local are to its study which will determine if there is a link between diet in managing the behavioural and psychological symptoms of the disease. 

There is increasing evidence that suggests the gut microbiota is a key link between specific nutrients and brain function.

The study will collect samples from three groups of people: people with dementia and challenging behaviour; people with dementia without challenging behaviour; and a control group of people without dementia.

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Professor Alex Johnstone from the University of Aberdeen said:

“This study is the first of its kind and could lead to the possibility of dietary intervention as a solution to prevent behavioural and psychosocial issues which are associated with adverse outcomes as well as distressing to people with dementia, their family and carers.

“We want to explore whether or not the gut-brain axis plays a key role in behavioural changes in dementia.” (Source: University of Aberdeen)

For further details of this study read the release from University of Aberdeen

Neuropsychiatric signs and symptoms of Alzheimer’s disease: New treatment paradigms

Neuropsychiatric symptoms (NPSs) are hallmarks of Alzheimer’s disease (AD), causing substantial distress for both people with dementia and their caregivers, and contributing to early institutionalization | Alzheimer’s & Dementia: Translational Research & Clinical Interventions

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Image source: Florence Winterflood – Wellcome Images // CC BY 4.0

Image shows an artistic interpretation of Alzheimer’s Disease.

They are among the earliest signs and symptoms of neurocognitive disorders and incipient cognitive decline, yet are under-recognized and often challenging to treat. With this in mind, the Alzheimer’s Association convened a Research Roundtable in May 2016, bringing together experts from academia, industry, and regulatory agencies to discuss the latest understanding of NPSs and review the development of therapeutics and biomarkers of NPSs in AD. This review will explore the neurobiology of NPSs in AD and specific symptoms common in AD such as psychosis, agitation, apathy, depression, and sleep disturbances. In addition, clinical trial designs for NPSs in AD and regulatory considerations will be discussed.

Full reference: Lanctôt, K.L. et al. (2017) Neuropsychiatric signs and symptoms of Alzheimer’s disease: New treatment paradigms. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. Published online: 5th August 2017

Delayed-onset post-traumatic stress disorder symptoms in dementia

In this review, Tarun Kuruvilla et al. consider three examples of delayed-onset PTSD and its frequent association, or misdiagnosis, as one of the numerous manifestations of the behavioural and psychological symptoms of dementia | Progress in Neurology and Psychiatry

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Image source: Progress in Neurology and Psychiatry

Dementia sufferers commonly experience non-cognitive symptoms as their disease progresses. These symptoms are often labelled as behavioural and psychological symptoms of dementia (BPSD) and encompass a broad range of symptoms relating to mood changes such as depression and anxiety, psychosis, and inappropriate behaviours like wandering, shouting and agitation. Post-traumatic stress disorder (PTSD) is a common diagnosis amongst working-age adults but it is infrequently diagnosed in the elderly, particularly those with dementia. Previous case reports have published examples of dementia sufferers experiencing post-traumatic stress disorder symptoms long after the original traumatic event. Despite these examples, little is known about the manifestation of traumatic exposure in the older adult population. We consider whether delayed-onset post-traumatic symptoms in the elderly are being misdiagnosed, instead falling under the umbrella of BPSD. In this article, we attempt to expand on previous work by describing three cases of delayed-onset PTSD associated with the development of dementia. We explore potential biological and psychosocial theories to explain the aetiology of these symptoms with reference to the literature. We end by considering the clinical implications for future practice, including suggestions for improved diagnosis and management.

Full reference: Martinez-Clavera, C. et al. (2017) Delayed-onset post-traumatic stress disorder symptoms in dementia. Progress in Neurology and Psychiatry. Vol. 21 (no. 03).

The management of behavioural and psychological symptoms of dementia in the acute general medical hospital

White, N. et al. (2017) International Journal of Geriatric Psychiatry. 32(3) p. 297-305

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Background: The acute hospital is a challenging place for a person with dementia. Behavioural and psychological symptoms of dementia (BPSD) are common and may be exacerbated by the hospital environment. Concerns have been raised about how BPSD are managed in this setting and about over reliance on neuroleptic medication. This study aimed to investigate how BPSD are managed in UK acute hospitals.

Conclusions: Antipsychotic medications and psychosocial interventions were the main methods used to manage BPSD; however, these were not implemented or monitored in a systematic fashion.

Read the full article here

Behavioural and psychological symptoms in patients with dementia, distress for nursing staff and complications in care

Hessler, J. B. et al. (2017) Source Epidemiology and psychiatric sciences (01) p. 1-10

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Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care.

BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.

Read the full abstract here

The use of non-pharmacological interventions for dementia behaviours in care homes

Backhouse, T. et al. (2016) Age Ageing. 45(6) pp.856-863

Background: Antipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions (NPIs) have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD.

Conclusions: There is a gap between rhetoric and practice with most NPIs in care homes used as social activities rather than as targeted interventions. If NPIs are to become viable alternatives to antipsychotic medications in care homes, further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.

Read the full abstract here

Psychological Dimensions of Dementia: Putting the Person at the Centre of Care

The following report, put together by the British Psychological Society Dementia Advisory Group, presents a psychological perspective on the nature and experience of dementia

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Image source: BPS 

As well as outlining the roles and contributions of psychologists in the field of dementia care (particularly in supporting a move towards addressing dementia not only in terms of the underlying disease but also in considering the practical dimensions of social and cognitive disability associated with it), this report presents recommendations for action in the following areas:

  • Prevention
  • Assessment
  • Planning of care
  • Treatment and support
  • Dealing efectively and appropriately with families and carers
  • Training and research

These recommendations were produced in consultation with people experiencing dementia, their families, and their carers, in order to present a truly person-centred approach to dementia treatment and management in the UK.

Read the overview here

Read the full report here

Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study

BMC Geriatrics 2015, 15:90

Background
General practitioners (GPs) are in best position to suspect dementia. Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) are widely used. Additional neurological tests may increase the accuracy of diagnosis. We aimed to evaluate diagnostic ability to detect dementia with a Short Smell Test (SST) and Palmo-Mental Reflex (PMR) in patients whose MMSE and CDT are normal, but who show signs of cognitive dysfunction.

Methods
This was a 3.5-year cross-sectional observational study in the Memory Clinic of the University Department of Geriatrics in Bern, Switzerland. Participating patients with normal MMSE (>26 points) and CDT (>5 points) were referred by GPs because they suspected dementia. All were examined according to a standardized protocol. Diagnosis of dementia was based on DSM-IV TR criteria. We used SST and PMR to determine if they accurately detected dementia.

Results
In our cohort, 154 patients suspected of dementia had normal MMSE and CDT test results. Of these, 17 (11 %) were demented. If SST or PMR were abnormal, sensitivity was 71 % (95 % CI 44–90 %), and specificity 64 % (95 % CI 55–72 %) for detecting dementia. If both tests were abnormal, sensitivity was 24 % (95 % CI 7–50 %), but specificity increased to 93 % (95 % CI 88–97 %).

Conclusion
Patients suspected of dementia, but with normal MMSE and CDT results, may benefit if SST and PMR are added as diagnostic tools. If both SST and PMR are abnormal, this is a red flag to investigate these patients further, even though their negative neuropsychological screening results.

via BMC Geriatrics | Full text | Detecting dementia in patients with normal neuropsychological screening by Short Smell Test and Palmo-Mental Reflex Test: an observational study.

Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment

Alzheimer’s & Dementia – Published Online: June 18, 2015

Abstract:

Neuropsychiatric symptoms (NPS) are common in dementia and in predementia syndromes such as mild cognitive impairment (MCI). NPS in MCI confer a greater risk for conversion to dementia in comparison to MCI patients without NPS.

NPS in older adults with normal cognition also confers a greater risk of cognitive decline in comparison to older adults without NPS. Mild behavioral impairment (MBI) has been proposed as a diagnostic construct aimed to identify patients with an increased risk of developing dementia, but who may or may not have cognitive symptoms.

We propose criteria that include MCI in the MBI framework, in contrast to prior definitions of MBI. Although MBI and MCI can co-occur, we suggest that they are different and that both portend a higher risk of dementia. These MBI criteria extend the previous literature in this area and will serve as a template for validation of the MBI construct from epidemiologic, neurobiological, treatment, and prevention perspectives.

via Neuropsychiatric symptoms as early manifestations of emergent dementia: Provisional diagnostic criteria for mild behavioral impairment – Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.