Specialist Dementia Research Articles

Cultural adaptations of the WHO iSupport for dementia: A scoping review.

The World Health Organisation (WHO) has developed iSupport for Dementia, a self-paced online training programme for caregivers of people with dementia which is adaptable to different cultural contexts. This scoping review aims to understand the iSupport adaptation process in different countries and provide recommendations for future adaptations. A systematic search was done in electronic databases such as Pubmed, MEDLINE, APA PsycINFO, and EMBASE to obtain relevant publications up to 18 February 2024. Only full-text publications describing iSupport cultural adaptation process were included. The publications obtained were reviewed using the Cultural Adaptation Process framework. Thirteen publications from ten studies were eligible for inclusion. Based on the Cultural Adaptation Process framework, the steps undertaken in the studies were grouped into: (i) setting the stage, (ii) initial adaptation, and (iii) adaptation iterations. The three significant players in this process are the intervention developer (researchers), the cultural adaptation specialist (researchers, caregivers, and dementia care professionals), and the target community (caregivers). In the publications reviewed, cultural adaptation was mostly undertaken using a co-design process between researchers, caregivers, and dementia care professionals deciding on necessary modifications. iSupport for Dementia is a versatile programme to support caregivers and is readily available for adaptation to different cultural settings. It is essential to engage caregivers early in co-designing its cultural adaptations to ensure their needs can be met by this online tool.

Evaluating the effectiveness of a home treatment team for older adults and adults with dementia in a mental health crisis: A retrospective analysis

The demographic shift towards an aging population presents challenges in healthcare, notably in addressing frailty and dementia. Hospitalization risks, including out-of-area (OOA) admissions, are well-documented. This evaluation focused on the Intensive Support Team (IST), designed to reduce hospitalisations for older adults, usually over 75 years old, and adults with dementia facing mental health crises. The study assessed the effectiveness of IST within the Specialist Dementia and Frailty Service (SDFS) in West Essex. Using a retrospective comparative design, IST admission data from 2018 (pre-IST) and 2022 (post-IST) were analysed, covering 246 patients’ records. Objectives included evaluating changes in admission rates for patients under or eligible for SDFS and comparing with other community teams, as well as examining IST’s impact on hospital stay length. Chi-square analysis showed a significant reduction in SDFS admissions post-IST, though no significant change was found for other admissions. One-way ANOVA revealed no significant difference in admission length. The results support IST’s effectiveness in reducing hospital admissions, aligning with NHS long-term goals and informing policy and clinical decisions.

Stakeholder Consultation to Establish Research Priorities for Specialist Dementia Nursing in the United Kingdom.

In the United Kingdom, there are a growing number of specialist dementia nurses called Admiral Nurses. Admiral Nurses, supported in their professional development and clinical supervision by the charity Dementia UK, work with families affected by dementia using a relationship-centred approach. Given the growing need for this type of support, Dementia UK is committed to research that will expand the evidence base for Admiral Nursing. This article describes a stakeholder consultation to identify research priorities for Admiral Nursing for the next 3 years (2023-2026). We adopted a participatory approach using an adapted Nominal Group Technique and priority-setting workshop. All elements of the process were designed in consultation with a steering group comprising a range of stakeholders, including people with dementia, carers, Admiral Nurses, Dementia UK staff and researchers. Stakeholders were identified as those who were likely to be affected by or interested in the emerging research priorities. Nominal groups were held both face-to-face and online. A total of 144 people shared their research priorities. Data generated through each nominal group were thematically analysed and then ranked in order of priority. Four themes reflecting research priority areas were taken to a priority-setting workshop for consideration. This resulted in three research priorities for Admiral Nursing: (1) people with dementia who live alone and carers who provide support from a distance; (2) people living with young onset and rarer dementia and their families; and (3) people living with multiple health conditions alongside dementia, including mental health problems. Risk, diversity and the effectiveness of Admiral Nursing were strands that ran throughout these themes. We identified shared research priorities for Admiral Nursing using a rigorous, consensus-driven approach involving key stakeholders. These priorities reflect a desire to ensure that Admiral Nursing services reach the most vulnerable people living with dementia and their families and respond to the widening health and social care inequalities faced by this group. People with dementia and carers were involved in the design of this process as members of our steering group and through consultation on our initial plans with Dementia UK's Lived Experience Advisory Panel (LEAP). People living with dementia and carers also participated in consultation groups to share their views on research priorities. All stakeholders were invited to share feedback on the themes as part of the analysis and interpretation of the priorities, and a meeting was held with LEAP to discuss the emerging priorities.

A - 100 Who Is at the Door? Clinical Presentations and Predictors of Dementia Diagnosis in a Specialist Dementia Service

Abstract Objective This service audit aimed to identify predictors associated with a dementia diagnosis and the diagnostic base rate in a UK-based, specialist Younger People with Dementia (YPWD) Service. Method All patients referred between July 2022 and 2023 to the YPWD service were included in the study. All 191 patients were under 65 years at the time of referral. 69 patients were excluded from analysis (e.g., if the patient withdrew from the service prior to assessment or if the referral was deemed inappropriate based on service guidelines). A quasi-experimental design was used, investigating the relative predictive value of factors such as demographics, presenting cognitive symptoms, comorbidities, or mental health to receiving a dementia diagnosis. Following definition, raters reviewed client case notes to establish the presence or absence of each criterion. Results Significant predictors of a dementia diagnosis in YPWD were functional change (p < 0.001), behavior change (p < 0.001), being accompanied to assessment (p < 0.001), diminished insight (p < 0.001), executive functioning difficulties (p < 0.05), cognitive screening test score below cut-off (p < 0.05) and previous radiological investigation prior to referral (p < 0.001). The diagnostic rate for YPWD was 15%. Conclusions Memory problems alone are an insufficient predictor for a dementia diagnosis in YPWD, unless accompanied by additional factors. Overreliance on the presence of subjective memory complaints in primary care as a percipient to referral for specialist assessment contributes to a low diagnostic rate for the service The presence of insight and attending appointments alone contraindicate the presence of an organic disorder. Results indicate that factors beyond diagnostic criteria may be clinically significant.

A Patient and Public Engagement Project to Inform Dementia Care in a UK Hospital Trust.

The increasing prevalence of dementia in the United Kingdom presents significant challenges for healthcare, with projections estimating over a million affected individuals by 2025, costing the NHS £6.3 billion annually. Hospital admissions among dementia patients are common, occupying about 25% of UK hospital beds and leading to prolonged stays and diminished health outcomes. This paper presents the opening stages, part of a larger project where Patient and Public Involvement and Engagement (PPIE) was employed to understand and navigate what it means for hospital care for a person living with dementia. To understand hospital care for dementia patients, focus groups were conducted through dementia cafés in Essex and Suffolk from February to July 2023 engaging patients, carers and family members. Recognised processes for reporting PPIE and thematic analysis were used and identified six themes and 21 subthemes regarding hospital care: individualised care, role of carers, basic care, interpersonal communication, information sharing and staffing. The results from the PPIE will be used to inform and work with stakeholders through the next phases of the project, which involves examining care processes in the hospital, identifying touchpoints and evaluating these areas. The project continues to be informed by stakeholders including people living with dementia, carers and staff. Additionally, the results may inform other service providers for care enhancements, processes and delivery. Moving forward, the study emphasises the importance of building collaborative relationships with stakeholders involved in dementia care. Additionally, it provides insights to focus areas that are fundamental for acute care organisations when delivering care to people living with dementia. By incorporating insights from PPIE, this project seeks to identify inequalities in dementia care services, improve hospital care for people living with dementia, fostering a more inclusive and supportive healthcare environment. The purpose of the study was to explore the most important issues around hospital care for people with dementia, their carers and families. Persons living with dementia, carers and family members were involved in the study through community dementia cafés and recruited to take part in focus groups to discuss hospital care for patients with dementia. The design of questions and materials for the discussions was developed through consultation with the university department's service user lead and dementia specialist and reviewed by a service user member living with dementia. A pilot focus group was conducted with a group of carers. We worked with the dementia café managers to coordinate recruitment and a suitable environment to run the focus groups. Not applicable.

Real-world occupational therapy interventions for early-stage dementia: Characteristics and contextual barriers.

There is an absence of evidence generated in a UK context to support interventions based on occupational therapists' core skills for people living with early-stage dementia. To inform the development of a programme theory and a future evaluation, this paper aimed to describe real-world (routine) community-based occupational therapy interventions for this population and contextual barriers. Occupational therapy practitioners (n = 21) from five Health Boards in Wales, UK participated in semi-structured interviews (n = 17) which were audio recorded, transcribed, and analysed thematically. The availability of, and access to, real-world community-based interventions was variable, and associated with multilevel contextual barriers (resources, understanding of dementia specialist occupational therapy, professional influence, and evidence base). Where available and accessible, contents comprised a pre-intervention component (relational work, assessment, and goal setting) and intervention component (personalised problem-solving and coping strategies, emotional support, and advice and signposting), to meet needs associated with everyday activities and poor wellbeing. Variation in mode, duration, contents, and who received interventions, was associated with contextual barriers. Findings indicate that the development of an intervention programme theory and future evaluation design, will need to account for the impact context may have on the variability of real-world intervention characteristics, and how this in turn may influence outcomes.

A comparison of written case notes and the delivery of care in dementia specialist mental health wards.

Introduction: Stigmatising language concerning people living with dementia can cause potentially harmful and dehumanising consequences. Language used about people living with dementia in mental health wards may focus on medical perspectives and suggest custodial relationships with patients rather than person-centred accounts of individuals. This language could have a devastating impact on the provision of person-centred care. This study investigated the relationship between accounts of people living with dementia written in healthcare case notes and clinical practice at three dementia specialist wards in Wales, UK. Language guidance was provided to ward staff to assess whether stigmatising language could be reduced and whether this influenced the provision of person-centred care.Methodology: Dementia Care Mapping was adapted to analyse case note entries for enhancing and detracting accounts of people living with dementia at three data collection points. These were compared to the results of routine DCM observations of care across the three wards. The healthcare case notes of 117 people living with dementia, encompassing 4, 522 entries over ten months were analysed. DCM observations of 38 people living with dementia within the three wards were compared against the case note results. Person-centred language guidance was shared with care staff following each data collection point.Results: Following the provision of person-centered language guidance, the use of personally enhancing language was observed to increase across all three wards. Non-person-centred case note entries predominantly focussed on Labelling language, whilst language concerning Invalidation and Objectification also occurred frequently compared to other DCM domains. Person centred language typically concerned Acknowledgement. A relationship between case note entries and practice was evident in some domains although findings were inconsistent.Discussion and Implications: The findings highlight the importance of addressing stigmatising language in healthcare and suggest that further studies to support the anti-stigma agenda in dementia care are required.

Associations between specialized dementia care, COVID-19 and central nervous system medication use in assisted living: a population-based repeated cross-sectional study

BackgroundAssisted living (AL) is an increasingly common residential setting for persons with dementia; yet concerns exist about sub-optimal care of this population in AL given its lower levels of staffing and services. Our objectives were to (i) examine associations between AL setting (dementia care vs. other), COVID-19 pandemic waves, and prevalent antipsychotic, antidepressant, anti-dementia, benzodiazepine, and anticonvulsant drug use among residents with dementia/cognitive impairment, and (ii) explore associations between resident and home characteristics and prevalent medication use.MethodsWe conducted a population-based, repeated cross-sectional study using linked clinical and health administrative databases for all publicly funded AL homes in Alberta, Canada, examined between January 2018 - December 2021. The quarterly proportion of residents dispensed a study medication was examined for each setting and period (pandemic vs. comparable historical [2018/2019 combined]) focusing on four pandemic waves (March-May 2020, September 2020-February 2021, March-May 2021, September-December 2021). Log-binomial GEE models estimated prevalence ratios (PR) for period (pandemic vs. historical periods), setting (dementia care vs. other) and period-setting interactions, adjusting for resident (age, sex) and home (COVID-19 cases, health region, ownership) characteristics.ResultsOn March 1, 2020, there were 2,779 dementia care and 3,013 other AL residents (mean age 83, 69% female) with dementia/cognitive impairment. Antipsychotic use increased during waves 2–4 in both settings, but this was more pronounced in dementia care than other AL during waves 3 and 4 (e.g., adjusted [adj]PR 1.20, 95% CI 1.14–1.27 vs. adjPR 1.09, 95% CI 1.02–1.17, interaction p = 0.023, wave 3). Both settings showed a statistically significant but modest increase in antidepressant use and decrease in benzodiazepine use. For dementia care AL residents only, there was a statistically significant increase in gabapentinoid use during several waves (e.g., adjPR 1.32, 95% CI 1.10–1.59, wave 3). Other than a modest decrease in prevalent anti-dementia drug use for both settings in wave 2, no other significant pandemic effects were observed.ConclusionsThe persistence of the pandemic-associated increase in antipsychotic and antidepressant use in AL residents coupled with a greater increase in antipsychotic and gabapentinoid use for dementia care settings raises concerns about the attendant risks for residents with cognitive impairment.

Effect of Soundscape Augmentation on Behavioral Symptoms in People With Dementia: A Pilot Randomized Controlled Trial.

Sound is an important environmental factor that influences the expression of behavioral and psychological symptoms of dementia. Recent research on the effect of soundscape has shown promising results in improving environmental impact on people with dementia. However, no controlled studies have aimed to quantify the effects of soundscape intervention on resident outcomes. The aim of this study was to assess the feasibility and impact of a soundscape intervention on people with dementia and behavioral symptoms. Pilot single-blind repeated-measures randomized controlled trial of an augmented soundscape intervention. Participants were people with dementia in a hospital-based specialized dementia unit. Participants were randomized to an augmented soundscape intervention delivered in their room in the morning and evening or treatment as usual, with 2 baseline weeks and 4 weekly post-randomization assessments of the primary and secondary behavioral outcomes. The soundscape intervention was feasible in terms of recruitment, retention, and delivery of the intervention. There were improvements in the neuropsychiatric inventory total scores over time in both groups (-5.89, 95%CI -8.45 to -3.28, p < .001), but no differences between groups. There were no significant group, time, or group × time differences for the Pittsburgh Agitation Scale (PAS) total score. For the PAS-resisting care subscale, there was a significant group × time difference, with a greater reduction in the soundscape group over the study period (-0.81, 95% CI -1.59 to -0.03, p = .042). In this pilot study, soundscape augmentation was a feasible and effective nonpharmacological approach to reducing resistance to care in people with dementia, although it did not improve neuropsychiatric symptoms more globally. Further studies with larger samples and of longer duration are needed to investigate the long-term effects of augmented sonic environments on people with dementia. NCT04809545.

Role of Neurologists in Dementia Practice

The September 2013 issue of this journal contains an article titled "The Role of Neurologists in Dementia Practice" in which I have highlighted the contributions of neurologists to dementia care. I have emphasized the importance of proactive leadership within interdisciplinary teams that include general practitioners and psychiatrists. Following the implementation of the Basic Act on Dementia to Promote an Inclusive Society and advances in medical science, such as introduction of the anti-Alzheimer drug lecanemab, neurologists are expected to play a more active role in dementia management and require more specialized skills. The emergence of lecanemab has led to more direct involvement of neurologists in dementia practice, which has resulted in the emergence of "novice" dementia specialists. However, a shortage of neurologists who specialize in behavioral neurology remains a significant concern in Japan. This challenge is compounded by the inadequate education of general neurologists in this domain, because dementia management requires deep knowledge and skills in behavioral neurology. The most important and urgent issue is to promptly address this shortage. Although neurologists' involvement in dementia practice is attributable to the introduction of lecanemab, I sincerely look forward to neurologists transitioning from "novice" to "real" experts in dementia. I reiterate this call as a recommendation to fellow neurologists, emphasizing the need to evolve into true specialists in the field.

Blood Biomarkers to Detect Alzheimer Disease in Primary Care and Secondary Care

An accurate blood test for Alzheimer disease (AD) could streamline the diagnostic workup and treatment of AD. To prospectively evaluate a clinically available AD blood test in primary care and secondary care using predefined biomarker cutoff values. There were 1213 patients undergoing clinical evaluation due to cognitive symptoms who were examined between February 2020 and January 2024 in Sweden. The biomarker cutoff values had been established in an independent cohort and were applied to a primary care cohort (n = 307) and a secondary care cohort (n = 300); 1 plasma sample per patient was analyzed as part of a single batch for each cohort. The blood test was then evaluated prospectively in the primary care cohort (n = 208) and in the secondary care cohort (n = 398); 1 plasma sample per patient was sent for analysis within 2 weeks of collection. Blood tests based on plasma analyses by mass spectrometry to determine the ratio of plasma phosphorylated tau 217 (p-tau217) to non-p-tau217 (expressed as percentage of p-tau217) alone and when combined with the amyloid-β 42 and amyloid-β 40 (Aβ42:Aβ40) plasma ratio (the amyloid probability score 2 [APS2]). The primary outcome was AD pathology (determined by abnormal cerebrospinal fluid Aβ42:Aβ40 ratio and p-tau217). The secondary outcome was clinical AD. The positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and area under the curve (AUC) values were calculated. The mean age was 74.2 years (SD, 8.3 years), 48% were women, 23% had subjective cognitive decline, 44% had mild cognitive impairment, and 33% had dementia. In both the primary care and secondary care assessments, 50% of patients had AD pathology. When the plasma samples were analyzed in a single batch in the primary care cohort, the AUC was 0.97 (95% CI, 0.95-0.99) when the APS2 was used, the PPV was 91% (95% CI, 87%-96%), and the NPV was 92% (95% CI, 87%-96%); in the secondary care cohort, the AUC was 0.96 (95% CI, 0.94-0.98) when the APS2 was used, the PPV was 88% (95% CI, 83%-93%), and the NPV was 87% (95% CI, 82%-93%). When the plasma samples were analyzed prospectively (biweekly) in the primary care cohort, the AUC was 0.96 (95% CI, 0.94-0.98) when the APS2 was used, the PPV was 88% (95% CI, 81%-94%), and the NPV was 90% (95% CI, 84%-96%); in the secondary care cohort, the AUC was 0.97 (95% CI, 0.95-0.98) when the APS2 was used, the PPV was 91% (95% CI, 87%-95%), and the NPV was 91% (95% CI, 87%-95%). The diagnostic accuracy was high in the 4 cohorts (range, 88%-92%). Primary care physicians had a diagnostic accuracy of 61% (95% CI, 53%-69%) for identifying clinical AD after clinical examination, cognitive testing, and a computed tomographic scan vs 91% (95% CI, 86%-96%) using the APS2. Dementia specialists had a diagnostic accuracy of 73% (95% CI, 68%-79%) vs 91% (95% CI, 88%-95%) using the APS2. In the overall population, the diagnostic accuracy using the APS2 (90% [95% CI, 88%-92%]) was not different from the diagnostic accuracy using the percentage of p-tau217 alone (90% [95% CI, 88%-91%]). The APS2 and percentage of p-tau217 alone had high diagnostic accuracy for identifying AD among individuals with cognitive symptoms in primary and secondary care using predefined cutoff values. Future studies should evaluate how the use of blood tests for these biomarkers influences clinical care.

Reminiscence respecified: A conversation analytic examination of practice in a specialist dementia care home

Although discussion of reminiscence is prevalent in dementia care research, few studies have examined what actually occurs in these interactions, and how they are structured. This study examined how reminiscence activities are structured and negotiated in a care home environment. Informal one-to-one reminiscence interactions between people living with dementia and professional carers were transcribed from a larger video dataset. We used Conversation Analysis to examine reminiscence sequences in a novel relational approach that explored the interactional practices used by carers and people living with dementia. We identified divergences between manualised practice recommendations and observed interactional practices, such as the rarity of open questions, and frequent use of closed questions. This was contrary to current practice recommendations. These and other divergences demonstrate the value of interactional research in informing reminiscence practice and training manuals. By examining how reminiscence operates in practice, our approaches to conducting such activities can be more empirically informed. Our findings can be used to advise and guide those doing reminiscence work in care home settings, and improve the inclusiveness of reminiscence interactions. Through incorporating empirically informed techniques that both carers and people with dementia use in practice, we can facilitate interactions around memories which are supportive of people with dementia's identity.

Acceptability and preliminary effects of the volunteer-supported Meaningful Moments program to engage older adults with advanced dementia on a hospital-based specialized dementia care unit: a mixed methods study

BackgroundNamaste Care offers practical skills for healthcare providers, volunteers, and families to meaningfully engage individuals with dementia in activities (e.g., music, massage, reminiscing, socialization, aromatherapy, snacks). A hospital-based specialized dementia care unit for patients with mid- to late-stage dementia offered an adapted version of the Namaste Care program, which was called Meaningful Moments. The aim of this study was to assess the acceptability and preliminary effects of this novel approach using trained volunteers for older adults with mid- to late-stage dementia.MethodsA mixed methods multiphase design was used. Qualitative description was used to explore acceptability of the Meaningful Moments program delivered over 6 months through focus groups (e.g., charge nurses, therapeutic recreationists, nurses, social workers) and individual interviews with one volunteer and two family members. A prospective pre-post-test study design was used to evaluate the preliminary effects of the program for patients with dementia and family members. Outcomes included quality of life, neuropsychiatric symptoms, and pain for patients with dementia and family carer role stress and the quality of visits for families. Data were collected from June 2018 to April 2019. Descriptive analyses of participants’ characteristics were expressed as a mean (standard deviation [SD]) for continuous variables and count (percent) for categorical variables. Focus group and individual interview data were analyzed using thematic analysis. The generalized estimating equations (GEE) method was used to assess change in the repeated measures outcome data.ResultsA total of 15 patients received the Meaningful Moments interventions. Families, staff, and volunteers perceived that patients experienced benefits from Meaningful Moments. Staff, volunteers, and families felt fulfilled in their role of engaging patients in the Meaningful Moments program. Individualized activities provided by volunteers were perceived as necessary for the patient population. There were no statistically significant improvements in patient outcomes. There was a statistically significant decline in family carer role stress.ConclusionsUsing a one-on-one approach by volunteers, patients experienced perceived benefits such as improved mood and opportunities for social interactions. There is a need for tailored activities for older adults with advanced dementia through practical strategies that can offer benefit to patients.

Geographic variation in shortfalls of dementia specialists in the United States.

Dementia specialists-neurologists, geriatricians, and geriatric psychiatrists-serve a critical clinical function in diagnosing early-stage Alzheimer's disease and determining eligibility for treatment with disease-modifying therapies. However, the availability of dementia specialists is limited and varies across the United States. Using data from the Area Health Resources Files, we found that the median density of dementia specialists across hospital referral regions in United States is 28.8 per 100 000 population aged 65 years and older (interquartile range 19.3-43.6). We derived thresholds of 33-45 dementia specialists per 100 000 population aged 65 years and older as the provider density necessary to care for older adults with mild cognitive impairment and dementia. Based on these thresholds, we estimated that 34%-59% of the population aged 65 years and older resided in areas with potential dementia specialist shortfalls. The extent of potential shortfalls varied by state and rurality. A better understanding of potential gaps in the availability of dementia specialists will inform policies and practices to ensure access to services for people with cognitive impairment and dementia.

Improving Safety and Satisfaction in the Safety Monitoring Unit.

BACKGROUND: The safety monitoring unit (SMU) is a 4-bed unit designated for patients who require continual observation. Most experience some form of dementia, and agitation and aggression are not uncommon. When deescalation techniques do not work, request for help may be necessary. Referred to as Security Alert: Behavioral Assist (SABA), this system-wide message requires response from designated personnel. An increase in SABA events prompted this quality improvement project. METHODS: A survey sent to all unit staff members identified a need for specialized training on the care and management of SMU patients. Education on dementia care and deescalation techniques was provided by a certified dementia specialist and a psychiatry advanced practice registered nurse. Staff expressed a need for defined SMU admission criteria and the establishment of patient care guidelines. Patient care guidelines were developed. A structured schedule was implemented, and dedicated staff were hired to provide familiarity for patients. RESULTS: A postproject survey indicated a nonsignificant increase in staff satisfaction. Security Alert: Behavioral Assist events in the SMU decreased from an average of 3.6 to 1.75 episodes per month. CONCLUSION: Caring for SMU patients creates unique challenges to staff. Staff confidence and satisfaction were higher after implementing new SABA policies. This project could be replicated on similar units with ongoing leadership support and staff education.

Rehabilitation Services for Young-Onset Dementia: Examples from High- and Low–Middle-Income Countries

The WHO Dementia Global Action Plan states that rehabilitation services for dementia are required to promote health, reduce disability, and maintain quality of life for those living with dementia. Current services, however, are scarce, particularly for people with young-onset dementia (YOD). This article, written by an international group of multidisciplinary dementia specialists, offers a three-part overview to promote the development of rehabilitation services for YOD. Firstly, we provide a synthesis of knowledge on current evidence-based rehabilitative therapies for early-onset Alzheimer’s disease (EOAD), behavioural variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). Secondly, we discuss the characteristics of rehabilitation services for YOD, providing examples across three continents for how these services can be embedded in existing settings and the different roles of the rehabilitation multidisciplinary team. Lastly, we conclude by highlighting the potential of telehealth in making rehabilitation services more accessible for people with YOD. Overall, with this paper, we aim to encourage clinical leads to begin introducing at least some rehabilitation into their services, leveraging existing resources and finding support in the collective expertise of the broader multidisciplinary dementia professional community.

Healthcare professionals’ perspectives on the key considerations for digital technology aiding the early detection of dementia-causing diseases: a qualitative approach

Abstract Introduction Digital health technologies (DHTs) can assist with the early detection of dementia-causing diseases.(1) Previous research has highlighted the benefits of involving health care professionals (HCPs) in their design and development.(2) Aim Explore HCPs’ perspectives on the key considerations when using DHTs for the early detection of dementia-causing diseases in healthcare settings. Methods HCPs in the National Health Service with a patient-facing role (independent of speciality or experience) were recruited using online clinical networks. Semi-structured interviews were conducted remotely (over Zoom) exploring their acceptance of DHTs and providing an early detection service, the optimal location for the service, and the challenges surrounding implementation. With the aid of NVivo, we applied an inductive framework approach using the ‘constant comparison’ to identify recurring themes in the data. Results Primary care (general practitioners [n=11]) and secondary care staff (mental health nurses [n=3], dementia specialist nurse [n=1], psychiatrist [n=1], community psychiatric nurse [n=1], care coordinator [n=1]) were interviewed. Three key themes were generated relating to healthcare service users, healthcare professionals, and DHTs (Table 1). HCPs stressed the importance of defining a target healthcare service user group to avoid wasting resources and avoiding contributing towards health inequities in terms of access to the service and post-detection care. Brain Health Centres, which use a combination of clinical and research methods for early detection, were favoured over traditional primary or secondary care settings, due to workload concerns. HCPs suggested training be provided to help interpret results and provide appropriate interventions post detection. Many HCPs were excited about the benefit of collecting longitudinal real-time data that could monitor patients over time but raised concerns around the accuracy of current digital tools. Conclusion Results highlighted important considerations for HCPs when developing and implementing DHTs to aid the early detection of dementia-causing diseases in clinical settings. Participants had an interest in older people’s health, dementia, mild cognitive impairment or digital health, which may have influenced their perspectives; however, our work shows DHTs should not contribute towards health inequities. Future work is needed to explore the perspectives of groups experiencing health inequities within the design, development and implementation of DHTs.

Factors Affecting Research Participation Among Specialist Dementia Nurses.

Research involvement and engagement is a vital aspect of nursing practice. However, research in dementia care remains limited compared to research focused on finding a cure, presenting a significant gap that specialist dementia nurses (Admiral Nurses) can help bridge by participating in research themselves and facilitating recruitment to research. This study aimed to assess the research involvement and support needs of Admiral Nurses and identify factors affecting their participation in research. This research is particularly timely as Dementia UK has launched its first research strategy, which necessitates strengthening research capacity within Admiral Nursing. We used a mixed methods convergent parallel synthesis design, simultaneously collecting quantitative and qualitative data. An online survey was conducted in January 2023, targeting current Admiral Nurses across the United Kingdom. The survey included questions addressing demographics, research experience, goals, barriers, facilitators, and support needs. Data analysis involved descriptive statistics, frequencies, univariate analyses, and thematic analysis. A positive relationship was found between the highest level of academic achievement and current or previous research involvement, as well as interest in becoming involved in research in the future. Although most nurses recognized the importance of research, only half reported current or past research involvement, indicating a need for increased support. A lack of access and opportunities for peer discussion hindered engagement with research findings. Time constraints, lack of support, and low confidence were major barriers to research involvement. Support needs varied but included mentorship, coaching, and the potential for a community of practice for research. This survey of Admiral Nurses sheds light on their research involvement, support needs, and barriers to participation. Recognizing the significance of research while identifying challenges and support requirements is crucial for enhancing research capacity among these specialized nurses. This study contributes valuable insights into the world of specialist dementia nursing and lays the foundation for future strategies to increase research engagement in this field.

Towards Evidence-based Care: Promoting Cognitive Well-being of Older People

The article by Mamayson and Lacanaria 1 in Acta Medica Philippina summarized the available evidence on the effects of cognitively stimulating activities (CSA) on the overall cognitive functioning of older people with mild cognitive impairment(MCI). Aside from the new evidence, it also provided insights on how the findings of study will inform the nursing profession in terms of clinical practice, leadership and policy, research, and education.&#x0D; Utilizing a meta-analysis of three randomized controlled trials (RCTs), the authors reported that cognitive training using CSA improves overall cognitive function among older people with MCI. 1 Calligraphy, cognitive, and language trainings werethe cognitively stimulating activities included in the reviewed RCTs which were conducted over the past years in Hong Kong, China, and Greece, respectively. The authors acknowledged that such activities are effective and practical, inexpensive, non- pharmacological approaches to slow down cognitive decline. 1 The strength of the paper is the inclusion of good methodical quality studies and only RCTs which are considered gold standard for evaluating the effectiveness of interventions. However, the authors emphasized that the interpretation of study results requires caution. This is due to the small number of studies reviewed which limits the generalizability of the findings.&#x0D; Older people with mild cognitive impairment are at increased risk of dementia since aging is a primary predictor of MCI progression to dementia. 2 The Global Action Plan on the Public Health Response to Dementia 2017-2025 outlined the growing consensus on protective measures which can reduce the risk of cognitive decline and dementia. These measures include healthy lifestyle (e.g., physical activity, balanced diet, smoking, and alcohol cessation), management of hypertension and diabetes, social engagement, and promotion of cognitively stimulating activities and learning. 3 These are aligned with the recommendations of the Lancet Commission which emphasized that dementia prevention is about policy and individuals. Preventive actions require both public health strategies and individually-tailored interventions. 4&#x0D; In the Philippines and as mandated by the Republic Act No. 9994 or also known as the Expanded Senior Citizens Act, the Department of Health (DOH) in coordination with relevant stakeholders shall institute a national health program andprovide an integrated health service for senior citizens. 5 The DOH developed the Health and Wellness Program for Senior Citizens 6 and several policies on the care of older people 7,8 . Specific policies relevant to cognition include the 2022 Omnibus Health Guidelines for the Elderly. The guidelines contain the conduct of cognitive stimulation therapy by a psychologist or mental health specialist for people with cognitive decline who may benefit from cognitive stimulation. 7 The implementation of this specific guideline is challenging due to the limited number of health workforce. In particular, there are only approximately 1600 psychologists and 500 psychiatrists serving about 110 million Filipinos. 9&#x0D; In the era of and prior to the introduction of evidence-based practice, nurses are one of the major key players in the care of older people. The study of Mamayson and Lacanaria added evidence which will be useful in guiding the current and future professional nursing practice. 1 Nurses can promote cognitive wellness by educating the older patient, family members, and the community on the importance of engaging in appropriate cognitively stimulating activities and the potential benefits of these non-pharmacological approaches. The recommendations on the incorporation of the findings into the gerontology courses, introduction of certification programs for dementia and MCI care specialists, and advocating for policy changes call for action. These recommendations can be put into action in close coordination with the right stakeholders. The involvement of key national government agencies namely Commission on Higher Education, Professional Regulation Commission, Department of Health, National Commission of Senior Citizens, as well as academic institutions, and professional societies such as the Philippine Nurses Association, Gerontology Nurses Association of the Philippines, and the Philippine Society of Geriatrics and Gerontology is crucial.&#x0D; The research recommendations outlined by Mamayson and Lacanaria highlighted the conduct of future studies with larger samples, longer follow ups, less language restrictions, and more rigorous analysis. 1 It is notable that no local study oncognitively stimulating activities that was cited or included in the review. Given this, the country should strengthen local evidence generation to develop age-, gender-, culturally-sensitive, and responsive interventions. The most recent NationalUnified Health Research Agenda of the Philippines included geriatric health and tailoring novel mental health interventions to different life-stages as priority topics. 10 This is an opportunity for professional societies, academe, and research institutions to pursue research, contribute to the local evidence base, promote cognitive well-being, and ultimately, improve the care and quality of life of older Filipinos.

Intelligent Differentiation Framework for Lewy Body Dementia and Alzheimer’s disease using Adaptive Multi-Cascaded ResNet–Autoencoder–LSTM Network

In recent years, most of the patients with dementia have acquired healthcare systems within the primary care system and they also have some challenging psychiatric and medical issues. Here, dementia-based symptoms are not identified in the primary care center, because they are affected by various factors like psychological symptoms, clinically relevant behavior, numerous psychotropic medications, and multiple chronic medical conditions. To enhance the healthcare-related applications, the primary healthcare system with additional resources like coordination with interdisciplinary dementia specialists, feasible diagnosis, and screening process need to be improved. Therefore, the differentiation between Alzheimer’s Disease (AD) and Lewy Body Dementia (LBD) has been acquired to provide the best clinical support to the patients. In this research work, the deep structure depending on AD and LBD systems has been implemented with the help of an adaptive algorithm to provide promising outcomes over dementia detection. Initially, the input images are collected from online sources. Thus, the collected images are forwarded to the newly designed Multi-Cascaded Deep Learning (MSDL), where the ResNet, Autoencoder, and weighted Long-Short Term Memory (LSTM) networks are serially cascaded to provide effective classification results. Then, the fully connected layer of ResNet is given to the Autoencoder structure. Here, the output from the encoder phase is optimized by using the Adaptive Water Wave Cuttlefish Optimization (AWWCO), which is derived from the Water Wave Optimization (WWO) and Cuttlefish Algorithm (CA), and the resultant selected output is fed to the weight-optimized LSTM network. Further, the parameters in the MSDL network are optimized by using the same AWWCO algorithm. Finally, the performance comparison over different heuristic algorithms and conventional dementia detection approaches is done for the validation of the overall effectiveness of the suggested model in terms of various estimation measures.