Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis

Cherbuin, N. et al. BMJ Open 2015;5:e008853

Objectives To perform a systematic review of reported HRs of all cause dementia, Alzheimer’s disease (AD) and vascular dementia (VaD) for late-life depression and depressive symptomatology on specific screening instruments at specific thresholds.

 

Results Searches yielded 121 301 articles, of which 36 (0.03%) were eligible. Included studies provided a combined sample size of 66 532 individuals including 6593 cases of dementia, 2797 cases of AD and 585 cases of VaD. The increased risk associated with depression did not significantly differ by type of dementia and ranged from 83% to 104% for diagnostic thresholds consistent with major depression. Risk associated with continuous depression symptomatology measures were consistent with those for clinical thresholds.

 

Conclusions Late-life depression is consistently and similarly associated with a twofold increased risk of dementia. The precise risk estimates produced in this study for specific instruments at specified thresholds will assist evidence-based medicine and inform policy on this important population health issue.

Interventions in supporting self-management of informal caregivers: Systematic Review

Informal caregivers of people with dementia face the challenge of  managing the consequences of dementia in daily life. This meta-review makes an attempt to synthesize evidence from previous systematic reviews about professional self-management support interventions for this group.

Full reference: Huis in het Veld, J et al. The effectiveness of interventions in supporting self-management of informal caregivers of people with dementia; a systematic meta reviewBMC Geriatrics 2015, 15:147

Qualitative studies of psychosocial interventions for dementia: a systematic review

Objectives: Whilst a range of psychosocial interventions are used for people with dementia, there lacks evidence for the processes which underpin them. Systematic reviews focus on quantitative studies and there is a lack of qualitative reviews in the area. The review aimed to address this gap by exploring what existing qualitative studies reveal about the implementation, effects and processes of psychosocial interventions for dementia.

Method: A systematic literature search was conducted, identifying 363 studies. Sixteen studies were found to meet the inclusion criteria and assessed for quality using pre-specified criteria. Thematic analysis was used to synthesise the findings.

Results: There were 10 descriptive themes. Despite the diversity of the psychosocial interventions, there were common themes in relation to (1) contextual and individual factors affecting implementation (2) perceived impact of the interventions and (3) the processes active in achieving these effects. Study quality was adequate but variable.

Conclusion: Common processes may underlie different psychosocial interventions for dementia. The synthesis of qualitative findings can offer insight into what makes interventions ‘work’ and factors which may facilitate or impede their use.

Reference: Dugmore, O, Orrell, M & Spector, A. Qualitative studies of psychosocial interventions for dementia: a systematic review. Aging & Mental Health Volume 19, Issue 11, 2015 pages 955-967

Living positively with dementia: a systematic review and synthesis of the qualitative literature

Aging & Mental Health: Published online: 16 Jun 2015

Abstract
Objective: Little is known about how and to what extent people with dementia live positively with their condition. This study aimed to review and carry out a synthesis of qualitative studies where accounts of the subjective experiences of people with dementia contained evidence of positive states, experiences or attributes.

Methods: A meta-synthesis was undertaken to generate an integrated and interpretive account of the ability of people with dementia to have positive experiences. A methodological quality assessment was undertaken to maximize the reliability and validity of this synthesis and to contextualize the findings with regard to methodological constraints and epistemological concepts.

Findings: Twenty-seven papers were included. Three super-ordinate themes relating to positive experiences and attributes were identified, each with varying and complementing sub-themes. The first super-ordinate theme related to the experience of engaging with life in ageing rather than explicitly to living with dementia. The second theme related to engaging with dementia itself and comprised the strengths that people can utilize in facing and fighting the condition. The third theme captured how people with dementia might transcend the condition and seek ways to maintain identity and even achieve personal growth.

Conclusions: This review provides a first step towards understanding what conceptual domains might be important in defining positive outcomes for people who live with dementia. Highlighting the potential for people to have positive experiences in spite of or even because of their dementia has important implications for de-stigmatizing dementia and will enhance person-centred approaches to care.

via Taylor & Francis Online.