Dementia Experts Research Articles

European Ultrahigh-Field Imaging Network for Neurodegenerative Diseases (EUFIND)

IntroductionThe goal of European Ultrahigh-Field Imaging Network in Neurodegenerative Diseases (EUFIND) is to identify opportunities and challenges of 7 Tesla (7T) MRI for clinical and research applications in neurodegeneration. EUFIND comprises 22 European and one US site, including over 50 MRI and dementia experts as well as neuroscientists. MethodsEUFIND combined consensus workshops and data sharing for multisite analysis, focusing on 7 core topics: clinical applications/clinical research, highest resolution anatomy, functional imaging, vascular systems/vascular pathology, iron mapping and neuropathology detection, spectroscopy, and quality assurance. Across these topics, EUFIND considered standard operating procedures, safety, and multivendor harmonization. ResultsThe clinical and research opportunities and challenges of 7T MRI in each subtopic are set out as a roadmap. Specific MRI sequences for each subtopic were implemented in a pilot study presented in this report. Results show that a large multisite 7T imaging network with highly advanced and harmonized imaging sequences is feasible and may enable future multicentre ultrahigh-field MRI studies and clinical trials. DiscussionThe EUFIND network can be a major driver for advancing clinical neuroimaging research using 7T and for identifying use-cases for clinical applications in neurodegeneration.

The Validity and Reliability of a Persian Version of the Brief Community Screening Instrument for Dementia in the Elderly Patients with Dementia in Iran

Background: The brief version of community screening instrument for dementia (CSI-D) is a neuropsychological tool, which can be used even by non-specialists in primary care settings following a short training. The CSI-D evaluates the cognitive and functional domains of the subjects and includes an informant interview. However, it should be adapted based on literacy level and sociocultural profile of population in each country. Objectives: The current study examined the validity and reliability of the Persian version of the brief CSI-D in elderly patients of Iran. Methods: The current descriptive, cross sectional study was conducted on people 60 and over from 16 provinces of Iran with seven different ethnicities and various levels of education (0 - 13 to ≥ 13 years). The participants consisted of subjects with normal cognition, subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and different types of dementia. Cognitive impairment was diagnosed by a neurologist with expertise in dementia. The psychometric properties were assessed by comparing Persian version of brief CSI-D with the gold standard. Area under ROC curve, optimal cutoff point, and sensitivity and specificity were also calculated. Results: Data were collected from 262 participants. Of all the participants, 112 were diagnosed with dementia, 64 with MCI, 32 with SCI, and 53 with normal cognition. The best cutoff point for the test- regardless of gender and level of education- was 8.5 compared with 8 - 9 in the original version of CSI-D and also the cutoff point for patient with dementia was 5.5, while it was 4 in the original version. Conclusions: The Persian version of CSI-D seems to be an accurate and sensitive tool to screen dementia and MCI in primary care setting, especially among low-educated and illiterate people.

Psychometric Evaluation of the Persian Version of Illustrated Memory Impairment Screen (PIMIS) Test in Elderly Patients with Alzheimer’s Disease in Iran

Background: The memory impairment screen (MIS) test is a brief, four-item, delay-free, and cued-recall test of memory impairment. It is highly correlated with Alzheimer’s pathology and can be easily used by trained non-specialists. However, the application of this test might be restricted due to minimum literacy levels requirement. The picture based MIS (PMIS) is a modified version that can be used by even illiterate or low-education people. The pictures can be adapted based on cultural differences. Objectives: The aim of this study was to provide and validate the Persian version of illustrated memory impairment screen (PIMIS) test in elderly patients with Alzheimer’s disease in Iran. Methods: This validation was a cross-sectional study on people 60 years of age and older with different levels of education (illiterate to > 13 years of education). The participants consisted of subjects with normal cognition, subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and different types of Dementia. Cognitive impairment was diagnosed by a neurologist with expertise in dementia (gold standard). The validity was assessed by comparing MISIP with the gold standard. Area under ROC curve, optimal cut-point, sensitivity, specificity, and Cronbach’s alpha were estimated. Results: Data were collected from 119 participants, 38 of which were diagnosed with Dementia, 17 with MCI, 21 with SCI and also 43 had normal cognition. The PIMIS score was significantly lower in patients diagnosed with dementia compared to the other groups (7.1 versus 4.3 for PIMIS score with a P value of less than 0.001). The PIMIS had a sensitivity of 60% and specificity of 91% for detecting dementia at a cut-point of five. Level of education had no significant effect on the test. Conclusions: IMIS is a simple reliable screening test in elderly population with variable literacy rates.

Detection of probable dementia cases in undiagnosed patients using structured and unstructured electronic health records

BackgroundDementia is underdiagnosed in both the general population and among Veterans. This underdiagnosis decreases quality of life, reduces opportunities for interventions, and increases health-care costs. New approaches are therefore necessary to facilitate the timely detection of dementia. This study seeks to identify cases of undiagnosed dementia by developing and validating a weakly supervised machine-learning approach that incorporates the analysis of both structured and unstructured electronic health record (EHR) data.MethodsA topic modeling approach that included latent Dirichlet allocation, stable topic extraction, and random sampling was applied to VHA EHRs. Topic features from unstructured data and features from structured data were compared between Veterans with (n = 1861) and without (n = 9305) ICD-9 dementia codes. A logistic regression model was used to develop dementia prediction scores, and manual reviews were conducted to validate the machine-learning results.ResultsA total of 853 features were identified (290 topics, 174 non-dementia ICD codes, 159 CPT codes, 59 medications, and 171 note types) for the development of logistic regression prediction scores. These scores were validated in a subset of Veterans without ICD-9 dementia codes (n = 120) by experts in dementia who performed manual record reviews and achieved a high level of inter-rater agreement. The manual reviews were used to develop a receiver of characteristic (ROC) curve with different thresholds for case detection, including a threshold of 0.061, which produced an optimal sensitivity (0.825) and specificity (0.832).ConclusionsDementia is underdiagnosed, and thus, ICD codes alone cannot serve as a gold standard for diagnosis. However, this study suggests that imperfect data (e.g., ICD codes in combination with other EHR features) can serve as a silver standard to develop a risk model, apply that model to patients without dementia codes, and then select a case-detection threshold. The study is one of the first to utilize both structured and unstructured EHRs to develop risk scores for the diagnosis of dementia.

Dementia care: international perspectives.

As awareness of dementia increases, internationally derived knowledge and information about dementia care and practice can be helpful to improve the care of people with dementia and their families. It can serve as a stimulus to develop new ideas for the provision of such care. An international survey of 47 countries has shown a high degree of national interest and commitment to dementia treatment and care. In each, a local dementia expert provided a bespoke narrative about the care and treatment of people with dementia, a review of national policies and a glimpse as to what the future holds. The detailed results have been published in book form and are summarized here. The majority of countries have made national attempts to estimate the number of people with dementia, have licenced antidementia drugs and have the support of a national Alzheimer's association with a website containing independent advice. More than half have a national plan targeted at the development of care and in a further quarter, the development of such plans is in progress. There appears to have been a great increase in interest and awareness of dementia in the last few years.

Attitudes of Students from the High Medical College of Professional Studies and Nurses Towards People Suffering from Dementia

Abstract Dementia is characterized by a progressive decrease in cognitive functions, and the term includes different etiologies. Cognitive decline includes loss of memory and deterioration in executive functions, such as planning and organizing skills, sufficient to influence social activities. The aim of this study was to examine and compare the attitudes (knowledge, emotions and behaviour) of students at the High Medical College of Professional Studies and nurses towards people suffering from dementia. The study was designed as a qualitative study with the use of a questionnaire. The Dementia Attitudes Scale (DAS) was used in our study. A total of 283 respondents answered the survey: 56.25% were students, and 43.75% were nurses. The internal consistency of the DAS was found to be good with a Cronbach’s α of 0.792. In the overall score for attitudes, a significant difference was found between students (100.47±10.91) and nurses (95.51±16.10). The students had a better score regarding questions describing their behaviour towards these individuals (p<0.001) and emotions for these patients (p<0.001). For knowledge, there was no difference between the two groups of subjects (p=0.901). Regarding the overall score, attitudes of students and nurses towards people with dementia were positive. This research suggested that the training of senior team members who then had dementia expertise was a key component in developing attitudes and improving care practices and outcomes for these patients. Continuous education of all medical staff who have contact with people who suffer from dementia is important.

The development of a Core Outcome Set for medicines management interventions for people with dementia in primary care.

people with dementia (PWD), and their carers, face challenges with medicines management activities. As interventions to support medicines management for PWD are developed, consideration must be given to the outcomes chosen to measure their effectiveness. A Core Outcome Set (COS) is a minimum set of outcomes to be measured in all trials in a particular clinical area, which seeks to reduce heterogeneity of outcome reporting across trials. to develop a COS for trials assessing the effectiveness of medicines management interventions for PWD in primary care. a comprehensive list of outcomes was compiled through a systematic review and semi-structured interviews with PWD (n = 18), their carers (n = 15), community pharmacists (n = 15) and general practitioners (n = 15). These outcomes were rated by a Delphi panel (n = 52) on a nine-point Likert scale from 1 (limited importance) to 9 (critical) during three sequential rounds of questionnaire distribution. The Delphi panel comprised participants with expertise in dementia and medicines management, including academics and healthcare professionals. An outcome was eligible for inclusion in the COS if ≥70% of participants rated it critical and <15% of participants rated it of limited importance. twenty-nine outcomes identified from the systematic review and stakeholder interviews were presented to the Delphi panel. Consensus was reached on 21 outcomes, of which the 7 most highly rated were recommended for inclusion in the COS. this study used robust methodology to develop a COS for medicines management interventions for PWD. Future work should identify the most appropriate tools to measure these outcomes.

Detecting Non-cognitive Features of Prodromal Neurodegenerative Diseases.

: Background: Prodromal Neurodegenerative Disease (ND) due to tauopathies such as Alzheimer’s Disease (AD) and Synucleinopathies (SN) such as Parkinson's Disease (PD) and Dementia with Lewy Bodies (DLB) present subtly. Although ND are considered cognitive disorders, in fact ND present with behavioral and even medical symptomatology years to decades prior to the onset of cognitive changes. Recognizing prodromal ND syndromes is a public health priority because ND is common, disabling and expensive. Diagnosing prodromal ND in real world clinical settings is challenging because ND of the same pathology can present with different symptoms in different people. Individual variability in nature and variability in nurture across the life course influence how ND pathology manifests clinically. The objective of this study was to describe how non-cognitive symptoms from behavioral, medical, neurological and psychiatric domains cluster in prodromal and early stages of ND.Methods: This was an observational study of patients receiving routine clinical care for memory disorders. All patients receiving a standardized evaluation including complete neurological history and examination and standardized brief neuropsychological testing. A Principal Component Analysis (PCA) considering emotion, motor, sensory and sleep factors was performed on the entire sample of patients in order to identify co-occurring symptom clusters. All patients received a consensus diagnosis adjudicated by at least two dementia experts. Patients were grouped into Cognitively Normal, Detectable Cognitive Impairment, and Mild Cognitive Impairment categories due to AD and/or PD/LBD or NOS pathology. Symptom cluster scores were compared between clinical diagnostic groups.Results: In this study 165 patients completed baseline neuropsychological testing and reported subjective measures of non-cognitive symptoms. Four syndrome specific symptom factors emerged and eight non-specific symptom factors. Symptoms of personality changes, paranoia, hallucinations, cravings, agitation, and changes in appetite grouped together into a cluster consistent with an “SN Non-motor Phenotype”. Appetite, walking, balance, hearing, increased falls, and dandruff grouped together into a cluster consistent with an “SN Motor Phenotype”. The Prodromal AD phenotype included symptoms of anxiety, irritability, apathy, sleep disturbance and social isolation. The fourth factor included symptoms of increased sweating, twitching, and tremor grouped into a cluster consistent with an Autonomic phenotype.Conclusions: Non-cognitive features can be reliably measured by self-report in busy clinical settings. Such measurement can be useful in distinguishing patients with different etiologies of ND. Better characterization of unique, prodromal, non-cognitive ND trajectories could improve public health efforts to modify the course of ND for all patients at risk.

Increasing Diagnostic Accuracy of Mild Cognitive Impairment due to Alzheimer's Disease by User-Independent, Web-Based Whole-Brain Volumetry.

Volumetric quantification of structural MRI has been shown to increase the diagnostic accuracy of patients with mild cognitive impairment (MCI); however, its implementation in clinical routine is usually technically difficult and time-consuming. The purpose of this study was to investigate whether volumetric information obtained from the free and easy-to-use online tool volBrain can improve correct identification of MCI patients with Alzheimer's disease (AD) compared to visual reading. The study cohort consisted of 27 patients with MCI due to AD (AD positive) as determined by biomarker information and 26 cognitively normal controls (CN). Three blinded readers, 2 radiologists and 1 clinical dementia expert, assessed the patients' MRI regarding brain atrophy and probability of underlying AD two times, without and with supporting volumetric information from volBrain. To assess diagnostic accuracy of volBrain measures alone, a simple sum score based on basic volumetric measures was developed and tested. Correct patient classification by readers 1, 2, and 3 without a volumetric report was 73.6%, 77.4%, and 83.0%. With a volumetric report, correct classification increased for the radiological readers to 77.4% and 81.1%, respectively and decreased to 77.4% for reader 3. Usage of the volumetric report alone yielded the highest diagnostic accuracy of 84.9%. Diagnostic confidence increased significantly for radiological readers. Volumetric information from volBrain increases the radiologist's diagnostic performance and confidence in identifying MCI patients with AD. We propose that such tools may be implemented in the routine diagnostic work-up of patients with suspected AD.

Preparedness of representatives for people with dementia in a self-directed program

ABSTRACTRepresentatives enact their role as decision-making partners across the intersection of participant direction (PD) and dementia care. Self-rated preparedness for key dimensions of the role endorsed by a panel of experts in PD and dementia was assessed by telephone survey of 30 representatives of persons with dementia in a PD program. The sample (daughters 60%; Black 50%; rural 70%) was diverse in length of time in the role and additional responsibilities. They represented participants with moderate to advanced dementia and ≥ two additional chronic illnesses. Overall preparedness scores were in the pretty well to very well prepared range, with variation across dimensions and between individuals. Preparedness varied according to what has to be done day-to-day in dynamic or unpredictable situations, gauging decisional capacity, anticipating changing needs, ensuring safety, supporting a dementia-capable care team and negotiation. Stress was related to having a safety net of capable back-up supports and dementia care literacy. Areas of strength, individual variation and particular challenges along the trajectory of representing can guide development of support counselor interventions to provide representatives with tailored training and resources as they enable the benefits of PD for persons with dementia.

Engagement of a Person with Dementia Scale: Establishing content validity and psychometric properties.

To develop and psychometrically test the Engagement of a Person with Dementia Scale. It is important to study engagement in people with dementia when exploring the effectiveness of psychosocial interventions that can promote meaningful activity, stimulation and well-being, through an increase in positive emotions and an improvement in quality of life. The Engagement of a Person with Dementia Scale was developed based on current literature and previous research work on a video coding tool to ascertain the effect of psychosocial interventions on engagement in people with dementia. Using the Delphi technique, the content validity of the scale was evaluated by 15 dementia experts and formal/informal dementia carers. Psychometric properties of the scale were evaluated using 131 videos of people with dementia presented with PARO-a therapeutic, interactive, robotic seal-in long-term aged care facilities. A 10-item scale was established following the rewording, combining and elimination of prospective items, with revisions made to the instructions for using and scoring the scale. An overall consensus with agreement for the scale was established among the panel of experts. The scale demonstrated robust internal consistency, inter-rater and test-retest reliability and convergent and discriminant validity. This study successfully developed the Engagement of a Person with Dementia Scale, with established content validity and psychometric properties. The scale assesses the behavioural and emotional expressions and responses of engagement by people with dementia when partaking in a psychosocial activity in five areas: affective, visual, verbal, behavioural and social engagement.

Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial.

BackgroundPhysicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports.ObjectiveThe aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators.MethodsThe study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm.ResultsA total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001).ConclusionsOn the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians.Trial RegistrationClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8)

Dementia care mapping to support staff in the care of people with intellectual disability and dementia: a feasibility study.

The number of people with intellectual disability and dementia increases; this combination causes behavioural changes. Dementia Care Mapping (DCM) supports staff in dementia care in nursing homes and may be useful in intellectual disability-care. This qualitative study examines the feasibility of DCM for older people with intellectual disability and dementia. The present authors obtained data in focus groups and interviews with professional users and analysed using a framework for feasibility studies. With experts in dementia and intellectual disability researches, the present authors determined the overall feasibility. DCM was found to be feasible in intellectual disability-care, regarding five domains of feasibility. Staff reported DCM to be useful and valuable and addresses to their demand for skills and knowledge. All professional users found DCM feasible in intellectual disability-care, which was confirmed by experts. DCM is feasible in intellectual disability-care. When fully tailored to intellectual disability-care, DCM is useful and provides opportunities to assess its effectiveness.

Early Detection of Alzheimer's Disease Based on the Patient's Creative Drawing Process: First Results with a Novel Neuropsychological Testing Method.

Based on the knowledge of art therapy, we developed a new neuropsychological drawing test in order to identify individuals with mild cognitive impairment (MCI) as well as dementia patients and healthy controls (HC). By observing a variety of drawing characteristics of 92 participants with a mean age of 67.7, art therapy and dementia experts discriminate HC from MCI, early dementia of the Alzheimer-type (eDAT), and moderate dementia of the Alzheimer-type (mDAT) by the process analysis of tree drawings on a digitizing tablet. The art therapist's average categorical rating of healthy and MCI or demented individuals matched the clinical diagnosis by 88%. In a first small study, we analyzed interrater reliability, sensitivity, specificity, negative and positive predicted values of our tree drawing test (TDT) in comparison with the clock drawing test (CDT). Similar values of moderate interrater reliability were found for the TDT (0.56) as well as for the CDT (0.54). A significant high sensitivity of 0.9 within this binary impairment scale (HC versus impaired or demented) can be demonstrated. Substantial values for the specificity (0.67) could be obtained that however remain under a perfect value of the CDT (1.0). Considering 31 individuals that received the clinical diagnosis "impaired or demented" the TDT shows a higher recognition rate for the MCI group than the CDT. Furthermore in 8 of 12 borderline cases of clinical diagnosis, the outcome of the TDT diagnosis was consistent with the final clinical result.

The experiences and preparedness of family carers for best interest decision-making of a relative living with advanced dementia: A qualitative study.

To explore the experience and the preparedness of family carers in their caregiving role as best interest decision-makers of a relative living with advanced dementia. The prevalence of dementia is a global issue. The role of being a carer of a relative living with dementia does not necessarily lessen once they are admitted to a nursing home. Best interest decision-making including end-of-life care decisions need to be made and reaching these choices can be challenging. The preparedness of family carers in this role needs greater understanding. Descriptive qualitative study. During 2015 twenty semi-structured interviews were conducted of family carers of nursing home residents living with advanced dementia, then analysed using Braun and Clarke's thematic analysis. Three themes were identified: (1) Caring for someone living with dementia. The impact on the carer's holistic well-being and their experience of being a best interest decision-maker; (2) Accessing support. The influential nature of formal and informal networks; (3) Perceived knowledge and understanding of the dementia trajectory of carers and nursing staff. The experiences and preparedness of informal carers is a reflection of their personal response, but the distress experienced highlights the significant need of adequate support availability and of enhancing nursing staffs' dementia expertise to maximize their role in facilitating best interest decision-making. This has significant implications for nursing practice and for service user and nursing staff education. Considering the global impact of dementia, our findings have international relevance to similar nursing homes across the world.

The development and use of the assessment of dementia awareness and person-centred care training tool in long-term care

Policy and practice guidelines recommend person-centred care to support people to live well with dementia in long-term care. Therefore, staff working in long-term care settings need to be trained in dementia awareness and person-centred care. However, the access to, content of and reach of training across long-term care settings can be varied. Data on current and ongoing access to person-centred care training can form an important component of data gathered on usual care in research studies, in particular clinical trials within long-term care. However, no suitable assessment tools are available to measure dementia awareness and person-centred care training availability, content and reach. This paper describes the development of a training audit tool to meet this need for a usual care measure of dementia awareness and person-centred care training. The ‘Assessment of Dementia Awareness and Person-centred care Training’ tool was based on a review of published person-centred care literature and consultation with dementia and aged care experts. The Assessment of Dementia Awareness and Person-centred care Training tool was piloted in 13 long-term care facilities the UK and Australia, before being used to assess the content of dementia and person-centred care awareness training in 50 UK settings in a randomized controlled trial as part of usual care recording. Following pilot testing, modifications to the Assessment of Dementia Awareness and Person-centred care Training tool’s wording were made to enhance item clarity. When implemented in the randomized controlled trial, pre-baseline training assessment data showed that the Assessment of Dementia Awareness and Person-centred care Training tool was able to differentiate between the training in different long-term care settings and identify settings where further dementia awareness training was required. The Assessment of Dementia Awareness and Person-centred care Training tool was then used as a method of recording data on dementia awareness and person-centred care training as part of ongoing usual care data collection. The Assessment of Dementia Awareness and Person-centred care Training tool is suitable for use by researchers to establish the availability, content and reach of dementia and person-centred care awareness training to staff within research studies.

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study

ObjectivesLittle is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient...

Commentary on State of the Science: Interprofessional Approaches to Aging, Dementia, and Mental Health.

It is expected that, by 2050, there will be 83.7 million adults aged 65 and older in the United States1 and 1.6 billion world-wide.2 Already there exists an unrecognized crisis in dementia and mental health care for this rapidly growing population.3 Further, the workforce with expertise in aging, dementia, and mental health/substance use (MH/SU) continues to decline, contributing to health disparities.3 As noted by both the Institute of Medicine (IOM)4 and the World Health Organization (WHO),5 interprofessional teams can play an important role in the improvement of population health outcomes for older adults. Interprofessional teams are not new to geriatrics and gerontology.6 Over the past decade, emerging strategies and models of care for interprofessional education and collaboration have built on foundations laid by several organizations.4 For example, the WHO generated the widely accepted definition and framework for interprofessional education and collaboration.5 For over 50 years, the IOM4,7–8 has supported interprofessional education and collaboration and raised awareness of workforce needs for older adults with MH/SU.3 The National Center for Interprofessional Practice and Education9 has partnered with the Robert Wood Johnson Foundation,10 the Josiah Macy Jr. Foundation,9 the John A. Hartford Foundation,9,11 and the Gordon and Betty Moore Foundation,9 to further the work of the Geriatric Interdisciplinary Team Training and Geriatric Interdisciplinary Teams in Practice programs.6,9,11 The Partnership for Health and Aging (PHA)12 developed competencies for geriatrics and gerontology. Finally, the PHA and the American Geriatrics Society13 published a position statement to support team training. Yet, despite longstanding and broad support for interprofessional education and collaboration in the care of older adults, physical and mental health disparities persist. In this supplement, Farrell et al.14 recommend a unified effort to integrate geriatric and gerontology competencies, content and principles into interprofessional curricula that are aligned with objectives for health systems science.15 Those objectives aim to transform curricula to improve population health, team-based care, high-value care, leadership, quality improvement, patient safety and health policy.15 Farrell et al.14 posit that an intentional, systematic approach by health science educators, health care systems leaders and clinicians is essential to advancing innovation for positive outcomes around aging, dementia and MH/SU. Guided by the Interprofessional Learning Continuum (IPLC) model4 (see Farrell et al.,14 Figure 1), this Commentary reinforces and extends the Farrell et al.14 recommendations by highlighting national and international innovations in interprofessional geriatrics and gerontology, especially related to dementia and mental health. The comprehensive IPLC model grew out of recognition in the IOM’s “Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes”4 that curriculum reform and collaborative practice redesign are prerequisite to improving health and system outcomes.16 In that context, this Commentary provides a discussion of curriculum reform, collaborative practice redesign and their linkages to health and systems outcomes15,16 and concludes with a brief global perspective17 on interprofessional education and practice as they relate to aging, dementia and MH/SU in older adults. Innovation exemplars in interprofessional education aim to challenge and stimulate leadership in interprofessional geriatrics and gerontology.

Understanding Important Issues in Young-Onset Dementia Care: the Perspective of Healthcare Professionals

Psychosocial research on the lived experiences of young-onset dementia patients and caregivers has identified salient issues about their care, however, views on care from the perspective of young-onset dementia healthcare professionals is less well known. The aim of this study was to investigate and identify important issues in young-onset dementia care provision from a healthcare provider perspective. The design was an exploratory qualitative interview study. In-depth semistructured interviews were conducted with healthcare professionals with clinical expertise in young-onset dementia drawn from medicine, nursing and allied health. Thematic analysis was applied to interview transcripts to identify themes representing important underlying issues in care across the dementia clinical pathway (i.e., prediagnosis, diagnosis and postdiagnosis). In prediagnosis, it is important for healthcare professionals to recognize symptoms as organic and degenerative and more than psychological, and to refer patients to an appropriate clinical facility for assessment. During diagnosis, it may be challenging to determine dementia, and methods are employed to manage diagnostic uncertainty. Following diagnosis, optimizing routine clinical care is important and can include the provision of practical informational guidance, empathic concern and psychoeducational support. Meeting service-user requirements in the community is an important aspect of care, and may be facilitated by the involvement of clinical nurse specialists. The findings are presented as a paradigm for holistic young-onset dementia care. The paradigm offers a framework for contemplating and evaluating the criteria and quality of young-onset dementia care.

National Institute on Aging /Alzheimer’s Association criteria for Mild Cognitive Impairment applied to chemotherapy treated breast cancer survivors

In this analysis we use the National Institute on Aging/Alzheimer's Association (NIA/AA) criteria to identify Mild Cognitive Impairment (MCI) in a sample of breast cancer survivors treated with chemotherapy. Sixty women ages 39-79 on a prospective clinical trial of donepezil were assessed at baseline using a battery of standardized/validated neurocognitive measures. Cognitive status was adjudicated to identify MCI by a panel of dementia experts. Fifty percent were not cognitively impaired, 43% met the NIA/AA criteria for MCI, 2% had dementia, and 5% could not be classified. In this sample, nearly half of breast cancer survivors met the NIA/AA criteria for MCI. We propose these criteria be used to define cancer-related Mild Cognitive Impairment (cMCI), providing a framework for conducting additional studies to further characterize cMCI and identify clinical, imaging, and genetic factors associated with the progression of cMCI to more advanced stages of cognitive impairment.