Delay in the diagnosis of dementia in urban India: Role of dementia subtype and age at onset

Social Factors, Age, and Health at Time of Dementia Diagnosis

Importance

A timely diagnosis is crucial in ensuring high-quality care for individuals with dementia. Comparing age and health status at the time of dementia diagnosis across population subgroups can provide insights into vulnerable groups that may experience delayed diagnosis and/or a poorer prognosis.

Objective

To examine how age and health at the time of dementia diagnosis vary across sociodemographic subgroups.

Design, Setting, and Participants

A nationwide cross-sectional study of individuals with an incident dementia diagnosis from either specialist care or who were dispensed antidementia drugs, identified from the Swedish National Patient Register and the Prescribed Drug Register between January 2018 and December 2022.

Exposures

Sociodemographic status at the time of dementia diagnosis was assessed through linkage with national registers and included education, place of birth, living arrangement, family status, and family disposable income.

Main outcomes and measures

Health status was assessed by calculating the number of dispensed medications during the year preceding dementia diagnosis, as well as the Charlson Comorbidity Index (CCI) and Hospital Frailty Risk Score (HFRS) using specialist diagnoses during the preceding 5 years.

Results

Of the 107 707 individuals with a dementia diagnosis, 61 127 (56.8%) were women and the mean (SD) age at diagnosis was 82.0 (7.7) years. Individuals with lower education, living alone or in a care home, or without a close relative were a mean (SD) of 3.1 (7.3) years older when diagnosed with dementia compared with their counterparts. At the time of diagnosis, individuals who had lower than high school education had higher CCI (odds ratio [OR], 1.11; 95% CI, 1.07-1.15) and more medications (OR, 1.38; 95% CI, 1.33-1.44) compared with those with university education. Age and health status at dementia diagnosis did not differ significantly by place of birth or income.

Conclusions and relevance

This nationwide register-based study indicated that clinical diagnosis of dementia may be significantly delayed among individuals with low education, those living alone or in a care home, or those without a close relative. These groups also had poorer health at the time of dementia diagnosis, which may impact their prognosis negatively. Future efforts should focus on improving health services to better address the diagnostic and care needs of these vulnerable subgroups.

Gaps in biomedical research in frontotemporal dementia: A call for diversity and disparities focused research

Frontotemporal dementia (FTD) is one of the leading causes of young-onset dementia before age 65, typically manifesting as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). Although FTD affects all populations across the globe, knowledge regarding the pathophysiology and genetics derives primarily from studies conducted in North America and Western Europe. Globally, biomedical research for FTD is hindered by variable access to diagnosis, discussed in this group's earlier article, and by reduced access to expertise, funding, and infrastructure. This perspective paper was produced by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) and discusses the field's current status on the cross-cultural aspects of basic and translational research in FTD (including that focused on epidemiology, genetics, biomarkers, and treatment). It subsequently provides a summary of gaps and needs to address the disparities and advance global FTD biomedical research.

Assessment of dementia knowledge in Indian speech-language pathology students

OBJECTIVES

Speech-language pathologists (SLPs) have a crucial role in assisting individuals with dementia due to the communication and swallowing challenges associated with the disease. As the number of dementia cases rises in India at an increasing rate, investigating the level of dementia knowledge of SLP students can offer insight into the preparedness of the healthcare system to meet this emerging demand.

METHOD

A cross-sectional survey was conducted on SLP students pursuing their final year undergraduate, postgraduate and doctoral degrees from four universities across India. Dementia knowledge was assessed using the Dementia Knowledge Assessment Scale (DKAS) and information about previous dementia exposure (both formal and informal) was collected. The collected data were analysed using quantitative methods.

RESULTS

A total of 220 students (64.70% response rate) completed the survey. Overall dementia knowledge was inadequate with an average score of 22.08 ± 10.06. Previous dementia exposure among the students was also found to be low and did not affect dementia knowledge scores.

DISCUSSION

Despite the fundamental role SLPs play in the care of individuals with dementia, the lack of knowledge in this area emphasizes the need for enhancing dementia training programs through educational curricula and clinical placements.

The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact

Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.

FDG-PET-based neural correlates of Addenbrooke's cognitive examination III scores in Alzheimer's disease and frontotemporal degeneration

Introduction

The Addenbrooke's Cognitive Examination III (ACE-III) is a brief test useful for neuropsychological assessment. Several studies have validated the test for the diagnosis of Alzheimer's disease (AD) and frontotemporal dementia (FTD). In this study, we aimed to examine the metabolic correlates associated with the performance of ACE-III in AD and behavioral variant FTD.

Methods

We enrolled 300 participants in a cross-sectional study, including 180 patients with AD, 60 with behavioral FTD (bvFTD), and 60 controls. An 18F-Fluorodeoxyglucose positron emission tomography study was performed in all cases. Correlation between the ACE-III and its domains (attention, memory, fluency, language, and visuospatial) with the brain metabolism was estimated.

Results

The ACE-III showed distinct neural correlates in bvFTD and AD, effectively capturing the most relevant regions involved in these disorders. Neural correlates differed for each domain, especially in the case of bvFTD. Lower ACE-III scores were associated with more advanced stages in both disorders. The ACE-III exhibited high discrimination between bvFTD vs. HC, and between AD vs. HC. Additionally, it was sensitive to detect hypometabolism in brain regions associated with bvFTD and AD.

Conclusion

Our study contributes to the knowledge of the brain regions associated with ACE-III, thereby facilitating its interpretation, and highlighting its suitability for screening and monitoring. This study provides further validation of ACE-III in the context of AD and FTD.