Medical Diagnosis Of Dementia Research Articles

Longitudinal Changes in Visual Acuity and Contrast Sensitivity and Incident Dementia

PurposeTo evaluate the impact of baseline and change in vision on the risk of developing dementia. DesignRetrospective cohort study. MethodsThis longitudinal analysis utilized data from the 2021 and 2022 National Health and Aging Trends Study. Binocular presenting vision was assessed, including distance (DVA) and near (NVA) visual acuity, and contrast sensitivity (CS). Dementia status was defined based on: 1) medical diagnosis of dementia, 2) dementia score, or 3) poor cognitive test performance. ResultsOf the 2,159 adults included in this study, weighted mean (SD) age was 77.9 years (5.2), with the majority being female (weighted: 54%), and White (88%). The baseline median (interquartile range [IQR]) DVA was 0.08 (0-0.20) logMAR, NVA was 0.17 (0.09-0.26) logMAR, and CS was 1.80 (1.65-1.85) logCS. Over the 1-year follow up period, 192 (6.6%) adults developed dementia. In time-to-event analyses, baseline DVA (HR: 1.08 [95% CI: 1.02-1.14], per 0.1 logMAR), NVA (HR: 1.07 [95% CI: 1.01-1.13], per 0.1 logMAR), and CS (HR: 1.09 [95% CI: 1.03-1.15], per 0.1 logCS) were associated with greater likelihood of incident dementia. Further, change in CS (HR: 1.14 [95% CI: 1.04-1.25], per 0.1 logCS worse/year), but not VA, was associated with greater likelihood of incident dementia. ConclusionsWorse baseline VA and CS are associated with greater likelihood of incident dementia. Further, worsening CS over time, but not VA, was associated with higher likelihood of incident dementia. Future work is needed to study interventions targeted at improving vision deficits and examine their impact on decreasing dementia risk.

Emotions, action strategies and expectations of health professionals and people with dementia regarding COVID-19 in different care settings in Switzerland: a mixed methods study

BackgroundMore than 55 million people are currently affected by dementia worldwide and over 144 thousand in Switzerland. In Swiss nursing homes, 47.6% of the residents had a medical diagnosis of dementia in 2014. Due to cognitive impairment, they have difficulties remembering hygiene measures or placing them in the epidemic context. This results in a higher infection risk. There are COVID-19-associated recommendations focused on dementia care management but studies simultaneously surveying and correlating perspectives of health professionals as well as people with dementia across care settings are largely lacking. This study is focused on COVID-19-associated perspectives and needs of health professionals and people with dementia across different care settings. Lessons learned from the pandemic shall be pointed out.MethodsWe conducted a mixed-methods approach based on an exploratory sequential design. Two qualitative interview rounds (n = 15 participants) and a quantitative online survey (n = 148 participants) with people with dementia, caring relatives, Advanced Practice Nurses and nursing home managers (health professionals) were performed. Data collected was performed in nursing home and home-care settings. The SQRQ checklist was used.ResultsFear and uncertainty were highest at the beginning of the pandemic among the interviewed nursing professionals and nursing home managers. As a positive side effect of the pandemic, increased cohesion in care teams was reported. Some people with dementia experienced the decelerated outside world as pleasant and less challenging to master. Particularly during the first wave, nursing home managers rated political decision-making processes as being too slow, partly non-transparent, inconsistent, and sometimes inappropriate for people with dementia.ConclusionsAlthough the identified emotional and physical consequences of the COVID-19 pandemic are mostly negative for health professionals and people with dementia, research should also investigate potential positive side effects. Furthermore, political decisions should be passed on to care institutions as promptly, transparently, and comprehensibly as possible. The results provide guidance on dementia-focused COVID-19 management interventions incorporating lessons learned and considering the emotional impact of the pandemic in Switzerland and beyond.

A Pilot Study of the Effects of Individualized Home Dual Task Training by Mobile Health Technology in People with Dementia.

The objective of this pilot study was to evaluate the effects of dual-task training implemented by mobile health technology on performance on motor and dual-task tests in subjects with dementia. Nineteen subjects with a medical diagnosis of dementia were assigned to an experimental group (EG, n = 12) or control group (CG, n = 7). The EG participated in 24 sessions (3/week) of a homebase dual-task exercises program, in addition to their ongoing cognitive and physiotherapy treatment. The training program was implemented individually in the patient's home by caregivers or relatives through electronic devices controlled by a mobile application. Before (Pre) and after (Post) the program, performance on motor and motor/cognitive (dual-task) tests were evaluated. Motor evaluation included gait at preferred and maximal speed, the Up and Go, and the Handgrip Strength test. Dual-task tests included gait with subtraction 3 s from 100 and naming animals (verbal fluency). The CG only performed the evaluations in addition to their cognitive and physiotherapy treatment. The statistical analysis (ANOVA Group*Test) showed a statically significant improvement for both dual-task tests in the EG after the training program, while the CG showed an impairment in the verbal fluency test. Conclusion: the implementation of a home exercise program carried out with mobile technology in people with dementia is feasible and positively affects their performance on dual tasks.

Physical activity attenuates or even eliminates the risk of all‐cause dementia associated with aging in older adults: A population‐based cohort study

AbstractBackgroundFrom 2016 to 2040 the number of people with all‐cause dementia in the United Kingdom is expected to increase by 57%, while 70% percent of it is due to a higher life expectancy. It is meaningful to examine whether physical activity could mitigate the risk of all‐cause dementia associated with aging in older adults. We aimed to examine the overall and age‐stratified effect of physical activity on the risk of all‐cause dementia in older adults.MethodOlder adults aged 50 or more participants of the English Longitudinal Study of Aging (ELSA) were followed during a 17‐years follow‐up, between 2002 and 2019. Physical activity was accessed using a self‐reported, validated questionnaire in each wave (2002‐2019). Participants were classified as inactive, low, or moderate‐to‐high levels of physical activity. Medical diagnosis of dementia was asked in each wave for either the cohort member or by a proxy interview with family or caregivers. Additionally, the Informant Questionnaire on Cognitive Decline in the Elderly was used to determine the presence of all‐cause dementia (cut‐off = 3.5).ResultData from 8,270 older adults were analyzed (55.6% women; mean [SD] age, 63.9 [9.7]). Over a 17‐year follow‐up, 7.8% (95%: 7.3 to 8.4) were diagnosed with all‐cause dementia. For each year increased in age, the odds of all‐cause dementia increased 6.1% (95%CI: 5.1% to 7.1%). On the other hand, participants engaging in low (OR: 0.27; 95%CI: 0.22 to 0.33) or moderate‐to‐high level (OR: 0.12; 95%CI: 0.09 to 0.16) of physical activity had lower odds of incidence of all‐cause dementia through the follow‐up period. Participants aged 80 or over who engaged in a moderate‐to‐high level of physical activity had a lower risk of all‐cause dementia than inactive adults aged between 50‐69 years. Results were sustained after sensitive analysis to reduce the impact of reverse causality.ConclusionAlthough aging is the strongest risk factor for all‐cause dementia, physical activity could eliminate the risk associated with aging in older adults. Public health policies should consider that for older adults, engaging in physical activity below recommended levels may be an accessible and achievable strategy to prevent all‐cause dementia.

Physical activity attenuates the risk for dementia associated with aging in older adults with mild cognitive impairment. Findings from a population-based cohort study

From 2016 to 2040 the number of people with dementia in the United Kingdom is expected to increase by 57%, while 70% percent of it is due to a higher life expectancy. Thus, we analyzed the overall and age-stratified effect of physical activity on risk of dementia in participants with mild cognitive impairment (MCI) of the English Longitudinal Study of Ageing (ELSA). Participants of the ELSA, aged over 50 with MCI, were followed-up nine times between 2002 and 2019. Physical activity was assessed using a self-reported, validated questionnaire and participants were classified as inactive, low, or moderate-to-high active. Medical diagnosis of dementia was self-reported or determined using the Informant Questionnaire on Cognitive Decline in the Elderly. Data from 521 participants with MCI were analyzed (56% women; mean [SD] age, 68.7 [10.6]). Over 17-year follow-up, 20.5 (95%CI: 17.3 to 24.2)% were diagnosed with dementia. The risk of incident dementia was reduced in participants engaging in low (HR: 0.34; 95%CI: 0.22 to 0.54) or moderate-to-high (HR: 0.16; 95%CI: 0.08 to 0.33) levels of physical activity. Risk of dementia in adults aged 80 or more engaging in low or moderate-to-high levels of physical activity was not different from inactive adults aged between 50 and 69 years. Results were sustained after competing risk regression model and sensitivity analyses to reduce the impact of reverse causality. Physical activity appears to minimize the risk associated with aging in older adults with MCI.

Spanish adaptation and validation of the Pain Assessment Scale in Advanced Dementia (PAINAD) in patients with dementia and impaired verbal communication: cross-sectional study

ObjectivesThe aim of this study was to adapt and validate the Pain Assessment in Advanced Dementia (PAINAD) scale in Spanish.DesignCross-sectional observational study.SettingTwo health districts of Andalusian provinces, located in the...

Dealing with the behaviour of residents with dementia that challenges: A stepped-wedge cluster randomized trial of two types of dementia-specific case conferences in nursing homes (FallDem)

BackgroundThe negative effects of behavioural changes among dementia residents and the consequences for caregivers are a major problem in the care of people with dementia. Case conferences (CC) are recommended as a useful method to understand the underlying causes of the behaviour and to plan tailored interventions ObjectivesThe aim of this article is to describe the effects of two dementia-specific CC models on the prevalence of behaviour that challenges and other secondary outcomes. DesignStepped-wedge cluster randomized trial. SettingNursing homes: The inclusion criterion was the participation of at least two units with a minimum of 30 residents who were mainly cared for in the study units. ParticipantsA total of 224 residents and 189 staff from six nursing homes in the IdA (Innovative dementia-orientated Assessment system) cohort and 241 residents and 284 staff from six nursing homes in the Neo (Narrative Approach) cohort were included in the study. The inclusion criteria were the following: medical diagnosis of dementia from nursing charts, FAST (Functional Assessment Staging) score > 1, living at least 15 days in the unit, and informed consent. MethodsThe nursing homes were randomized to the type of intervention and time point of intervention delivery. The two interventions in the form of the case conference models (Welcome-IdA and -Neo) differed in the type of behaviour analysis method. The intervention duration was seven months. The primary outcome was the change in the prevalence of behaviour that challenges. Secondary outcomes were residents’ quality of life, prescription of psychotropic medications, formal caregiver burnout, dementia-related stress, and vocational action competence. The outcomes were measured on seven data points every three months. Linear mixed-effects models were used to analyze intervention effects between the control, intervention and follow-up periods. ResultsNo differences were found concerning the primary outcome between the control and intervention cohorts for both CC models. Further exploratory data analyses showed a reduction in behaviours such as apathy (18%) and eating disturbances (29%) for the IdA cohort and hallucination (27%) and delusion (28%) in the NEO cohort. Only staff in the IdA cohort demonstrated a reduction in work-related burnout from the control phase to the intervention phase. ConclusionSpecific CC for behaviour that challenges do not decrease the overall prevalence of residents showing changes in behaviour. However, there are indications that the case conferences influence some types of behaviour and reduce the risk factors for work-related burnout

Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project)

BackgroundDepression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates.MethodsThe aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project, which aims to recruit a study population of 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who live in a nursing home, have no medical diagnosis of dementia, and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance-related disorders, or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design.DiscussionOur main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life, and social participation. The project’s results can make an important contribution toward improving the health care of nursing home residents who have late-life depression.Trial registrationDRKS, DRKS00015686, Oct. 10, 2018.

The "Violent Resident": A Critical Exploration of the Ethics of Resident-to-Resident Aggression.

Resident-to-resident aggression is quite prevalent in long-term care settings. Within popular and empirical accounts, this form of aggression is most commonly attributed to the actions of an aberrant individual living with dementia characterized as the "violent resident." It is often a medical diagnosis of dementia that is highlighted as the ultimate cause of aggression. This neglects the fact that acts of aggression are influenced by broader structural conditions. This has ethical implications in that the emphasis on individual aberration informs public policy strategies for prevention with a focus on restricting the freedom of individuals using behavioural modification, drugs, or other restraints with the intent to protect others from harm. A more ethical approach requires attention to the structural conditions of long-term care that both foster aggression and constrain prevention efforts. To this end, we turn to a model of relational citizenship that offers a theory of embodied selfhood and relationality as essential to human dignity, thus entailing human rights protections. The application of an ethic based on this model offers a more holistic prevention strategy for resident-to-resident aggression by drawing attention to the critical need and obligation to promote human flourishing through system level efforts.

The Role of Reading Classic Fiction in Book Groups for People with Dementia is Better Understood through Use of a Qualitative Feasibility Study

A Review of:
 Rimkeit, B.S. and Claridge, G. (2017). Peer reviewed: literary Alzheimer’s, a qualitative feasibility study of dementia-friendly book groups. New Zealand Library & Information Management Journal, 56(2), 14-22. https://figshare.com/articles/Literary_Alzheimer_s_A_qualitative_feasibility_study_of_dementia-friendly_book_groups/5715052/1
 
 Abstract
 Objective – To explore how people living with dementia experience reading classic fiction in book groups and what benefits this intervention provides. 
 Design – Qualitative feasibility study.
 Setting – Day centre within a care home in the North Island of New Zealand.
 Subjects – Eight participants with a medical diagnosis of dementia – four community dwellers who attend day centers, and four residents of a secure dementia unit in a care home.
 Methods – Investigators used surveys, focus groups, and interpretative phenomenological analysis (IPA), for ideographic analysis of the data. 
 Main results – Following analysis of the focus book group data, three superordinate, with related subordinate, themes were found: 1) the participant as a lively reader. The participants shared childhood memories of reading and when they became adults, how they encouraged reading within the household and with their own children. Subordinate themes included: recall, liveliness of discussion, and interest in reading and book clubs; 2) the participant as guardian of the voice of Dickens. Participants believed that, when the language is simplified, the beauty and rich imagery of Dickens is lost. Subordinate themes included: oversimplifying “loses the voice of Dickens”, familiarity, and continued play on words; and 3) the participant as a discerning book reviewer. The participants offered a number of ‘dementia-friendly’ suggestions, including the use of memory aids and simplifying text. Subordinate themes were expressed as four recommendations: use cast of characters; illustrations pick up the energy of the story, but balance quantity with risk of being childish; the physical quality of the text and paper; and chunk quantity of text while keeping the style of the original author. The choice of using classic fiction that was already well known was validated by the participants, who had some preconceptions about Ebenezer Scrooge, and described him by using epithets such as mean, an old bastard, and ugly. The participants found the investigators’ adapted version to be oversimplified, as short excerpts of the original Dickens seemed to evoke emotional and aesthetic responses of appreciation. Therefore, when creating adaptations, it is important to preserve the beauty of the original writing as much as possible.
 Conclusion – This qualitative feasibility study has provided a better understanding of how people living with dementia experience classic fiction in shared book groups. For individuals with Alzheimer’s disease, language skills may be well-preserved until later in the disease course. For example, the focus group participants demonstrated an appreciation and command of language, as well as enthusiasm and excitement in the sharing of the original Dickens with others. They suggested the use of memory aids, such as including a cast of characters, and repeating the referent newly on each page. Participants also suggested that the adapted version be shortened, to use a large font, and to include plenty of pictures. The choice of using classic fiction was validated by the participants, as they found these tales comforting and familiar, particularly when they included such colorful characters as Ebenezer Scrooge. Finally, people living with dementia should be encouraged to enjoy books for the same reason other adults love to read – primarily for the creative process. Classic fiction may be adapted to enhance readability, but the adaptation must be done in a thoughtful manner. While memory deficits occur in Alzheimer’s disease, an appreciation of complex language may be preserved until the later disease stages.

The psychometric viability of measures of functional performance commonly employed for older adults with dementia: a systematic review of measurement properties protocol.

REVIEW QUESTION / OBJECTIVE Are the measures of functional performance that are used within populations of adults with dementia psychometrically sound? More specifically, the objective is to: Review the reliability, validity and responsiveness of common measures of functional performance that are used in exercise interventions for adults with dementia. INCLUSION CRITERIA Types of participants Participants will be adults, aged 65 years and older, with a confirmed medical diagnosis of dementia. While no specific aetiology of disease will be targeted, any study that provides such details will be reported on. Studies that include dementia as only part of the sample will be included in this review, but will be differentiated from dementia specific studies. Types of intervention(s)/phenomena of interest The following measures have been identified as common measures used within exercise-based interventions for older adults with dementia from a recent JBI systematic review. General physical function Performance Orientated Mobility Assessment Senior Fitness Test Short Physical Performance Battery Strength 1RM Leg Press Grip Strength Standing from Floor Balance BERG Balance Test 1 Leg Balance Mobility 2min walk 6min walk 800m walk Gait parameters of Stride Length, Cadence and Double Limb Support Time Walk Speed Stair climbs Timed Up and Go Flexibility Sit and Reach Back Scratch Test These are the main outcome measures that are of interest to this review because they are commonly employed and presented on in dementia and exercise intervention literature. Types of outcomes Studies that examined the reliability, validity and sensitivity/responsiveness of measurement tools TRUNCATED AT 250 WORDS

The effects of physical exercise on older adults, aged 65 years and older, with a diagnosis of dementia: a systematic review protocol

Review question/objective Does physical exercise affect functional performance, quality of life, cognitive impairment and physical activity levels of older adults (<65yrs) with a diagnosis of dementia? More specifically, the objectives are to: determine the effect of physical exercise on domains of functional performance, physical activity levels, quality of life and cognitive impairment determine whether resistance training or aerobic training is more effective on the elderly with dementia determine the impact of exercise on Behavioural and Psychological Symptoms of Dementia (BPSD) Determine whether program effectiveness is dependent upon living arrangements (ie community-dwelling adults with dementia compared to those living in residential aged care facilities [RACF]) evaluate the validity and reliability of functional performance and physical activity measurement tools for peoples with dementia. Inclusion criteria Types of participants This review will consider studies that target older adults, aged 65 years and older, with a specific medical diagnosis of dementia, living in the community (with respite care) or in residential aged care facilities. Due to the nature of dementia diagnosis, the duration since diagnosis will not be considered as a point of reference for the severity of the disease. Exclusion criteria are studies that include older adults who are bed-ridden or hospitalized, dementia diagnosis based off MMSE scores alone (no medical diagnosis of dementia). Types of intervention(s)/phenomena of interest This review will consider all studies that evaluate physical exercise interventions using an experimental study design, of any length. Specifically, studies will compare a specific intervention in one–on-one and group settings. Studies aimed at increasing exercise through education or health promotion will not be included. Types of outcomes This review will include studies that measure at least one of the following primary outcome measures: quality of life, functional performance, physical activity levels and cognitive impairment. Secondary outcome measures may include any mentioned changes attributed to the program for dementia patients and/or their carers, as well as validity, reliability and appropriateness of outcome tools used.

How Did the Doctor Decide? What SLPs Should Know About the Medical Diagnosis of Dementia

Abstract Even though the speech-language pathologist (SLP) does not assign a medical diagnosis, communication disorders professionals are responsible for the provision of screening and assessment of cognitive/linguistic skills in health-care environments. When a new patient is admitted with a diagnosis of Alzheimer's disease or another dementing condition, or when an existing patient seems to be exhibiting cognitive decline, the SLP should be aware of the procedures that the medical profession suggests for the assignment of this medical diagnosis. Furthermore, an awareness of the co-morbid conditions that can exacerbate cognitive impairments can guide the SLP in making appropriate referrals so that patients' cognitive abilities remain at their highest potential. The purpose of this article is to review the medical literature about the recommended practices for diagnosing Alzheimer's disease and other dementing conditions, to contrast the cognitive impairments that occur with some more common diseases and conditions, and to invite thoughtful reflection on the part of the SLP working with residents who have an Alzheimer's disease or other dementing diagnosis on a face sheet, a care plan, or a list of ICD-9 codes.

When home care ends--changes in the physical health of informal caregivers caring for dementia patients: a longitudinal study.

To verify the change in health variables and parameters of health service utilization in a group of active caregivers for older persons with dementia in comparison with former caregivers who had ceased to provide home care for at least 6 months (death of the patient or institutionalized care). A prospective longitudinal study with 1-year follow-up. Active and former caregiver groups originated from a sample of active caregivers at baseline. Participants were recruited mainly via advertisements placed in two magazines with large, nationwide circulation. The questionnaires were sent on request. Seven hundred twenty primary caregivers of dementia patients living in the community. All patients had a medical diagnosis of dementia and had a score of 20 or greater on the mental-mnestic disturbances factor of the Sandoz Clinical Assessment--Geriatric scale. Their care needs covered at least one of four activities of daily living (personal hygiene, eating, toilet use/excretion, mobility). After 12 months, 681 caregivers were reinterviewed. The physical complaints were assessed with the 24-item Giessen Symptom List (subscales: aching limbs, stomach complaints, heart complaints, physical exhaustion). Other key variables were the number of illnesses, number of somatic and psychotropic medications, and number of physician visits. Although the somatic symptoms of the active caregivers (n = 427) remained stable at a high level, they decreased significantly (24%) in the group of former caregivers (n = 121). Simultaneously, the number of visits former caregivers made to physicians almost doubled. The reason why home care was terminated (death or institutionalization) did not influence health variables or health service utilization. The physical health of former caregivers improves in the long term once they cease to provide home care. The fact that former caregivers go to the doctor much more frequently is to be interpreted as an indication that they take the time to attend to their own physical and medical needs.

The Relationship Between Minimum Data Set Ratings and Scores on Measures of Communication and Hearing Among Nursing Home Residents With Dementia

The Minimum Data Set (MDS) is a federally mandated assessment tool used to evaluate individuals residing in skilled nursing facilities, a large percentage of whom have dementia. Best described as a rating scale, it comprises items related to 16 domains of functioning, including communication and hearing. Typically, the MDS is completed by a nurse. When a deficit is observed, Resident Assessment Protocols (RAPs) are designed to address the impairment and provide information for appropriate plans of care. The purposes of this study were to: (a) comprehensively assess the communication and hearing function of nursing home residents with dementia, (b) evaluate the relationship between ratings on MDS communication and hearing items and the performance of dementia patients on standardized assessments, and (c) determine the number of residents with MDS-identified deficits who received a referral for further evaluation. Fifty-seven individuals with a medical diagnosis of dementia participated. All exhibited deficits in communication and hearing function; however, the majority of participants were rated as having normal or adequate communication and hearing on the MDS. Of those participants with MDS-identified impairments in communication and hearing, none was referred for further evaluation. Implications for policy and care for nursing home residents with dementia are discussed.