Early Recognition Of Dementia Research Articles

Understanding how community-dwelling persons with early dementia perceive health and community services: Informing the dementia strategy of Newfoundland and Labrador, Canada.

With an increased aging population, the number of individuals with dementia is expected to rise. The onset of dementia marks the start of negotiating access to a wide range of health and social services to find practical and emotional supports to deal with the management of changes and subsequent challenges that individual with dementia face. The toll of dementia goes beyond the health care system, affecting families and caregivers' quality of life. This places more pressure on family caregivers and health care institutions to provide services for affected individuals. It is important to understand the service needs of this population to enable them to live at home longer, contribute to society and maintain a positive quality of life. To increase understanding of how persons living at home with early dementia and their caregivers/significant others currently perceive and interact with health and community-based services and service providers. A qualitative descriptive approach was used to explore the experiences of individuals with early dementia and care providers with health and community-based services using semi-structured interviews and content analysis. Participants included 16 individuals 50years and older with mild/early dementia living at home, 22 informal caregivers of individuals with mild/early dementia, and 5 key community informants (community health nurses and social workers). Four thematic categories of barriers and two thematic categories of facilitators for access to and uptake of supportive services were identified. Five strategies to inform the development of an action plan to enhance access to, and uptake of, supportive services were determined. Early recognition of dementia through education and publicity enhanced public awareness, attention, and social inclusion with dementia-friendly neighborhoods and facilities need to be considered to achieve effective dementia-related services. Inclusion and recognition of the wishes of persons with dementia is key.

Association of Age with Dual-Task Objective Cognitive Indicators and Gait Parameters in Older Adults.

Early recognition of dementia like Alzheimer's disease is crucial for disease diagnosis and treatment, and existing objective tools for early screening of cognitive impairment are limited. To investigate age-related behavioral indicators of dual-task cognitive performance and gait parameters and to explore potential objective markers of early cognitive decline. The community-based cognitive screening data was analyzed. Hierarchical cluster analysis and Pearson correlation analysis were performed on the 9-item subjective cognitive decline (SCD-9) scores, walking-cognitive dual-task performance, walking speed, and gait parameters of 152 participants. The significant differences of indicators that may related to cognitive decline were statistically analyzed across six age groups. A mathematical model with age as the independent variable and motor cognition composite score as the dependent variable was established to observe the trend of motor cognition dual-task performance with age. Strong correlation was found between motor cognitive scores and SCD and age. Gait parameters like the mean value of ankle angle, the left-right difference rate of ankle angle and knee angle and the coefficient of variation of gait cycle showed an excellent correlation with age. Motor cognition scores showed a decreasing trend with age. The slope of motor cognition scores with age after 50 years (k = -1.06) was six times higher than that before 50 years (k = -0.18). Cognitive performance and gait parameters in the walking-cognitive dual-task state are promising objective markers that could characterize age-related cognitive decline.

Early recognition of dementia within the family

The awareness of communities with dementia in Western Europe has moved closer to recognizing priority issues such as the environment or climate change. Dementia-friendly communities how have a history of 30 years and have achieved significant results through their work, both for those affected by the disease and those not directly affected. It probably affects many families, the topic is also getting into the spotlight in Hungary.
 Without specific and detailed statistics and databases, dementia currently exists in the latent zone. The vast majority of the literature defines dementia as a diesease for which there is no treatment or cure. The effect of dementia is considered primarily as problems in the brain that negatively affect clear thinking, memory processes and result in additional emotional turbulence. Dementia is known as an age-related condition.
 In general, dementia is identified as senility, incorrectly. Dementia can occur in different areas and at different levels in individual patients. As a result, families affected by the disease often face serious difficulties in identifying the disease. Without proper and detailed knowledge of the diagnosis, many families struggle with the situation of self care solutions at home. This personal involvement not only imposes a significant financial and emotional burden on the family but also often leads to separation and isolation, which can have additional negative effects on the disease itself and even on the mental health of the patient’s family members.
 The global extent of dementia is generally known only to experts in the field, and to this day there is still a lack of adequate representation in the wider social dialogue. There is a unique and innovative incentive in Gyöngyös where Matralab’s integrated care centers offer day-care activities and solutions to support and provide experts advice to families with dementia. The project is implemented at the regional level, where 25 municipalities start monitoring the conditions and impacts of dementia in the region. As dementia is a prevalent and identifiable condition, affected families need help and support at the widest possible level.

Development and Validation of eRADAR: A Tool Using EHR Data to Detect Unrecognized Dementia.

Early recognition of dementia would allow patients and their families to receive care earlier in the disease process, potentially improving care management and patient outcomes, yet nearly half of patients with dementia are undiagnosed. Our aim was to develop and validate an electronic health record (EHR)-based tool to help detect patients with unrecognized dementia (EHR Risk of Alzheimer's and Dementia Assessment Rule [eRADAR]). Retrospective cohort study. Kaiser Permanente Washington (KPWA), an integrated healthcare delivery system. A total of 16 665 visits among 4330 participants in the Adult Changes in Thought (ACT) study, who undergo a comprehensive process to detect and diagnose dementia every 2 years and have linked KPWA EHR data, divided into development (70%) and validation (30%) samples. EHR predictors included demographics, medical diagnoses, vital signs, healthcare utilization, and medications within the previous 2 years. Unrecognized dementia was defined as detection in ACT before documentation in the KPWA EHR (ie, lack of dementia or memory loss diagnosis codes or dementia medication fills). Overall, 1015 ACT visits resulted in a diagnosis of incident dementia, of which 498 (49%) were unrecognized in the KPWA EHR. The final 31-predictor model included markers of dementia-related symptoms (eg, psychosis diagnoses, antidepressant fills), healthcare utilization pattern (eg, emergency department visits), and dementia risk factors (eg, cerebrovascular disease, diabetes). Discrimination was good in the development (C statistic = .78; 95% confidence interval [CI] = .76-.81) and validation (C statistic = .81; 95% CI = .78-.84) samples, and calibration was good based on plots of predicted vs observed risk. If patients with scores in the top 5% were flagged for additional evaluation, we estimate that 1 in 6 would have dementia. The eRADAR tool uses existing EHR data to detect patients with good accuracy who may have unrecognized dementia. J Am Geriatr Soc 68:103-111, 2019.

Dementia in Hungary: General practitioners’ routines and perspectives regarding early recognition

Background Undetected dementia in primary care is a global problem. Since general practitioners (GPs) act as the first step in the identification process, examining their routines could help us to enhance the currently low recognition rates. Objectives The study aimed to explore, for the first time in Hungary, the dementia identification practices and views of GPs. Methods In the context of an extensive, national survey (February-November 2014) 8% of all practicing GPs in Hungary (n = 402) filled in a self-administered questionnaire. The questions (single, multiple-choice, Likert-type) analysed in the present study explored GPs’ methods and views regarding dementia identification and their ideas about the optimal circumstances of case-finding. Results The vast majority of responding GPs (97%) agreed that the early recognition of dementia would enhance both the patients’ and their relatives’ well-being. When examining the possibility of dementia, most GPs (91%) relied on asking the patients general questions and only a quarter of them (24%) used formal tests, even though they were mostly satisfied with both the Clock Drawing Test (69%) and the Mini-Mental State Examination (65%). Longer consultation time was chosen as the most important facet of improvement needed for better identification of dementia in primary care (81%). Half of the GPs (49%) estimated dementia recognition rate to be lower than 30% in their practice. Conclusions Hungarian GPs were aware of the benefits of early recognition, but the shortage of consultation time in primary care was found to be a major constraint on efficient case-finding.

Early diagnosis of dementia in primary care: a representative eight‐year follow‐up study in Lower Saxony, Germany

To investigate whether primary care competency in early diagnosis of dementia might have changed during 1993 and 2001. By means of a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) in Lower Saxony, Germany, were randomly assigned to two written case samples presenting a patient with mild cognitive impairment (case 1a vs. 1b: female vs. male patient) and moderate dementia (case 2a vs 2b: vascular type (VD) vs Alzheimer's disease (DAT)), respectively. By means of a structured face-to-face interview, they were asked for their diagnostic considerations. In comparison to 1993, dementia was significantly more frequently considered. However, there was a striking tendency in overestimating vascular aetiology and under-diagnosing probable DAT (case 1a/1b: DAT: 11.0% in 1993 vs 26.2% in 2001; VD: 2.1% in 1993 vs 17.2% in 2001). As a possible contributor to a dementia syndrome, concomitant medication was considered only exceptionally (case 2a/2b: 4.4% in 1993 vs 2.5% in 2001). Physicians above 50 years of age showed a significantly lower early diagnostic awareness. At follow-up, the presumed interest in geriatric (psychiatric) topics dramatically faded from 66.9% to 35.2%. Our results demonstrate a persistent need of training efforts aiming at the early recognition of dementia, especially of DAT, in primary care.

Timely Responses to Dementia

Summary: Little attention has been paid to the impact of early recognition of dementia on mental health social work. This paper reports a small study of the views of 20 social workers employed by an English social services department to set out possible agendas for debate about the role of mental health social work in this area. A modified nominal group methodology was used in a workshop undertaken as part of a regular series of information and training days, to elicit participants’ experiences of the early recognition of dementia and any anticipation about their future role. Findings: We identified three main themes from these social workers’ experiences and perceptions: diagnostic and prognostic skills; the impact of resource availability on professional activity; and a disability model of dementia. Application: Specialist social workers working within dementia teams may have much to contribute and may find the emergence of such teams enables them to exercise their therapeutic, communication and problem-solving skills.

Early recoginition of dementia by nurses.

The early recognition of dementia has assumed an increasingly important place in primary care nursing. This paper reports a survey conducted in the context of a national programme of educational workshops on dementia which attracted almost one thousand participants. The subjects who answered the questionnaires included community mental health nurses (CMHNs), community nurses (CNs), and practice nurses (PNs). The results indicated that CMHNs were the most confident in their ability to recognise dementia and found it easier to provide appropriate support. However, it was also apparent that CNs in particular also had considerable contacts with some people with dementia. This highlighted the need for a team approach to dementia care in the community, with CMHNs taking the key co-ordinating role which previous studies had tended to allocate to the general practitioner.

Early recognition of dementia by nurses.

Early recognition of dementia is a key policy objective designed to maximize the efficacy of treatment and to provide timely and appropriate support before crisis occurs. The impact of early recognition of dementia is under-researched in primary care nursing. To explore whether community mental health nurses (CMHNs), community nurses (CNs) and practice nurses (PNs) have different perspectives on early diagnosis of dementia and to consider the possible effects of any variation. Data are drawn from questionnaires completed by CMHNs (79), CNs (153) and PNs (36) who attended workshops offered on 24 occasions in 21 settings across the United Kingdom. The workshops attracted a range of primary care practitioners and were part of a training programme on early diagnosis of dementia. Analysis of the data shows some differences in knowledge, experience and confidence between the three nurse groups. CMHNs were more confident in their abilities to recognize dementia and found providing support less difficult than CNs and PNs. CMHNs considered that they were best placed to co-ordinate services for people with newly recognized dementia. CNs and PNs, however, reported experience of working with people with dementia and many appeared able to respond to early signs and to identify potential sources of support. While CMHNs may have a key role in responding effectively to the newly identified needs of people with early dementia, other nurses working in the community are likely to encounter people with early dementia. In the context of a policy objective to identify people with dementia earlier, all community-based nurses should be able to recognize the possibility of dementia and support those undergoing referral or assessment. Their confidence in doing so should be enhanced by continued professional development. Training in dementia recognition, involvement in and membership of primary care teams supporting people with dementia should not be confined to CMHNs. Nurses who regularly encounter the general population of older people may be well placed to provide continuity of support for those who may, or may not, have cause to suspect that they or their relatives have early dementia.

The Implications of the Early Recognition of Dementia for Multiprofessional Teamworking

In health and social care in the UK there is increasing emphasis on the need to recognize mental health problems as early as possible, particularly among older people. Both research and policy have identified the difficulties caused by delayed or late awareness of dementia and depression, and the potential benefits of their recognition at earlier stages. This article draws on the output from a series of multidisciplinary dementia workshops to explore the implications of such a shift in practice for interprofessional working. At a time when core specialist mental health teams have been identified as a way forward for dementia care in the UK, this discussion sets out four key bipolar categories derived from the workshops which may be useful in planning, implementing and reviewing the development of services and the drawing of professional responsibilities. These categories are opportunistic recognition versus population screening; referral and responsibility; key working and team working; generalist versus specialist roles. From this discussion we note a further four determinants which in our view need to be addressed in order to promote positive developments in dementia services: learning processes, resource implications, professional capacity and confidence and the impact of new teams on broader systems.

Deciphering the 4 D's: cognitive decline, delirium, depression and dementia--a review.

The purpose of this paper is to assist advanced practice nurses to recognize, identify, and diagnose cognitive change in older adults. Optimal cognitive function is important for continued independence, and yet changes in cognition are frequently unrecognized among older adults. Cognitive change in older adults can be observed due to age-related cognitive decline, the development of acute confusion (delirium), depression, dementia and/or a combination of these. When the aetiological source for alterations in cognitive function is delirium or depression, the potential for reversibility mandates that the reason for the cognitive change be identified with steps taken to remedy the situation. Also, early recognition of dementia is an important factor in obtaining timely and appropriate care. These conditions can exist concurrently and may fluctuate making deciphering the reason for the cognitive change problematic. It is essential to understand how the 4 'D's' are expressed and to recognize the potential contributing factors to an observable change in cognitive function for diagnosis and treatment. Recommendations for obtaining a person's history are included.

Dementia Diagnosis and Management in Primary Care

Dementia presents a challenge for primary care and the advent of new therapeutic options has highlighted the need to improve its detection so that early decisions about medication use can be made. Efforts at earlier diagnosis should be targeted at primary care as the gateway to specialist health and social services. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice throughout the world. This article reviews the obstacles to early recognition of dementia and the factors causing sub-optimal management in the community, and discusses educational approaches to enhancing professional skills in the recognition of and response to dementia. Three educational interventions with different characteristics and methods of delivery are described.

Early recognition of dementia in the elderly: First findings of a survey in general practice

Early recognition of dementia in the elderly: First findings of a survey in general practice

The early recognition of dementia in the elderly: A preliminary communication about a longitudinal study using the gms–agecat package (community version)

AbstractA random community sample of 1070 subjects aged over 65 was interviewed by trained non‐medical interviewers using the Geriatric Mental State, community version (GMSA). A sub‐sample of 126 subjects was selected so as to contain possible early cases of dementia, pseudo‐dementia, and normal subjects; and re‐interviewed, a mean 1 year and 23 weeks later, by a group of psychiatrists in training. The computer diagnosis AGECAT, based on GMSA applied by non‐medical raters, had predicted at initial interview, nine out of twelve cases of dementia at follow‐up and five out of nine borderline cases. An Organic/Depression Index may prove useful in predicting which of those cases with early organic levels will eventually develop dementia, depression or recover.

Second Thoughts on Dementia: Evaluation and Management of Patients with Mild Dementia

The early recognition of dementia along with consideration of differential diagnosis and elucidation of its underlying causes is of paramount importance because many of these conditions are remediable, given proper diagnosis and adequate treatment. The purpose of this article is to emphasize possible alternatives to the grim sentence of slowly progressive irreversible deterioration of personality and intellect when the verdict of dementia is pronounced.