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

Alzheimer’s Society: 5 ways our new early career researchers are helping defeat dementia

The Alzheimer’s Society | 26 April 2021 | 5 ways our new early career researchers are helping defeat dementia

The Alzheimer’s Society has announced, that thanks to its supporters generosity over the past year, they are now able to fund early career researchers whose work has hung in the balance due to the pandemic.

The Alzheimer’s Society are investing over £800,000 into exciting research projects led by PhD students and postdoctoral fellows. Not only will these projects advance dementia research but they will help secure the positions for our dementia researcher leaders of tomorrow. 

It outlines five research projects they are funding:

  1. How certain factors could increase the risk of developing dementia
  2. How brain cells die in diseases causing dementia
  3.  How we could treat dementia
  4. How we can improve the quality of life for those living with dementia
  5. How we can support with quality end-of-life care planning-

The full details about each of these projects plus links to the project homepage are available from The Alzheimer’s Society

5 ways our new early career researchers are helping defeat dementia

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]

For a copy of this article contact the Library

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

Stirling researchers explore how assistive tech can help people with dementia

University of Stirling | February 2021 | Uni researchers explore how assistive tech can help people with dementia

A new research project will explore how assistive technology, such as telecare devices, can better support residents in retirement living schemes and those living with long-term conditions such as dementia.

The project INVITE (promoting inclusive living via technology-enabled support) is being funded by Longleigh Foundation and will investigate the success of assistive and everyday technologies in retirement living schemes and what further technologies might be required in the future.

This piece of research will combine the expertise of three acadmeics from the University of Stirling: Dr Jane Robertson, Dr Vikki McCall and Dr Grant Gibson from the Faculty of Social Sciences. Other stakeholders involved include the social housing provider Stonewater, as well as other experts from Stirlings Dr Steve Rolfe, a Research Fellow with expertise in housing, and Angela Pusram, a Research Assistant with expertise in dementia, will work with Stonewater’s retirement communities and their families in three localities of England – Eastbourne, Hereford and Nottingham (Source: University of Stirling).

Full details are available from the University of Stirling

Cambridge Research: Apathy could predict onset of dementia years before other symptoms

University of Cambridge | October 2020 |Apathy could predict onset of dementia years before other symptoms

A team of researchers led by Professor James Rowe at the University of Cambridge have shown how apathy predicts cognitive decline even before the dementia symptoms emerge. 

This longitudinal study followed 304 healthy participants who carry a faulty gene that causes frontotemporal dementia (FTD), and 296 of their relatives who have normal genes. All particpants were assessed at the outset of the study and every two years over several years. None had dementia, and most people in the study did not know whether they carry a faulty gene or not. The researchers looked for changes in apathy, memory tests and MRI scans of the brain, and they found that apathy severity increased over time in presymptomatic carriers, but not in non‐carriers. Among those who carried the gene , baseline gray matter volume of frontal lobe and cingulate cortex predicted the faster progression of apathy over 2 years. (Source: Malpetti, et al, 2020 & University of Cambridge).

“By studying people over time, rather than just taking a snapshot, we revealed how even subtle changes in apathy predicted a change in cognition, but not the other way around,” explained Malpetti, the study’s first author. “We also saw local brain shrinkage in areas that support motivation and initiative, many years before the expected onset of symptoms. The more we discover about the earliest effects of frontotemporal dementia, when people still feel well in themselves, hte better we can treat symptoms and delay or even prevent the dementia.

First author of the study Dr Maura Malpetti

The paper discusses how apathy is an early marker of FTD‐related changes and predicts a subsequent subclinical deterioration of cognition before dementia onset.

Malpetti, M. et al (2020)| Apathy in presymptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes| Alzheimer’s & Dementia |https://doi.org/10.1002/alz.12252

Abstract
Introduction

Apathy adversely affects prognosis and survival of patients with frontotemporal dementia (FTD). We test whether apathy develops in presymptomatic genetic FTD, and is associated with cognitive decline and brain atrophy.

Methods

Presymptomatic carriers of MAPTGRN or C9orf72 mutations (N = 304), and relatives without mutations (N = 296) underwent clinical assessments and MRI at baseline, and annually for 2 years. Longitudinal changes in apathy, cognition, gray matter volumes, and their relationships were analyzed with latent growth curve modeling.

Results

Apathy severity increased over time in presymptomatic carriers, but not in non‐carriers. In presymptomatic carriers, baseline apathy predicted cognitive decline over two years, but not vice versa. Apathy progression was associated with baseline low gray matter volume in frontal and cingulate regions.

Discussion

Apathy is an early marker of FTD‐related changes and predicts a subsequent subclinical deterioration of cognition before dementia onset. Apathy may be a modifiable factor in those at risk of FTD.

Primary paper is published in the journal Alzheimer’s & Dementia

University of Cambridge Apathy could predict onset of dementia years before other symptoms

Apathy in presymptomatic genetic frontotemporal dementia predicts cognitive decline and is driven by structural brain changes

In the news:

Science Daily Apathy could predict onset of dementia years before other symptoms

The Daily Mail Apathy and lack of motivation in your mid-forties could be an early warning sign of dementia, study suggests

Alzheimer’s Research: Progressing towards a tau blood test for Alzheimer’s disease

Alzheimer’s Research UK | July 2020 | Progressing towards a tau blood test for Alzheimer’s disease

  • Four new studies presented at the Alzheimer’s Association International Conference (AAIC) and two published papers show that levels of tau, a hallmark protein of Alzheimer’s disease, in the blood could be used to detect the disease
  • The research focuses on a specific form of tau, p-tau217
  • The new data suggests blood levels of p-tau217 can predict the development of Alzheimer’s disease before symptoms appear, track well with levels of tau in the brain and distinguish Alzheimer’s from other diseases that cause dementia

Researchers from both the US and Europe have presented data that indicates levels of a specific form of tau, one of the hallmark proteins of Alzheimer’s disease, can be measured in blood to detect the disease, even before symptoms appear. 

Full details of the studies are available from Alzheimer’s Research UK

In the news:

The Independent ‘Exciting’ results on blood test that could detect Alzheimer’s 20 years before memory falter

BBC News Alzheimer’s: ‘Promising’ blood test for early stage of disease

The Telegraph Flu jab may reduce risk of dementia by a fifth, study finds

Finding a life-changing treatment for dementia

Alzheimer’s Research UK has called on government to invest in six priority research areas, which will help to deliver a life-changing treatment for dementia

moonshot
Image source: https://www.alzheimersresearchuk.org/

In their 2019 manifesto, the Conservative party pledged to launch a “Dementia Moonshot” to find a cure for dementia – doubling research funding and speeding up trials for new treatments.

Alzheimer’ Research UK are now calling for action to deliver on those commitments. In this publication, Alzheimer’s UK puts forward the steps government must take to deliver its Moonshot ambition of finding a life-changing treatment for dementia.

 

 

These are:

  1. Find ways to detect the diseases that cause dementia 10-15 years earlier, to broaden the search for new treatments and intervene with those most at risk of developing dementia.
  2. Find ways to more effectively validate novel targets in early drug development to maximise chances of successful clinical trials.
  3. Make the UK the best place to conduct clinical dementia research.
  4. Expand research infrastructure to maintain the UK’s position as a world leader in dementia research.
  5. Further our understanding of dementia risk reduction and prevention and dementia in the context of multi-morbidities.

Full document: Delivering the Dementia Moonshot: A plan to find life-changing treatments 

Are large simple trials for dementia prevention possible?

William N Whiteley et al. | Are large simple trials for dementia prevention possible? | Age and Ageing | published 12th December 2019

  • Large simple trials have transformed care for heart attack and stroke. Lessons from these trials may be applicable to dementia prevention.
  • The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge. The reliable identification of higher risk populations is difficult but will be important.
  • Patients and families prioritise loss of function. Loss of functional abilities or clinical dementia are infrequent, but might be measured with lower variability than cognitive scores.

Abstract

New trials of dementia prevention are needed to test novel strategies and agents. Large, simple, cardiovascular trials have successfully discovered treatments with moderate but worthwhile effects to prevent heart attack and stroke. The design of these trials may hold lessons for the dementia prevention.Here we outline suitable populations, interventions and outcomes for large simple trials in dementia prevention. We consider what features are needed to maximise efficiency. Populations could be selected by age, clinical or genetic risk factors or clinical presentation. Patients and their families prioritise functional and clinical outcomes over cognitive scores and levels of biomarkers. Loss of particular functions or dementia diagnoses therefore are most meaningful to participants and potential patients and can be measured in large trials.

The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge and will need collaboration between many clinical investigators, funders and patient organisations.

Full article: Are large simple trials for dementia prevention possible?

Biggest ever map of human Alzheimer’s brain published

Alzheimer’s Research UK | February 2019| Biggest ever map of human Alzheimer’s brain published

A study of the differences between healthy brains and those with Alzheimer’s Disease has produced largest dataset of its type ever.

The team included researchers from the Universities of Manchester, Bristol, Liverpool and Auckland. The dataset is now freely available online for any scientist to use.

The research team also show that one region of the brain previously thought to be unaffected by the disease, the cerebellum, displayed a series of changes which they think might protect it from damage caused by Alzheimer’s.

brain-1787622_640 (1).jpg

The development is an important advance for scientists researching Alzheimer’s. Their analysis, mapped the relative levels of over 5,825 distinct proteins across six regions of the brain, generated a massive 24,024 data points.

The brain regions in the study included the more heavily affected Hippocampus, Entorhinal cortex, Cingulate gyrus and the less affected Motor Cortex, Sensory Cortex, and Cerebellum.

Full details from Alzheimer’s Research UK

See also: University of Manchester Biggest ever map of human Alzheimer’s brain published