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Jaakkimainen RL, Bronskill SE, Tierney MC, Herrmann N, Green D, Young J, Ivers N, Butt D, Widdifield J, Tu K. Identification of Physician-Diagnosed Alzheimer’s Disease and Related Dementias in Population-Based Administrative Data: A Validation Study Using Family Physicians’ Electronic Medical Records. J Alzheimers Dis 2016; 54:337-49. [DOI: 10.3233/jad-160105] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- R. Liisa Jaakkimainen
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Sunnybrook Academic Family Health Team, Toronto, ON, Canada
| | | | - Mary C. Tierney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Primary Care Research Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nathan Herrmann
- Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Diane Green
- Performance Management, Cancer Screening, Cancer Care Ontario, Toronto, ON, Canada
| | | | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Hospital, Toronto, ON, Canada
| | - Debra Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Scarborough Hospital, Toronto, ON, Canada
| | - Jessica Widdifield
- Sunnybrook Academic Family Health Team, Toronto, ON, Canada
- McGill University Health Centre, Montreal, QC, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Academic Family Health Team, Toronto, ON, Canada
- Toronto Western Family Health Team, Toronto, ON, Canada
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452
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Jackson M, Pelone F, Reeves S, Hassenkamp AM, Emery C, Titmarsh K, Greenwood N. Interprofessional education in the care of people diagnosed with dementia and their carers: a systematic review. BMJ Open 2016; 6:e010948. [PMID: 27531724 PMCID: PMC5013417 DOI: 10.1136/bmjopen-2015-010948] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This systematic review is linked to the multifaceted social, economic and personal challenges of dementia and the international recognition of the value of interprofessional education (IPE) and its influence on health and social care outcomes. This review therefore aimed to identify, describe and evaluate the impact of IPE interventions on health and social care practitioners (prequalification and postqualification) understanding of dementia, the quality of care for people with dementia and support for their carers. METHODS Following PRISMA guidelines, 9 databases were searched (MEDLINE, EMBASE, The Cochrane Library, PsycINFO, CINAHL Plus, Applied Social Sciences Index and Abstracts, Healthcare Management Information Consortium, ERIC and British Education Index). Narrative analysis of the findings was undertaken. DESIGN Systematic review. RESULTS 6 studies meeting the inclusion criteria were identified. The majority of studies were conducted in North America. Participants in 4 studies were health and social care practitioners caring for people with dementia, whereas the remaining studies focused on training graduate or undergraduate students. Diverse IPE activities with varying content, delivery mode and duration were reported. Although some studies reported more positive attitudes to interprofessional working as a result of the interventions, none reported benefits to patients or carers. The quality of the included studies varied. Overall, the evidence for the reported outcomes was considered weak. CONCLUSIONS This review identified 6 studies describing IPE interventions intended to improve collaborative knowledge, skills, interprofessional practice and organisational awareness of dementia and dementia care. The small number of studies, their varied nature, scope and settings combined with poor quality of evidence limits our understanding of the effectiveness of IPE on the care and support of people with dementia and their carers. Further research is required to develop the evidence base and provide robust studies to inform IPE development. TRIAL REGISTRATION NUMBER CRD42014015075.
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Affiliation(s)
- Marcus Jackson
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Ferruccio Pelone
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Scott Reeves
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Anne Marie Hassenkamp
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Claire Emery
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Kumud Titmarsh
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Nan Greenwood
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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453
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Rossor M, Collinge J, Fox N, Mead S, Mummery C, Rohrer J, Schott J, Warren J. Dementia and Cognitive Impairment. Neurology 2016. [DOI: 10.1002/9781118486160.ch8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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454
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Farrand P, Woodford J, Llewellyn D, Anderson M, Venkatasubramanian S, Ukoumunne OC, Adlam A, Dickens C. Behavioural activation written self-help to improve mood, wellbeing and quality of life in people with dementia supported by informal carers (PROMOTE): a study protocol for a single-arm feasibility study. Pilot Feasibility Stud 2016; 2:42. [PMID: 27965860 PMCID: PMC5153814 DOI: 10.1186/s40814-016-0083-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 06/25/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Increases in life expectancy have resulted in a global rise in dementia prevalence. Dementia is associated with poor wellbeing, low quality of life and increased incidence of mental health difficulties such as low mood or depression. However, currently, there is limited access to evidence-based psychological interventions for people with dementia experiencing low mood and poor wellbeing. Behavioural activation-based self-help, supported by informal carers and guided by mental health professionals, may represent an effective and acceptable solution. METHODS/DESIGN The present study is a phase II (feasibility) single-arm trial informed by the Medical Research Council complex interventions research methods framework. Up to 50 dementia participant/informal carer dyads will be recruited from a variety of settings including primary care, dementia-specific health settings and community outreach. People living with dementia will receive behavioural activation-based self-help and be supported by their informal carer who has received training in the skills required to support the self-help approach. In turn, during the use of the intervention, the informal carer will be guided by mental health professionals to help them work through the materials and problem solve any difficulties. Consistent with the objectives of feasibility studies, outcomes relating to recruitment from different settings, employment of different recruitment methods, attrition, data collection procedures, clinical delivery and acceptability of the intervention will be examined. Clinical outcomes for people with dementia (symptoms of depression and quality of life) and informal carers (symptoms of depression and anxiety, carer burden and quality of life) will be measured pre-treatment and at 3 months post-treatment allocation. DISCUSSION This study will examine the feasibility and acceptability of a novel behavioural activation-based self-help intervention designed to promote wellbeing and improve low mood in people living with dementia, alongside methodological and procedural uncertainties associated with research-related procedures. As determined by pre-specified progression criteria, if research procedures and the new intervention demonstrate feasibility and acceptability, results will then be used to inform the design of a pilot randomised controlled trial (RCT) to specifically examine remaining methodological uncertainties associated with recruitment into a randomised controlled design. TRIAL REGISTRATION Current Controlled Trials ISRCTN42017211.
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Affiliation(s)
- Paul Farrand
- Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences, University of Exeter, Washington Singer Labs, Perry Road, Exeter, EX4 4QG UK
| | - Joanne Woodford
- Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences, University of Exeter, Washington Singer Labs, Perry Road, Exeter, EX4 4QG UK
| | - David Llewellyn
- University of Exeter Medical School, St. Luke's Campus, Exeter, EX1 2LU UK
| | - Martin Anderson
- Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences, University of Exeter, Washington Singer Labs, Perry Road, Exeter, EX4 4QG UK
| | - Shanker Venkatasubramanian
- Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences, University of Exeter, Washington Singer Labs, Perry Road, Exeter, EX4 4QG UK
| | - Obioha C Ukoumunne
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, St. Luke's Campus, Exeter, EX1 2LU UK
| | - Anna Adlam
- Clinical Education Development and Research (CEDAR), Psychology: College of Life and Environmental Sciences, University of Exeter, Washington Singer Labs, Perry Road, Exeter, EX4 4QG UK
| | - Chris Dickens
- University of Exeter Medical School, St. Luke's Campus, Exeter, EX1 2LU UK
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455
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O'Brien N, Heaven B, Teal G, Evans EH, Cleland C, Moffatt S, Sniehotta FF, White M, Mathers JC, Moynihan P. Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition. J Med Internet Res 2016; 18:e210. [PMID: 27489143 PMCID: PMC4989122 DOI: 10.2196/jmir.5790] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/31/2016] [Indexed: 01/28/2023] Open
Abstract
Background Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible.
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Affiliation(s)
- Nicola O'Brien
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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456
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Davies N, Mathew R, Wilcock J, Manthorpe J, Sampson EL, Lamahewa K, Iliffe S. A co-design process developing heuristics for practitioners providing end of life care for people with dementia. BMC Palliat Care 2016; 15:68. [PMID: 27484683 PMCID: PMC4969644 DOI: 10.1186/s12904-016-0146-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia. METHODS An iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2) focus groups with health and care professionals. Family carers were recruited from a national charity, purposively sampling those with experience of end-of-life care for a person with dementia. Health and care professionals were purposively sampled to include a broad range of expertise including; general practitioners, palliative care specialists, and geriatricians. A co-design group was established consisting of health and social care experts and family carers, to synthesise the findings from the qualitative work and produce a toolkit of heuristics to be tested in practice. RESULTS Four broad areas were identified as requiring complex decisions at the end of life; 1) eating/swallowing difficulties, 2) agitation/restlessness, 3) ending life-sustaining treatment, and 4) providing "routine care" at the end of life. Each topic became a heuristic consisting of rules arranged into flowcharts. Eating/swallowing difficulties have three rules; ensuring eating/swallowing difficulties do not come as a surprise, considering if the situation is an emergency, and considering 'comfort feeding' only versus time-trialled artificial feeding. Agitation/restlessness encourages a holistic approach, considering the environment, physical causes, and the carer's wellbeing. Ending life-sustaining treatment supports practitioners through a process of considering the benefits of treatment versus quality-of-life and comfort. Finally, a heuristic on providing routine care such as bathing, prompts practitioners to consider adapting the delivery of care, in order to promote comfort and dignity at the end of life. CONCLUSIONS The heuristics are easy to use and remember, offering a novel approach to decision making for dementia end-of-life care. They have the potential to be used alongside existing end-of-life care recommendations, adding more readily available practical assistance. This is the first study to synthesise experience and existing evidence into easy-to-use heuristics for dementia end-of-life care.
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Affiliation(s)
- Nathan Davies
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Rammya Mathew
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, WC2B 6NR, UK
| | - Elizabeth L Sampson
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK
| | - Kethakie Lamahewa
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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457
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Prince M, Ali GC, Guerchet M, Prina AM, Albanese E, Wu YT. Recent global trends in the prevalence and incidence of dementia, and survival with dementia. Alzheimers Res Ther 2016; 8:23. [PMID: 27473681 PMCID: PMC4967299 DOI: 10.1186/s13195-016-0188-8] [Citation(s) in RCA: 508] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/20/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Current projections of the scale of the coming dementia epidemic assume that the age- and sex-specific prevalence of dementia will not vary over time, and that population ageing alone (increasing the number of older people at risk) drives the projected increases. The basis for this assumption is doubtful, and secular trends (that is, gradual decreases or increases in prevalence over long-term periods) are perfectly plausible. METHODS We carried out a systematic review of studies of trends in prevalence, incidence and mortality for people with dementia, conducted since 1980. RESULTS We identified nine studies that had tracked dementia prevalence, eight that had tracked dementia incidence, and four that had tracked mortality among people with dementia. There was some moderately consistent evidence to suggest that the incidence of dementia may be declining in high-income countries. Evidence on trends in the prevalence of dementia were inconsistent across studies and did not suggest any clear overall effect. Declining incidence may be balanced by longer survival with dementia, although mortality trends have been little studied. There is some evidence to suggest increasing prevalence in East Asia, consistent with worsening cardiovascular risk factor profiles, although secular changes in diagnostic criteria may also have contributed. CONCLUSIONS We found no evidence to suggest that the current assumption of constant age-specific prevalence of dementia over time is ill-founded. However, there remains some uncertainty as to the future scale of the dementia epidemic. Population ageing seems destined to play the greatest role, and prudent policymakers should plan future service provision based upon current prevalence projections. Additional priorities should include investing in brain health promotion and dementia prevention programs, and monitoring the future course of the epidemic to chart the effectiveness of these measures.
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Affiliation(s)
- Martin Prince
- The Global Observatory for Ageing and Dementia Care, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 36, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
| | - Gemma-Claire Ali
- The Global Observatory for Ageing and Dementia Care, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 36, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.,Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Maëlenn Guerchet
- The Global Observatory for Ageing and Dementia Care, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 36, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - A Matthew Prina
- The Global Observatory for Ageing and Dementia Care, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, PO 36, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | | | - Yu-Tzu Wu
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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458
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Jamieson M, Grealish L, Brown JA, Draper B. Carers: The navigators of the maze of care for people with dementia—A qualitative study. DEMENTIA 2016; 15:1112-23. [DOI: 10.1177/1471301214554930] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Dementia is a challenge in our society, with individuals accessing services across multiple settings. Carers are navigating and delivering care services in the home. This research sought to investigate the experiences of people with dementia and their carers when transitioning home from hospital. Methods This study used a qualitative descriptive design, employing in-depth interviews with 30 carers recruited through networks known to one state branch of Alzheimer’s Australia. Emerging themes were validated in one focus group. Results During the hospital stay carers experienced a paradox: being required to deliver care yet perceiving that they were being ignored in regard to decisions about care. The time in hospital was considered by some carers to be stressful, as they were concerned about the safety of the person with dementia. Many reported that discharge home was rarely planned and coordinated. Returning home carers found re-establishing and/or accessing new services challenging, with available services often inappropriate to need. Conclusion The paradox of the care experience in the acute setting, whereby the carer was either invited, or sought, to deliver care, yet was excluded in staff decisions about that care, challenges the current communication and coordination of care. For people with dementia and their carers, there is a need for a coordinated seamless service that enables continued unbroken care and support from acute care to home. Carers also need support navigating the wide range of services available and importantly both carers and care providers may need to understand service boundaries. Recommendations This study highlights the need to acknowledge the expertise of the carer, and their need for support. Enabling a smooth discharge from hospital and support to navigate care access in the community is paramount. These experiences provide insight into gaps in service provision and modifying existing services may lead to improved experiences.
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Affiliation(s)
| | - Laurie Grealish
- Subacute and Aged Nursing Griffith University, Griffith, Australia; Gold Coast Hospital and Health Services, Southport, Australia
| | | | - Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia
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459
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Soto-Gordoa M, Arrospide A, Moreno-Izco F, Martínez-Lage P, Castilla I, Mar J. Projecting Burden of Dementia in Spain, 2010-2050: Impact of Modifying Risk Factors. J Alzheimers Dis 2016; 48:721-30. [PMID: 26402090 DOI: 10.3233/jad-150233] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Risk and protective factors such as obesity, hypercholesterolemia, physical activity, and hypertension can play a role in the development of dementia. Our objective was to measure the effect of modification of risk and protective factors on the prevalence and economic burden of dementia in the aging Spanish population during 2010-2050. A discrete event simulation model including risk and protective factors according to CAIDE (Cardiovascular Risk Factors, Aging and Incidence of Dementia) Risk Score was built to represent the natural history of dementia. Prevalence of dementia was calculated from 2010 to 2050 according to different scenarios of risk factor prevalence to assess the annual social and health care costs of dementia. The model also supplied hazard ratios for dementia. Aging will increase between 49% and 16% each decade in the number of subjects with dementia. The number of working-age individuals per person with dementia will decrease to a quarter by 2050. An intervention leading to a 20% change in risk and protective factors would reduce dementia by 9% , prevent over 100,000 cases, and save nearly 4,900 million euros in 2050. Switching individuals from a group with a specific risk factor to one without it nearly halved the risk of the development of dementia. Dementia prevalence will grow unmanageable if effective prevention strategies are not developed. Interventions aiming to reduce modifiable risk factor prevalence represent valid and effective alternatives to reduce dementia burden. However, further research is needed to identify causal relationships between dementia and risk factors.
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Affiliation(s)
| | - Arantzazu Arrospide
- AP-OSI Research Unit, Alto Deba Hospital, Mondragon, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Spain
| | - Fermín Moreno-Izco
- Department of Neurology, Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | | | - Iván Castilla
- Health Services Research on Chronic Patients Network (REDISSEC), Spain.,HTA Unit of the Canary Islands Health Service (SESCS), S/C de Tenerife, Spain
| | - Javier Mar
- Health Services Research on Chronic Patients Network (REDISSEC), Spain.,Clinical Management Unit, Alto Deba Hospital, Mondragon, Spain
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460
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Gates NJ, Karim S, Rutjes AWS, Ware J, Chong LY, March E, Vernooij RWM. Computerised cognition-based interventions for maintaining cognitive function in cognitively healthy people in late life. Hippokratia 2016. [DOI: 10.1002/14651858.cd012277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicola J Gates
- University of New South Wales; Centre for Healthy Brain Ageing (CHeBA); Suite 407 185 Elizabeth Street Sydney NSW Australia 2000
| | - Salman Karim
- Lancashire Care NHS Foundation Trust; Memory Assessment Service; Charnley Fold, Cottage Lane Preston UK PR5 6YA
| | - Anne WS Rutjes
- Fondazione "Università G. D'Annunzio"; Centre for Systematic Reviews; Via dei Vestini 31 Chieti Chieti Italy 66100
- University of Bern; CTU Bern; Bern Bern Switzerland 3012
- University of Bern; Institute of Social and Preventive Medicine (ISPM); Finkenhubelweg 11 Bern Bern Switzerland 3012
| | - Jennifer Ware
- University of Oxford; Cochrane Dementia and Cognitive Improvement Group; Oxford UK OX3 9DU
| | | | - Evrim March
- St Vincent's Hospital (Melbourne); St Vincent's Adult Mental Health; 46 Nicholson Street Fitzroy VIC Australia 3065
| | - Robin WM Vernooij
- Iberoamerican Cochrane Centre; C/ Sant Antoni Maria Claret 167 Barcelona Barcelona Spain 08025
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461
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Bowen M, Edgar DF, Hancock B, Haque S, Shah R, Buchanan S, Iliffe S, Maskell S, Pickett J, Taylor JP, O’Leary N. The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04210] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BackgroundThe prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia.ObjectivesTo measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management.DesignStage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care.SettingStage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions.ParticipantsStage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants.InterventionsStage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behaviour were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers).Main outcome measures.VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction.ResultsStage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA < 6/12) and 47% (VA < 6/18) were correctable with new spectacles. Almost 50% of remaining uncorrectable VI (VA < 6/12) was associated with cataract, and was, therefore, potentially remediable, and one-third was associated with macular degeneration. Uncorrected/undercorrected VI prevalence (VA < 6/12) was significantly higher in participants in care homes (odds ratio 2.19, 95% CI 1.30 to 3.73;p < 0.01) when adjusted for age, sex and sMMSE score. VA could not be measured in 2.6% of group 1 and 34.2% of group 2 participants (p < 0.01). The main eye examination elements (excluding visual fields) could be performed in > 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis.LimitationsSampling bias is possible owing to quota-sampling and response bias.ConclusionsThe prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Michael Bowen
- Research Department, College of Optometrists, London, UK
| | - David F Edgar
- Division of Optometry and Visual Science, City University London, London, UK
| | | | - Sayeed Haque
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rakhee Shah
- Research Department, College of Optometrists, London, UK
- The Outside Clinic, Swindon, UK
| | - Sarah Buchanan
- Research Department, Thomas Pocklington Trust, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Susan Maskell
- Public and participant involvement representative, Alzheimer’s Society Research Network, London, UK
| | - James Pickett
- Research Department, Alzheimer’s Society, London, UK
| | - John-Paul Taylor
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil O’Leary
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Republic of Ireland
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462
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Bermejo-Pareja F, Llamas-Velasco S, Villarejo-Galende A. Alzheimer's disease prevention: A way forward. Rev Clin Esp 2016; 216:495-503. [PMID: 27325510 DOI: 10.1016/j.rce.2016.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 01/22/2023]
Abstract
This review proposes a more optimistic view of Alzheimer's disease (AD), in contrast to that contributed by the ageing of the population and the failure of potentially curative therapies (vaccines and others). Treatment failure is likely due to the fact that AD gestates in the brain for decades but manifests in old age. This review updates the concept of AD and presents the results of recent studies that show that primary prevention can reduce the incidence and delay the onset of the disease. Half of all cases of AD are potentially preventable through education, the control of cardiovascular risk factors, the promotion of healthy lifestyles and specific drug treatments. These approaches could substantially reduce the future incidence rate of this disease.
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Affiliation(s)
- F Bermejo-Pareja
- Imas12 (Instituto de Investigación Hospital Universitario 12 de Octubre), Madrid, España; Cátedra Extraordinaria de Alzheimer y enfermedades Neurodegenerativas, Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España; CIBERNED, Instituto de Investigación Carlos III, Madrid, España
| | - S Llamas-Velasco
- Imas12 (Instituto de Investigación Hospital Universitario 12 de Octubre), Madrid, España; Departamento de Neurología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - A Villarejo-Galende
- CIBERNED, Instituto de Investigación Carlos III, Madrid, España; Departamento de Neurología, Hospital Universitario 12 de Octubre, Madrid, España
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463
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The Prevalence and Incidence of Dementia: a Systematic Review and Meta-analysis. Can J Neurol Sci 2016; 43 Suppl 1:S3-S50. [DOI: 10.1017/cjn.2016.18] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionDementia is a common neurological condition affecting many older individuals that leads to a loss of independence, diminished quality of life, premature mortality, caregiver burden and high levels of healthcare utilization and cost. This is an updated systematic review and meta-analysis of the worldwide prevalence and incidence of dementia.MethodsThe MEDLINE and EMBASE databases were searched for relevant studies published between 2000 (1985 for Canadian papers) and July of 2012. Papers selected for full-text review were included in the systematic review if they provided an original population-based estimate for the incidence and/or prevalence of dementia. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. Random-effects models and/or meta-regression were used to generate pooled estimates by age, sex, setting (i.e., community, institution, both), diagnostic criteria utilized, location (i.e., continent) and year of data collection.ResultsOf 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 160 studies met the inclusion criteria. Among individuals 60 and over residing in the community, the pooled point and annual period prevalence estimates of dementia were 48.62 (CI95%: 41.98-56.32) and 69.07 (CI95%: 52.36-91.11) per 1000 persons, respectively. The respective pooled incidence rate (same age and setting) was 17.18 (CI95%: 13.90-21.23) per 1000 person-years, while the annual incidence proportion was 52.85 (CI95%: 33.08-84.42) per 1,000 persons. Increasing participant age was associated with a higher dementia prevalence and incidence. Annual period prevalence was higher in North America than in South America, Europe and Asia (in order of decreasing period prevalence) and higher in institutional compared to community and combined settings. Sex, diagnostic criteria (except for incidence proportion) and year of data collection were not associated with statistically significant different estimates of prevalence or incidence, though estimates were consistently higher for females than males.ConclusionsDementia is a common neurological condition in older individuals. Significant gaps in knowledge about its epidemiology were identified, particularly with regard to the incidence of dementia in low- and middle-income countries. Accurate estimates of prevalence and incidence of dementia are needed to plan for the health and social services that will be required to deal with an aging population.
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464
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Dening KH, Hibberd P. Exploring the community nurse role in family-centred care for patients with dementia. Br J Community Nurs 2016; 21:198-202. [PMID: 27282506 DOI: 10.12968/bjcn.2016.21.4.198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A diagnosis of dementia can have a significant effect, not only on the person diagnosed, but also on the person's family. Drivers within national policy and strategy to raise awareness and promote education have improved the understanding of dementia across professional groups, as well as within the wider population. However, families living with dementia still struggle to find information and support. This paper explores the common issues faced by families, and focuses on a relationship approach to care. The role of the community nurse can be central to supporting people with dementia and their families to live well in their own communities. The paper uses a case-study approach to discuss three scenarios commonly raised by family carers and people with dementia: (1) seeking help and support at point of seeking diagnosis, (2) knowing the 'right time' to seek help and advice, and (3) when symptomatic changes affect wellbeing and relationships.
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Affiliation(s)
| | - Penny Hibberd
- Consultant Admiral Nurse, The Good Care Group, London, England
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465
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Dovjak P. Sinkende Inzidenz der Demenz. Z Gerontol Geriatr 2016; 49:350. [DOI: 10.1007/s00391-016-1076-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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466
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Bezdicek O, Lukavsky J, Stepankova H, Nikolai T, Axelrod BN, Michalec J, Růžička E, Kopecek M. The Prague Stroop Test: Normative standards in older Czech adults and discriminative validity for mild cognitive impairment in Parkinson's disease. J Clin Exp Neuropsychol 2016; 37:794-807. [PMID: 26313510 DOI: 10.1080/13803395.2015.1057106] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to provide normative data for older and very old Czech adults on the Prague Stroop Test (PST) and to test its discriminative validity in individuals with Parkinson's disease mild cognitive impairment (PD-MCI). METHOD The construction of the PST was modeled after the Victoria Stroop Test. We examined 539 participants aged 60-96 that met strict inclusion criteria. After, we compared the PST scores for a group of 45 PD-MCI patients with a healthy adult sample (HAS) of 45 age- and education-matched individuals. RESULTS I. In the non-clinical sample, robust age- and education-related influences were observed on all PST scores. No gender effect was noted. II. For clinical cases, interference condition (PST-C) was able to discriminate between PD-MCI and HAS (all scores ps < .01). Area under the curve (AUC) was 77% when a screening cut-off of ≤ 27 s was used, showing sensitivity of 82% and specificity of 53%. A more conservative diagnostic cut-off of ≤ 33 s showed sensitivity of 60% and specificity of 80%. DISCUSSION The present study provides PST normative data for basic, interference, and error scores stratified by age (60-96 years). PST appears to be a helpful tool for the diagnostics of PD-MCI especially in research settings at Level II (Litvan et al., 2012) and for PD-MCI attention/working memory and executive function subtyping.
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Affiliation(s)
- Ondrej Bezdicek
- a Department of Neurology and Centre of Clinical Neuroscience , First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague , Prague , Czech Republic
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467
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Rizzi S, Thinggaard M, Engholm G, Christensen N, Johannesen TB, Vaupel JW, Lindahl-Jacobsen R. Comparison of non-parametric methods for ungrouping coarsely aggregated data. BMC Med Res Methodol 2016; 16:59. [PMID: 27216531 PMCID: PMC4877978 DOI: 10.1186/s12874-016-0157-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/08/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Histograms are a common tool to estimate densities non-parametrically. They are extensively encountered in health sciences to summarize data in a compact format. Examples are age-specific distributions of death or onset of diseases grouped in 5-years age classes with an open-ended age group at the highest ages. When histogram intervals are too coarse, information is lost and comparison between histograms with different boundaries is arduous. In these cases it is useful to estimate detailed distributions from grouped data. METHODS From an extensive literature search we identify five methods for ungrouping count data. We compare the performance of two spline interpolation methods, two kernel density estimators and a penalized composite link model first via a simulation study and then with empirical data obtained from the NORDCAN Database. All methods analyzed can be used to estimate differently shaped distributions; can handle unequal interval length; and allow stretches of 0 counts. RESULTS The methods show similar performance when the grouping scheme is relatively narrow, i.e. 5-years age classes. With coarser age intervals, i.e. in the presence of open-ended age groups, the penalized composite link model performs the best. CONCLUSION We give an overview and test different methods to estimate detailed distributions from grouped count data. Health researchers can benefit from these versatile methods, which are ready for use in the statistical software R. We recommend using the penalized composite link model when data are grouped in wide age classes.
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Affiliation(s)
- Silvia Rizzi
- />Max Planck Odense Center on the Biodemography of Aging, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, Odense, 5000 Denmark
| | - Mikael Thinggaard
- />Max Planck Odense Center on the Biodemography of Aging, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, Odense, 5000 Denmark
| | - Gerda Engholm
- />Danish Cancer Society, Strandboulevarden 49, Copenhagen, 2100 Denmark
| | - Niels Christensen
- />Danish Cancer Society, Strandboulevarden 49, Copenhagen, 2100 Denmark
| | | | - James W. Vaupel
- />Max Planck Odense Center on the Biodemography of Aging, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, 18057 Germany
| | - Rune Lindahl-Jacobsen
- />Max Planck Odense Center on the Biodemography of Aging, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, Odense, 5000 Denmark
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468
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Lewis FI, Torgerson PR. The current and future burden of late-onset dementia in the United Kingdom: Estimates and interventions. Alzheimers Dement 2016; 13:38-44. [PMID: 27157826 DOI: 10.1016/j.jalz.2016.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/26/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We estimate the burden of late-onset dementia in the United Kingdom through to 2025 and assess the impact of potential interventions. METHODS We compute disability adjusted life years (DALYs) through to 2025 and consider three interventions, all assumed launched in 2018; (1) an optimistic limiting case of a 100% preventive intervention with immediate uptake of 100% of the population at risk; (2) an intervention which delays onset by 5 years, linear uptake to 50% after 5 years; (3) as (2) but uptake 75% after 5 years. RESULTS By 2025, the DALY burden will have increased by 42% from the Global Disease Burden 2010 estimate. Intervention results: (1) a 9% decrease by 2025; (2) a 33% increase; and (3) a 28% increase. DISCUSSION At current prevalence rates, the ability of an intervention to offset the projected increase in DALY burden of dementia in the United Kingdom by 2025 appears low.
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Affiliation(s)
| | - Paul R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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469
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Abstract
Lifestyle factors in midlife have an important influence on the risk of developing a neurodegenerative disease during later life. Data on lifestyle factors exist for Alzheimer's disease and Parkinson's disease. Continuous physical and cognitive activity, a balanced or Mediterranean diet with a high proportion of unsaturated fatty acids, the pharmacological treatment of arterial hypertension, sufficient and unfragmented sleep and possibly treatment with lipophilic statins reduce the risk of developing dementia later in life. Several studies in recent years have provided evidence that during the last decades the age-adjusted incidence of dementia has decreased. This is probably due to a healthier lifestyle and the treatment of risk factors. Continuous physical activity also decreases the likelihood of developing Parkinson's disease. Whether lifestyle factors also have an influence on the course and the progression of Alzheimer's and Parkinson's diseases in the symptomatic stages is unknown.
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470
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Kopecek M, Stepankova H, Lukavsky J, Ripova D, Nikolai T, Bezdicek O. Montreal cognitive assessment (MoCA): Normative data for old and very old Czech adults. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:23-29. [DOI: 10.1080/23279095.2015.1065261] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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471
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Buswell M, Lumbard P, Fleming J, Ayres D, Brayne C, Goodman C. Using ambulance service PCRs to understand 999 call-outs to older people with dementia. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/jpar.2016.8.5.246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marina Buswell
- Research fellow, Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire
| | - Philip Lumbard
- Assistant director—urgent care, East and North Hertfordshire Clinical Commissioning Group, Welwyn Garden City
| | - Jane Fleming
- Senior research associate, NIHR CLAHRC-EoE, Institute of Public Health, University of Cambridge
| | | | - Carol Brayne
- Professor of public health medicine, Cambridge Institute of Public Health, University of Cambridge
| | - Claire Goodman
- Professor of health care research, CRIPACC, University of Hertfordshire
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472
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Niu H, Álvarez-Álvarez I, Guillén-Grima F, Aguinaga-Ontoso I. Prevalence and incidence of Alzheimer's disease in Europe: A meta-analysis. Neurologia 2016; 32:523-532. [PMID: 27130306 DOI: 10.1016/j.nrl.2016.02.016] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/28/2015] [Accepted: 02/27/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A disease of unknown aetiology, Alzheimer's disease (AD) is the most common type of dementia. As the elderly population grows worldwide, the number of patients with AD also increases rapidly. The aim of this meta-analysis is to evaluate the prevalence and incidence of AD in Europe. METHODOLOGY We conducted a literature search on Medline, Scopus, and CINAHL Complete using the keywords «Alzheimer», «Alzheimer's disease», and «AD» combined with «prevalence», «incidence», and «epidemiology». A Bayesian random effects model with 95% credible intervals was used. The I2 statistic was applied to assess heterogeneity. RESULTS The prevalence of Alzheimer's disease in Europe was estimated at 5.05% (95% CI, 4.73-5.39). The prevalence in men was 3.31% (95% CI, 2.85-3.80) and in women, 7.13% (95% CI, 6.56-7.72), and increased with age. The incidence of Alzheimer's disease in Europe was 11.08 per 1000 person-years (95% CI, 10.30-11.89). Broken down by sex, it was 7.02 per 1000 person-years (95% CI, 6.06-8.05) in men and 13.25 per 1000 person-years (95% CI, 12.05-14.51) in women; again these rates increased with age. CONCLUSIONS The results of our meta-analysis allow a better grasp of the impact of this disease in Europe.
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Affiliation(s)
- H Niu
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Navarra, España.
| | - I Álvarez-Álvarez
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Navarra, España
| | - F Guillén-Grima
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Navarra, España; Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, Navarra, España; Medicina Preventiva, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - I Aguinaga-Ontoso
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Navarra, España
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473
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Brodaty H, Woolf C, Andersen S, Barzilai N, Brayne C, Cheung KSL, Corrada MM, Crawford JD, Daly C, Gondo Y, Hagberg B, Hirose N, Holstege H, Kawas C, Kaye J, Kochan NA, Lau BHP, Lucca U, Marcon G, Martin P, Poon LW, Richmond R, Robine JM, Skoog I, Slavin MJ, Szewieczek J, Tettamanti M, Viña J, Perls T, Sachdev PS. ICC-dementia (International Centenarian Consortium - dementia): an international consortium to determine the prevalence and incidence of dementia in centenarians across diverse ethnoracial and sociocultural groups. BMC Neurol 2016; 16:52. [PMID: 27098177 PMCID: PMC4839126 DOI: 10.1186/s12883-016-0569-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/07/2016] [Indexed: 12/29/2022] Open
Abstract
Background Considerable variability exists in international prevalence and incidence estimates of dementia. The accuracy of estimates of dementia in the oldest-old and the controversial question of whether dementia incidence and prevalence decline at very old age will be crucial for better understanding the dynamics between survival to extreme old age and the occurrence and risk for various types of dementia and comorbidities. International Centenarian Consortium – Dementia (ICC-Dementia) seeks to harmonise centenarian and near-centenarian studies internationally to describe the cognitive and functional profiles of exceptionally old individuals, and ascertain the trajectories of decline and thereby the age-standardised prevalence and incidence of dementia in this population. The primary goal of the ICC-Dementia is to establish a large and thorough heterogeneous sample that has the power to answer epidemiological questions that small, separate studies cannot. A secondary aim is to examine cohort-specific effects and differential survivorship into very old age. We hope to lay the foundation for further investigation into risk and protective factors for dementia and healthy exceptional brain ageing in centenarians across diverse ethnoracial and sociocultural groups. Methods Studies focusing on individuals aged ≥95 years (approximately the oldest 1 percentile for men, oldest 5th percentile for women), with a minimum sample of 80 individuals, including assessment of cognition and functional status, are invited to participate. There are currently seventeen member or potential member studies from Asia, Europe, the Americas, and Oceania. Initial attempts at harmonising key variables are in progress. Discussion General challenges facing large, international consortia like ICC-Dementia include timely and effective communication among member studies, ethical and practical issues relating to human subject studies and data sharing, and the challenges related to data harmonisation. A specific challenge for ICC-Dementia relates to the concept and definition of’abnormal’ in this exceptional group of individuals who are rarely free of physical, sensory and/or cognitive impairments.
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Affiliation(s)
- Henry Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Claudia Woolf
- Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Psychogeriatric Mental Health and Dementia Service, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Stacy Andersen
- New England Centenarian Study, Geriatrics Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, USA.,Department of Genetics, Albert Einstein College of Medicine, Bronx, USA
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Cambridge, UK
| | - Karen Siu-Lan Cheung
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, SAR, China.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Maria M Corrada
- Department of Neurology, University of California Irvine, Irvine, USA.,Department of Epidemiology, University of California Irvine, Irvine, USA
| | - John D Crawford
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Catriona Daly
- Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Yasuyuki Gondo
- Graduate School of Human Sciences, Clinical Thanatology and Geriatric Behavioral Science, Osaka University, Suita, Japan
| | - Bo Hagberg
- Gerontology Research Centre, Lund, Sweden
| | - Nobuyoshi Hirose
- Centre for Supercentenarian Research, Keio University School of Medicine, Tokyo, Japan
| | - Henne Holstege
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, The Netherlands.,Alzheimer Centre, Department of Neurology, VU University Medical Centre, Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Claudia Kawas
- Department of Neurology, University of California Irvine, Irvine, USA.,Department of Neurobiology and Behavior, University of California Irvine, Irvine, USA
| | - Jeffrey Kaye
- Department of Neurology and Biomedical Engineering, Oregon Health and Science University, Portland, USA
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia
| | - Bobo Hi-Po Lau
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, SAR, China
| | - Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Gabriella Marcon
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy.,AAS 1 Triestina, Trieste, Italy
| | - Peter Martin
- Department of Human Development and Family Studies, Iowa State University, Ames, USA
| | - Leonard W Poon
- Institute of Gerontology, University of Georgia, Athens, Georgia, USA
| | - Robyn Richmond
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Jean-Marie Robine
- National Institute on Health and Medical Research, INSERM, Paris, France
| | - Ingmar Skoog
- Department of Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Melissa J Slavin
- Dementia Collaborative Research Centre - Assessment and Better Care, School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - José Viña
- Department of Physiology, University of Valencia and INCLIVA, Valencia, Spain
| | - Thomas Perls
- New England Centenarian Study, Geriatrics Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia. .,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Australia.
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Corriveau RA, Bosetti F, Emr M, Gladman JT, Koenig JI, Moy CS, Pahigiannis K, Waddy SP, Koroshetz W. The Science of Vascular Contributions to Cognitive Impairment and Dementia (VCID): A Framework for Advancing Research Priorities in the Cerebrovascular Biology of Cognitive Decline. Cell Mol Neurobiol 2016; 36:281-8. [PMID: 27095366 DOI: 10.1007/s10571-016-0334-7] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/22/2016] [Indexed: 01/17/2023]
Abstract
The World Health Organization reports that 47.5 million people are affected by dementia worldwide. With aging populations and 7.7 million new cases each year, the burden of illness due to dementia approaches crisis proportions. Despite significant advances in our understanding of the biology of Alzheimer's disease (AD), the leading dementia diagnosis, the actual causes of dementia in affected individuals are unknown except for rare fully penetrant genetic forms. Evidence from epidemiology and pathology studies indicates that damage to the vascular system is associated with an increased risk of many types of dementia. Both Alzheimer's pathology and cerebrovascular disease increase with age. How AD affects small blood vessel function and how vascular dysfunction contributes to the molecular pathology of Alzheimer's are areas of intense research. The science of vascular contributions to cognitive impairment and dementia (VCID) integrates diverse aspects of biology and incorporates the roles of multiple cell types that support the function of neural tissue. Because of the proven ability to prevent and treat cardiovascular disease and hypertension with population benefits for heart and stroke outcomes, it is proposed that understanding and targeting the biological mechanisms of VCID can have a similarly positive impact on public health.
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Affiliation(s)
- Roderick A Corriveau
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA.
| | - Francesca Bosetti
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Marian Emr
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Jordan T Gladman
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - James I Koenig
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Claudia S Moy
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Katherine Pahigiannis
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Salina P Waddy
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
| | - Walter Koroshetz
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), 6001 Executive Blvd, Bethesda, MD, 20892-9525, USA
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475
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A two decade dementia incidence comparison from the Cognitive Function and Ageing Studies I and II. Nat Commun 2016; 7:11398. [PMID: 27092707 PMCID: PMC4838896 DOI: 10.1038/ncomms11398] [Citation(s) in RCA: 277] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/21/2016] [Indexed: 01/29/2023] Open
Abstract
Dramatic global increases in future numbers of people with dementia have been predicted. No multicentre population-based study powered to detect changes over time has reported dementia incidence. MRC Cognitive Function and Ageing Study (CFAS) undertook baseline interviews in populations aged 65+ years in England and Wales (1989–1994). Three areas (CFAS I) were selected for new sampling two decades later (2008–2011) with same geographical boundaries, sampling and approach methods (CFAS II). At 2 years CFAS I interviewed 5,156 (76% response) with 5,288 interviewed in CFAS II (74% response). Here we report a 20% drop in incidence (95% CI: 0–40%), driven by a reduction in men across all ages above 65. In the UK we estimate 209,600 new dementia cases per year. This study was uniquely designed to test for differences across geography and time. A reduction of age-specific incidence means that the numbers of people estimated to develop dementia in any year has remained relatively stable. Future dramatic rises in dementia are widely reported, assuming no change in incidence. Matthews and colleagues report that, in contrast to such statements, age-specific incidence has dropped over 20 years, with overall incidence of dementia remaining stable in a large multi-site population study from England.
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476
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Abstract
Food and nutrient intake data are scarce in very old adults (85 years and older) - one of the fastest growing age segments of Western societies, including the UK. Our primary objective was to assess energy and macronutrient intakes and respective food sources in 793 85-year-olds (302 men and 491 women) living in North-East England and participating in the Newcastle 85+ cohort Study. Dietary information was collected using a repeated multiple-pass recall (2×24 h recalls). Energy, macronutrient and NSP intakes were estimated, and the contribution (%) of food groups to nutrient intake was calculated. The median energy intake was 6·65 (interquartile ranges (IQR) 5·49-8·16) MJ/d - 46·8 % was from carbohydrates, 36·8 % from fats and 15·7 % from proteins. NSP intake was 10·2 g/d (IQR 7·3-13·7). NSP intake was higher in non-institutionalised, more educated, from higher social class and more physically active 85-year-olds. Cereals and cereal products were the top contributors to intakes of energy and most macronutrients (carbohydrates, non-milk extrinsic sugars, NSP and fat), followed by meat and meat products. The median intakes of energy and NSP were much lower than the estimated average requirement for energy (9·6 MJ/d for men and 7·7 MJ/d for women) and the dietary reference value (DRV) for NSP (≥18 g/d). The median SFA intake was higher than the DRV (≤11 % of dietary energy). This study highlights the paucity of data on dietary intake and the uncertainties about DRV for this age group.
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477
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and (select 8682 from (select(sleep(5)))aqxj)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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478
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- rkdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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479
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 waitfor delay '0:0:5'-- bmov] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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480
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481
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Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H, Fratiglioni L, Frisoni GB, Gauthier S, Georges J, Graff C, Iqbal K, Jessen F, Johansson G, Jönsson L, Kivipelto M, Knapp M, Mangialasche F, Melis R, Nordberg A, Rikkert MO, Qiu C, Sakmar TP, Scheltens P, Schneider LS, Sperling R, Tjernberg LO, Waldemar G, Wimo A, Zetterberg H. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15:455-532. [DOI: 10.1016/s1474-4422(16)00062-4] [Citation(s) in RCA: 1001] [Impact Index Per Article: 125.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
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482
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- bcpd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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483
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484
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485
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486
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487
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489
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 waitfor delay '0:0:5'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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490
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 2364=4691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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491
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492
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 8336=8336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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493
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 8336=8336-- yvja] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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494
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495
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 9592=(select 9592 from pg_sleep(5))-- pgrd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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496
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 9592=(select 9592 from pg_sleep(5))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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497
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and (select 8682 from (select(sleep(5)))aqxj)-- zwlx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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498
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 5109=2486-- lenk] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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499
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500
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Temporal Trends and Geographic Variations in Dementia Mortality in China Between 2006 and 2012: Multilevel Evidence From a Nationally Representative Sample. Alzheimer Dis Assoc Disord 2016; 30:348-353. [PMID: 26999577 DOI: 10.1097/wad.0000000000000147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We aimed to explore the temporal trends and geographic variations in dementia mortality in China. MATERIALS AND METHODS Annual dementia mortality counts (years 2006 to 2012) in 161 counties and districts (Disease Surveillance Points, DSP) were extracted from the nationally representative China Mortality Surveillance System and stratified by 5-year age group (aged >65), sex, and time. These counts were linked to annually adjusted denominator populations. Multilevel negative binomial regression with random intercepts and slopes were used to investigate spatiotemporal variation in dementia mortality. RESULTS Dementia mortality varied over 2-fold between DSPs (median rate ratio: 2.59). Significant variation in DSP slopes through time (variance 0.075, SE 0.020) indicated spatiotemporal variations. Mortality rates were significantly higher in the east (rate ratio 2.28; 95% confidence intervals, 1.45-3.60) compared with the north. There was a declining trend in 2 (east and northwest) of the 7 regions. Dementia mortality decreased by 15% in urban areas but increased by 24% in rural areas. CONCLUSIONS Our findings indicate that regional inequalities in dementia mortality are salient, and the increase in mortality rates in rural areas is an emerging public health challenge in China. Tailored preventive health strategies should be in place to narrow down this avoidable and wholly unnecessary inequality.
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