Dementia In Older People Research Articles

Validity of Criteria for Dementia in Older People With Intellectual Disability

Validity of Criteria for Dementia in Older People With Intellectual Disability

Association between polypharmacy and dementia in older people: A population‐based case–control study in Taiwan

The aim of the present study was to investigate whether polypharmacy correlates with the risk of dementia in older people. From representative claims data established from the National Health Insurance with a population coverage rate of 99% in Taiwan, we identified 7135 newly diagnosed patients with dementia in 2000-2008 and 2,8540 randomly selected controls without dementia, both aged ≥ 65 years. The daily use of prescribed drugs in the past 2 years was compared between cases and controls, controlling for demographic characters and comorbidities. The incidence of dementia increased with the number of medications used and age. Cases were older than controls, predominant with women and more likely to use five or more drugs daily (44.0% vs 32.0%, P < 0.0001). Multivariate logistic regression analysis showed that, compared with participants using zero to one drug, the odds ratios (OR) of dementia were 1.28 (95% confidence interval [CI] 1.18-1.38) for those using two to four drugs, 1.34 (95% CI 1.23-1.46) for those using five to nine drugs and 1.56 (95% CI 1.38-1.76) for those using 10 or more drugs. Cerebrovascular disease (OR 3.19), diabetes mellitus (OR 1.23), chronic kidney disease (OR 1.21) and hypertension (OR 1.08) were significant comorbidities predicting the risk of dementia. There was significant interaction between cerebrovascular disease and the number of medications used in the dementia risk. The risk of dementia increases steadily with the number of medications used and age in older people in Taiwan. Cerebrovascular disease, diabetes mellitus, chronic kidney disease and hypertension might also correlate with the risk of dementia.

Whether, when and how chronic inflammation increases the risk of developing late-onset Alzheimer's disease

Neuropathological studies have revealed the presence of a broad variety of inflammation-related proteins (complement factors, acute-phase proteins, pro-inflammatory cytokines) in Alzheimer's disease (AD) brains. These constituents of innate immunity are involved in several crucial pathogenic events of the underlying pathological cascade in AD, and recent studies have shown that innate immunity is involved in the etiology of late-onset AD. Genome-wide association studies have demonstrated gene loci that are linked to the complement system. Neuropathological and experimental studies indicate that fibrillar amyloid-β (Aβ) can activate the innate immunity-related CD14 and Toll-like receptor signaling pathways of glial cells for pro-inflammatory cytokine production. The production capacity of this pathway is under genetic control and offspring with a parental history of late-onset AD have a higher production capacity for pro-inflammatory cytokines. The activation of microglia by fibrillar Aβ deposits in the early preclinical stages of AD can make the brain susceptible later on for a second immune challenge leading to enhanced production of pro-inflammatory cytokines. An example of a second immune challenge could be systemic inflammation in patients with preclinical AD. Prospective epidemiological studies show that elevated serum levels of acute phase reactants can be considered as a risk factor for AD. Clinical studies suggest that peripheral inflammation increases the risk of dementia, especially in patients with preexistent cognitive impairment, and accelerates further deterioration in demented patients. The view that peripheral inflammation can increase the risk of dementia in older people provides scope for prevention.

The lived experience of spirituality and dementia in older people living with mild to moderate dementia

A literature review highlighted the importance of understanding the subjective experience of spirituality and dementia. Two research aims were identified: to build an understanding of how older people's experience of spirituality, religion or faith is affected by having dementia and to understand how the spiritual aspects of their lives affect the experience of dementia. Six older people with mild to moderate dementia were interviewed about their experience of spirituality and dementia. Interview transcripts were analysed using Interpretive Phenomenological Analysis. Five superordinate themes were identified: experience of faith; searching for meaning in dementia; ‘I'm not as I was’ – changes and losses in experience of the self; staying intact; and current pathways to spiritual connection and expression. The results offered a unique perspective on the experience of spirituality and dementia, uniting themes from both research and theory concerning the experience of the self and the experience of spirituality in dementia.

Vascular dementia: why pathology is still important

SummaryCerebral infarction, as the result of atheroma in large blood vessels, was one of the first explanations for dementia in older people. However, this was a relatively uncommon finding in those presenting with dementia and it was soon realized that subcortical infarctions due to non-atheromatous changes in small blood vessel walls were more important factors in cognitive decline. Furthermore, small vessel disease (SVD) producing lacunar infarcts (LI) and white matter changes increased dementia severity in individuals with only moderate Alzheimer's disease (AD) pathology. Magnetic resonance imaging (MRI) found subcortical (lacunar) ‘silent infarcts’ and white matter changes were surrogate markers for SVD and increased significantly the likelihood of developing dementia. Detailed histopathological studies of SVD showed it was in fact a range of pathologies, but the aetiology of the most common type (arteriosclerosis/lipohyalinosis) is difficult to explain. Theories to explain SVD include effects of hypertension, a leaky blood–brain barrier (BBB), amyloid accumulation, microbleeds, venous changes and endothelial inflammation. Endothelial expressed inflammatory molecules could represent potential biomarkers of SVD. Many of the risk factors associated with SVD are also present in AD, such as diabetes, systemic hypertension and ageing; all of these can target the endothelium with the potential to initiate SVD, resulting in ischaemic changes and neurodegeneration, including AD pathology.

A multicentre community‐based study of dementia cases and subcases in older people in China—the GMS‐AGECAT prevalence and socio‐economic correlates

Previous studies indicated overall relatively low prevalence of dementia in older people in China, which may be biased by studied samples or methods. We determined the prevalence of dementia cases and subcases in China and examined their socio-economic correlates. Using the Geriatric Mental State interview, we examined random samples of 2917 participants aged ≥ 65 years in urban and rural Anhui, China in 2001-2003, and 3327 in four other provinces in 2008-2009. Dementia cases and subcases were diagnosed by Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy. Age-standardised prevalence for cases and subcases of dementia in the Anhui elders was 7.20% (95%CI 6.29%-8.20%) and 10.5% (9.38%-11.6%), and in the four provinces, 9.86% (8.80%-10.9%) and 8.51% (7.51%-9.52%). The matched figures among the participants who were literate were 3.05% (2.08%-4.02%) and 10.0% (8.38%-11.6%), and 4.92% (3.89%-5.96%) and 6.76% (5.55%-7.96%), respectively. There were higher prevalence rates of dementia cases and subcases in the rural elders than in the urban. Both the Anhui and four-province studies showed an obvious association of dementia with higher and lower incomes among elders who had lower educational levels or had the lowest occupational class. The highest risk of dementia was found in those who were illiterate but had the highest income or had the job of business/nonmanual labouring. People in China have a higher prevalence of dementia than previously reported. Its U-shaped relationship with income and the excess subcases prevalence predicates a significant burden of disease, both now and for the future, suggesting preventive strategy for dementia in China.

Factors impacting on early detection of dementia in older people of Asian background in primary healthcare

AbstractIntroductionThe prevalence of dementia in people from Culturally and Linguistically Diverse (CALD) backgrounds is predicted to increase. By 2026, Chinese and Vietnamese languages are projected to be the first and fourth most prevalent languages spoken by older people from CALD backgrounds living in Australia. Varying expressions of dementia literacy within these groups sometimes result in presentation to health services at a later stage of the disease.MethodsThis paper aims to present a literature review on factors impacting on the early diagnosis of dementia in primary care. Cultural factors pertaining to older people of Chinese and Vietnamese backgrounds are identified and described.ResultsThe review found that despite the benefits and emphasis on early diagnosis of dementia, GPs′ uncertainty, insufficient training, ambivalent attitude and therapeutic nihilism have contributed to delayed diagnosis of dementia in CALD populations in primary care. Other factors included time pressures, poor remuneration and lack of CALD appropriate diagnostic tools and services. From the older Chinese and Vietnamese people and their families′ perspective, living arrangements, level of dementia literacy, symptom interpretation, stigma associated with dementia and their concept of morality significantly impacted on health‐seeking behaviour, contributing to delayed presentation to GPs. Language barriers and lack of bilingual GPs were also found to be deterring factors.DiscussionThere is a need to remove barriers impacting on the timely diagnosis of dementia in primary healthcare for older people from CALD backgrounds. Increasing CALD‐appropriate services, workforce training, public awareness and removing stigma may assist.

Alcohol intake linked to level of dementia in older people

Alcohol intake linked to level of dementia in older people

Dementia among older in-hospital patients with obstructive airway disease

Dementia may influence as a co-morbid condition the management of chronic obstructive airway disease. However, the frequency and the consequences of dementia in older people with chronic obstructive airway disease are largely unknown. The frequency and the severity of dementia in geriatric in-hospital patients and its impact on feasibility of lung function testing and drug treatment provided were determined. Out of a total of 1,424 patients with obstructive airway disease, 433 (30%) suffered from mild and 307 (22%) suffered from moderate to severe dementia. The frequency of any treatment for obstructive airway disease on admission decreased from 58% in subjects without dementia to 51% of those with mild and to 36% of those with moderate to severe dementia (p<0.01). The feasibility of performing lung function testing also decreased with increasing prevalence of dementia from 86% to 66% and 43%, respectively (p<0.001). Dementia is a frequent finding in older in-hospital patients with obstructive airway disease. The majority of subjects with dementia were not able to perform lung function testing. Furthermore, the risk of undertreatment for chronic obstructive airway disease increased. Future guidelines for management of obstructive airway disease must also take into account the special needs and skills of older subjects with dementia.

Design considerations in long-term intervention studies for the prevention of cognitive decline or dementia

The results of randomized controlled trials of nutritional interventions aimed at preventing cognitive decline or dementia in older people have been largely disappointing. A reasonable argument can be made that this is at least in part because the design of primary prevention trials in older people is not straightforward and that the complexities of such trials are not readily apparent and commonly remain not fully recognized. This article analyzes some of the difficulties associated with identifying and enrolling study participants in long-term prevention trials, with available data from three large, recently published trials used as examples. This analysis also serves to identify examples of good practice and areas for further research. Randomized controlled trials remain the single most important tool in the epidemiological arsenal for identifying the effects of specific interventions, but consideration of critically important design features is essential.

A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients

Older people are commonly admitted to the acute hospital and increasing numbers will have dementia. In this study we systematically reviewed the prevalence, associations and outcomes of dementia in older people in the general hospital, to examine the range of diagnostic tools used and highlight gaps in the literature. We searched the English language literature using Embase, PsychInfo and Medline. Studies were included if they used validated criteria for diagnosing dementia, involved subjects over the age of 55 years and were set in the general hospital. Fourteen papers were identified. Prevalence estimates for dementia in studies with robust methodology were 12.9-63.0%. Less than a third of studies screened for delirium or depression and therefore some subjects may have been misclassified as having dementia. The data were highly heterogeneous and prevalence estimates varied widely, influenced by study setting and demographic features of the cohorts. Patients with dementia in the acute hospital are older, require more hours of nursing care, have longer hospital stays, and are more at risk of delayed discharge and functional decline during admission. When planning liaison services, the setting and demographic features of the population need to be taken into account. Most study cohorts were recruited from medical wards. More work is required on the prevalence of dementia in surgical and other specialties. A wider range of associations (particularly medical and psychiatric comorbidity) and outcomes should be studied so that care can be improved.

Genes and cognitive aging

Genes and cognitive aging

The prevalence of cognitive impairment with no dementia in older people: The Seoul study

The prevalence of cognitive impairment with no dementia in older people: The Seoul study

Combined instruments for the screening of dementia in older people with low Education

To determine which combination of cognitive tests and informant reports can improve the diagnostic accuracy of dementia screening in low educated older people. Patients with mild to moderate dementia (n=34) according to ICD-10 and DSM-III-R criteria and 59 older controls were assessed with the Mini-Mental State Examination (MMSE) and the Fuld Object Memory Evaluation (FOME). Informants were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living Scale. The 4 instruments combined with the mixed rule correctly classified 100% and the logistic regression (weighted sum) classified 95.7% of subjects. The weighted sum had a significantly larger ROC area compared to MMSE (p=0.008) and FOME (p=0.023). The specificity of the tested combinations was superior to the MMSE alone (p=0.002). Cognitive tests combined with informant reports can improve the screening of mild to moderate dementia in low educated older people.

Application of Reminiscence Treatment on Older People With Dementia

Reminiscence therapy has been utilized for many years in the treatment of dementia in older people. Purposes of the research included examining different methods of promoting interactivity, social participation, cognitive function improvement in those with dementia, and the effectiveness in reducing symptoms of depression following group treatment. This study used pretest and posttest electroencephalography (EEG) measurements to test reminiscence therapy efficacy on participants. This research organized a social group work with 12 elderly clients with dementia (mild to moderate stage) selected from among 90 residents of an older persons care facility in Pingtung. Eleven agreed to join the study, and 10 completed successfully all treatment sessions. Eight sessions of reminiscence cooking lessons were conducted. The effectiveness of interventions was evaluated by comparing presession and postsession EEG, mental health status, depression scale, and feeling of participation scale scores. Significant differences in values, particularly for EEG, were found between the two sets of scores. The average value of participants' fast waves rose from 43.88 to 55.12, whereas average slow-wave values fell from 56.12 to 44.13. After analysis using the Wilcoxon matched paired signed rank test, significant differences were noted. Findings and suggestions include the following: (a) The rise in Mini-Mental State Examination and reduction in depression scale scores, although noted, were not significant, and (b) the self-achievement, emotional stability, family atmosphere, and physical needs of participants were met. The authors recommend that reminiscence group work be promoted in the home for older persons and that childhood cooking sessions twice each week may be the ideal format for reminiscence group work.

Anti-inflammatory effects of daidzein on primary astroglial cell culture

Introduction: Alzheimer's disease is the common cause of dementia in old people. The pathological hallmarks of Alzheimer's disease include neuronal loss, deposition of amyloid-β, and presence of neurofibrillary tangles. The endogenous steroid estrogen has been shown to affect neuronal growth, differentiation and survival, while isoflavones also have a neuroprotective effect on human cortical neurons. Daidzein, however, has a superior neuron-protective effect to other isoflavones. The present study is to determine whether daidzein is able to inhibit the production of pro-inflammatory mediators under amyloid-β and lipopolysaccharide stimulation.Materials and methods: Astrocyte cells were stimulated with amyloid-β or lipopolysaccharide in the absence and presence of diadzein. Nitric oxide released into the culture media was determined using the Griess reaction, and concentrations of IL-1, IL-6, TNF-α and estrogen receptor gene expression were measured by semi-quantitative real-time polymerase chain reaction assay.Results: Diadzein-treatment increases astrocyte cell counts and attains its maximal effect at the 10−12M concentration. The addition of 20 μM amyloid-β or 10−6 g/ml LPS can significantly decrease the viability of astrocytes, up-regulated IL-1, IL-6, TNF-α mRNA and estrogen receptor expression; in addition, 1-h daidzein pre-treatment can restore the decreased viability of astrocytes induced by amyloid-β or lipopolysaccharide as well as down-regulate their mRNA expression.Conclusions: It seems that this response is estrogen receptor-mediated. These results further increase the possibility that daidzein may have potential to ameliorate the inflammatory process and also alleviate the risk of Alzheimer's disease progression.

MANAGEMENT OF PATIENTS WITH MILD COGNITIVE IMPAIRMENT AND MILD TO MODERATE DEMENTIA

Click to increase image sizeClick to decrease image sizeKeywords: MCIdementiacholinesterase-inhibitorsmanagement of MCI

TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 1. LONG-TERM USE OF RIVASTIGMINE IN PATIENTS WITH DEMENTIA WITH LEWY BODIES: AN OPEN-LABEL TRIAL

Eleven authors, 29 patients and an open-label design would not generally be regarded as strong predictors of a publication's citation success, so this one (Grace et al., 2001) probably needs some explaining. I was advised early in my prospective publishing career always to look for “a gap in the market” and in 2001 this short paper probably filled a significant gap in clinical knowledge. It was almost a decade since the first reports had appeared about dementia with Lewy bodies (DLB) being a relatively common cause of dementia in older people, and by 2001 the first iteration of the consensus criteria for DLB diagnosis was starting to be widely used. Clinicians were therefore becoming more confident about recognizing DLB in their clinics, realized that cholinesterase inhibitors (ChEIs) were often useful in symptom control, and wanted to know more about their effects in the longer term. This short paper gave them some useful evidence to support their practice. The lead author, Janet Grace, who was working as my clinical lecturer, had for a couple of years been following up a group of DLB patients whom she had originally entered in an earlier placebo controlled study (McKeith et al., 2000) and was interested in charting their progress with the ready help of U.K. colleagues in Essex, Manchester, Southampton and Nottingham. Although the 21 patients who remained on treatment did show some evidence of disease progression after two years, neither their Mini-mental State Examination (MMSE) scores nor their Neuropsychiatric Inventory (NPI) scores were significantly worse than at baseline. And reassuringly their parkinsonism had not worsened, which was a common concern at that time.

The prevalence of cognitive impairment with no dementia in older people: The seoul study

This study aimed to estimate prevalence of cognitive impairment with no dementia (CIND) in older people. It was conducted in an urban area of Korea, Seoul, and employed a two-stage design for case identification. Overall 643 persons aged 65 years and older participated and 217 persons sampled from the three levels of performance of MMSE underwent a second stage clinical evaluation. CIND was diagnosed when the global Clinical Dementia Rating (CDR) index was 0.5 and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition diagnostic features of dementia were not satisfied. CIND cases without any apparent causes were classified as CIND of unidentified cause (CIND(uc)). CIND prevalence ranged from 26.3% in persons aged 65-69 to 46.5% in persons aged 85 years and older. The age-standardized prevalence for overall CIND was 31.9% and for CIND(uc) 19.2%. The prevalences of CIND for the three severity grade were 15.8%, 9.7%, and 6.2% for CDR sum of boxes scores of 0.5, 1-1.5, and >or=2, respectively. The prevalence of CIND in community-residing elderly is probably higher than previously reported. The results of this study are useful for assessments of present and future demands for healthcare services.

Review: some screening tests for dementia are accurate and practical for use in primary care

T Holsinger Correspondence to: Dr T Holsinger, Durham VA Medical Center, Durham, NC, USA; tracey.holsinger@va.gov How accurate are screening tests for detecting dementia in older people in primary care settings?...