Fear of Dementia

Reducing fear and avoidance of memory loss improves mood and social engagement in community-based older adults: a randomized trial

BACKGROUND

Alzheimer's disease and related dementias (ADRD) are among the most feared age-related conditions. The aim of this study was to evaluate a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear of ADRD and investigate positive downstream effects on health-related secondary outcomes, including frequency of reported memory failures, psychosocial functioning, and quality of life.

METHODS

Eighty-one older adults were recruited and randomized into REFRAME or active control intervention arms. Both groups received psycho-education and training in mindful monitoring of fears related to ADRD. The REFRAME group received an additional behavioral activation component intended to disrupt maladaptive avoidant coping (i.e., avoidance) strategies. Both groups completed 3-weeks of intervention exercises with accompanying questionnaires (baseline, mid- and post-intervention and 4-week follow-up).

RESULTS

Adherence was strong (> 75%). We observed a significant reduction in ADRD-related fear and avoidance in both groups. Significant reductions were also observed for frequency of self-reported memory failures, anxiety, and depression. Depression was significantly reduced in the REFRAME group compared to the control group. Significant increases in participants' ability to participate in social activities and well-being were also observed.

CONCLUSIONS

Findings suggest that a brief psychological intervention can mitigate ADRD-related fears and avoidant coping in older adults, and that benefits extend to broader health-related outcomes including anxiety, depression, social functioning, and well-being. Addressing ADRD-related fear has implications for healthy aging and risk reduction, as individuals may be more likely to engage in activities that are protective against ADRD but were previously avoided.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT04821960 .

Translation and Validation of the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) Questionnaire among the General Israeli Population

OBJECTIVE

The need to promote awareness of dementia prevention is broadly emphasized in Israel. Currently, there is no valid version of a Hebrew questionnaire to assess attitudes and beliefs related to dementia prevention. This study aimed to translate and validate the MCLHB-DRR questionnaire among the general Israeli population.

METHODS

A total sample of 328 participants between the ages of 50-83 years (mean = 58.7, SD = 6.9) were included in this study. Participants completed the online translated MCLHB-DRR questionnaire. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were conducted to assess the questionnaire's validity. Internal consistency was assessed using Cronbach's alpha.

RESULTS

The EFA analysis revealed a seven-factor model with 27 items. One item related to perceived barriers and two items related to perceived severity were deleted. The CFA analysis confirmed a good model fit with the deleted items (χ²/df = 2.146, CFI = 0.930, TLI = 0.916, RMSEA = 0.049). Cronbach's alpha values ranged from 0.61 to 0.92.

CONCLUSIONS

The Hebrew MCLHB-DRR questionnaire is a valid and reliable measurement tool for assessing attitudes and beliefs related to health behaviours and lifestyle changes for dementia risk reduction in Israeli adults over the age of 50.

The Influence of Dementia Beliefs and Knowledge on Perceived Dementia Worry: An Empirical Study Among Adults in Rural China

Alzheimer's disease and related dementias are more prevalent in rural areas than in urban areas in China. This study aims to examine the role of dementia beliefs and knowledge in influencing dementia worry among rural adults in China. Data were generated in a cross-sectional survey of 577 participants. Hierarchical regression analyses found that both the beliefs and knowledge of dementia contributed to higher levels of dementia worry. The propensity score matching method affirmed the robustness of regression results. In addition, those aged 45-64 reported higher worry about dementia than those aged 65 or older, while being married was related to lower dementia worry. As one of the first kind studies that examined dementia worry in rural Chinese population, our findings suggest that policy and practice efforts should address cultural beliefs of dementia as they contributed to higher worry about dementia in rural areas.

Estimating the lifetime risk of dementia using nationwide individually linked cause-of-death and health register data

BACKGROUND

Previous estimates of the lifetime risk of dementia are restricted to older age groups and may suffer from selection bias. In this study, we estimated the lifetime risk of dementia starting at birth using nationwide integral linked health register data.

METHODS

We studied all deaths in The Netherlands in 2017 (n = 147 866). Dementia was assessed using the cause-of-death registration, individually linked with registers covering long-term care, specialized mental care, dispensed medicines, hospital discharges and claims, and primary care. The proportion of deaths with dementia was calculated for the total population and according to age at death and sex.

RESULTS

According to all data sources combined, 24.0% of the population dies in the presence of dementia. This proportion is higher for females (29.4%) than for males (18.3%). Using multiple causes of death only, the proportion with dementia is 17.9%. Sequential addition of long-term care and hospital discharge data increased the estimate by 4.0 and 1.5%-points, respectively. Further addition of dispensed medicines, hospital claims and specialized mental care data added another 0.6%-points. Among persons who die at age ≤65-70 years, the proportion with dementia is ≤6.2%. After age 70, the proportion rises sharply, with a peak of 43.9% for females and 33.1% for males at age 90-95 years.

CONCLUSIONS

Around one-fourth of the Dutch population is diagnosed with dementia at some point in life and dies in the presence of dementia. It is a major challenge to arrange optimal care for this group.

Television Viewing and Cognitive Dysfunction of Korean Older Adults

This study examined the association between television (TV) viewing and cognitive dysfunction in elderly Koreans. Among participants of the 2014 National Survey of Older Koreans, 9644 were considered in this study. To better identify the association between two factors, propensity score (PS) matching with exact method was used. Finally, 168 viewers and non-viewers each were selected based on estimated PS on key variables and eliminating double matches. Multivariate logistic regression analysis was performed when controlling for possible covariates. Viewers were more likely to have cognitive dysfunction than non-viewers, with significant differences in most covariates. After correcting confounding effects of these covariates with PS matching, TV viewing was found to be a significant risk factor of cognitive dysfunction, along with absence of diagnosed hypertension and non-participation in physical leisure activities. TV viewing might be associated with increased risk of cognitive dysfunction in later life. Appropriate education and strategies to minimize TV viewing among older adults should be established to contribute to attenuating cognitive aging. More interventional studies can help older adults, caregivers, and healthcare professionals explore the cognitively beneficial alternatives to TV use considering the impact of socioeconomic factors of selecting TV viewing as a preferred leisure activity.

Physiological and pathological functions of beta-amyloid in the brain and alzheimer's disease: A review

Alzheimer's disease is a major health problem all over the world. The role of beta-amyloid (Aβ) is at the center of investigations trying to discover the disease pathogenesis and to develop drugs for treatment or prevention on Alzheimer's disease. This review summarizes both physiological and pathological functions of Aβ and factors that may participate in the disease development. Known genetic factors are trisomy of chromosome 21, mutations of presenilin 1 and 2, and apolipoprotein E4. Lifetime stresses that increase the risk of development of Alzheimer's disease are described. Another important factor is the level of education, especially of linguistic ability. Lifestyle factors include mental and physical exercise, head injury, social contacts, and diet. All these factors might potentiate the effect of aging on the brain to increase the risk of development of pathological changes. The review summarizes pathological features of Alzheimer brain, Aβ plaques, neurofibrillary tangles composed of hyperphosphorylated tau, and brain atrophy. Consequences of Alzheimer's disease that are reviewed include cognitive deficit, loss of function, and neuropsychiatric symptoms. Because there is no effective treatment, many persons with Alzheimer's disease survive to severe and terminal stages which they may fear. Alzheimer's disease at this stage should be considered a terminal disease for which palliative care is indicated. Importance of advance directives, promoting previous wishes of the person who was developing dementia and who subsequently lost decision-making capacity, and limitations of these directives are discussed. Information in this review is based on author's knowledge and clinical experience that were updated by searches of PubMed.

Voluntarily Stopping Eating and Drinking: A Practical Approach for Long-Term Care Facilities

Some residents of long-term care (LTC) facilities with lethal or serious chronic illnesses may express a wish to hasten their death by voluntarily stopping eating and drinking (VSED). LTC facility clinicians, administrators, and staff must balance resident safety, moral objections to hastened death, and other concerns with resident rights to autonomy, self-determination, and bodily integrity. Initially, requests for hastened death, including VSED must be treated as opportunities to uncover underlying concerns. After a concerted effort to address root causes of suffering, some residents will continue to request hastened death. Rigorous resident assessment, interdisciplinary care planning, staff training, and clear and complete documentation are mandatory. In addition, an independent second opinion from a consultant with palliative care and/or hospice expertise is indicated to help determine the most appropriate response. When VSED is the only acceptable option to relieve suffering of residents with severe chronic and lethal illnesses, facilitating VSED requests honors resident-centered care. The author offers practice suggestions and a checklist for LTC facilities and staff caring for residents requesting and undergoing VSED.

Different Effects of Cognitive and Non-exercise Physical Leisure Activities on Cognitive Function by Age in Elderly Korean Individuals

Objectives

We aimed to examine the effects of various leisure activities on cognitive impairment in young-old (aged 65–74 years) and old-old (aged ≥ 75 years) adults.

Methods

In total, 10,279 elderly Korean individuals from the 2014 Korean National Survey on Older Adults’ cohort were enrolled in our study. Cognitive impairment was assessed using the standardized score of the Mini-Mental State Examination for Dementia Screening, whereas leisure activities were recorded via self-reporting of the extent and type of leisure activity the subjects involved in over the past year. Multivariate logistic regression was used to assess the effect of leisure activities on cognitive impairment, while controlling for potential covariates.

Results

The subjects were more likely to participate in cognitive activities than in non-exercise physical activities. After controlling for selected covariates, involvement in cognitive activities was found to be a significant predictor of cognitive impairment in both the groups, whereas involvement in non-exercise physical activities was not a predictor of cognitive impairment in individuals aged ≥ 75 years. Moreover, depressive symptoms, rural residence, and hearing difficulties were common predictors of cognitive impairment among elderly-Korean-individuals.

Conclusion

Leisure activity involvement may help delay cognitive impairment, which is often concomitant with aging. Hence, an early intervention service may significantly benefit both young-old and old-old individuals.

Ageing, dementia and the social mind: past, present and future perspectives

Accompanying the ageing of contemporary ageing societies is an increase in age associated morbidity, with dementia having an important impact. Mental frailty in later life is a source of fear for many and a major policy concern to all those concerned with health and welfare services. This introduction to the special issue on 'Ageing, dementia and the social mind' situates the selected papers within the context of debates about dementia and its social relations. In particular it draws attention to the importance of the social imaginary of the fourth age and what this means for the issue of personhood, care, social representations of dementia and its social contextualisation. The papers illuminating these themes draw on a variety of disciplines and approaches; from the social sciences to the humanities and from the theoretical to the empirical in order to help orientate future researchers to the complexities of dementia and the social and cultural matrix in which it exists. This paper provides an introduction to the potential for a more extended sociology of dementia; one which could combine the insights from medical sociology with the concerns of social gerontology.