Ökonomische und gesellschaftliche Herausforderungen der Demenz in Deutschland – Eine Metaanalyse

Quantitative analysis of systemic perfusion and cerebral blood flow in the modeling of aging and orthostatic hypotension

Introduction: Orthostatic hypotension (OH) is common among the older population. The mechanism hypothesized by OH as a risk factor for cognitive decline and dementia is repeated transient cerebral blood flow deficiency. However, to our knowledge, quantitative evaluation of cardiac output and cerebral blood flow due to acute blood pressure changes resulting from postural changes is rare. Methods: We report a new fluid-structure interaction model to analyze the quantitative relationship of cerebral blood flow during OH episodes. A device was designed to simulate the aging of blood vessels. Results and Discussion: The results showed that OH was associated with decreased transient cerebral blood flow. With the arterial aging, lesions, the reduction in cerebral blood flow is accelerated. These findings suggest that systolic blood pressure regulation is more strongly associated with cerebral blood flow than diastolic blood pressure, and that more severe OH carries a greater risk of dementia. The model containing multiple risk factors could apply to analyze and predict for individual patients. This study could explain the hypothesis that transient cerebral blood flow deficiency in recurrent OH is associated with cognitive decline and dementia.

[Motoric cognitive risk syndrome-Setting the course for dementia prevention?]

BACKGROUND

The predicted increase in adults with dementia will pose a major challenge for the German healthcare system. To mitigate this challenge, the early detection of adults with an increased risk of dementia is crucial. In this context, the concept of motoric cognitive risk (MCR) syndrome has been introduced into the English literature but is currently relatively unknown in German-speaking countries.

OBJECTIVE

What are the characteristics and diagnostic criteria of MCR? What is the impact of MCR on health-related parameters? What is the current state of evidence regarding the risk factors and prevention of the MCR?

MATERIAL AND METHODS

We reviewed the English language literature concerning MCR, the associated risk factors, and protective factors, similarities or differences with the concept of mild cognitive impairment (MCI), and its influence on the central nervous system.

RESULTS

The MCR syndrome is characterized by subjective cognitive impairment and a slower gait speed. Compared to healthy adults, adults with the MCR have a higher risk of dementia, falls, and mortality. Modifiable risk factors provide a starting point for specific multimodal lifestyle-related preventive interventions.

CONCLUSION

As MCR can be easily diagnosed in practical settings, it could become an important concept for the early detection of adults with an increased risk of dementia in German-speaking countries, although further research is necessary to empirically confirm this assumption.

Dementia in Germany: Epidemiology and Prevention Potential

BACKGROUND

The further development of public-health approaches for the prevention of dementia requires estimates of the number of people with dementia, trends in incidence and prevalence, and the potential impact of preventive measures.

METHODS

The projections described here are based on incidence and prevalence data for Europe and on current and projected population figures from the German Federal Statistical Office. Four scenarios were calculated on the basis of two different population projections and the assumption of either stable or declining prevalence. Data from the German Aging Survey were used to estimate the prevention potential for eleven potentially modifiable risk factors for dementia. Weighting factors were determined to adjust for correlations between risk factors.

RESULTS

Approximately 1.8 million people were living with dementia in Germany as of December 31, 2021; the number of new dementia cases in 2021 is estimated at 360 000 to 440 000. In 2033, depending on the scenario, 1.65 to 2 million people aged 65 and older may be affected; we consider likelihood of the lower end of this range to be very low. It is estimated that 38% of these cases are associated with 11 potentially modifiable risk factors. A 15% reduction in the prevalence of risk factors could potentially decrease the number of cases by up to 138 000 in 2033.

CONCLUSION

We assume that the number of people with dementia in Germany will increase, but there is considerable prevention potential. Multimodal prevention approaches to promote healthy aging should be further developed and put into practice. Better data are needed on incidence and prevalence of dementia in Germany.

The Impact of Dance Movement Interventions on Psychological Health in Older Adults without Dementia: A Systematic Review and Meta-Analysis

BACKGROUND

Lifestyle-based multimodal interventions that integrate physical, sensory, cognitive and social enrichment are suggested to promote healthy mental aging and resilience against aging and Alzheimer's disease (AD).

OBJECTIVES

This meta-analysis examined the efficacy of dance movement interventions (DMI) as an integrated mind-body activity on outcomes of psychological health in older adults.

METHODS

Pre-registration was carried out with PROSPERO (CRD42021265112). PubMed, Web of Science and PsycINFO were searched for randomized controlled trials (RCT) evaluating the effects of DMI (>4 weeks' duration) compared to comparators on measures of psychological health (primary outcome) and cognitive function (additional outcome) among older adults without dementia (aged ≥55). Data of 14 primary RCT (n = 983, n-DMI = 494, n-control = 489) were synthesized using a random effects meta-analysis with robust variance estimation.

RESULTS

DMI had a small positive effect on overall psychological health (g = 0.30; 95% confidence interval [CI]: 0.06, 0.53; p = 0.02, I²= 65.04) compared to control conditions. Small effects of DMI on positive and negative psychological domains as well as quality of life were not statistically significant. DMI had a medium positive effect on general cognitive function (g = 0.50; 95% CI: 0.12, 0.89, p = 0.02, I²= 79.61) over comparators. None of the primary intervention studies evaluated measures of neuroplasticity.

CONCLUSIONS

We found that DMI was effective in promoting mental health amongst older adults without dementia, suggesting that the multimodal enrichment tool is a potential strategy for health promotion and prevention of AD. High-quality intervention studies are needed to expand evidence on DMI-induced changes in specific psychological domains and identify underlying neurophysiological correlates.

Robust estimation of dementia prevalence from two-phase surveys with non-responders via propensity score stratification

BACKGROUND

Missing diagnoses are common in cross-sectional studies of dementia, and this missingness is usually related to whether the respondent has dementia or not. Failure to properly address this issue can lead to underestimation of prevalence. To obtain accurate prevalence estimates, we propose different estimation methods within the framework of propensity score stratification (PSS), which can significantly reduce the negative impact of non-response on prevalence estimates.

METHODS

To obtain accurate estimates of dementia prevalence, we calculated the propensity score (PS) of each participant to be a non-responder using logistic regression with demographic information, cognitive tests and physical function variables as covariates. We then divided all participants into five equal-sized strata based on their PS. The stratum-specific prevalence of dementia was estimated using simple estimation (SE), regression estimation (RE), and regression estimation with multiple imputation (REMI). These stratum-specific estimates were integrated to obtain an overall estimate of dementia prevalence.

RESULTS

The estimated prevalence of dementia using SE, RE, and REMI with PSS was 12.24%, 12.28%, and 12.20%, respectively. These estimates showed higher consistency than the estimates obtained without PSS, which were 11.64%, 12.33%, and 11.98%, respectively. Furthermore, considering only the observed diagnoses, the prevalence in the same group was found to be 9.95%, which is significantly lower than the prevalence estimated by our proposed method. This suggested that prevalence estimates obtained without properly accounting for missing data might underestimate the true prevalence.

CONCLUSION

Estimating the prevalence of dementia using the PSS provides a more robust and less biased estimate.

Sociodemographic structure and health care-related outcomes of community-dwelling dementia caregiving dyads: a latent class replication study

BACKGROUND

The identification of dyadic subgroups of individuals living with dementia and their informal caregivers can help to design effective tailored support. In a previous German study, we identified six dementia dyad subgroups by applying Latent Class Analysis (LCA). Results showed sociodemographic heterogeneity as well as differences in health care outcomes (i.e., quality of life, health status, caregiver burden) between subgroups. The objective of this study is to determine if the dyad subgroups from the previous analysis can be replicated in a similar but distinct Dutch sample.

METHODS

A LCA 3-step procedure was applied to baseline data from the COMPAS study, a prospective cohort study. LCA is a statistical approach used to identify heterogeneous subgroups within populations based on their pattern of answers on a set of categorical variables. Data comprises 509 community-living individuals with predominantly mild to moderate dementia and their informal caregivers. A narrative analysis was used to compare latent class structures of the original versus the replication study.

RESULTS

Six distinct dementia dyad subgroups were identified: A subgroup of "adult-child-parent relation with younger informal caregiver" (31.8%), a "couple with female informal caregiver of older age" group (23.1%), an "adult-child-parent relation with middle-aged informal caregiver" group (14.2%), a "couple with middle-aged female informal caregiver" group (12.4%), a "couple with older male informal caregiver" group (11.2%) and a "couple with middle-aged male informal caregiver" group (7.4%). Quality of life of individuals with dementia was rated better in couples than in adult-child-relationships. Worst health for caregivers was reported by subgroups with female informal caregivers living together with male individuals with dementia in couple relationships. A subgroup with older female informal caregivers in couple relationships report the most severe burden on physical and mental health. In both studies, a model with six subgroups fitted the data best. Although substantive similarities between the subgroups of both studies appeared, considerable differences are also evident.

CONCLUSION

This replication study confirmed the existence of informal dementia dyad subgroups. The observed differences between the subgroups provide useful contributions for a more tailored health care services for informal caregivers and individuals living with dementia. Furthermore, it underlines the relevance of dyadic perspectives. To facilitate replication studies and increase the validity of evidence, a standardization of collected data across studies would be beneficial.

Association Between Psoriasis and Dementia: A Retrospective Cohort Study

Background

To date, no large study has examined the relationship between psoriasis and dementia in Germany.

Objective

The aim of this study was to assess the association between psoriasis and the risk of all-cause dementia in patients followed in general practices in Germany.

Methods

This retrospective cohort study is based on longitudinal data from the IQVIA^TM Disease Analyzer database and included patients with an initial diagnosis of psoriasis between January 1995 and December 2014 in 1,173 general practices in Germany. Patients without psoriasis were matched individually (1:1) to psoriasis patients using propensity scores. The main outcome of the study was the cumulative incidence of dementia diagnoses within up to 15 years of the index date. Univariate Cox proportional regression models were used to assess the relationship between psoriasis or psoriatic arthritis and dementia.

Results

The present study included 10,583 patients with a diagnosis of psoriasis and 10,583 controls without psoriasis. After 15 years of follow-up, 22.0% of the psoriasis patients and 19.1% (p < 0.001) of the non-psoriasis patients developed dementia. The incidence rate of dementia in 1,000 person-years was 15.0 in psoriasis patients and 11.9 in the non-psoriasis cohort. Psoriasis was significantly associated with a dementia risk (HR: 1.24; 95% CI: (1.14-1.35); p < 0.001). The association was stronger in patients with PsA (HR: 1.35; 95% CI: (0.98-1.86)) but this was not significant (p = 0.070).

Conclusion

The present study found a positive association between psoriasis and all-cause dementia in patients in general practices in Germany.

Effects of enriched environment on the expression of β-amyloid and transport-related proteins LRP1 and RAGE in chronic sleep-deprived mice

Sleep plays an important role in the learning process and memory consolidation, and sleep deprivation (SD) leads to inadequate memory consolidation and plays an important role in brain development and plasticity. SD increases β-amyloid levels while impairing cognitive function. We explored the effect of enriched environment (EE) on β-amyloid and transporter protein LRP1 and receptor for advanced glycosylation end-products (RAGE) expression in chronic sleep deprived mice. We randomly divided mice into four groups (n = 10), the standard environment group (Ctrl group), the sleep deprivation group (SD group), the enriched environment intervention group (EE group), and the sleep deprivation plus environmental enrichment intervention group (SD + EE group). A modified multi-platform SD model was used to sleep deprive the mice for 19 h per day. Five hours of EE intervention was performed daily in the EE group and the SD + EE group, respectively. The behavioral measurements of mice were performed by Y-maze method and new object recognition; the expression levels of Aβ1-42, LRP1, and RAGE in prefrontal cortex and hippocampus of mice were measured by immunofluorescence; the expression levels of LRP1 and RAGE in prefrontal cortex and hippocampus were detected by Western blot. The results showed that EE could effectively ameliorate the effects of SD on cognitive impairment, reduce SD induced Aβ deposition, and decrease the expression of RAGE, while increase the expression of LRP1.

Translation of Collaborative Dementia Care Management into Different Healthcare Settings: Study Protocol for a Multicenter Implementation Trial (DCM:IMPact)

Background: Collaborative care models for people living with dementia (PwD) have been developed and evaluated, demonstrating safety, efficacy, and cost-effectiveness. However, these studies are based on heterogeneous study populations and primary care settings, limiting the generalizability of the results. Therefore, this study aims to implement and evaluate collaborative care across various healthcare settings and patient populations. Objective: To describe the study design of this multicenter implementation trial. Methods: This single-arm, multicenter, longitudinal implementation study will be conducted in five different healthcare settings, including 1) physicians’ networks, 2) dementia networks, 3) counselling centers, 4) hospitals, and 5) ambulatory care services. Eligibility criteria are: having a formal dementia diagnosis or having been screened positive for dementia and living community-dwelling. The staff of each healthcare setting identifies patients, informs them about the study, and invites them to participate. Participants will receive a baseline assessment followed by collaborative individualized dementia care management, comprising proven safe, effective, and cost-effective modules. Over six months, specially-qualified nurses will assess patients’ unmet needs, transfer them to individualized care plans, and address them, cooperating with various healthcare providers. A follow-up assessment is conducted six months after baseline. Approximately 60–100 PwD per setting per year are expected to participate. Differences across settings will be assessed regarding acceptability, demand, implementation success and barriers, efficacy, and cost-effectiveness. Results: We expect that acceptability, demand, implementation success and barriers, efficacy, and cost-effectiveness will vary by patients’ sociodemographic and clinical characteristics and unmet needs in each setting. Conclusion: The results will provide evidence highlighting differences in the implementation of collaborative care in various healthcare settings and demonstrating the settings with the highest need, best conditions for a successful implementation, and highest (cost-)effectiveness, as well as the population group that benefits most from collaborative care. Trial registration: German Clinical Trials Register: DRKS00025074. Registered 16 April 2021-retrospectively registered.

Advanced nursing practice and interprofessional dementia care (InDePendent): study protocol for a multi-center, cluster-randomized, controlled, interventional trial

BACKGROUND

A redistribution of tasks between specialized nurses and primary care physicians, i.e., models of advanced nursing practice, has the potential to improve the treatment and care of the growing number of people with dementia (PwD). Especially in rural areas with limited access to primary care physicians and specialists, these models might improve PwD's quality of life and well-being. However, such care models are not available in Germany in regular healthcare. This study examines the acceptance, safety, efficacy, and health economic efficiency of an advanced nursing practice model for PwD in the primary care setting in Germany.

METHODS

InDePendent is a two-arm, multi-center, cluster-randomized controlled intervention study. Inclusion criteria are age ≥70 years, cognitively impaired (DemTect ≤8) or formally diagnosed with dementia, and living in the own home. Patients will be recruited by general practitioners or specialists. Randomization is carried out at the physicians' level in a ratio of 1:2 (intervention vs. waiting-control group). After study inclusion, all participants will receive a baseline assessment and a follow-up assessment after 6 months. Patients of the intervention group will receive advanced dementia care management for 6 months, carried out by specialized nurses, who will conduct certain tasks, usually carried out by primary care physicians. This includes a standardized assessment of the patients' unmet needs, the generation and implementation of an individualized care plan to address the patients' needs in close coordination with the GP. PwD in the waiting-control group will receive routine care for 6 months and subsequently become part of the intervention group. The primary outcome is the number of unmet needs after 6 months measured by the Camberwell Assessment of Need for the Elderly (CANE). The primary analysis after 6 months is carried out using multilevel models and will be based on the intention-to-treat principle. Secondary outcomes are quality of life, caregiver burden, acceptance, and cost-effectiveness. In total, n=465 participants are needed to assess significant differences in the number of unmet needs between the intervention and control groups.

DISCUSSION

The study will provide evidence about the acceptance, efficacy, and cost-effectiveness of an innovative interprofessional concept based on advanced nursing care. Results will contribute to the implementation of such models in the German healthcare system. The goal is to improve the current treatment and care situation for PwD and their caregivers and to expand nursing roles.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04741932 . Registered on 2 February 2021.

[Task sharing in outpatient dementia care - Focus groups with GPs and nurses]

Task sharing in outpatient dementia care - Focus groups with GPs and nurses Abstract. Background: Caring for people with dementia (PWD) is challenging for the health system and family carers and can only be managed through interprofessional medical and nursing care.

AIM

The AHeaD study investigated attitudes of general practitioners (GPs) and nurses towards the transfer of activities previously performed by GPs to advanced nurses in the outpatient care of PWDs.

METHODS

In four focus group discussions with 10 GPs and 13 nurses, qualitative content analysis was used to investigate attitudes towards the transfer of certain tasks and to identify opportunities and barriers to their introduction.

RESULTS

GPs primarily preferred the transfer of nursing activities such as blood sampling, assessments, their monitoring or follow-up prescriptions for nursing aids. "Classical" medical tasks (e. g. diagnosis of diseases, initial prescription of medication) are still seen in the hands of GPs. Nurses demanded more appreciation and recognition for the relationship between GPs and nurse and criticised the lack of trust and insufficient communication. Both sides pointed to tight time budgets that were hardly oriented towards the actual needs of the PWD.

CONCLUSIONS

The implementation of a redistribution of tasks requires the creation of legal and financial framework conditions, time resources, concrete task descriptions as well as a stronger cooperation between the professional groups involved. Innovative concepts could contribute to the sensible use of the resources GP and nurses and strengthen the care of PWDs.

Effects of the dementia care toolbox on personnel's self-reported confidence in patient care: a CRT in general practices

Background

In rapidly aging populations, general practitioners (GPs) are challenged in dementia care of patients with and without migration background. Uncertainties in treating dementia in migrant patients due to language barriers or information deficits are reported. To address these deficits, we developed the Dementia Care Toolbox which was judged helpful by GP practice personnel. This two-armed cluster-randomised trial (CRT) investigated the effects of this toolbox on German GPs’ and practice assistants’ (PrAs) attitudes and confidence in dementia care, especially in patients with migration background.

Methods

A total of 32 GP practices were recruited and randomised into intervention (toolbox use for 3 months) and waiting-list control (toolbox after follow-up). After 3 months all participating GPs and PrAs received a standardised questionnaire addressing their levels of self-reported confidence in dementia care for patients with and without migration background. A generalized estimating equation model that took practice cluster effects into account was applied to assess GPs and PrAs self-reported confidence in dementia care in patients with and without migration background.

Results

Overall, the intervention had no significant effect on self-reported confidence in dementia care. However, the use of the dementia care toolbox showed a tendency for a learning effect on knowledge about local support structures for migrant patients with dementia (odds ratio 1.43; 95% CI 0.68-3.03, p = 0.35) and for less communication difficulties with dementia patients in general (odds ratio 0.72; 95% CI 0.33-1.56; p = 0.40). Moreover, intervention practices showed a tendency towards more awareness of own limitations: less self-confidence regarding answering questions (odds ratio 0.82; 95% CI 0.36-1.86, p = 0.64) and providing information for patients with migration background (odds ratio 0.60; 95% CI 0.25-1.45, p = 0.26).

Conclusion

The Toolbox Dementia Care increased awareness on the respective topic. Given a small sample size, further studies on its effectiveness in primary care are needed.

Trial registration

German Clinical Trials Register, DRKS00014632. Registered 02/08/2018.

Influence of a multidimensional music-based exercise program on selected cognitive and motor skills in dementia patients—a pilot study

One of the most common causes of needing care in old age is dementia. In order to enjoy a pleasant retirement for people with dementia, it is essential for them to maintain their independence. Studies have shown that a combination of physical activity and music has positive effects on dementia patients. Therefore, this study aimed to investigate the feasibility of implementing a multidimensional music-based exercise program for dementia patients and the effects on an intervention group (IG) compared to a control group (CG, usual care). The study design was based on a 12-week intervention with two (IG/CG) by two (pretest/posttest) parallel groups and block randomization with unequal group sizes. Participants had to be able to move independently or with a walker and not have severe cardiovascular disease or cardiac arrhythmias. Fifty-three blinded dementia patients (age: 83.63 ± 6.03 years) from inpatient facilities participated in the study and were assigned from the exercise instructors to IG (n = 34) and CG (n = 19). The primary outcomes were feasibility (Observation sheet), modified Chair Rising test, Timed Up and Go test, hand dynamometer test, FICSIT‑4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques), and drop bar test. Secondary endpoints included: verbal fluency (“animals”), the Mini-Mental State Examination, memory, Trail Making Test A, and Qualidem. Forty-nine subjects were analyzed (IG = 32; CG = 17). There were significant differences between the groups in the modified Chair Rising test (p = 0.033), FICSIT‑4 (p = 0.035), and Timed Up and Go test (p = 0.005) at posttest, which showed improved performance of the IG compared to the CG. The IG additionally showed improvements in the modified Chair Rising test (p = 0.000), drop bar test (p = 0.033), hand dynamometer test (p = 0.001), Timed Up and Go test (p = 0.000), verbal fluency (p = 0.002) and Trail Making Test A (p = 0.04) after 12 weeks. There were no adverse events or side effects. The multidimensional music-based exercise program could be performed by the dementia patients and was well received. The improved functional mobility could contribute to a lower risk of falls and thus maintain independence. For the follow-up study, the number of subjects, randomization, and parameters should be considered.

Neuroscience20 (BRAIN20, SPINE20, and MENTAL20) Health Initiative: A Global Consortium Addressing the Human and Economic Burden of Brain, Spine, and Mental Disorders Through Neurotech Innovations and Policies

Neurological disorders significantly impact the world's economy due to their often chronic and life-threatening nature afflicting individuals which, in turn, creates a global disease burden. The Group of Twenty (G20) member nations, which represent the largest economies globally, should come together to formulate a plan on how to overcome this burden. The Neuroscience-20 (N20) initiative of the Society for Brain Mapping and Therapeutics (SBMT) is at the vanguard of this global collaboration to comprehensively raise awareness about brain, spine, and mental disorders worldwide. This paper aims to provide a comprehensive review of the various brain initiatives worldwide and highlight the need for cooperation and recommend ways to bring down costs associated with the discovery and treatment of neurological disorders. Our systematic search revealed that the cost of neurological and psychiatric disorders to the world economy by 2030 is roughly $16T. The cost to the economy of the United States is $1.5T annually and growing given the impact of COVID-19. We also discovered there is a shortfall of effective collaboration between nations and a lack of resources in developing countries. Current statistical analyses on the cost of neurological disorders to the world economy strongly suggest that there is a great need for investment in neurotechnology and innovation or fast-tracking therapeutics and diagnostics to curb these costs. During the current COVID-19 pandemic, SBMT, through this paper, intends to showcase the importance of worldwide collaborations to reduce the population's economic and health burden, specifically regarding neurological/brain, spine, and mental disorders.

Differences in Function and Healthcare Cost of Older Adults with Dementia by Long-Term Care Service Type: A National Dataset Analysis

This study aims to analyze the function and cost changes among long-term care insurance (LTCI) beneficiaries with low-severity dementia according to their LTCI service type. Data were collected from the Korean LTCI and national health insurance (NHI) datasets. Participants were 4414 beneficiaries with dementia aged 65 or older who received LTC services continuously for 4 years (2008–2011). LTCI service types were classified into home care (HC), institutional care (IC), and combined care (CC). Activities of daily living (ADL), cognitive function, medical cost, and benefit-cost were assessed. Linear mixed models and multiple regression models were used to analyze the changes in function and costs of the beneficiaries. ADL, cognitive function, medical cost, and benefit-cost differed significantly depending on the service type and time (p < 0.001). LTCI service types affected the degree of changes in ADL, cognitive function, medical cost, and benefit-cost over four years and showed negative changes in IC and CC beneficiaries than HC beneficiaries. HC is a cost-effective way to maintain the function of beneficiaries with low-severity dementia. Thus, efforts are needed to actively promote HC services.

[Competence, creativity and communication: basics for quality improvement in traumatology : Reality and future challenges]

Interdisciplinary collaboration is one of the key factors for successful treatment of patients with complex injuries and diseases. Hence, several innovative concepts have been initiated to improve the treatment quality within the field of trauma surgery. The implementation of a ward pharmacist with the daily discussion of prescribed medications shows a reduction of side effects, costs for medicaments and the use of antibiotics. An interdisciplinary and multimodal delirium team was introduced and every patient over the age of 65 years was screened for the risk of perioperative and postoperative delirium, the medication was adjusted and expert advice was available in the case of acute delirium. Corresponding to the well-established tumor boards, an interdisciplinary musculoskeletal conference to decide on the treatment of complex interdisciplinary injuries of the musculoskeletal system should be established. The future challenges will include the digital connection of hospitals within the already existing trauma networks in order to provide rapid access to this interdisciplinary expertise also outside maximum care hospitals.

A Long-Term Enriched Environment Ameliorates the Accelerated Age-Related Memory Impairment Induced by Gestational Administration of Lipopolysaccharide: Role of Plastic Mitochondrial Quality Control

Studies have shown that gestational inflammation accelerates age-related memory impairment in mother mice. An enriched environment (EE) can improve age-related memory impairment, whereas mitochondrial dysfunction has been implicated in the pathogenesis of brain aging. However, it is unclear whether an EE can counteract the accelerated age-related memory impairment induced by gestational inflammation and whether this process is associated with the disruption of mitochondrial quality control (MQC) processes. In this study, CD-1 mice received daily intraperitoneal injections of lipopolysaccharide (LPS, 50 μg/kg) or normal saline (CON group) during gestational days 15–17 and were separated from their offspring at the end of normal lactation. The mothers that received LPS were divided into LPS group and LPS plus EE (LPS-E) treatment groups based on whether the mice were exposed to an EE until the end of the experiment. At 6 and 18 months of age, the Morris water maze test was used to evaluate spatial learning and memory abilities. Quantitative reverse transcription polymerase chain reaction and Western blot were used to measure the messenber RNA (mRNA) and protein levels of MQC-related genes in the hippocampus, respectively. The results showed that all the aged (18 months old) mice underwent a striking decline in spatial learning and memory performances and decreased mRNA/protein levels related to mitochondrial dynamics (Mfn1/Mfn2, OPA1, and Drp1), biogenesis (PGC-1α), and mitophagy (PINK1/parkin) in the hippocampi compared with the young (6 months old) mice. LPS treatment exacerbated the decline in age-related spatial learning and memory and enhanced the reduction in the mRNA and protein levels of MQC-related genes but increased the levels of PGC-1α in young mice. Exposure to an EE could alleviate the accelerated decline in age-related spatial learning and memory abilities and the accelerated changes in MQC-related mRNA or protein levels resulting from LPS treatment, especially in aged mice. In conclusion, long-term exposure to an EE can counteract the accelerated age-related spatial cognition impairment modulated by MQC in CD-1 mother mice that experience inflammation during pregnancy.

Burden of Providing Informal Care for Patients with Atrial Fibrillation

OBJECTIVES

Patients with atrial fibrillation (AF) have rapid and irregular heart rates, increasing the risk of comorbidities and mortality. Next to formal medical care, many patients receive informal care from their social environment. The objective of this study was to examine the well-being and economic burden of providing informal care to patients with AF in the UK, Italy, and Germany.

METHODS

Caregivers of patients with AF completed an online survey based on the iMTA Valuation of Informal Care Questionnaire, with questions about their caregiving situation, perceived burden of caregiving, and absence from work due to health problems resulting from caregiving. Care-related quality-of-life utilities were calculated using the Care-related Quality of Life instrument and associated tariffs. Societal costs of caregiving were calculated based on the proxy good method.

RESULTS

A total of 585 caregivers participated in this study. On average, caregivers provided 33 hours of informal care per week to patients (SD 29 hours). On a scale from 0 to 10, their self-rated burden was 5.4. The average Care-related Quality of Life utility was 72. Caregivers primarily indicated problems with daily activities, mental health, and physical health. Still, the vast majority of caregivers (87%) derived fulfillment from providing care. Weekly societal costs of caregiving were on average €636. Comorbidities contributed substantially to the caregiver time and burden.

CONCLUSIONS

Caring for a patient with AF is associated with substantial objective and subjective burden, but also provides fulfillment from being able to care for a loved one.

Anticipated Social and Healthcare Economic Burden of People with Alzheimer's Disease in Two Selected Regions of the Czech Republic

Increasing life expectancy in modern society is undoubtedly due to improved healthcare, scientific advances in medicine, and the overall healthy lifestyle of the general population. However, this positive trend has led to an increase in the number of older people with a growing need for a sustainable system for the long-term care of this part of the population, which includes social and health services that are essential for a high quality of life. Longevity also brings challenges in the form of a polymorbid geriatric population that places financial pressure on healthcare systems. Regardless, one disease dominates the debate about financial sustainability due to the increasing numbers of people diagnosed, and that is Alzheimer’s disease (AD). The presented paper aims to demonstrate the economic burden of social and healthcare services. Data from two regions in the Czech Republic were selected to demonstrate the potential scope of the problem. The future costs connected with AD are calculated by a prediction model, which is based on a population model for predicting the number of people with AD between 2020 and 2070. Based on the presented data from the two regions in the Czech Republic and the prediction model, several trends emerged. There appears to be a significant difference in the annual direct costs per person diagnosed with AD depending on the region in which they reside. This may lead to a significant inequality of the services a person can acquire followed by subsequent social issues that can manifest as a lower quality of life. Furthermore, given the prediction of the growing AD population, the costs expressed in constant prices based on the year 2020 will increase almost threefold during the period 2020–2070. The predicted threefold increase will place additional financial pressure on all stakeholders responsible for social and healthcare services, as the current situation is already challenging.

Cost of care for persons with dementia: using a discrete-time Markov chain approach with administrative and clinical data from the dementia service Centres in Austria

BACKGROUND

There is growing evidence that the cost for dementia care will increase rapidly in the coming years. Therefore, the objective of this paper was to determine the economic impact of treating clients with dementia in outpatient Dementia Service Centres (DSCs) and simulate the cost progression with real clinical and cost data.

METHODS

To estimate the cost for dementia care, real administrative and clinical data from 1341 clients of the DSCs were used to approximate the total cost of non-pharmaceutical treatment and simulate the cost progression with a discrete-time Markov chain (DTMC) model. The economic simulation model takes severity and progression of dementia into account to display the cost development over a period of up to ten years.

RESULTS

Based on the administrative data, the total cost for treating these 1341 clients of the DSCs came to 67,294,910 EUR in the first year. From these costs, 74% occurred as indirect costs. Within a five-year period, these costs will increase by 7.1-fold (16.2-fold over 10 years). Further, the DTMC shows that the greatest share of the cost increase derives from the sharp increase of people with severe dementia and that the cost of severe dementia prevails the cost in later periods.

CONCLUSION

The DTMC model has shown that the cost increase of dementia care is mostly driven by the indirect cost and the increase of severity of dementia within any given year. The DTMC reveals also that the cost for mild dementia will decrease steadily over the time period of the simulation, whereas the cost for severe dementia increases sharply after running the simulation for 3 years.

[Estimating the Number of People with Dementia in Germany in 2030 on County Level]

GOAL OF THE STUDY

The number of people with dementia (PwD) in Germany is expected to grow beyond 2 million until 2030. The present analysis aims to estimate (a) the number of PwD in 10 years and b) the percentage change until 2030, and c) the proportion of the population in 2030, each on the county level.

METHODS

For all n = 401 counties in Germany estimates are provided on how many PwD are living there in 2030, how the share of POwD in the population is and how both figures change between 2018 and 2030. The data is illustrated graphically.

RESULT

In 2030 it is expected that approx. 2.170.000 PwD above age 65 are living in Germany. The development differs strongly between counties ranging between no change up to an increase of 50 %. The proportion of PwD in the population is 2.61 % nationally, but varies by county between 1.75 % and 4,18 %.

CONCLUSION

Regional prognoses are helpful to plan health care and support for the coming 10 years at an early stage and evidence-based. The population of PwD is growing as important group in all counties in Germany.

Effect of Glycyrrhizic Acid on Scopolamine-Induced Cognitive Impairment in Mice

Purpose

Cognitive impairment is one of the main symptoms of Alzheimer disease and other dementias. Glycyrrhiza uralensis is a natural product that has a protective effect against cognitive impairment. In this study, we investigated whether glycyrrhizic acid, among the main bioactive components of Glycyrrhiza uralensis, has a neuroprotective effect on scopolamine-induced cognitive impairment.

Methods

Twenty-week-old male Institute of Cancer Research mice were used in this study. The scopolamine-induced cognitive impairment mice model was used. Glycyrrhizic acid was orally administered to mice once daily for 21 days, while scopolamine (1 mg/kg) treatment was delivered 30 minutes before behavioral tests. Donepezil (2 mg/kg) was used as a positive drug control. To evaluate the effect of glycyrrhizic acid, the following assessments were performed on hippocampal tissue: Y-maze test, acetylcholinesterase activity, antioxidant enzymes’ activity (superoxide dismutase, catalase). Western blotting for phosphor-extracellular signal-regulated kinase, P38, and c-Jun NH2-terminal kinase was conducted.

Results

We found that glycyrrhizic acid administration significantly improved scopolamine-induced cognitive impairment in the Y-maze test. The acetylcholinesterase activity, superoxide dismutase, and catalase activity in the glycyrrhizic acid-treated group showed a significant reversal of cognitive impairment compared with the scopolamine-treated group.

Conclusions

Our results suggest that glycyrrhizic acid has a neuroprotective effect on cognitive function in scopolamine-induced cognitive impairment.

Development and testing of an informative guide about palliative care for family caregivers of people with advanced dementia

BACKGROUND

Since people with advanced dementia are usually not able to make complex decisions, it is usually the family caregivers, as proxies, who have to decide on treatments and their termination. However, these decisions are difficult for the caregivers to make, as they are often inadequately informed and cannot properly assess the consequences; moreover, they are concerned about harming the sick person. We aimed to first develop an informative booklet about palliative care issues for caregivers of people with advanced dementia. Secondly, we aimed to investigate a change in family caregivers' knowledge regarding palliative care issues and caregivers' involvement in medical and care decisions before and after studying this booklet.

METHODS

A first version of the booklet was drafted by an experienced psychiatrist and palliative care specialist based on existing booklets and guidelines; necessary cultural adaptions were taken into consideration. A nominal group process was conducted to develop the informative guide. In order to investigate the acceptance of the booklet and the possibility to implement it, 38 patient-caregiver dyads were recruited, and caregivers were interviewed both before receiving the booklet and after 3 months of receiving the booklet.

RESULTS

Experts from various disciplines collaborated on a German booklet for family caregivers of people with advanced dementia as an information aid regarding issues of palliative care. The subsequent test showed that all caregivers had experienced a personal benefit from the booklet. Caregivers had a significant gain of knowledge after provision of the booklet. A large proportion of caregivers who had not previously considered and/or discussed medical topics reported that they had done so within 3 months after obtaining the booklet, or planned to do so in the near future.

CONCLUSIONS

The caregivers valued the comprehensible, concise and well-structured information guide on palliative care issues in advanced dementia. They agreed it increases knowledge and prompts decision making and therefore should be developed in many languages and disseminated among family caregivers of people with dementia.

TRIAL REGISTRATION

clinicaltrial.gov, NCT03548142. Retrospectively registered 7 June 2018.

Association Between Hearing and Vision Impairment and Risk of Dementia: Results of a Case-Control Study Based on Secondary Data

Introduction: Hearing and vision loss are highly prevalent in elderly adults, and thus frequently occur in conjunction with cognitive impairments. Studies have shown that hearing impairment is associated with a higher risk of dementia. However, evidence concerning the association between vision loss and dementia, as well as the co-occurrence of vision and hearing loss and dementia, has been inconclusive. Objectives: To assess the association between: (i) either hearing or vision loss and the risk of dementia, as well as between; and (ii) the combination of both sensory impairments and the risk of dementia. Methods: This case-control study was based on a 5-year data set that included patients aged 65 years and older who had initially been diagnosed with dementia diseases by one of 1,203 general practitioners in Germany between January 2013 and December 2017. In total, 61,354 identified dementia cases were matched to non-dementia controls, resulting in a sample size of 122,708 individuals. Hearing loss and vision loss were identified using the ICD-10 diagnoses documented in the general practitioners' files prior to the initial dementia diagnosis. Multivariate logistic regression models were fitted to evaluate the associations between visual and/or hearing impairment and the risk of dementia and controlled for sociodemographic and clinical variables. Results: Hearing impairment was documented in 11.2% of patients with a dementia diagnosis and 9.5% of patients without such a diagnosis. Some form of vision impairment was documented in 28.4% of patients diagnosed with dementia and 28.8% of controls. Visual impairment was not significantly associated with dementia (OR = 0.97, CI = 95% 0.97-1.02, p = 0.219). However, patients with hearing impairment were at a significantly higher risk of developing dementia (OR = 1.26, CI = 95% 1.15-1.38, p < 0.001), a finding that very likely led to the observed significant association of the combination of both visual and hearing impairments and the risk of dementia (OR = 1.14, CI = 95% 1.04-1.24, p = 0.005). Discussion: This analysis adds important evidence that contributes to the limited body of knowledge about the association between hearing and/or vision loss and dementia. It further demonstrates that, of the two, only hearing impairment affects patients' cognition and thus contributes to dementia risk.