Comorbid Dementia Research Articles

The impact of bone mineral density screening on incident fractures and healthcare resource utilization among postmenopausal breast cancer survivors treated with aromatase inhibitors

Postmenopausal women with hormone receptor-positive breast cancer (BC) often receive aromatase inhibitor (AI) therapy. However, AIs induce bone loss and BC survivors are at an increased risk of bone fractures. This study determined whether receipt of baseline dual-energy x-ray absorptiometry (DXA) screening is associated with decreased incident fractures and lower healthcare resource utilization. We retrospectively analyzed 22,713 stage 0-III primary BC survivors who received AI therapy ≤ 1year prior to BC diagnosis from the Medicare-Linked Surveillance, Epidemiology, and End-Results database. We categorized DXA screening for those who had a procedural claim within 12months prior through 6months after first AI claim. We used propensity score methods to assess the association of DXA screening with bone fractures and health resource utilization. Of the study cohort, 62% received a DXA screening. Women with comorbid dementia, renal disease, and congestive heart failure were less likely to receive a DXA. After adjusting for confounders, BC survivors who received a DXA had a 32% decreased risk of any bone fracture compared to those who did not (hazard ratio (HR): 0.68, 95% confidence interval (CI): 0.60-0.76, p < 0.001). Similarly, those who received a DXA were less likely to be hospitalized (HR 0.73 (0.62-0.86)) or use outpatient services (HR 0.85 (0.74-0.97)). Bone density screening is associated with decreased incident bone fractures and a lower likelihood of utilizing healthcare resource for fracture-related events. Postmenopausal BC survivors treated with AIs should undergo appropriate bone density screening to reduce morbidity, mortality, and health care expenses.

Time trends in cancer and dementia related hospital admissions among Medicare fee-for-service population, 2013–2018

Cancer and dementia are two complicated morbidities that are commonly found in older adults and require substantial healthcare resources.[ [1] Caba Y. et al. The impact of dementia on cancer treatment decision-making, cancer treatment, and mortality: a mixed studies review. JNCI Cancer Spectr. 2021; 5: 1-18 Crossref Google Scholar , [2] McWilliams L. et al. A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care. Aging Ment Health. 2017; : 1-18 Google Scholar ] Caring for patients with the co-presence of cancer and dementia, who suffer from impaired cognitive function with complex medical needs, is challenging for clinicians, caregivers, and healthcare systems. With the aging US population, the increasing number of older adults with these two comorbid conditions is likely to place a high demand on hospitals. Meanwhile, the shift of care delivery from inpatient to settings such as outpatient and homes, increasing reliance on family caregivers, and improved community care support may help reduce unnecessary hospitalizations.[ 3 2021 Alzheimer's disease facts and figures Alzheimers Dement. 2021; 17: 327-406 Crossref PubMed Scopus (739) Google Scholar , 4 Federman A.D. et al. Association of a bundled hospital-at-home and 30-day postacute transitional care program with clinical outcomes and patient experiences. JAMA Intern Med. 2018; 178: 1033-1040 Crossref PubMed Scopus (88) Google Scholar , 5 Handley N.R. Bekelman J.E. The oncology hospital at home. J Clin Oncol. 2019; 37: 448-452 Crossref PubMed Scopus (23) Google Scholar ] It is important to understand the pattern of hospitalization, which is one of the major drivers of healthcare costs and high financial and caregiving burden for patients and their families, among the growing population with cancer and dementia. While there has been extensive research on the incidence, prevalence, and healthcare utilization among older adults with either cancer or dementia, existing literature examining older adults with both conditions is scarce and limited in scope. [ [1] Caba Y. et al. The impact of dementia on cancer treatment decision-making, cancer treatment, and mortality: a mixed studies review. JNCI Cancer Spectr. 2021; 5: 1-18 Crossref Google Scholar , [2] McWilliams L. et al. A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care. Aging Ment Health. 2017; : 1-18 Google Scholar , [6] Kedia S.K. et al. Health care utilization among elderly medicare beneficiaries with coexisting dementia and cancer. Gerontol Geriatr Med. 2017; 3 (p. 2333721416689042) Crossref PubMed Google Scholar , [7] Liu B. et al. Trends of hospitalizations among patients with both cancer and dementia diagnoses in New York 2007-2017. Healthc (Amst). 2021; 9100565 Google Scholar ] In particular, no national estimates exist regarding the hospitalization rates among older adults with comorbid cancer and dementia. To fill this gap, we examined the national and state-level trends in hospitalization rates among Medicare fee-for-service (FFS) beneficiaries with the co-presence of a major cancer (breast, prostate, lung, and colorectal) and dementia diagnoses. We hypothesized a growing trend of inpatient use among this population during the years 2013–2018. Due to the heterogeneity in cancer-specific prognosis and treatment, we also examined the trend of hospitalizations among this population by cancer types.

Cancer treatment decisions for people living with dementia: Experiences of family carers, a qualitative interview study.

BackgroundAs the UK population ages, the prevalence of both dementia and cancer will increase. Family carers of people with dementia who are subsequently diagnosed with cancer are often involved in treatment decisions about cancer. These decisions are uniquely challenging.ObjectivesTo explore the experience of carers involved in cancer treatment decisions for people with dementia.DesignA cross‐sectional qualitative interview study with inductive thematic analysis.Setting and ParticipantsSixteen carers of people with dementia were identified via Primary Care Research Networks and the Join Dementia Research database.ResultsThree main themes were derived: ‘already at breaking point’, which describes the extreme strain that carers were already under when the cancer diagnosis was made; ‘maintaining the status quo’, which describes how despite the gravity of a cancer diagnosis, avoiding further dementia‐related deterioration was of prime importance; and ‘LPA’, which explores the benefits and frustrations of the use of lasting powers of attorney.DiscussionCurrent services are ill‐equipped to deal with people who have a combination of dementia and cancer. Proxy decisions about cancer care are made in the context of carer stress and exhaustion, which is exacerbated by shortcomings in service provision.ConclusionsAs the prevalence of comorbid cancer and dementia rises, there is an urgent need to improve services that support carers with proxy health care decision‐making.Patient or Public ContributionThe study design was codeveloped with a local dementia‐specific patient and public involvement (PPI) group. A project‐specific PPI group was formed with support from the Alzheimer's Society Research Partnership scheme to provide further bespoke input.

Implementation of the Mental Capacity Act: a national observational study comparing resultant trends in place of death for older heart failure decedents with or without comorbid dementia

BackgroundHeart failure (HF) is increasingly prevalent in the growing elderly population and commonly associated with cognitive impairment. We compared trends in place of death (PoD) of HF patients with/without comorbid dementia around the implementation period of the Mental Capacity Act (MCA) in October 2007, this legislation supporting patient-centred decision making for those with reduced agency.MethodsAnalyses of death certification data for England between January 2001 and December 2018, describing the PoD and sociodemographic characteristics of all people ≥ 65 years registered with HF as the underlying cause of death, with/without a mention of comorbid dementia. We used modified Poisson regression with robust error variance to determine the prevalence ratio (PR) of the outcome in dying at home, in care homes or hospices compared to dying in hospital. Covariates included year of death, age, gender, marital status, comorbidity burden, index of multiple deprivation and urban/rural settings.ResultsOne hundred twenty thousand sixty-eight HF-related death records were included of which 8199 mentioned dementia as a contributory cause. The overall prevalence proportion of dementia was 6.8%, the trend significantly increasing from 5.6 to 8.0% pre- and post-MCA (Cochran-Armitage trend test p < 0.0001). Dementia was coded as unspecified (78.2%), Alzheimer’s disease (13.5%) and vascular (8.3%). Demented decedents were commonly older, female, and with more comorbidities. Pre-MCA, PoD for non-demented HF patients was hospital 68.2%, care homes 20.2% and 10.7% dying at home. Corresponding figures for those with comorbid dementia were 47.6%, 48.0% and 4.2%, respectively. Following MCA enforcement, PoD for those without dementia shifted from hospital to home, 62.5% and 17.2%, respectively; PR: 1.026 [95%CI: 1.024–1.029]. While home deaths also rose to 10.0% for those with dementia, with hospital deaths increasing to 50.4%, this trend was insignificant, PR: 1.001 [0.988–1.015]. Care home deaths reduced for all, with/without dementia, PR: 0.959 [0.949–0.969] and PR: 0.996 [0.993–0.998], respectively. Hospice as PoD was rare for both groups with no appreciable change over the study period.ConclusionsOur analyses suggest the MCA did not materially affect the PoD of HF decedents with comorbid dementia, likely reflecting difficulties implementing this legislation in real-life clinical practice.

Prevalence and Impact of Comorbid Cancer and Dementia on Health Outcomes in Older Adults: A Longitudinal Study

Dementia and cancer are two common chronic conditions in older adults. However, there are few studies examining the prevalence of comorbid cancer and dementia and the longitudinal impact of these comorbid conditions on health outcomes. This study investigated the prevalence and longitudinal impact on health outcomes in older adults with comorbid cancer and dementia. This is a secondary analysis, using data from the 2010 and 2016 waves of the Health and Retirement Study (HRS). The health outcomes of the study included nursing home stay, hospital stay, home care use, activities of daily living (ADL) limitations, instrumental activities of daily living (IADL), self-rated health status, mortality, and the out-of-pocket medical expenditure in older adults with cancer and dementia. Data were analyzed using descriptive statistics, logistic regression, and linear regression analyses. The results revealed that the prevalence of comorbid cancer and dementia ranged from 2.6% to 2.8% over the 6-year period. Older adults with comorbid cancer and dementia demonstrated higher likelihood of nursing home stay, ADL and IADL limitations, and mortality; but a decreased likelihood of homecare use and hospital stay compared to older adults with cancer only or dementia only (some outcomes were not significant for dementia only group). Findings point out the risk of increased functional decline and mortality in older adults with comorbid cancer and dementia. Future research is needed to explore the contributing factors of the risk and identify interventions to promote physical function and reduce mortality for this population.

Monitoring dementia and stroke comorbidity in Canada: Prevalence and mortality time trends among individuals aged 65+, from 2003–2004 to 2016–2017

AbstractBackgroundDementia and stroke are debilitating and interrelated conditions. This study describes the time trends in prevalence and mortality of comorbid stroke and dementia in Canada, among individuals aged 65+.MethodUsing data from the Canadian Chronic Disease Surveillance System (CCDSS) for Canadians aged 65+, Joinpoint analyses were conducted to estimate change over time (2003–2004 to 2016–2017) in the age‐standardized prevalence and all‐cause mortality of comorbid dementia and stroke. Validated case definitions were applied to longitudinal CCDSS linked administrative health data to identify comorbid cases (regardless of the sequence of disease identification). Diagnosed cases for both conditions were identified since 1996–1997, but a run‐in period was applied until 2003–2004 to allow a better capture of prevalent cases. Time trends were significant (unless otherwise noted), but differences between sexes were not significant.ResultFrom 2003–2004 to 2016–2017, the age‐standardized prevalence of the comorbidity increased from 1.4% (∼64,000 individuals) to 1.7% (∼110,000 individuals), representing an average annual percent change (AAPC) of 1.1% (females: 1.0%; males: 1.3%). The increase was more pronounced at the beginning of the period and among those aged 80‐84, 85‐89 and 90+. In contrast, during the same period, the age‐standardized prevalence rate among individuals with dementia/without stroke increased with an AAPC of 1.5% (females: 1.5%; males 1.7%), but only with an AAPC of 0.2% (not statistically significant) among those with stroke/without dementia.Following the general declining mortality pattern observed in the Canadian population, the age‐standardized all‐cause mortality rate for those with the comorbidity decreased (AAPC ‐1.4%; females: ‐1.2%; males: ‐1.7%), with a steeper reduction over the first portion of the period. However, Canadians without the comorbidity benefited from a greater decline in all‐cause mortality (AAPC ‐2.2%; females: ‐2.1%; males: ‐2.5%).ConclusionThis surveillance analysis explores the prevalence and all‐cause mortality of dementia and stroke comorbidity, by highlighting its evolution over time in older Canadians. Although further research is needed to explain the drivers of these trends, such public health surveillance data can inform health care policies and programs. Other countries could consider the CCDSS model for enhancing surveillance of dementia and its comorbidities.

Prevalence and health outcomes in community-dwelling older adults with comorbid cancer and dementia: a longitudinal analysis

Objectives To examine health outcomes in community-dwelling older adults with: dementia only, cancer only, and comorbid cancer and dementia. Methods Longitudinal analysis was conducted using data from 2010 to 2016 waves of the Health and Retirement Study. Health outcomes included mortality, limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), nursing home utilization, hospital stay, homecare use, self-rated health, and out-of-pocket medical expenditure. Panel regression was used for statistical analysis. Results The prevalence of comorbid cancer and dementia ranged from 2.56% to 2.97%. Individuals with comorbid cancer and dementia demonstrated a higher likelihood of nursing home utilization and poorer self-rated health but a lower likelihood of hospital stay, homecare use, and out-of-pocket expenditures, compared to the cancer only or dementia only groups. The differences in mortality and ADL and IADL limitations were not statistically significant. Conclusion Comorbid cancer and dementia predicted longer nursing home utilization and poorer self-rated health. The results help guide care planning for individuals with comorbid cancer and dementia.

Supporting older people experiencing anxiety through non-pharmacological interventions.

Anxiety is a debilitating condition that adversely affects people's quality of life. It is challenging to differentiate anxiety from other physical and mental health conditions in older people, particularly those with co-morbid dementia or depression. The coronavirus 2019 pandemic has compounded social isolation and loneliness in older people, causing increased levels of anxiety. Nurses need to be able to detect and assess anxiety in older people and offer short, low-intensity interventions to support older people's mental health or refer them to specialist assessment and treatment. While research on anxiety in older people is lacking, cognitive behavioural therapy, mindfulness, yoga, music therapy and pleasant activities have shown potential as non-pharmacological interventions for alleviating anxiety in older people. This article explores the role of nurses in identifying when an older person may be experiencing anxiety and then choosing the optimal non-pharmacological intervention to support them.

Impact of Comorbid Dementia on Patterns of Hospice Use.

Background: The evidence base for understanding hospice use among persons with dementia is almost exclusively based on individuals with a primary terminal diagnosis of dementia. Little is known about whether comorbid dementia influences hospice use patterns. Objective: To estimate the prevalence of comorbid dementia among hospice enrollees and its association with hospice use patterns. Design: Pooled cross-sectional analysis of the nationally representative Health and Retirement Study (HRS) linked to Medicare claims. Subjects: Fee-for-service Medicare beneficiaries in the United States who enrolled with hospice and died between 2004 and 2016. Measurements: Dementia was assessed using a validated survey-based algorithm. Hospice use patterns were enrollment less than or equal to three days, enrollment greater than six months, hospice disenrollment, and hospice disenrollment after six months. Results: Of 3123 decedents, 465 (14.9%) had a primary hospice diagnosis of dementia and 943 (30.2%) had comorbid dementia and died of another illness. In fully adjusted models, comorbid dementia was associated with increased odds of hospice enrollment greater than six months (adjusted odds ratio [AOR] = 1.52, 95% confidence interval [CI]: 1.11-2.09) and hospice disenrollment following six months of hospice (AOR = 2.55, 95% CI: 1.43-4.553). Having a primary diagnosis of dementia was associated with increased odds of hospice enrollment greater than six months (AOR = 2.62, 95% CI: 1.86-3.68), hospice disenrollment (AOR = 1.82, 95% CI: 1.32-2.51), and hospice disenrollment following six months of hospice (AOR = 4.31, 95% CI: 2.37-7.82). Conclusion: Approximately 45% of the hospice population has primary or comorbid dementia and are at increased risk for long hospice enrollment periods and hospice disenrollment. Consideration of the high prevalence of comorbid dementia should be inherent in hospice staff training, quality metrics, and Medicare Hospice Benefit policies.

Impact of psychiatric comorbidities on emergency surgical patients’ outcomes

AimsPsychiatric disorders are increasingly prevalent and present as a comorbidity in many hospitalized patients. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with worsened inpatient outcomes. Emergency surgical admissions and the impact of CPC on their outcomes has not been studied in Ireland to date. This study aims to provide a comprehensive analyses of the relationship between a wide range of psychiatric comorbidities and surgical presentations.MethodThe Hospital In-Patient Enquiry (HIPE) and prospectively maintained electronic patient records were used to identify all surgical emergency admissions between 31st August 2019 and 1st September 2020 to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), discharge destination, and surgical interventions were recorded. Subgroup analyses were performed examining LoS variation in the type of surgical presentation. Physical comorbidities were scored using the Charlson Comorbidity Index (CCI). Statistical calculations were performed using SPSS.ResultA total of 995 admissions were recorded. The presence of CPC increased the overall mean LoS by 1.9 days (p = .002). This trend was observed in both operative and conservative management. Significant increase in LoS was noted in patients with a comorbid depression (2.4 days, p = .003), dementia (2.8 days, p = .019), and intellectual disability (6.7 days, p = .007). Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = .019), skin and soft tissue infections (2.5 days, p = .040), bowel obstruction (4.3 days, p = .047), and medical disorders (18.6 days, p = .010). The odds of nursing home or convalescence as a discharge destination was 2.44 (95% CI: 1.37–4.35, p = 0.002) in patients with CPC and the odds of self-discharge against medical advice in this population was 4.89 (95% CI: 1.43–16.70, p = 0.005). No significant difference was observed in mortality and readmission rates.ConclusionPsychiatric comorbidities significantly impact length of hospital stay and influence discharge planning in surgical inpatients. Greater vigilance is required in providing care for patients with psychiatric comorbidities, particularly those with depression, dementia and intellectual disability. Better optimisation of facilities and a more personalised approach to patients with CPC are required to improve inpatient outcomes and resource allocation.

Socioeconomic, Behavioral and Clinical Characteristics and Risk of Depression and Dementia Comorbidity: A Prospective Cohort Study

Background: Depressive symptom may be a risk factor or prodrome of dementia, and the two neuropsychiatric disorders are commonly comorbid in late-life, but the patterns of depression-dementia comorbidity have not been well established. The current study aimed to investigate the associations of socioeconomic status, behavioral factors and clinical characteristics with the risk of depression-dementia comorbidity, along with how these factors modify the temporal progression of dementia after the onset of depression. Methods: Our analysis was based on data from the ongoing UK Biobank study, which included 497,533 participants (age 37-73 years) between 2006 and 2010, and thereafter followed up to 2020. Three sets of risk factors were assessed at baseline, each on a 5-point scale: socioeconomic status (Townsend deprivation index), behavioral factors (smoking, alcohol consumption, diet, physical activity) and clinical profile (obesity, hypertension, hyperglycemia, hypercholesterolemia). Electronic health records were used to assess the incidence of depression, dementia and comorbidity. Multistate models to estimate the transition-specific hazard ratios (HRs) and 95% confidence interval (CIs) of 3 risk factor scales in the transitions from a healthy state to progression of depression and subsequent comorbid dementia. Findings: During a median follow-up of 11.8 years, 23,516 (4.7%) and 6,872 (1.4%) participants separately developed depression and dementia, 1,341 (0.3%) had depression-dementia comorbidity. Adverse socioeconomic status, behavioral factors and clinical scale was strongly associated with increased risk of depression-dementia comorbidity, with highest vs. lowest group HRs of 2.40 (95% CI: 2.03-2.84), 3.43 (95% CI: 2.35-5.00) and 2.95 (95% CI: 2.06-4.22), respectively. In multistate models, adverse socioeconomic status (HR = 1.35, 95% CI: 1.11-1.65), behavioral factors (HR = 1.85, 95% CI: 1.22-2.80) and clinical scale (HR = 1.75, 95% CI: 1.15-2.66) was significantly associated with elevated risk of transition from depression to comorbid dementia. The incidence of dementia in people with depression was far more than those who were free of depression (9.16 vs. 1.04 per 1000 person-years). Of the 3 risk factor scales, behavioral factors were the strongest predictor of incident dementia whether in those with depression or not. Interpretation: Adverse socioeconomic status, behavioral factors and clinical characteristics increase the risk of depression-dementia comorbidity. Behavioral scale had the strongest association with temporal progression of dementia after the onset of depression, making it a central target for improving healthy aging. Funding: The National Natural Science Foundation of China (71910107004, 91746205). Declaration of Interest: The authors declare that they have no competing interests. Ethical Approval: All participants gave written informed consent prior data collection.UK Biobank has full ethical approval from the NHS National Research Ethics Service (16/NW/0274).

Risk factors for dementia development, frailty, and mortality in older adults with epilepsy – A population-based analysis

ObjectiveAlthough the prevalence of comorbid epilepsy and dementia is expected to increase, the impact is not well understood. Our objectives were to examine risk factors associated with incident dementia and the impact of frailty and dementia on mortality in older adults with epilepsy. MethodsThe CALIBER scientific platform was used. People with incident epilepsy at or after age 65 were identified using Read codes and matched by age, sex, and general practitioner to a cohort without epilepsy (10:1). Baseline cohort characteristics were compared using conditional logistic regression models. Multivariate Cox proportional hazard regression models were used to examine the impact of frailty and dementia on mortality, and to assess risk factors for dementia development. ResultsOne thousand forty eight older adults with incident epilepsy were identified. The odds of having dementia at baseline were 7.39 [95% CI 5.21–10.50] times higher in older adults with epilepsy (n = 62, 5.92%) compared to older adults without epilepsy (n = 88, 0.86%). In the final multivariate Cox model (n = 326), age [HR: 1.20, 95% CI 1.09–1.32], Charlson comorbidity index score [HR: 1.26, 95% CI 1.10–1.44], and sleep disturbances [HR: 2.41, 95% CI 1.07–5.43] at baseline epilepsy diagnosis were significantly associated with an increased hazard of dementia development over the follow-up period. In a multivariate Cox model (n = 1047), age [HR: 1.07, 95% CI 1.03–1.11], baseline dementia [HR: 2.66, 95% CI 1.65–4.27] and baseline e-frailty index score [HR: 11.55, 95% CI 2.09–63.84] were significantly associated with a higher hazard of death among those with epilepsy. Female sex [HR: 0.77, 95% CI 0.59–0.99] was associated with a lower hazard of death. SignificanceThe odds of having dementia were higher in older adults with incident epilepsy. A higher comorbidity burden acts as a risk factor for dementia, while prevalent dementia and increasing frailty were associated with mortality.

An Integrative Review of Behavioral Disturbances in Veterans With Dementia and PTSD.

Both posttraumatic stress disorder (PTSD) and dementia have been associated with a variety of behavioral changes; however, little is known about the behavioral consequences of comorbid PTSD and dementia. An integrative review was conducted to identify and examine studies reporting on behavioral disturbances in Veterans with PTSD and dementia. PubMed and PsychINFO databases were searched for articles on behavioral disturbances in Veterans with comorbid PTSD and dementia. Seven studies met inclusion for this review, sampling a total of 822 Veterans. Preliminary findings suggest that though Veterans with dementia and comorbid PTSD may present with more difficult behavioral symptoms, they do not typically display increased levels of aggression. Given the limited study inventory, the key finding from this review highlights the lack of methodologically rigorous empirical studies on this topic. A research agenda is proposed to encourage future studies to address gaps in the literature.

Care for Older People with Dementia During COVID-19 Pandemic.

Older people living with dementia, who are likely frail with multiple comorbidities, appear particularly vulnerable to COVID-19. Care for older people with comorbid dementia and COVID-19 is a challenge to health care professionals due to their complex needs. COVID-19 is a respiratory disease which typically presents with respiratory symptoms; however, in older people with dementia, it may present atypically with delirium. Delirium may precede respiratory symptoms, and in some cases, it may be the only symptom, leading to a delay in the diagnosis. Therefore, screening for delirium should be part of the routine clinical practice for older people with dementia and suspected COVID-19 infection. Due to the complexity of care required for older people with dementia affected by COVID-19, a holistic and individualised approach that includes acute, transitional and long-term care is required. Advanced decision-making, for example, ceiling of care and resuscitation decisions, should be made early on admission to hospital. Screening for frailty with clinical frailty scale may help to aid decision-making. Palliative care and relief of suffering should be considered from the outset. Early and regular involvement of patients and their families in care plans and periodic updates regarding any changes in the clinical condition are good clinical practice. The introduction of telehealth programmes that are suitable for older people with poor cognitive function and also cover diverse cultural backgrounds are urgently required for the future support of this vulnerable group of patients.

The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review.

Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.

When Cancer Meets Dementia: The End-of-Life Caregiving Experience for Older Adults With Comorbid Dementia and Cancer

Older adults with comorbid dementia and cancer is an increasing phenomenon with the aging population worldwide. Caregivers of these older adults might have a totally different and unique end-of-life caregiving experience. This is because all physical and behavioral signs and symptoms of dementia and cancer may interact with each other and complicate the caregiving experience. The aims of this study was to understand and examine the end-of-life caregiving experiences for older adults with comorbid dementia and terminal cancer from the perspective of family caregivers. Twenty-one caregivers were invited to participate in a semi-structured interview that examined the end-of-life caregiving experiences, its impact and how they coped with the challenges they faced. The interviews were transcribed and analyzed using interpretative phenomenological analysis. The essential meaning of the phenomenon is understood as “grieving thrice, suffering dually and becoming one”, characterized by how caregivers understood the meaning of togetherness after going through the time of recurring losses from dementia through cancer to death and experiencing ambiguous sufferings dually with their loved one. Ambiguous sufferings were not “there” before the diagnosis of cancer but emerge in the context of comorbid dementia and cancer and in the connection with the caregivers making interpretation and appraisal of their internal and external resources. These important findings fill in the knowledge gap in the literature related to end-of-life caregiving experience for older adults with comorbid dementia and cancer; and may guide the development of appropriate interventions to support the older adults and their caregivers in a holistic approach.

Strategy for screening cognitive impairment in Chinese patients with amyotrophic lateral sclerosis

BackgroundIt is an economical strategy to design a screening method to decide which patients with amyotrophic lateral sclerosis/ motor neuron disease (ALS/MND) should enter into the stage for further comprehensive neuropsychological investigation. Methods59 patients (including 8 with frank dementia) were recruited. They underwent the extensive neuropsychological evaluation and short screening batteries, namely the Mini-Mental State Examination (MMSE), the Peking Union Medical College Hospital version of Montreal Cognitive Assessment (MoCA-P) and the Frontal Assessment Battery (FAB). Results of the extensive neuropsychological evaluation were set as the gold standard to diagnose cognitive impairment, and the effectiveness of screening tests were measured against them. ResultsBy comparing the sensitivity and specificity, we found that the combination of FAB plus both or either of the other 2 short batteries provided a satisfactorily high sensitivity, but none of these screening batteries was significantly associated with quantitative behavioral measurements among non-demented subjects, the Frontal Behavioral Inventory-ALS version (FBI-ALS). ConclusionsThe combination of the FBI-ALS, the FAB, and the MMSE or the MoCA-P or both could effectively screen comorbid dementia, cognitive and behavioral impairment in ALS but this implicates a limited specificity. And the FAB needed to be validated in large Chinese sample.

Pharmacological treatment of apathy in Parkinson's disease, review of the literature

Background: Apathy is a highly challenging factor in the general treatment of patients with Parkinson's disease (PD) and can present a major burden for caregivers. The objective of this study to answer the question of what is known about the current evidence-based pharmacological treatment of apathy, not combined with comorbid depression or dementia, in PD.

Navigating cancer treatment and care when living with comorbid dementia: an ethnographic study

ObjectivesThe risks of developing cancer and dementia increase as we age; however, this comorbidity remains relatively under-researched. This study reports on the challenges that people affected by comorbid cancer and dementia face when navigating engagement with cancer treatment within secondary care.Materials and methodsAn ethnographic study recruiting 17 people with cancer and dementia, 22 relatives and 19 oncology staff in two UK National Health Service Trusts. Observations (46 h) and informal conversations were conducted during oncology appointments involving people with dementia. Semi-structured interviews (n = 37) with people living with cancer and dementia, their relatives and staff working in various roles across oncology services were also carried out. Data were analysed using ethnographically informed thematic analysis.ResultsPeople with cancer and dementia experienced challenges across three areas of navigating cancer treatment and care: navigating through multiple services, appointments and layers of often complex information; repeatedly navigating transport to and from hospital; and navigating non-dementia-friendly hospital outpatient environments alongside the cognitive problems associated with dementia.ConclusionsDementia impacts patients’ abilities to navigate the many practical aspects of attending hospital for cancer treatment and care. This study indicates the importance of addressing ways to improve the experience of travelling to and from the hospital, alongside extending the ongoing efforts to develop ‘dementia-friendly’ hospital in-patient areas and practices, to outpatient departments. Such steps will serve to improve hospital-based cancer treatment and care and more broadly outpatient appointment experiences for people with dementia and their families.

New pharmacologic agents for insomnia and hypersomnia.

Insomnia and hypersomnia are conditions with multifactorial causes that can be difficult to treat. There have been recent developments and changes in the treatment of both conditions, including the addition of some agents that have a novel mechanism of action. This review summarizes recent changes and highlights pertinent updates. Benzodiazepine receptor agonists received a warning in 2019 regarding the possibility of complex sleep behaviors, such as sleepwalking. Zolpidem has been marketed in new dosage forms that include sublingual tablets and oral spray formulations. Orexin receptor antagonists appear to be well tolerated with a good safety profile. Suvorexant received an approval for the treatment of patients with comorbid insomnia and dementia. Lemborexant was demonstrated to be effective for maintenance insomnia. Trazodone was shown to affect the oligomerization of tau proteins thus suggesting potential implications in attenuating dementia pathology. Pitolisant, a novel histamine-3 receptor antagonist/inverse agonist, gained approval for the treatment of excessive daytime sleepiness in adults with narcolepsy as well as obstructive sleep apnea. Solriamfetol, a new norepinephrine and dopamine reuptake inhibitor, was approved for hypersomnolence based on good efficacy, but with cardiovascular warnings. Recent advancements in the treatment of insomnia includes agents with novel mechanisms, new indications, and new dosage forms. Risk of complex sleep behaviors, and possible next-day driving impairment, should be discussed for all agents used for insomnia, including orexin receptor antagonists. Novel agents also are available for hypersomnia and there are options beyond traditional stimulants that may have great utility.