Dementia In Canada Research Articles

Alzheimer's and other dementias in Canada, 2011 to 2031: a microsimulation Population Health Modeling (POHEM) study of projected prevalence, health burden, health services, and caregiving use.

BackgroundWorldwide, there is concern that increases in the prevalence of dementia will result in large demands for caregivers and supportive services that will be challenging to address. Previous dementia projections have either been simple extrapolations of prevalence or macrosimulations based on dementia incidence.MethodsA population-based microsimulation model of Alzheimer’s and related dementias (POHEM:Neurological) was created using Canadian demographic data, estimates of dementia incidence, health status (health-related quality of life and mortality risk), health care costs and informal caregiving use. Dementia prevalence and 12 other measures were projected to 2031.ResultsBetween 2011 and 2031, there was a projected two-fold increase in the number of people living with dementia in Canada (1.6-fold increase in prevalence rate). By 2031, the projected informal (unpaid) caregiving for dementia in Canada was two billion hours per year, or 100 h per year per Canadian of working age.ConclusionsThe projected increase in dementia prevalence was largely related to the expected increase in older Canadians, with projections sensitive to changes in the age of dementia onset.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0107-z) contains supplementary material, which is available to authorized users.

Antipsychotic Use in Dementia.

Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.

Report summary – Prevalence and monetary costs of dementia in Canada (2016): a report by the Alzheimer Society of Canada

Dementia prevalence estimates vary among population-based studies, depending on the definitions of dementia, methodologies and data sources and types of costs they use. A common approach is needed to avoid confusion and increase public and stakeholder confidence in the estimates. Since 1994, five major studies have yielded widely differing estimates of dementia prevalence and monetary costs of dementia in Canada. These studies variously estimated the prevalence of dementia for the year 2011 as low as 340 170 and as high as 747 000. The main reason for this difference was that mild cognitive impairment (MCI) was not consistently included in the projections. The estimated monetary costs of dementia for the same year also varied, from $910 million to $33 billion. This discrepancy is largely due to three factors: (1) the lack of agreed-upon methods for estimating financial costs; (2) the unavailability of prevalence estimates for the various stages of dementia (mild, moderate and severe), which directly affect the amount of money spent; and (3) the absence of tools to measure direct, indirect and intangible costs more accurately. Given the increasing challenges of dementia in Canada and around the globe, reconciling these differences is critical for developing standards to generate reliable information for public consumption and to shape public policy and service development.Les estimations de la prévalence des maladies cognitives dans les études populationnelles varient en raison de différences dans la définition même des maladies cognitives, dans les méthodologies et sources de données et dans les types de coûts inclus. Une approche commune est nécessaire pour dissiper toute confusion et pour améliorer la confiance du public et des intervenants à l’égard de ces estimations. Depuis 1994, cinq études majeures ont dégagé des estimations largement différentes concernant la prévalence et les coûts financiers des maladies cognitives au Canada. Sur la base de ces études, la prévalence des maladies cognitives a été estimée en 2011 selon une fourchette comprise entre 340 170 (estimation basse) et 747 000 (estimation haute). La principale raison de cette différence est l’inclusion ou non du « déficit cognitif léger » (DCL) dans les projections. Les coûts financiers estimés des troubles cognitifs variaient également, dans une fourchette comprise entre 910 millions de dollars et 33 milliards de dollars. Cette différence s’explique majoritairement par (1) le manque de méthodes communes pour estimer les coûts financiers, (2) l’absence d’estimations de la prévalence aux différents stades de la maladie (léger, modéré et avancé), ce qui a un impact direct sur le montant dépensé, et (3) l’absence d’outils pour mesurer plus précisément les coûts directs, indirects et intangibles. Étant donné le nombre croissant d’enjeux liés aux troubles cognitifs au Canada comme dans le reste du monde, harmoniser ces estimations divergentes est essentiel pour générer les informations fiables pour le public, afin d’orienter l’action publique et l’élaboration de services.

Negotiating access to a diagnosis of dementia: Implications for policies in health and social care.

The 'Pathways to Diagnosis' study captured the experience of the prediagnosis period of Alzheimer's disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in Toronto. In this cross-site analysis, we use the 'Candidacy' framework to comprehensively explore the challenges to securing a diagnosis of dementia in Canada and to develop relevant health and social policy. Candidacy views eligibility for appropriate medical care as a process of joint negotiation between individuals and health services, which can be understood relative to seven dimensions: identification of need, navigation, appearances at services, adjudication by providers, acceptance of/resistance to offers, permeability of services and local conditions. Interviewees experienced challenges relative to each of the seven dimensions and these varied in form and emphasis across the four ethno-linguistic groups.

CONSIDERATIONS IN CULTURALLY SAFE CARE FOR INDIGENOUS PEOPLE WITH DEMENTIA IN CANADA

CONSIDERATIONS IN CULTURALLY SAFE CARE FOR INDIGENOUS PEOPLE WITH DEMENTIA IN CANADA

Amyloid imaging for dementia in Canada.

See also page [603][1] and [www.cmaj.ca/lookup/doi/10.1503/cmaj.150508][2] Alzheimer disease and other types of dementia affect an increasing number of people in our societies and are predicted to be the leading cause of health costs in Canada. Although Alzheimer disease is a clinical diagnosis,

The “Rising Tide” of dementia in Canada

Dementia is an umbrella term for a large class of brain disorders. The prevalence of dementia was estimated at 44.4 million people worldwide in 2013, and in the absence of any significant new scientific discovery, prevalence rates are estimated to increase to 75.6 million in 2030 and 135.5 million in 2050.1 Alzheimer’s disease is the most common irreversible form of dementia. It is a fatal, progressive and degenerative disease that destroys brain cells.2 The syndrome consists of a number of symptoms that include changes in memory, judgment, reasoning, mood, behaviour, communication abilities and the ability to function on a day-to-day basis. Rising Tide: The Impact of Dementia on Canadian Society3 is a report released by the Alzheimer Society in 2010 following 2 years of intensive study. It is the first study to estimate the health and economic burden of dementia in Canada over the next 30 years. It also reviews and makes recommendations on policy options to address this issue. The 5 main pillars are as follows: Provide support for family caregivers (family includes anyone in the supportive network of the individual). Emphasize risk reduction and early intervention. Build an integrated system of care. Strengthen and supplement Canada’s dementia workforce. Increase investment in dementia research. Approximately 747,000 Canadians are living with cognitive impairment including dementia.4 Additional statistics from Rising Tide are similarly compelling. Despite advancing age being the biggest risk factor for Alzheimer’s disease, more than 70,000 of those living with dementia are under the age of 65. Women make up 72% of those living with Alzheimer’s disease. Within a generation, incidences of new cases will increase from 1 every 5 minutes to 1 every 2 minutes. The total cost of care for persons with dementia was about $15 billion in 2008 in Canada; this is expected to rise to $153 billion in 2038.3 Moreover, long-term care beds are projected to have a shortfall of 157,000 in Canada by the year 2038. The number of older persons with dementia living at home is expected to steadily rise from 55% to 62%.3 All of these trends will require community or home-based care to become more responsive to the needs of those living with dementia. Pharmacists play a vital role in the health and overall well-being of all Canadians. Pharmacists are highly visible and regularly accessed by members of the community, forming long-standing relationships with their patients. They are trained to understand pharmacotherapy that can benefit or impair cognitive function, and they can monitor for progression and related issues such as medication adherence. However, like many health care professionals, pharmacists may feel ill-equipped to support the unique needs of people living with dementia and their families or caregivers. Simply put, many pharmacists are uncomfortable dealing with patients with dementia. This article is the first in a series that aims to identify roles, strategies and resources pharmacists can apply in daily practice in service of people with dementia.

Estimating the Lifetime Risk of Dementia in the Canadian Elderly Population Using Cross-Sectional Cohort Survival Data

Dementia is one of the world’s major public health challenges. The lifetime risk of dementia is the proportion of individuals who ever develop dementia during their lifetime. Despite its importance to epidemiologists and policy-makers, this measure does not seem to have been estimated in the Canadian population. Data from a birth cohort study of dementia are not available. Instead, we must rely on data from the Canadian Study of Health and Aging, a large cross-sectional study of dementia with follow-up for survival. These data present challenges because they include substantial loss to follow-up and are not representatively drawn from the target population because of structural sampling biases. A first bias is imparted by the cross-sectional sampling scheme, while a second bias is a result of stratified sampling. Estimation of the lifetime risk and related quantities in the presence of these biases has not been previously addressed in the literature. We develop and study nonparametric estimators of the lifetime risk, the remaining lifetime risk, and cumulative risk at specific ages, accounting for these complexities. In particular, we reveal the fact that estimation of the lifetime risk is invariant to stratification by current age at sampling. We present simulation results validating our methodology, and provide novel facts about the epidemiology of dementia in Canada using data from the Canadian Study of Health and Aging. Supplementary materials for this article are available online.

Hospitalized Alzheimer's disease or dementia in Canada

Hospitalized Alzheimer's disease or dementia in Canada

Knowledge translation: an overview and recommendations in relation to the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia

The growing population of persons with dementia in Canada and the provision of quality care for this population is an issue that no healthcare authority will escape. Physicians often view dementia as a difficult and time-consuming condition to diagnose and manage. Current evidence must be effectively transformed into usable recommendations for physicians; however, we know that use of evidence-based practice recommendations is a challenge in all realms of medical care, and failure to utilize these leads to less than optimal care for patients. Despite this expanding need for readily available resources, knowledge translation (KT) is often seen as a daunting, if not confusing, undertaking for researchers. Here we offer a brief introduction to the processes around KT, including terms and definitions, and outline some common KT frameworks including the knowledge to action cycle, the Promoting Action on Research Implementation in Health Services framework and the Consolidated Framework for Implementation Research. We also outline practical steps for planning and executing a KT strategy particularly around the implementation of recommendations for practice, and offer recommendations for KT planning in relation to the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia.

Knowledge translation: an overview and recommendations in relation to the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia.

The growing population of persons with dementia in Canada and the provision of quality care for this population is an issue that no healthcare authority will escape. Physicians often view dementia as a difficult and time-consuming condition to diagnose and manage. Current evidence must be effectively transformed into usable recommendations for physicians; however, we know that use of evidence-based practice recommendations is a challenge in all realms of medical care, and failure to utilize these leads to less than optimal care for patients. Despite this expanding need for readily available resources, knowledge translation (KT) is often seen as a daunting, if not confusing, undertaking for researchers. Here we offer a brief introduction to the processes around KT, including terms and definitions, and outline some common KT frameworks including the knowledge to action cycle, the Promoting Action on Research Implementation in Health Services framework and the Consolidated Framework for Implementation Research. We also outline practical steps for planning and executing a KT strategy particularly around the implementation of recommendations for practice, and offer recommendations for KT planning in relation to the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia.

Checking stationarity of the incidence rate using prevalent cohort survival data

When survival data are collected as part of a prevalent cohort study with follow-up, the recruited cases have already experienced their initiating event, say onset of a disease, and consequently the incidence process is only partially observed. Nevertheless, there are good reasons for interest in certain features of the underlying incidence process, for example whether or not it is stationary. Indeed, the well known relationship between incidence and prevalence, often used by epidemiologists, requires stationarity of the incidence rate for its validity. Also, the statistician can exploit stationarity of the incidence process by improving the efficiency of estimators in a prevalent cohort survival analysis. In addition, whether the incident rate is stationary is often in itself of central importance to medical and other researchers. We present here a necessary and sufficient condition for stationarity of the underlying incidence process, which uses only survival observations, possibly right censored, from a prevalent cohort study with follow-up. This leads to a simple graphical means of checking for the stationarity of the underlying incidence times by comparing the plots of two Kaplan-Meier estimates that are based on partially observed incidence times and follow-up survival data. We use our method to discuss the incidence rate of dementia in Canada between 1971 and 1991.

Canadian Study of Health and Aging: Study Description and Patterns of Early Cognitive Decline

The Canadian Study of Health and Aging (CSHA) is a national longitudinal study of the epidemiology of dementia in Canada. The CSHA also described patterns of disability, frailty and healthy aging. The study involved 10,263 people aged 65 or over, sampled representatively from the community and from long-term care institutions, and participants were interviewed and assessed clinically in 1991, 1996 and 2001. Over 200 papers have been published from the study; a brief summary of results is given. The current analyses provide descriptive statistics on patterns and correlates of early cognitive decline in the study cohort. Several salient findings emerged: almost half of this representative sample showed no cognitive decline over a 10-year period. Education showed a strong protective effect against decline, but not after age 80. There was little difference in crude rates of cognitive decline between men and women, but after adjustment for disability and cardiovascular risk factors, men showed a greater risk of decline, up to age 80. Among those who experienced cognitive decline, the extent of decline was predicted mainly by age, rather than by baseline cognitive scores. Among those who developed dementia, baseline tests were better able to predict Alzheimer’s disease than vascular dementia. Further analyses designed to elucidate these complex associations are described.

The Incidence of Vascular Dementia in Canada: A Comparison with Europe and East Asia

Vascular dementia (VaD) is the second commonest subtype of dementia after Alzheimer’s disease (AD). However, its incidence has been studied much less extensively than that of AD. This article reviews the incidence data for VaD reported in the international literature. Results from 10 incidence studies are compared to those of the Canadian Study of Health and Aging using age-standardized incidence ratios (SIR). SIRs vary from 0.42 to 2.68, indicating that geographical variation is still present after taking into account the countries’ differential age distributions. It is still unclear if these differences are due to genetic and/or environmental factors since a large part reflects methodological differences between studies.

Diagnosis, Classification and Natural History of Degenerative Dementias

The release of the first approved medications for the treatment of Alzheimer's disease in Canada has highlighted the renewed need and importance of diagnostic accuracy and understanding of the spectrum of the dementias. The epidemiological scope of the problem of dementia in Canada including risk factors, caregiving patterns and costs of care have been well-characterized through the Canadian Study of Health and Aging (CSHA 1991-1996) with some of the key findings reviewed here. Beyond Alzheimer's disease the phenotypes and genotypes of the other degenerative dementias have been emerging with proposed operational diagnostic criteria that should facilitate their recognition in clinical practice. This paper reviews the clinical phenotypes of the most common causes of dementia with a proposed classification scheme and with discussion of their relevance from a differential treatment standpoint. This paper served as a background document for the working group of the Consensus Conference on Dementia (C3D) in February 1998 and has been revised subsequently for this publication.

The incidence of dementia in Canada

Objective: To estimate the incidence of dementia, including AD, among Canadians aged 65 and over.Methods: A 5-year cohort study of 10,263 seniors was undertaken, including community and institutional samples. The baseline study in 1991 identified 1,132 prevalent cases of dementia through screening and clinical examination. The remaining 9,131 cases formed the incidence study sample and were rescreened and selectively reexamined in 1996. Incident cases were diagnosed using established criteria. Incidence was estimated based on the 1991 population, and included data on those who died between the first and second phases of the study.Results: Of the nondemented cohort who remained alive in 1996, 5,432 people in the community (88.3%) and 210 (91.3%) in the institutional sample participated in the incidence study. Nine hundred sixty incident cases were identified; the overall age-standardized incidence rates were 21.8 (women) and 19.1 (men) per 1,000 nondemented persons per year. This translates into 60,150 new cases of dementia per year in Canada. The logarithm of the rates rises linearly with age, but suggests a slight slowing of growth in incidence in the oldest age groups.Conclusions: Our incidence estimates lie toward the upper end of the range of incidence estimates found in other studies. Nonetheless, we calculate that several factors may have biased our estimates downward, suggesting that the incidence of dementia may be higher than many studies have reported.

The Entropy of Health and Disease: Dementia in Canada

The object of this paper is to combine two concepts which have developed on the interface between public health and demography: health expectancy and the analysis of linkage in demographic models. The paper addresses in the general case the question: what are the marginal effects of changes in incidence or mortality rates on the expectation of life with and without a particular irreversible non-communicable disease or type of disability? A simple model of disease in a population is described and general solutions for the two components of the expectation of life are obtained.... It is shown that under certain conditions the entropy of the expectation of disease free life with respect to changes in incidence can be approximated by an extension of Sullivans index. Data on dementia among elderly Canadians obtained from the Canadian Study of Health and Aging are used for illustration. (EXCERPT) (SUMMARY IN FRE)

Patterns of Caring for People with Dementia in Canada The Canadian Study of Health and Aging

RÉSUMÉCette étude porte sur les tendances, au Canada, en matière de soins auprès de personnes âgées de 65 ans ou plus atteintes de démence, ainsi que leurs effets sur le bien-être des dispensateurs de soins. Les données ont été tirées d'un échantillon représentatif de personnes âgées vivant au sein de la communauté et en établissement de santé dans les dix provinces canadiennes dans le cadre de l'Étude sur la santé et le vieillissement au Canada (ESVC). Des entrevues ont été menées auprès de personnes donnant des soins à des personnes âgées atteintes de démence et d'un groupe de personnes prodiguant des soins à des personnes âgées non atteintes à des fins de comparaison. Près de la moitié des personnes atteintes de démence au Canada vivent au sein de la communauté et, selon nos résultats, plus de 98 pour cent d'entre elles bénéficient de soins. Dans 94 pour cent de ces cas, le dispensateur de soins est un membre de la famille non rémunéré, un membre de la parenté ou un ami; le conjoint et la fille représentent respectivement 37 et 29 pour cent de ceux-ci. Les dispensateurs de soins font rarement appel aux services de soutien communautaire. Parmi ce groupe, les personnes prenant soins d'un aîné atteint de démence sont le plus susceptibles d'éprouver des problèmes de santé chroniques et de présenter des signes de dépression, par opposition aux personnes prenant soins d'aînés non atteints. De plus, les dispensateurs de soins au sein de la communauté risquent davantage de sentir qu'elles portent un lourd fardeau que les personnes dont un membre de la famille se trouve en établissement et ce, même si les personnes en établissement sont atteintes de démence grave. Ces données nationales soutiennent bon nombre des résultats obtenus dans le cadre d'études menées à plus petite échelle dans les localités. Les résultats suggèrent que les établissements de soins de longue durée jouent un rôle important au Canada pour les personnes âgées, particulièrement celles atteintes de démence, et que les dispensateurs de soins prodiguent des soins à leurs proches même s'ils éprouvent des problèmes de santé chroniques, de dépression, ou doivent porter un fardeau plus lourd.

Prevalence of dementia in Canada : Ian McDowell. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

Prevalence of dementia in Canada : Ian McDowell. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

Some calculations on the prevalence of dementia in Canada

Some calculations on the prevalence of dementia in Canada