Increasing Prevalence Of Dementia Research Articles

Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies

Some cohort studies have reported a decline in dementia prevalence and incidence over time, although these findings have not been consistent across studies. We reviewed evidence on changes in dementia prevalence and incidence over time using published population-based cohort studies that had used consistent methods with each wave and aimed to quantify associated changes in risk factors over time using population attributable fractions (PAFs). We searched for systematic reviews of cohort studies examining changes in dementia prevalence or incidence over time. We searched PubMed for publications from database inception up to Jan 12, 2023, using the search terms "systematic review" AND "dementia" AND ("prevalence" OR "incidence"), with no language restrictions. We repeated this search on March 28, 2024. From eligible systematic reviews, we searched the references and selected peer-reviewed publications about cohort studies where dementia prevalence or incidence was measured in the same geographical location, at a minimum of two timepoints, and that reported age-standardised prevalence or incidence of dementia. Additionally, data had to be from population-based samples, in which participants' cognitive status was assessed and where validated criteria were used to diagnose dementia. We extracted summary-level data from each paper about dementia risk factors, contacting authors when such data were not available in the published paper, and calculated PAFs for each risk factor at all available timepoints. Where possible, we linked changes in dementia prevalence or incidence with changes in the prevalence of risk factors. We identified 1925 records in our initial search, of which five eligible systematic reviews were identified. Within these systematic reviews, we identified 71 potentially eligible primary papers, of which 27 were included in our analysis. 13 (48%) of 27 primary papers reported change in prevalence of dementia, ten (37%) reported change in incidence of dementia, and four (15%) reported change in both incidence and prevalence of dementia. Studies reporting change in dementia incidence over time in Europe (n=5) and the USA (n=5) consistently reported a declining incidence in dementia. One study from Japan reported an increase in dementia prevalence and incidence and a stable incidence was reported in one study from Nigeria. Overall, across studies, the PAFs for less education or smoking, or both, generally declined over time, whereas PAFs for obesity, hypertension, and diabetes generally increased. The decrease in PAFs for less education and smoking was associated with a decline in the incidence of dementia in the Framingham study (Framingham, MA, USA, 1997-2013), the only study with sufficient data to allow analysis. Our findings suggest that lifestyle interventions such as compulsory education and reducing rates of smoking through country-level policy changes could be associated with an observed reduction, and therefore future reduction, in the incidence of dementia. More studies are needed in low-income and middle-income countries, where the burden of dementia is highest, and continues to increase. National Institute for Health and Care Research Three Schools' Dementia Research Programme.

Benzodiazepines and risk of dementia – Is there a reason for alarm?

IntroductionThe population ageing is a reality associated with an increase in prevalence of Dementia. The use of benzodiazepines is often postulated as a risk factor in these syndromes.Contrary to recommendations for its short-time use, long-term and chronic use are common, with an estimated 8,7% of elderly people in the US taking benzodiazepines.ObjectivesTo clarify the most recent evidence on the use of benzodiazepines and the risk of developing dementia.MethodsNon-systematic review of literature, using PubMed as database and filtering the results for meta-analysis.ResultsFour articles were included in this review.Zhong G et al. concluded that risk of dementia increased in consumers of benzodiazepines and it was associated with higher doses.In turn, AlDawasari A et al., when trying to clarify the use of different sedative-hypnotic drugs, found and increased risk with the consumption of benzodiazepines. After exclusion of articles with confounders and adjustment for protopathic bias, the risk was not maintained.Lucchetta RC et al. concluded that the risk exists but without inferring differences between doses or duration of action.Finally, Penninkilampi R e Eslick GD investigated this association, after controlling for the protopathic bias, concluding, contrary to AlDawasari et al., that the association benzodiazepines consumption and dementia do not result from this bias.ConclusionsWe cannot draw robust and concrete conclusions between benzodiazepines consumption and the pathogenesis of dementia because not only is the literature limited, but results are also heterogeneous. However, these prescriptions must be carried out cautiously, especially in the elderly, due to the known adverse effects associated with them.Disclosure of InterestNone Declared

Forecasted Dementia Prevalence in Portugal (2020-2080).

Dementia is a global public health challenge, and its impact on Portugal is yet unclear. This study forecasts dementia prevalence in Portugal until 2080. Using the Gonçalves-Pereira et al (2021) method, we estimated dementia cases among older adults (≥65 years) in the community. Applying age-sex specific prevalence rates of the Gonçalves-Pereira study to population projections for Portugal between 2020-2080, based on the 10/66 Dementia Research Group criteria (10/66 DRG) and the Diagnostic and Statistical Manual of Mental Disorders IV criteria (DSM-IV), to Portugal's population projections (2020-2080) under various growth scenarios (low, medium, and high). We anticipate a more than 2-fold increase in dementia prevalence from 2020 to 2080, both for 10/66 DRG [2.1%-5.0%] and DSM-IV [.8%-2.0%]. By 2080, those aged ≥80 years are projected to constitute 75.0% (vs 59.0% in 2020) of all dementia cases, particularly affecting women. Addressing dementia growth in Portugal calls for a comprehensive global response, while country-level estimates facilitate informed public health planning, policy-making, and resource allocation.

Trends in the prevalence of dementia in LMIC: findings from 10/66 studies in Latin America and the Caribbean.

AbstractBackgroundPopulation ageing will lead to a dramatic increase in dementia prevalence globally. Recent evidence suggest a decline in dementia incidence in High Income Countries due to increasing education levels and improvements in cardiovascular health. Although, most of the increase will occur in low and middle‐income countries (LMICs), there are no recent estimates of dementia prevalence and incidence in LMICs. The present study aimed to examine new trends on dementia prevalence and incidence in Latin‐America and associations of socioeconomic determinants and cardiovascular risk factors.MethodSample size included older adults from Latin America (Cuba, Dominican Republic [DR], Puerto Rico [PR], and Mexico) drawn from the 10/66 Dementia Research Group study. We compare wave 1 (2003‐2006) with wave 3 (2016‐2019) of 10/66 studies. The main outcome was dementia prevalence relative to previous waves. Dementia diagnosis was determined according to 10/66 dementia criteria. All the 10/66 waves used the same standardized assessments and protocols.ResultDementia prevalence is stable Cuba, standardized dementia prevalence rates was 12.4% in wave I and 10.1% in wave III. Relative to wave I, Dominican Republic (wave I 11.5% vs wave II 13.6%), Peru (wave I 9.2% vs wave II 16.8%) and Mexico (wave 1 8.3% vs wave 2 17.1%) experience a significant increase in dementia prevalence. Despite, improvements in levels of education, increases in dementia prevalence were associated with higher rates of cardiovascular disease and cardiovascular risk factors, including diabetes, hypertension, obesity and heart disease in the later‐born cohorts. Self‐reported stroke is also rising.ConclusionThe prevalence of dementia in the older Latin American and Caribbean population is high and increasing relative to the previous decade. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries

The association of physical activity and cognitive decline has become important with the increase in dementia prevalence. These systematic review and meta‐analysis of longitudinal studies demonstrate that association

AbstractBackgroundDementia is increasing in prevalence across our globally ageing population. In absence of disease modifying therapy, the need to assess the effectiveness of preventative measures becomes important. It is becoming clear that intervention before disease manifests is crucial. Physical activity (PA) is the most influential risk factor for dementia, examining impact on cognitive decline is important to discern.MethodOur search criteria involved conducting a database search through MEDLINE (Ovid) as well as examining two prior reviews, with protocol registered with PROSPERO (registration number: CRD42019129449). Longitudinal studies on population ≥18 years of age with cognition measured at both baseline and follow‐up were included. Included studies were assessed for their methodological quality.ResultOverall, 42 studies were included, with literature showing evidence of an association between increase PA and reduced cognitive decline. Components of PA were reported on as follows: frequency in 37 studies, intensity in 28 studies, duration in 25 studies, and type in 22 studies. Meta‐analysis showed PA of greater frequency and duration, and more vigorous intensity, was significantly associated with reduced cognitive decline (relative risk 0.72, 95% confidence interval 0.62, 0.82; p<0.001).ConclusionData available to date suggests that a wide range of different types of activity may be important on influencing preventive impact. In addition frequency, duration and intensity of PA are each significantly associated with reduced cognitive decline where greater frequency and duration of PA are associated with reduced cognitive decline, as is increased average intensity. PA recommendations are required to increase adherence in order to delay the onset of cognitive decline. It is important that future studies examine these details as this review revealed a paucity of research on key components to guide adherence to recommendations.

Living with Dementia in Aotearoa (LiDiA): A Feasibility Study for a Dementia Prevalence Study in Māori and Non-Māori Living in New Zealand.

Recent estimations have projected a threefold increase in dementia prevalence in Aotearoa New Zealand (NZ) by 2050, particularly in Maori and Pacific peoples. However, to date, there are no national data on dementia prevalence, and overseas data are used to estimate the NZ dementia statistics. The aim of this feasibility study was to prepare the groundwork for the first full-scale NZ dementia prevalence study that is representative of Māori, European, Pacific and Asian peoples living in NZ. The main feasibility issues were: (i) Sampling to ensure adequate community representation from the included ethnic groups, (ii) Preparing a workforce to conduct the fieldwork and developing quality control, (iii) Raising awareness of the study in the communities (iv) Maximizing recruitment by door-knocking, (v) Retaining those we have recruited to the study and (vi) Acceptability of study recruitment and assessment using adapted versions of the 10/66 dementia protocol in different ethnic groups living in South Auckland. We found that a probability sampling strategy using NZ Census data was reasonably accurate and all ethnic groups were sampled effectively. We demonstrated that we were able to train up a multi-ethnic workforce consisting of lay interviewers who were able to administer the 10/66 dementia protocol in community settings. The response rate (224/297, 75.5%) at the door-knocking stage was good but attrition at subsequent stages was high and only 75/297 (25.2%) received the full interview. Our study showed that it would be feasible to conduct a population-based dementia prevalence study using the 10/66 dementia protocol in Māori, European and Asian communities living in NZ, utilizing a qualified, skilled research team representative of the families participating in the study. The study has demonstrated that for recruitment and interviewing in Pacific communities a different but culturally appropriate approach is required.

Canada’s changing dementia landscape: Preliminary findings from The Landmark Study

AbstractBackgroundAs with many nations, the prevalence of dementia in Canada is expected to rise dramatically in the upcoming decades as the population ages. The Landmark Study is aimed at updating these estimates and the broader population changes associated for the Canadian population made in the 2010 Rising Tide Report.MethodUsing the Canadian Centre for Economic Analysis’s socio‐economic statistical analysis platform, a simulation model was developed using demographic characteristics (age, sex, ethnicity) and risk factors for dementia to forecast the burden of dementia in Canada over the next 30 years. This approach allows for comparisons across sex, ethnicity, provinces, while accounting for population dynamics including immigration. The model was also used to examine how a delay in incidence (1‐year, 5‐years, 10‐years) would impact prevalence and incident cases.ResultAs expected, the model forecasts the number of Canadians with dementia to more than double in the next 30 years: 493,718 (2020; 59.6% female) to 1,296,707(2050; 61.2% female; Figure 1). With changing immigration patterns, the ethnic background of people with dementia will be quite different than today. People with Asian origin could increase from 8% of people with dementia today to 24% by 2050 (Figure 2). The changes are driven both by future immigration, and people who have already immigrated to Canada in the past. Delays in onset of 1 year would avoid over 300K cases, whereas a deferred incidence of 10 years would bring Canadian dementia rates to lower than where it is today (Figure 3). With the increase in prevalence of dementia, comes an increase in the number of informal caregivers and the number of hours providing care to persons living with dementia. The number of informal caregivers in 2020 (349,551; 472.6 million hours/year) is projected to increase in 2050 to 1,005,815 (1,386 million hours/year; Figure 4).ConclusionThis study forecasts rising dementia prevalence in Canada, illustrates the changing landscape of ethnicity in Canadians living with dementia, and estimates the population‐level impacts of interventions that delay onset of dementia would have on prevalence, incidence, and informal care.

A systematic review and meta-analysis of randomized controlled trials on the effect of serious games on people with dementia.

An increase in dementia prevalence has been accompanied by increasing interest in new rehabilitation methods, such as serious games. Serious games hold the potential to postpone functional and cognitive declines in people with dementia by increasing their independence and engagement; however, the efficacy of serious games remains underexplored. This review was conducted to quantify the effects of serious games in people with dementia, including several newly published trials, with the hopes of contributing to evidence-based practice by offering support for clinical decision-making. Only randomized controlled trials (RCTs) assessing the impacts of game-based intervention programs compared with conventional therapy on cognitive function, instrumental and non-instrumental activities of daily living, or depression among people with dementia were included in this review. Meta-analyses were performed to determine the pooled standardized mean difference (SMD) of each outcome using a random-effects model. The final search identified 12 studies that met our criteria. Overall, serious games were found to improve cognitive function (pooled SMD: 0.34; 95% CI: 0.07-0.61) and alleviated depression (pooled SMD: -0.131; 95% CI: -1.85 to -0.77) in people with dementia. Serious games improve cognitive function and reduce depression in people with dementia. Future studies in this field should aim to evaluate and determine the long-term effect of these games.

Island Study Linking Aging and Neurodegenerative Disease (ISLAND) Targeting Dementia Risk Reduction: Protocol for a Prospective Web-Based Cohort Study.

BackgroundUp to 40% of incident dementia is considered attributable to behavioral and lifestyle factors. Given the current lack of medical treatments and the projected increase in dementia prevalence, a focus on prevention through risk reduction is needed.ObjectiveWe aim to increase dementia risk knowledge and promote changes in dementia risk behaviors at individual and population levels.MethodsThe Island Study Linking Aging and Neurodegenerative Disease (ISLAND) is a long-term prospective, web-based cohort study with nested interventions that will be conducted over a 10-year period. Target participants (n=10,000) reside in Tasmania and are aged 50 years or over. Survey data on knowledge, attitudes, and behaviors related to modifiable dementia risk factors will be collected annually. After each survey wave, participants will be provided with a personalized dementia risk profile containing guidelines for reducing risk across 9 behavioral and lifestyle domains and with opportunities to engage in educational and behavioral interventions targeting risk reduction. Survey data will be modeled longitudinally with intervention engagement indices, cognitive function indices, and blood-based biomarkers, to measure change in risk over time.ResultsIn the initial 12 months (October 2019 to October 2020), 6410 participants have provided baseline data. The study is ongoing.ConclusionsRecruitment targets are feasible and efforts are ongoing to achieve a representative sample. Findings will inform future public health dementia risk reduction initiatives by showing whether, when, and how dementia risk can be lowered through educational and behavioral interventions, delivered in an uncontrolled real-world context.International Registered Report Identifier (IRRID)DERR1-10.2196/34688

Gut microbiome alterations in Alzheimer’s patients from Kazakhstan

AbstractBackgroundRecent studies strongly suggest that gut microbiome is capable of influencing brain functions and contribute to the development of Alzheimer’s disease (AD). However, only few studies have characterized the human gut microbiome communities associated with AD. Moreover, reported changes in the gut microbiomes in AD patients from different countries are not similar. Therefore, more research is needed in order to reveal the relationships existing between human microbiomes and AD in different ethnic populations. Here, we report the first pilot case‐control study of diversity and composition of gut microbiomes isolated from the patients diagnosed with AD in comparison with healthy seniors from the Central Asian region.MethodMicrobial DNA was isolated from fecal samples of the patients with confirmed AD (n=11) and healthy age‐ and gender‐matched individuals (n=13). The composition of gut microbiomes were characterized by 16S ribosomal RNA MiSeq sequencing. Data analysis was performed using less operational taxonomic units scripts (LotuS) and R (v4.03).ResultOur results demonstrated that gut microbiota of AD individuals had overall higher α‐diversity compared to healthy controls, although this difference was not significant. The absence of statistical power might be explained by a low sample size. However, we have found significant differences of bacterial abundance at class, order and genus levels. At class level the amount of Bacilli was depleted in AD group; at order level, the relative abundance of Oscillospirales increased, while the abundance of Lactobacillales decreased in AD patients. Among bacterial genera, microbiomes of AD participants were characterized by a preponderance of unknown_Prevotellaceae and unknown_Ruminococcaceae. Linear discriminant analysis (LDA) has revealed that the relative abundances of Eubacterium coprostanoligenes group, Rikenellaceae RC9 gut group, Bacilli RF39, Oscillospirales UCG‐011 were significantly different in AD patients compared to healthy participants.ConclusionStudying the gut microbiome alterations in AD patients is of considerable interest. By focusing on the mechanism of interactions between human microbiota and the brain, we can uncover new pathophysiological pathways leading to the onset and progression of AD, evaluate the contributions of environment and lifestyle to the increase in prevalence of dementia and develop practical recommendations for the prevention and treatment of this severe pathology.

Race, Genetic Admixture, and Cognitive Performance in the Cuban Population.

Population aging will lead to a dramatic increase in dementia prevalence, which will disproportionally affect racial minorities. The presence of racial differences in dementia prevalence has been widely reported in United States, but there are no relevant studies on this topic in low- and middle-income countries. In a cross-sectional survey, 2944 older Cubans were recruited at a community-based level aimed to identify the effects of self-identified race and genetic admixture on cognitive performance. Dementia diagnosis was established using 10/66 Dementia and DSM-IV criteria. APOE-ε4 genotype was determined in 2511 (85%) and genetic admixture was completed for all dementia cases and in a randomly selected sample of cognitive healthy participants (218 dementia cases and 367 participants without dementia). The overall prevalence of dementia was 8.7%, without large or statistically significant differences on dementia prevalence (p = .12) by self-identified race. Mean cognitive scores were similar across racial groups (p = .46). After controlling for age, sex, and education, greater proportion of African ancestry was not associated with cognitive performance (p = .17). We found no evidence of an independent effect of self-identified race and/or population ancestry on dementia prevalence or cognitive performance. This suggests that observed differences in dementia prevalence among diverse populations may be driven primarily by social determinants of health.

Higher Prevalence of Dementia but No Change in Total Comfort While Dying among Nursing Home Residents with Dementia between 2010 and 2015: Results from Two Retrospective Epidemiological Studies.

Important policy developments in dementia and palliative care in nursing homes between 2010 and 2015 in Flanders, Belgium might have influenced which people die in nursing homes and how they die. We aimed to examine differences between 2010 and 2015 in the prevalence and characteristics of residents with dementia in nursing homes in Flanders, and their palliative care service use and comfort in the last week of life. We used two retrospective epidemiological studies, including 198 residents in 2010 and 183 in 2015, who died with dementia in representative samples of nursing homes in Flanders. We found a 15%-point increase in dementia prevalence (p-value < 0.01), with a total of 11%-point decrease in severe to very severe cognitive impairment (p = 0.04). Controlling for residents’ characteristics, in the last week of life, there was an increase in the use of pain assessment (+20%-point; p < 0.03) but no change in total comfort. The higher prevalence of dementia in nursing homes with no change in residents’ total comfort while dying emphasizes an urgent need to better support nursing homes in improving their capacities to provide timely and high-quality palliative care services to more residents dying with dementia.

Is Brazil ready for the expected increase in dementia prevalence?

Is Brazil ready for the expected increase in dementia prevalence?

Dementia Prevalence Declined in the U.S. Between 2000 and 2012

Theoretically, the aging of the U.S. population could be associated with an increase in dementia prevalence, but several studies suggest that dementia

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

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

Prevention of Age-Related Cognitive Decline: Which Strategies, When, and for Whom?

Brain aging is characterized by the progressive and gradual accumulation of detrimental changes in structure and function, which increase risk of age-related cognitive decline and dementia. This devastating chronic condition generates a huge social and economic burden and accounts for 11.2% of years of disability. The increase in lifespan has contributed to the increase in dementia prevalence; however, there is currently no curative treatment for most causes of dementias. This paper reviews evidence-based strategies to build, enhance, and preserve cognition over the lifespan by examining approaches that work best, proposing when in the life course they should be implemented, and in which population group(s). Recent work shows a tendency to decreased age-specific prevalence and incidence of cognitive problems and dementia among people born later in the first half of the 20th century, citing higher educational levels, improvements in lifestyle, and better handling of vascular risk factors. This implies that we can target modifiable environmental, lifestyle, and health risk factors to modify the trajectory of cognitive decline before the onset of irreversible dementia. Because building cognitive reserve and prevention of cognitive decline are of critical importance, interventions are needed at every stage of the life course to foster cognitive stimulation, and enable healthy eating habits and physical activity throughout the lifespan. Preventive interventions to decrease and delay cognitive decline and its consequences in old age will also require collaboration and action on the part of policy-makers at the political and social level.

Demencija u primarnoj zdravstvenoj zaštiti

Dementia is defined as an acquired loss of cognitive abilities, accompanied by disturbances of behavior, emotions, and activities of daily living. Dementia is uncommon among younger population, but its prevalence among people over 60 years of age is growing rapidly, and is doubling approximately every five years. At the Community health center Savski venac number of patients with variety of cognitive problems, is followed for the period from 2010 to 2014. The aim of this paper is a description of the obtained data on the prevalence of patients with dementia at the Community health center Savski venac. Also, indirect objective is to consider the importance of early diagnosis, due to the timely prescription of medications, and recommendation of therapeutic interventions, which are aimed at improving communication, and social skills of patients, and the protection of caregivers from stress. Method used in this paper is recording of the prevalence of dementia among patients older than 60 years, based on the data from the medical records. For the purposes of assessment of cognitive abilities at the primary level of health care two screening tests are used: TCS (The Clock Drawing Test) and MMSE (MiniMental State Examination), both of them originally made to assess the severity of dementia, but which also have a widespread use, due to the simplicity of application. The results show that dementia is becoming more prevalent, both worldwide, and in our country. For the period from 2010. to 2014. Alzheimer's dementia in the population of people over the age of 60 show an increase of 44%; for the diagnosis of mild cognitive impairment this increase is 38%, and for the diagnosis of vascular dementia 56%. Conclusion. Exact reasons for the increase in prevalence of dementia is still unknown. However, what's taken into account, on one hand, is the progress of medicine, which enables longer average life span, and on the other, socioeconomic conditions, wars, fast pace of life, large influx of information via television and Internet... High cost of treatment and medicines for dementia further complicate the disease. In addition to providing an adequate help and treatment of patients with dementia, at the Community health center Savski venac, in the context of health educational work, we have formed a support groups for caregivers.

A COMPARISON OF HEALTH UTILITY SCORES CALCULATED USING UNITED KINGDOM AND CANADIAN PREFERENCE WEIGHTS IN AN ALZHEIMER'S DISEASE SAMPLE

Background: The predicted increase in dementia prevalence over the next few decades poses enormous health and socio-economic challenges. In the absence of a cure, strategies to prevent or delay the onset of dementia within the population have been proposed as imperative. This approach is complicated, however, by the relative paucity of research evidence between modifiable risk factors and dementia, and limited knowledge of applying promotion, prevention and early intervention (PPEI) concepts to dementia. Nevertheless, several nations are attempting such an approach and Alzheimer’s Disease International (2009) recommends governments make dementia a health priority and develop national plans to deal with the disease.Methods:A number of national frameworks for dementia were identified, most included some population health approaches. Results: Common elements were: Public education campaigns to improve public and professional awareness and understanding of dementia,Promotion of early/ timely diagnosis,Increase the workforce to meet the likely increase in demand for services as a result of education, Provide sufficient guidance and support for people with dementia and their carers,Funding for research, and Strategies promoting the prevention message ’what’s good for your heart is good for your heart’ and healthy lifestyle messages (stopping smoking, eating healthily, exercising regularly). There are barriers to applying a population health approach to dementia PPEI. Identified barriers included: Difficulty in applying early intervention strategies at the individual level due to difficulties in establishing a diagnosis of dementia in the early stages, Inadequate scientific evidence regarding risk and protective factors for dementia, Attitudes and stigma, Little developmental work towards a potential population health model for dementia in Australia, and Policy barriers e.g. lack of linkage to healthy ageing, mental health or chronic disease initiatives. Conclusions: The considerable evidence that p opulation health approaches including mass marketing campaigns can improve health outcomes and save health costs suggests that such an approach to dementia may reduce the impact of the condition. A lthough barriers exist to applying such an approach to dementia, the evidence suggests that it is feasible to do so and many western countries are adopting such an approach.

Are the safety profiles of antipsychotic drugs used in dementia the same? An updated review of observational studies.

With an increase in the global prevalence of dementia, there is also an increase in behavioural and psychological symptoms of dementia (BPSD) for which antipsychotic drugs are often used. Despite several safety warnings on antipsychotic use in dementia, there is little evidence to support the efficacy of antipsychotics in individual BPSD symptoms or to evaluate the drug safety profile by individual antipsychotic drug. There is emerging but scarce evidence that suggests an inter-drug variability between antipsychotic safety outcomes in BPSD. The objective of this review was to examine the existing literature on antipsychotic drug use in dementia patients; in particular to see whether inter-drug differences regarding antipsychotic safety were reported. A literature search was conducted for observational studies published in the English language from 2004 to 2014 that reported the risk of all-cause mortality, cerebrovascular events, pneumonia and other outcomes such as hip/femur fracture, deep vein thrombosis (DVT) and hyperglycaemia. Six of 16 mortality studies (38%), 7 of 28 stroke studies (25%), 1 of 6 pneumonia (17%) studies and 2 of 6 fracture studies (33%) investigated inter-drug safety outcomes in elderly patients/dementia patients, while to our knowledge, there are no studies investigating the inter-drug variation of deep-vein thrombosis and hyperglycaemia risk. The results of the observational studies provide mixed results on the safety of antipsychotics in BPSD but it is clear that there are differences between the safety profiles of antipsychotic drugs. Robust evidence of such inter-drug variability could significantly improve patient safety as antipsychotics become more targeted to clinical risk factors.

A Pilot Study Examining the Awareness, Attitude, and Burden of Informal Caregivers of Patients With Dementia

Pakistan is 1 of 5 countries with the highest projected increase in prevalence of dementia in the Asia Pacific region (Access Economic, 2006), where there is a lack of structured support network for caregivers in general and for dementia caregivers in specific. The caregivers and other related individuals predominantly rely on traditional familial support for caregiving. This approach places immense burdens on the familial caregivers (Shaji, 2009). In Pakistan, there is paucity of research evidence on care of patients with dementia and the needs of caregivers dealing with such patients. This study explores awareness among caregivers, their attitudes toward family members suffering from dementia, and their experience of burden. In-depth interviews were conducted with 12 caregivers of patients diagnosed with dementia in Rawalpindi/Islamabad Pakistan. There was a considerable lack of awareness about dementia as an illness among the caregivers. They reported a conflict between emotional and religious commitments to nurture older adult relatives and their experience of psychological, physical, and economic burden, resulting in occasional episodes of carelessness and violence toward them. The study indicated that women, particularly those who were employed outside of the home, reported higher levels of stress. It is suggested that support from extended family in all forms was perceived as a concrete form of stress relief by the primary caregiver. The findings of this study indicate that the social and financial burden of dementia on families of caregivers in Pakistan may be exacerbated if they do not have support. This indicates a need for multipronged intervention from both government and nongovernment organizations, as well as the community, to develop programs for caregivers that are nested within the cultural context of filial piety in Pakistan. These strategies should also be gender sensitive, giving priority to more at-risk groups.