Physical fitness and dementia risk in the very old: a study of the Lothian Birth Cohort 1921

 Sibbett, R. A., Russ, T.C.,  Allerhand, M., Deary, I.J., &  Starr, J. M. | 2018| Physical fitness and dementia risk in the very old: a study of the Lothian Birth Cohort 1921 |BMC Psychiatry |  18 | 285 | https://doi.org/10.1186/s12888-018-1851-3

A new article in the BMC Psychiatry examines physical fitness and dementia risk in the very old (participants aged 79 at starting point of the study). Unlike previous studies whch have found an association with old age and dementia risk, this study found that lower fitness beyond age 79 was not a risk factor for subsequent dementia.

Abstract 

Background

Previous studies have demonstrated that individual measures of fitness – such as reduced pulmonary function, slow walking speed and weak handgrip – are associated with an increased risk of dementia. Only a minority of participants included in these studies were aged over 80. The aim of this study was therefore to investigate the association between physical fitness and dementia in the oldest old.
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Methods

Subjects (n = 488) were enrolled in the Lothian Birth Cohort 1921 and aged 79 at baseline. Dementia cases arising after enrolment were determined using data from death certificates, electronic patient records and clinical reviews. Fitness measures included grip strength, forced expiratory volume in 1 s (FEV1) and walking speed over 6 m, measured at 79 years. Dementia risk associated with each fitness variable was initially determined by logistic regression analysis, followed by Cox regression analysis, where death was considered as a competing risk. APOE ε4 status, age, sex, height, childhood IQ, smoking, history of cardiovascular or cerebrovascular disease, hypertension and diabetes were included as additional variables. Cumulative incidence graphs were calculated using Aalen-Johansen Estimator.

Results

Although initial results indicated that greater FEV1 was associated with an increased risk of dementia (OR (odds ratio per unit increase) 1.93, p = 0.03, n = 416), taking into account the competing risk of mortality, none of the fitness measures were found to be associated with dementia; FEV1 (HR (hazard ratio per unit increase) 1.30, p = 0.37, n = 416), grip strength (HR 0.98, p = 0.35, n = 416), walking speed (HR 0.99, p = 0.90, n = 416). The presence of an APOE ɛ4 allele was however an important predictor for dementia (HR 2.85, p < 0.001, n = 416). Cumulative incidence graphs supported these findings, with an increased risk of dementia for APOE ɛ4 carriers compared with non-carriers. While increased FEV1 was associated with reduced risk of death, there was no reduction in risk for dementia.

Conclusions

In contrast to previous studies, this study found that lower fitness beyond age 79 was not a risk factor for subsequent dementia. This finding is not explained by those with poorer physical fitness, who would have been more likely to develop dementia, having died before onset of dementia symptoms.

The full article can be read at BMC Psychiatry

What features of stigma do the public most commonly attribute to Alzheimer’s disease dementia? Results of a survey of the U.S. general public

Stites, S. D., Rubright, J. D., & Karlawish, J. |2018| What features of stigma do the public most commonly attribute to Alzheimer’s disease dementia? Results of a survey of the US general public| Alzheimer’s & Dementia | Vol. 14 | 7 | P. 925- 932 | DOI: https://doi.org/10.1016/j.jalz.2018.01.006

A new abstract presented at last month’s Alzheimer’s Association Conference in Chicago has been published as a journal article in Alzheimer & Dementia, the journal of the Alzheimer’s Association. 

Abstract

Introduction

Understanding the prevalence of beliefs, attitudes, and expectations about Alzheimer’s disease dementia in the public could inform strategies to mitigate stigma.

Methods

Random sample of 317 adults from the U.S. public was analyzed to understand reactions toward a man with mild-stage Alzheimer’s disease dementia.

Results

In adjusted analyses, over half of respondents expected the person to be discriminated against by employers and be excluded from medical decision-making. Almost half expected his health insurance would be limited based on data in the medical record, a brain imaging result, or genetic test result.

Discussion

Public education and policies are needed to address concerns about employment and insurance discrimination. Studies are needed to discover how advances in diagnosis and treatment may change Alzheimer’s disease stigma.

The article is available for NHS staff to request here 

Black men receiving less dementia diagnoses than white peers

Homecare| July 2018 | Black men receiving less dementia diagnoses than white peers

Data presented at the recent Alzheimer’s Association International Conference (AAIC)  in Chicago last month, shows that black males are 11 per cent less likely to receive a diagnosis of dementia. This is despite dementia having a higher prevalence in black men than white males. Researchers from University College London, King’s College London are behind the research findings. 

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Dr Doug Brown, chief policy and research officer at Alzheimer’s Society said:

“This research adds flesh to the bones of a worrying pattern we’re starting to see in the UK. Black men are receiving fewer diagnoses than white men, despite prevalence being higher amongst black men.“Everyone has the right to know what condition they have and the right to the care and support they need. A dementia diagnosis gives people an answer and access to this. It is vital that everyone has equal access to a diagnosis, regardless of their race, gender, age or postcode, and we will continue to build on our work with government to make sure this happens.”

The full story is at Homecare
Of interest:

Alzheimer’s Society 3 hot topics from the world’s largest dementia research conference

New research on the impact of exercise for people with dementia

The BMJ has published a trial on the effects of moderate to high intensity exercise for people with dementia.  

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Image source: bmj.com

Abstract

Objective To estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia.

Design Multicentre, pragmatic, investigator masked, randomised controlled trial.

Setting National Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions.

Participants 494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm.

Interventions Usual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises.

Main outcome measures The primary outcome was score on the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention.

Results The average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm. This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer’s disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m).

Conclusion A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.

Trial registration Current Controlled Trials ISRCTN10416500.

Full reference:
Lamb,  S.E.Sheehan, B.Atherton N.Nichols V.Collins H.Mistry Dipesh et al|Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial |

The article is available at the BMJ 

In the media:

The Guardian Rigorous exercise does not halt dementia decline, study concludes

BBC News  Dementia exercise programmes ‘don’t slow brain decline’

Join Dementia Research (JDR) NHS toolkit for healthcare professionals

Join Dementia Research has produced an online toolkit for healthcare professionals.

The toolkit has been divided into four sections:

  • Integrating Research with Care
  • Establishing a Research Culture
  • Building Research Partnerships
  • Working Collaboratively to Raise Awareness

JDR also have a variety of case studies as a resource for healthcare professionals to support implementation of Join Dementia Research into NHS care pathways. They showcase work from across the health and social care environments, sharing stories, ideas, tips and tools to support delivery – putting research with care.

For full details, visit the Join Dementia Research website

The European Prevention of Alzheimer’s Dementia (EPAD) Longitudinal Cohort Study

EPAD is looking for participants aged 50 and above without a diagnosis of dementia to take part in a Europe-wide major study. . All study participants are required to have a partner,  friend or relative who can also attend study visits . Volunteers should generally be in good health, and cannot have been diagnosed with cancer in the last 5 years.

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Image source: http://ep-ad.org/

EPAD is a major study which takes place all over Europe, and is led from the University of Edinburgh. It is one of the biggest dementia studies in the world and as such, it is hugely important that researchers are able to recruit lots of volunteers into the study.

The aim of the study is to find early changes that happen in the brain when dementia starts developing.

Full details available at Join Dementia Research

Dementia-related Stigma Research

Herrmann, Lynn K et al | A Systematic Review of Dementia-related Stigma Research: Can We Move the Stigma Dial?The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry | Mar 2018; vol. 26 (no. 3); p. 316-331

Abstract:

Stigma negatively affects individuals with cognitive impairment and dementia. This literature review examined the past decade (January 2004 to December 2015) of world-wide research on dementia-related stigma.

Using standard systematic review methodology, original research reports were identified and assessed for inclusion based on defined criteria. Initial database searches yielded 516 articles. After removing duplicates and articles that did not fit inclusion criteria (419), 97 articles were reviewed, yielding a final total of 51 publications, mainly originating in the United States and Europe. Studies were assessed for date, geographic region, sample description, methodology, and key findings.

Reports were evaluated on 1) how stigmatizing attitudes may present in various subgroups, including in racial or ethnic minorities; 2) stigma assessment tools; and 3) prospective or experimental approaches to assess or manage stigma.

Stigma impedes help-seeking and treatment, and occurs broadly and world wide. Stigmatizing attitudes appear worse among those with limited disease knowledge, those with little contact with people with dementia, in men, in younger individuals, and in the context of ethnicity and culture.

In some cases, healthcare providers may have stigmatizing attitudes. In research studies, there does not appear to be consensus on how to best evaluate stigma, and there are few evidence-based stigma reduction approaches.

Given the projected increase in persons with dementia globally, there is a critical need for research that better identifies and measures stigma and tests new approaches that can reduce stigmatizing attitudes.

 

A life-course approach to prevent dementia

This article discusses the need for more research to better understand dementia and to find the approaches to dementia that are effective | Bulletin of the World Health Organisation

In this article, Carol Brayne, one of the world’s leading researchers on dementia and the public health of brain ageing discusses the important role of research in understanding Dementia.

Full document available here

A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025

Pickett JBird CBallard C, et al. | A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025 | International Journal of Geriatric Psychiatry  201817

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  • A broad-based taskforce of researchers, clinicians, UK funders of dementia research, people with dementia, and carer representatives was convened to generate consensus on research ambitions in prevention, diagnosis, intervention, and care for people with dementia.
  • Five goals and 30 recommendations that align with current national dementia strategies and plans were produced. A 10-point action plan was developed to support the delivery of these goals.

Abstract

Objective

National and global dementia plans have focused on the research ambition to develop a cure or disease-modifying therapy by 2025, with the initial focus on investment in drug discovery approaches. We set out to develop complementary research ambitions in the areas of prevention, diagnosis, intervention, and care and strategies for achieving them.

Methods

Alzheimer’s Society facilitated a taskforce of leading UK clinicians and researchers in dementia, UK funders of dementia research, people with dementia, and carer representatives to develop, using iterative consensus methodology, goals and recommendations to advance dementia research.

Results

The taskforce developed 5 goals and 30 recommendations. The goals focused on preventing future cases of dementia through risk reduction, maximising the benefit of a dementia diagnosis, improving quality of life, enabling the dementia workforce to improve practice, and optimising the quality and inclusivity of health and social care systems. Recommendations addressed gaps in knowledge and limitations in research methodology or infrastructure that would facilitate research in prioritised areas. A 10-point action plan provides strategies for delivering the proposed research agenda.

Conclusions

By creating complementary goals for research that mirror the need to find effective treatments, we provide a framework that enables a focus for new investment and initiatives. This will support a broader and more holistic approach to research on dementia, addressing prevention, surveillance of population changes in risk and expression of dementia, the diagnostic process, diagnosis itself, interventions, social support, and care for people with dementia and their families.

Full document: A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025

Dementia research must study care as well as cure

In this article, Doug Brown, Chief policy and research officer at Azheimers Society explores research investment in dementia.  He finds that there is a strong focus on finding a cure, with less than 5% of funding studying the best possible care for those affected | Story via The Guardian

The need for a cure for dementia is as pressing as ever, but we also need care research to develop practical solutions that can benefit people with the condition and their carers. In this article, Doug Brown argues that Improving knowledge and practices among health and social care professionals, as well as the quality and inclusivity of the wider system, is just as important as developing medical treatments.

A new Alzheimer’s Society report asked researchers, people with dementia, and the professionals who support them to help create a roadmap for the research needed to deliver these improvements. The roadmap offers five key goals:

  • Increase knowledge of risk factors to prevent future cases of dementia
  • Maximise the benefits of seeking and receiving a dementia diagnosis
  •  Improve quality of life for people affected by dementia
  •  Enable the dementia workforce to deliver improved practice
  •  Optimise quality and inclusivity of health and social care systems

These broad research goals are broken down into recommendations and an action plan that will help achieve them.

Full article via The Guardian

Related: Dementia research roadmap for prevention, diagnosis, intervention and care by 2025 | Azheimers Society