Reflections on quality of care for persons with dementia: moving toward an integrated, comprehensive approach

Effects of a home-based exercise program on mental health for caregivers of relatives with dementia: a randomized controlled trial

OBJECTIVE

This study was aimed to evaluate the effectiveness of a home-based physical exercise program on participants' mental health: psychological symptoms, depression, and burden of female informal caregivers.

DESIGN AND PARTICIPANTS

In a randomized controlled trial, a sample of 48 female informal primary caregivers completed the entire study, 25 were randomly allocated to the intervention group (IG), and 23 participants to the control group (CG).

INTERVENTION

Participants in the IG performed two 60-minute-long physical exercise sessions per week (36 weeks) that were supervised by a personal trainer at caregivers' home during 9 months. The CG continued their habitual leisure-time activities.

MEASUREMENTS

Subjective burden was assessed by the Zarit Burden Interview. The risk of depression was measured by the Geriatric Depression Scale Short Form 15-item version, and psychological symptoms were evaluated by the Symptom Check List-90-Revised (SCL-90-R). All participants were evaluated at baseline and at the end of the intervention.

RESULTS

A promising positive impact of the intervention on caregivers' subjective burden and risk of depression was found in the IG. In addition, no significant between-group differences were found in any of nine subscales scores of the SCL-90-R. Finally, care recipients' level of functional independence and area of residence were found to be predictors of the promising positive impact on caregivers' subjective burden and risk of depression.

CONCLUSIONS

The present home-based physical exercise intervention that was individually implemented has shown promising results to reduce subjective burden and risk of depression in female caregivers of relatives with dementia. However, future research efforts should elucidate both the particular dose of physical exercise and the particular duration of the intervention that are required to obtain the expected significant positive impact. Finally, future inclusion of psychological approaches, besides physical exercise, might help reduce female caregivers' psychological symptoms.

2021 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain - both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.

Hybrid diffusion tensor imaging feature-based AD classification

BACKGROUND

Effective detection of Alzheimer's disease (AD) is still difficult in clinical practice. Therefore, establishment of AD detection model by means of machine learning is of great significance to assist AD diagnosis.

OBJECTIVE

To investigate and test a new detection model aiming to help doctors diagnose AD more accurately.

METHODS

Diffusion tensor images and the corresponding T1w images acquired from subjects (AD = 98, normal control (NC) = 100) are used to construct brain networks. Then, 9 types features (198×90×9 in total) are extracted from the 3D brain networks by a graph theory method. Features with low correction in both groups are selected through the Pearson correlation analysis. Finally, the selected features (198×33, 198×26, 198×30, 198×42, 198×36, 198×23, 198×29, 198×14, 198×25) are separately used into train 3 machine learning classifier based detection models in which 60% of study subjects are used for training, 20% for validation and 20% for testing.

RESULTS

The best detection accuracy levels of 3 models are 90%, 98% and 90% with the corresponding sensitivity of 92%, 96%, and 72% and specificity of 88%, 100% and 94% when using a random forest classifier trained with the Shortest Path Length (SPL) features (198×14), a support vector machine trained with the Degree Centrality features (198×33), and a convolution neural network trained with SPL features, respectively.

CONCLUSIONS

This study demonstrates that the new method and models not only improve the accuracy of detecting AD, but also avoid bias caused by the method of direct dimensionality reduction from high dimensional data.

Racial and Ethnic Disparities in Serious Psychological Distress Among Those With Alzheimer's Disease and Related Dementias

BACKGROUND

Alzheimer's disease and related dementias (ADRD) is a growing public health challenge. Prior research suggests that non-Hispanic whites (whites), non-Hispanic African Americans (African Americans), and Hispanics have differing risks for ADRD.

OBJECTIVE

To examine the existence of serious psychological distress (SPD) among whites, African Americans, and Hispanics; to calculate the predicted probability of ADRD in whites, African Americans, and Hispanics, and to decompose the differences among ADRD populations, quantifying the burden of higher SPD among African Americans and Hispanics, compared to whites.

DATA AND METHOD

The authors use nationally representative data from the Medical Expenditure Panel Survey (2007-2015) to estimate the association between ADRD and race, ethnicity, and SPD. Using Blinder-Oaxaca decomposition analysis, the authors estimate to what extent higher SPD among Hispanics and African Americans was associated with higher ADRD rates compared to whites.

RESULTS

After controlling for individuals' demographic and socioeconomic characteristics and co-existing medical conditions, the presence of SPD was still significantly associated with a higher likelihood of having ADRD. The model predicted significantly higher likelihood of having ADRD among African Americans (7.1%) and Hispanics (5.7%) compared to whites (4.5%). Higher rates of having SPD among African Americans explained 15% of white-black difference and 40% of the white-Hispanic difference in ADRD rates, respectively.

DISCUSSION AND CONCLUSION

Our findings suggest a significant relationship between SPD and ADRD and that the burden of SPD was greater among African Americans and Hispanics with ADRD. Efficient screening using self-reported SPD, compared to simply using diagnoses codes of mental illness, may be more helpful to reduce racial and ethnic disparities in ADRD.

2020 Alzheimer's disease facts and figures

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid-century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.