Dementia Sufferers Research Articles

FTD‐MND: Importance of Specialised Multidisciplinary Input

ABSTRACTA case of frontotemporal dementia with motor neurone disease (FTD‐MND) is presented including diagnosis and inpatient management. This rare form of dementia demonstrates that input from multiple professional sources is required to effectively manage this condition. It highlights the ongoing need experienced by this small but significant population of dementia sufferers.

The Evidentiary Power of Dementia Witnesses in Domestic Violence Cases

The Indonesian criminal justice system often neglects crime victims, relegating them to mere witnesses needed for case substantiation, a consequence of its bias towards perpetrator protection. This disregard extends to vulnerable victims like those with dementia, whose cognitive limitations significantly hinder their courtroom testimony, posing challenges in recalling events and expressing themselves clearly. Consequently, the credibility and evidentiary value of their statements are compromised, exacerbating the social and psychological impacts on dementia sufferers. This research aims to address this issue by examining the evidentiary power of dementia witnesses in domestic violence cases within the Indonesian legal framework, drawing on theories of legal protection and certainty. Employing a normative juridical approach, the study analyzes the role of the Public Prosecutor in the evidentiary process and proposes regulatory frameworks to ensure the fair treatment and protection of vulnerable individuals within the criminal justice system.

Treating Depression in Dementia Patients: A Risk or Remedy-A Narrative Review.

The diagnosis of depression in dementia patients leads to an increase in the burden of the disease. To treat depression in this patient group, antidepressants are frequently used; however, there is not any proof of their therapeutic effectiveness, and their use may be potentially harmful. This narrative review aims to summarize the existing evidence regarding the role of antidepressants in treating depression in dementia patients. A search was conducted in the PubMed, Excerpta Medica database (EMBASE), and Cochrane databases for randomized controlled trials and meta-analyses wherein antidepressants were given to dementia sufferers to address depression. Fifteen randomized controlled trials and seven meta-analyses were identified. Most well-designed blinded placebo-controlled trials reported a lack of effectiveness of antidepressants in treating depression in dementia patients. Among the seven metanalyses, two reported good efficacy of Selective serotonin reuptake inhibitors (SSRIs). However, two major Cochrane reviews reported little or no effectiveness and increased side effects of antidepressants in dementia patients. There is robust evidence regarding the lack of efficacy of antidepressants in treating depression in dementia patients. However, further well-designed Randomized controlled trials (RCTs,) using scales with good validity and reliability to diagnose depression in dementia patients, sufficient sample sizes, and detailed adverse effect profiles may help determine the rationale for their use.

Artificial Intelligence (AI) Based Game Development ``Memory Game'' for Training Functions Alzheimer and Dementia Cognitive

Smart games, especially crossword puzzles can be an effective tool in aiding cognitive and physical exercise by stimulating the brain and strengthening brain connections, which can help prevent or slow the progression of Alzheimer’s and dementia. This research aimed to develop a crossword puzzle game into a digital version in Bahasa Indonesia with Artificial Intelligence (AI) features. The benefit of this game product can be used as a cognitive therapy for Alzheimer’s and dementia sufferers. The research method used is game development using the Game Development Life Cycle (GDLC) model with stages of initiation, pre-production, implementation/development, testing, launch, and maintenance. Implementation of digital version using Unity 3D game engine with AI feature of hint generating. This research was carried out for 8 months. Game testing results were carried out by testing the functionality of game features and the results were that all features functioned well. The innovation and importance of this work was to implement the memory crossword puzzle game design into a digital version in Bahasa by implementing artificial intelligence methods for the hints feature. This work will inspire developers to do greater work on Bahasa and implement various features based on AI methods.
 Keywords: digital memory games, artificial intelligence, crosswords, game development

Dementia, music, and fields of care

ABSTRACT The number of elderly people is rising in many countries and a marked increase in people susceptible to dementia can be expected. Research in the field of arts and health shows that culture and art can have a positive effect for dementia sufferers. The author takes his starting point in earlier research in this field and shows that systematic use of biographically adapted music and song can have a positive effect for dementia sufferers. Music and song can provide pleasure, activity, merriment, reduced uneasiness, and emotions, which to a certain degree help them to awaken and recognize memories. He examines the relationship between place as fields of care, music, dementia, and memory, and addresses how humanistic geography and awareness of place may contribute to increased understanding of the effect that use of music and song can have for alleviating suffering. The main findings are that biographically adapted music and song can have positive effects in reawakening and recognition of memories for people suffering from dementia, and through memories sufferers can maintain emotional ties to places embodied in their earlier life. The author concludes that a humanistic geographical approach could indicate the importance of place and home for dementia sufferers.

Review of Alzheimer's disease drugs and their relationship with neuron-glia interaction.

Alzheimer's disease (AD) is the most common cause of dementia worldwide. Because Alzheimer's disease has no known treatment, sufferers and their caregivers must concentrate on symptom management. Astrocytes and microglia are now known to play distinct physiological roles in synaptic function, the blood-brain barrier, and neurovascular coupling. Consequently, the search for drugs that can slow the degenerative process in dementia sufferers continues because existing drugs are designed to alleviate the symptoms of Alzheimer's disease. Drugs that address pathological changes without interfering with the normal function of glia, such as eliminating amyloid-beta deposits, are prospective treatments for neuroinflammatory illnesses. Because neuron-astrocytes-microglia interactions are so complex, developing effective, preventive, and therapeutic medications for AD will necessitate novel methodologies and strategic targets. This review focused on existing medications used in treating AD amongst which include Donepezil, Choline Alphoscerate, Galantamine, Dextromethorphan, palmitoylethanolamide, citalopram, resveratrol, and solanezumab. This review summarizes the effects of these drugs on neurons, astrocytes, and microglia interactions based on their pharmacokinetic properties, mechanism of action, dosing, and clinical presentations.

The Burden of Next-of-Kin Carers of Dementia Sufferers in the Home Environment.

The role and responsibilities of next-of-kin carers are significant, filling several years of their lives and causing them to experience a burden of care. This study was conducted to investigate the burden of next-of-kin carers for dementia sufferers in Slovakia. Data were compiled via the Relatives' Stress Scale (RSS) screening instrument through a survey of 112 primary next-of-kin carers and analysed using the statistical tests of descriptive statistics, means, scores and significance differences (Wilcoxon test). This is one of the few scales which provides: (a) specific measures of caregiver stress, and (b) is standardised for a population of informal carers in the home environment. The profiles of Slovak next-of-kin carers were identified with statistically significant characteristics (gender, age of carers). The study identified a high level of caregiving stress (82.15%), and selected factors were found to be significant in all burden dimensions: emotional stress (p = 0.001), social stress (p = 0.003), and negative feelings (p = 0.002). The results emphasise the need for coordination of healthcare and social services, possibly by expanding the network of social support groups, operating a counselling hotline/chat, and introducing national educational programmes for the next-of-kin carers of dementia sufferers. The results are also a source of reference for the umbrella organisation 'the Slovak Alzheimer's Society' to access when implementing changes at a national level.

Education of Formal Caregivers as a Predictor of the Quality of Institutional Care for Dementia Sufferers

Introduction: Due to demographic trends, caring for dementia sufferers is the subject of research by multidisciplinary research teams. In this paper, we declare the importance of increasing the knowledge, skills and competence of formal caregivers as a predictor of the quality of institutional care provided for dementia sufferers. Material and methods: In the presented study, we determine the subjective assessment of the level of theoretical knowledge and practical skills of formal caregivers in relation to the care of dementia sufferers. The research involved 46 formal caregivers in two specialist facilities that provide health and social care to dementia sufferers. In order to meet the objectives, we have chosen a quantitative method using a non-standard questionnaire of our own design. Results: We found that the questionnaire respondents positively assess their previous knowledge and practical skills in providing nursing care to dementia sufferers, yet declare an interest in continuing education. Conclusion: Preparation and implementation of continuing education of formal caregivers is the active part played by an educational institution in relation to the improvement of the quality of care provided to dementia sufferers and at the same time it is evidence of the link between theory and practice in professionally oriented study programs reflecting the currently expected demographic trends in society.

Explaining caregiver burden in a large sample of UK dementia caregivers: The role of contextual factors, behavioural problems, psychological resilience, and anticipatory grief

Objectives Dementia caregiver burden is a significant public health concern, affecting both the wellbeing of caregivers and their care-recipients. This study investigated a range of variables associated with caregiver burden in a large sample of UK dementia caregivers. Clinical characteristics and novel psychological constructs were used – including anticipatory grief and psychological resilience. Anticipatory grief refers to the process of experiencing loss prior to the death of a significant person. Method Caregivers of persons with dementia (N = 530) completed a survey obtaining the Zarit-Burden Interview (ZBI-SF) and other psychological and demographic/caregiving-related factors. Results Findings illustrate that 71% of the sample experienced high levels of caregiver burden and around 95% met the criteria for clinically significant levels of burden. A regression model explained 49% of the variance in subjective caregiver burden; contextual factors (care-recipients living situation, frequency of caregiving), behavioural challenges in the care-recipient (memory-related problem behaviours), caregiver psychological resilience and caregiver anticipatory grief (heartfelt long & sadness, worry & felt isolation) were all significant variables. Caregiver anticipatory grief, followed by psychological resilience, had the strongest association with burden Conclusion Caregiver anticipatory grief and psychological resilience, have a significant interaction with the clinical presentation of the dementia sufferer in explaining subjective caregiver burden. More grief and resilience-focused interventions targeting both the practical and emotional challenges are imperative to reduce burden and thus to ensure caregiver wellbeing.

Toward an Integrated Context-Based Design Approach for Dementia Residential Care Homes: A Review of Key Operational Design Problems.

This article seeks to develop a context-based management system focusing on assessing key operational and design problems and affecting wayfinding in dementia residential care homes. Dementia is multifaceted neurocognitive impairments largely attributed to cognitive deterioration manifested in memory loss and visuospatial deficit which have wider practical implications to both environmental safety and wayfinding and navigation of dementia user. Two key questions were addressed in this context: (1) How can cognitively facilitating assistive technology (AT) be made more user-focused to mitigate the impacts of cognitive impairments on environmental safety and wayfinding? (2) How can design intervention and changes in design topology, colors and texture, and internal finishing aid wayfinding, navigation, and orientation in dementia residential care homes? A systematic literature review and analysis was undertaken to assess the efficacy of key cognitively-related AT to support activities of daily living and environmental safety of dementia sufferers in a care home and aid wayfinding, navigation, and orientation. Several key design variables to facilitate wayfinding and spatial orientation were identified which include design topology, floor finishing, signposting, and use of color and texture strengthened by meaning, emotional connection to places and cognitively focused intervention via memory cueing and objects-centered recognition. Key operational and design guidelines were proposed to assist built environment, care home developers, clinicians and healthcare professionals, and care services providers. There is a need to move toward a dementia-centered design to address the challenges facing people living with dementia in care homes. This should be based on the interrelated behavioral, cognitive, and communication factors.

Dementia Sufferer and Person Living with a Diagnosis of Dementia

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Pinpointing novel risk loci for Lewy body dementia and the shared genetic etiology with Alzheimer’s disease and Parkinson’s disease: a large-scale multi-trait association analysis

BackgroundThe current genome-wide association study (GWAS) of Lewy body dementia (LBD) suffers from low power due to a limited sample size. In addition, the genetic determinants underlying LBD and the shared genetic etiology with Alzheimer’s disease (AD) and Parkinson’s disease (PD) remain poorly understood.MethodsUsing the largest GWAS summary statistics of LBD to date (2591 cases and 4027 controls), late-onset AD (86,531 cases and 676,386 controls), and PD (33,674 cases and 449,056 controls), we comprehensively investigated the genetic basis of LBD and shared genetic etiology among LBD, AD, and PD. We first conducted genetic correlation analysis using linkage disequilibrium score regression (LDSC), followed by multi-trait analysis of GWAS (MTAG) and association analysis based on SubSETs (ASSET) to identify the trait-specific SNPs. We then performed SNP-level functional annotation to identify significant genomic risk loci paired with Bayesian fine-mapping and colocalization analysis to identify potential causal variants. Parallel gene-level analysis including GCTA-fastBAT and transcriptome-wide association analysis (TWAS) was implemented to explore novel LBD-associated genes, followed by pathway enrichment analysis to understand underlying biological mechanisms.ResultsPairwise LDSC analysis found positive genome-wide genetic correlations between LBD and AD (rg = 0.6603, se = 0.2001; P = 0.0010), between LBD and PD (rg = 0.6352, se = 0.1880; P = 0.0007), and between AD and PD (rg = 0.2136, se = 0.0860; P = 0.0130). We identified 13 significant loci for LBD, including 5 previously reported loci (1q22, 2q14.3, 4p16.3, 4q22.1, and 19q13.32) and 8 novel biologically plausible genetic associations (5q12.1, 5q33.3, 6p21.1, 8p23.1, 8p21.1, 16p11.2, 17p12, and 17q21.31), among which APOC1 (19q13.32), SNCA (4q22.1), TMEM175 (4p16.3), CLU (8p21.1), MAPT (17q21.31), and FBXL19 (16p11.2) were also validated by gene-level analysis. Pathway enrichment analysis of 40 common genes identified by GCTA-fastBAT and TWAS implicated significant role of neurofibrillary tangle assembly (GO:1902988, adjusted P = 1.55 × 10−2).ConclusionsOur findings provide novel insights into the genetic determinants of LBD and the shared genetic etiology and biological mechanisms of LBD, AD, and PD, which could benefit the understanding of the co-pathology as well as the potential treatment of these diseases simultaneously.

“The Graying of the World”: Medical and Popular Expressions of Dementia

Unlike the biomedical account of illness, cultural/social/literary models investigate the central role of culture in mediating the lived experiences of the sufferers. As such, the meaning of illness is not shaped by biomedical factors alone, cultural artefacts also determine the social meanings of illness and suffering. Put differently, popular cultural media such as films, novels, television, and advertisements among others collectively generate and shape public attitudes toward illness. However, popular cultural media very often promote the prevailing stereotypes and normative concepts of illness and thus negatively contribute to the understanding of illness conditions. Along these lines, existing cultural and literary discourses on Alzheimer’s disease and related dementia (ADRD) trivialize dementia and dehumanize the sufferers of dementia as zombies, empty shells, and non-persons. Taking these cues, the present paper close reads popular representations of dementia in movies, newspapers, novels, and comics in order to demonstrate how such representations of ADRD reinforce dominant stereotypes and even sustain them. Furthermore, the paper also investigates the negative implications of such representations in the context of illness and ADRD on personal and social lives.

Effect of Grape and its Derivatives on Cognitive Function: A Systematic Review of Clinical Trials

Background: According to the world health organization (WHO), in 2019, around 50 million people suffer from dementia, worldwide; and approximately 60% live in low- and middle-income countries. Dementia has physical, psychological, social, and economic effects on dementia sufferers, their caregivers, families, and the community.
 Objectives: This systematic review investigated the effect of short-term and long-term interventions with grapes and their derivatives on different cognitive functions, such as executive function, memory, attention and language in all people.
 Methods: Pubmed, Scopus, and Proquest were searched until June 12, 2020 for English studies. Clinical trials in which grapes and its derivatives were considered as an intervention and changes of cognition and its components as an outcome, were selected. Two independent individuals assessed the quality of the articles according to Jadad checklist and extracted the information of the articles with inclusion criteria based on a specific table. The differences were resolved with the discussion and opinion of a third person.
 Results: Nine Studies (211 individuals) were included in the content analysis, of which 3 studies had short-term intervention and 6 studies had long-term intervention with grape juice, freeze-dried grape powder, and a syrup made from grapes (Enoant Syrup). It can be said that the consumption of grapes and its derivatives improved various cognitive components (such as attention, executive function, immediate spatial memory, learning, and driving skill) between groups.
 Conclusion: In general, long-term intervention with grapes and their derivatives has led to the improvement of some cognitive functions, but its short-term intervention is not very effective and only 2 studies showed improvement in attention speed. However, the included studies were highly heterogeneous and more research is needed using similar cognitive assessment tools.

Informal Caregivers and Psychosocial Support: Analysis of European Dementia Policy documents

Various countries in Europe have different strategies for promoting care solutions for dementia challenges. The different approaches of Austria, Belgium, Czechia, Denmark, Finland, Germany, Gibraltar, Ireland, Israel, Malta, Nederland, Norway, Sweden and the United Kingdom (Scotland and Wales) were investigated. Dementia has a significant social, psychological and economic impact on the individual, family and society. As the disease progresses dementia sufferers become increasingly dependent. As many dementia sufferers are at home during the initial stages, the physical, emotional, and social demands of the dementia sufferers are often covered by informal caregivers. This study, therefore, aims to investigate the integration of psychosocial interventions for comprehensive care pertaining to informal caregivers of people with dementia in Europe. Furthermore, the study will highlight how implementation of technologies might enable psychosocial support of informal caregivers. The data is based on 15 national dementia strategies from various European countries. Data was based on preexisting coding systems with the predefined keywords and analyzed by qualitative content analysis by four of the authors. Our results show that psychosocial support is provided in various modalities and that informal caregivers need to be supported by a psychosocial approach. Due to this need the national dementia strategies should include measures to reduce the emotional burden of informal caregivers. Psychosocial support provided to informal caregivers in a comprehensive and systematic way is likely to enable informal caregivers to handle the emotional, cognitive, and behavioral consequences of the disease and its treatment, while helping to maintain their work-life balance. Significance for public health This study has important public health impacts on informal caregivers in a European context. The study reveals that the European countries of Alzheimer Europe - especially policymakers, social and healthcare providers and non-government organizations - should update or prepare the necessary national dementia strategies, promote benchlearning, improve international collaboration and systematically manage those who provide psychosocial support.

Delineating caregiver distress and health condition of dementia sufferers during lockdown due to COVID-19 pandemic

Delineating caregiver distress and health condition of dementia sufferers during lockdown due to COVID-19 pandemic

Association between ambient temperature and dementia‐related hospital admissions in England

AbstractBackgroundThe impacts of a changing climate on dementia burdens have not been widely explored, despite the increasing pressures associated with dementia on the public health and social care systems. This study explores the association between ambient temperature and the dementia‐related emergency hospital admission, using the national hospital inpatient dataset for England. We also examine important modifiers of the heat‐risk, including separate results for each Government region of the country.MethodsDaily counts of emergency admissions with a primary diagnosis of dementia (ICD codes F00‐F03) and daily ambient temperature data from Met Office land surface stations were obtained for the period 2000‐2009 in England. Poisson regression was used to detect short‐term associations between daily mean temperature and daily counts of dementia admissions, adjusting for overdispersion and day‐of‐week effects, and including spline functions to model any underlying trends and seasonal patterns in the series. Distributed lag non‐linear models employing cross‐basis functions were used to characterise the exposure‐response relationship, at both national and regional levels at different lags of temperature; a 7‐day lag structure was used to explore potential delayed effects of temperature on the week leading up to admission. The modifying effects of age‐group, urban/rural residence, and quintiles of area‐level deprivation were also examined.ResultThere was some suggestion of seasonality in dementia admissions, with numbers peaking in the summer and winter months each year. After seasonal adjustment, there was an increase in the risk of dementia‐related hospital admission associated with high temperature, with adverse effects becoming apparent once daily mean temperatures rose above 15.0°C. At the national level, we estimated an approximately 10% increase in the risk of dementia admission for every 5°C increase in temperature above 15.0°C. When disaggregated by regions, the risk was highest in London. Separate results by age‐group, deprivation and urban/rural residence will be presented.ConclusionThe findings are likely to have important public health implications for priority settings, such as for hospital emergency department planning during hot seasons. The dangers of heat‐induced symptoms among dementia sufferers can be anticipated by caregivers whenever hot weather is forecast.

Support needs of carers making proxy healthcare decisions for people with dementia: a systematic review based on the Noblit and Hare meta-ethnographic synthesis of qualitative studies

BackgroundThere are 50 million dementia sufferers worldwide. Decisions about healthcare often need to be made when the person with dementia lacks capacity to do so.Understanding the support needs of carers...

Dementia and COVID-19 pandemia: The situation in various European countries

COVID-19 pandemia means a special threat to elderly patients in nursing homes. Dementia sufferers, who make up most of nursing home clients throughout Europe, have been in a critical situation. They bear a higher risk of delirium when affected by the virus. They often do not understand and easily forget, how to use a mask and keep the distance required. In many institutions the elderly were isolated and could not even take their meals together. And finally they do not recognize and even fear nursing staff and other personnel, which has to wear “protective clothes”. Caregivers were told not to visit their loved ones any more.Where available, modern techniques werde used. Skype and/or Zoom, Facetime telephone should replace face to face contacts. Some insitutions offered visitor rooms, where clients and visitors were separated by acrylic windows and microphones were applied. In some areas, physicians’ visits were reduced to a minimum.Just recently, regular testing of staff and clients in nursing homes has been introduced. However, this is consuming staff time, which - again - is taken from the patients. We discuss, whether the elderly and their caregivers could set their own preferences.DisclosureNo significant relationships.

Spousal Dementia Grief: A Research Report from the Two-Track Model of Dementia Grief Project

Caregiving for a loved one suffering from cognitive decline involves coping with many challenges and losses. This experience increases the risk of worsening the physical and mental health of the caregiver and has been the subject of a substantial number of studies focusing on the stress and burden of the primary caretaker. Theory and research on the grief reactions experienced by the family members, however, continues to lag in terms of the attention given to the behavioral and psychological burden of caregivers. This study aimed for a deeper understanding of the emotional processes in an individual involved in caring and caregiving for a spouse suffering from cognitive decline, through the prism of the Two-Track Model of Dementia Grief (TTM-DG). The TTM-DG emphasizes the continuous emotional attachment to the loved one suffering from cognitive decline (Track II), along with a medico-psychiatric perspective associated with stress, trauma, and changes in life (Track I). In this research project, we examined the degree to which spouses of cognitively impaired, deceased, and healthy partners showed differences and perceptible patterns considering the elements associated with the model and their interrelationship. These elements include behavioral characteristics of the clinical patients suffering from cognitive decline, objective circumstances of the caregiving situation, personality measures of attachment of the caring spouse, and a range of measures assessing psychological well-being and spousal relationship. The current study is a part of a larger ongoing project in Israel to address loss and grief among caregiving family members whose loved ones suffer from cognitive decline. The findings reported in the current paper are based on data derived from self-report questionnaires (i.e., socio-demographic variables, problematic behaviors in patients, objective burden, social support, physical health status, attachment patterns, depression, dementia grief, and relationship satisfaction). Participants in the sample size of 49 came from three groups: (a) spouses of patients suffering from cognitive decline, (b) widowers of deceased dementia sufferers, (c) and a control group of similarly aged participants whose spouses have no cognitive or functional impairment. Examination of the research hypotheses was done by running correlations and one/two-way analyses of variance (ANOVA). Behavioral disorders in the affected spouse correlated positively with the objective burden of the caring/caregiving spouse and with outcome variables. That is, biopsychosocial functioning (Track I) and the ongoing attachment bond with the ill spouse (Track II); objective burden correlated positively with depression and dementia grief, but not with relationship satisfaction; poor caregiver’s physical health was associated positively with depression and dementia grief, but not with relationship satisfaction; social support correlated positively with low levels of depression and dementia grief, as well as to the higher degree of relationship satisfaction; insecure attachment was found to correlate positively with depression and dementia grief, but not with relationship satisfaction. Spouses of cognitively impaired patients reported more difficulties in outcome variables compared to the control group; widowers of deceased dementia sufferers reported higher levels of dementia grief and depression than the control group. In terms of outcome measures, there was no difference between widowers and spouses of cognitively impaired patients. Among the control group participants, there was no difference between secure and insecure attachment on outcome variables. A significant difference between secure and insecure attachment on outcome variables was observed among spouses of cognitively impaired patients and widowers so that insecure participants reported higher levels of distress. The findings of the present study constitute the initial empirical evidence for the utility of the TTM-DG and support the transition of the field of loss and bereavement, which emphasizes the importance of the emotional attachment with the loved one as one of the primary foci of the process of coping with the loss. Furthermore, the findings highlight factors that contribute to the health and emotional resilience (secure attachment style, perceived social support, etc.) and provide a framework that can assist in the process of clinical assessment and intervention to improve the quality of life of caregivers whose loved one suffers from cognitive decline.