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

NIHR: low-cost video technology may help care home residents feel more connected to peers

NIHR | March 2021 | Virtual quizzes involving several care homes are feasible and might reduce loneliness and social isolation

Twenty-two care home residents, from three homes, volunteered to take part in virtual quizzes (8), which included conversation of around fifteen minutes duration before 20 straightforward quiz questions. Care staff helped to facilitate, Skype TV was used in most cases and residents took it in turns to use webcams.

Participants talked about ‘our home’s pride’ and ‘top star’ residents who could answer questions. Many residents participated in multiple sessions and some who initially observed took part in later sessions.

Four themes emerged from interviews with staff and residents:

  1. Residents with moderate-advanced dementia remembered faces and conversations but could not recall having seen the technology before. They expressed happiness when remembering conversations with people ‘outside’ of their care home, and answering questions in a ‘game’. They could recall details such as the gender or clothing of people who had spoken.
  2. Residents felt more connected with others. Within the same care home, residents learnt more about each other’s backgrounds and interests, and spoke fondly about their ‘teammates’. Across care homes, residents enjoyed comparing features of their environments.
  3. Residents re-gained a sense of self by sharing their stories and remembering their pasts with people of a similar age. One resident said the sessions were encouraging her to regain an interest in technology, but two expressed some insecurities, worrying that others may not like their image, and that ‘just anyone’ could see. However, the residents acknowledged that everyone on the calls had been friendly, and that they could move away from the screen if they wished.
  4. The virtual quizzes provided relief from loneliness or boredom. Most residents said the video calls helped them to ‘pass the time’ and gave them ‘something to do’. Residents said the quizzes encouraged them to get to know others within the same home more than passive activities, such as watching TV. Across care homes, residents were surprised that there were so many people with similar interests or professions, or who had grown up in the same area as they had.

Full details are available from the NIHR Alert

Primary paper by Zamir et al, 2021 is avaialble from Geriatrics

NIHR Alert: Careful phrasing of requests by hospital staff could help people with dementia accept care

NIHR | December 2020 | Careful phrasing of requests by hospital staff could help people with dementia accept care

“Healthcare professionals in acute hospitals are not generally trained in how to communicate with people with dementia. This has an impact on their job satisfaction and stress levels. People with dementia and their relatives also report dissatisfaction with communication in hospital.”

Rebecca O’Brien, Study Author, Clinical Researcher School of Health Sciences/ Division of Rehab, Ageing and Well-being University of Nottingham
This study intended to provide healthcare professionals with ways to communicate more effectively with people living with dementia (PLWD). The authors analysed video recordings of HCPs and PWDs interactions from three inpatient wards. Their analysis led to a recognition of requests which led to patients agreement or refusal
The experts also recognise that no manner of verbal requesting would guarantee compliance or ultimately override a patient’s right to refuse to comply with a request. They identify several features of requests can be seen to precede acceptance, principally the use of higher entitlement requests, and the lowering of contingencies. This indicates that by varying tone, phrasing and question construction led to a more positive response from patients who were confused or resisting care.

The authors want to equip health professionals with the skills to make requests in different ways. O’Brien also wants “policymakers to understand the importance of the need to train staff in communication skills.” (Source: NIHR and O’Brien et al, 2020)

O’Brien, R., Beeke, s., Pilnick, A. & Harwood, R.H. | 2020| When people living with dementia say ‘no’: Negotiating refusal in the acute hospital setting | Social Science and Medicine | Vol. 263 113188

Abstract

A quarter of UK acute hospital beds are occupied by people living with dementia (PLWD). Concerns have been raised by both policy makers and carers about the quality of communication between hospital staff and PLWD. PLWD may experience communication impairments such as word finding difficulties, limited ability to construct coherent narratives and difficulties understanding others. Since much healthcare delivery occurs through talk, healthcare professionals (HCPs) and PLWD are likely to experience increased communication barriers. Consistent with this, HCPs report stress and reduced job satisfaction associated with difficulty communicating with PLWD. HCPs face these challenges whilst striving to deliver person-centred care, respecting the autonomy and wishes of the patient before them. However, best practice recommendations in the field tend not to be based on actual interactional evidence. This paper investigates recurring interactional difficulties around HCP requests to carry out health and social care tasks and subsequent reluctance or refusal on the part of PLWD. Using conversation analysis, we examined 41 video recordings of HCP/PLWD interactions collected across three acute inpatient wards. We identify both the nature of the refusals, and any mitigation offered, and explore the requests preceding them in terms of entitlement and contingency. We also explore the nature of HCP requests which precede PLWD agreement with a course of action. We conclude that several features of requests can be seen to precede acceptance, principally the use of higher entitlement requests, and the lowering of contingencies. Our findings underline the importance of examining the contextual interactional detail involved in the negotiation of healthcare, which here leads to an understanding of how design of HCP requests can impact on an important healthcare activity being carried out. They also emphasise the power of conversation analytic methods to identify areas of frequent interactional trouble in dementia care which have not previously been articulated.

Primary paper is available from Social Science & Medicine

NIHR Alert Careful phrasing of requests by hospital staff could help people with dementia accept care

NIHR: VOICE training for healthcare professionals aids communication with dementia patients

NIHR | November 2020 | VOICE training for healthcare professionals aids communication with dementia patients

The NIHR highlights how a training course has improved the confidence and communication skills of healthcare staff in treating and caring for patients with dementia.

Around 25 per cent of hospital beds are occupied by patients with dementia and their difficulties with communication can make treating other co/multi-morbidities more challenging. In many cases these problems are made worse by admission to hospital because they are unsettled by the change of environment, illness and seeing unfamiliar faces. 

Earlier studies underlined that clinicians currently receive very little or no dementia specific training to help them care for patients with dementia, despite the high number of patients with dementia in emergency care and acute settings. This enabled the NIHR to recognsie the potential benefit of appropriate dementia-specific training for healthcare professionals and, through its Health Services and Delivery Research (HS&DR) Programme, funded the VOICE (VideOing to Improve Communication Education) study to evaluate and deliver a new training programme. 

Led by Professor Rowan Harwood at the University of Nottingham, the VOICE study has shown promising results that evidence-based communication skills training for health professionals can improve their communication with patients with dementia.

The researchers developed a practical skills training course and online e-learning resource with the help of experts in communication skills training and carers of people with dementia. Actors were specially trained in simulating people with dementia, by the researchers to recreate the types of situations that healthcare professionals face in their everyday roles. The training course was tested on forty healthcare professional to determine whether they experienced improvements in their confidence and skills in communicating with people with dementia. At the outset the clinicians were asked to self-assess their confidence and a month after completing the training course they repeated this self-assessment. The study demonstrates that the intervention improves the communication skills of the healthcare professionals which will benefit patients by improving determination of needs, provision of comfort, reduce distress, and enhance inclusion in decision making.

Now the VOICE training course has been delivered to more than 180 healthcare professionals across the UK. Included in this number are 31 healthcare professionals who “trained as trainers”, and the 54 they went on to train at five English hospital trusts. More training has been planned for the future. The full impact news story is available from NIHR

Project information for the VOICE study is available from NIHR

First patient trial will test new approach to treating Alzheimer’s disease

UCL | October 2018 | First patient trial will test new approach to treating Alzheimer’s disease

A new clinical trial that is using a novel approach to the progression of Alzheimer’s disease is being led by UCL researchers in London. The trial known as DESPIAD will study whether a drug that removes a protein from the brain can help patients with Alzheimer’s disease. 

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 “After a long struggle for funding of our different approach to possible treatment of Alzheimer’s disease, it is exciting to finally have started the DESPIAD trial, which has been made possible by the NIHR and the Wolfson Foundation. We now hope it can proceed as swiftly as possible,” said Professor Sir Mark Pepys (UCL Medicine), who led the development of the new drug.

Almost all medications tested have been focussed on the abnormal fibrous protein accumulations, known as amyloid plaques and neurofibrillary tangles, which are always present in the brain in Alzheimer’s disease. The drugs have aimed at removing or preventing the formation of these abnormal deposits (Source: UCL).

For the full details of the trial, read the press release from  UCL 

See also:

NIHR | Landmark new trial starts for novel Alzheimer’s disease treatment