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Kårelind F, Finkel D, Zarit SH, Wijk H, Bielsten T, Johansson L. Post-diagnostic support for persons with young-onset dementia - a retrospective analysis based on data from the Swedish dementia registry SveDem. BMC Health Serv Res 2024; 24:649. [PMID: 38773535 PMCID: PMC11110303 DOI: 10.1186/s12913-024-11108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/14/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Approximately 3.9 million persons worldwide have young-onset dementia. Symptoms related to young-onset dementia present distinct challenges related to finances, employment, and family. To provide tailored support, it is important to gain knowledge about the formal support available for persons with young-onset dementia. Therefore, this paper aims to describe formal support for persons with young-onset dementia in Sweden and the factors influencing this support. METHODS This retrospective study used data on persons under 65 years of age (n = 284) from The Swedish Registry for Cognitive/Dementia Disorders (SveDem) between 2021 and 2022. SveDem was established to monitor the quality of dementia care in Sweden. Characteristics of participants were obtained, including age, sex, dementia diagnosis, MMSE, medications, accommodation, and care setting. Descriptive statistics and logistic regression were used to test for associations between participant characteristics and post-diagnostic support. RESULTS Information and educational support were usually offered to the person with young-onset dementia (90.1%) and their family (78.9%). Approximately half of the sample were offered contact with a dementia nurse (49.3%), counsellor (51.4%), or needs assessor (47.9%). A minority (28.5%) were offered cognitive aids. Six regression models were conducted based on participant characteristics to predict the likelihood that persons were offered support. Support was not predicted by age, sex, children at home, accommodation, or medications. Lower MMSE scores (p < .05) and home help (p < .05) were significantly associated with offer of a needs assessor. Living together was a significant predictor (p < .01) for information and educational support offered to the family. Care setting significantly predicted (p < .01) an offer of information and educational support for the person and family members, as well as contact with a counsellor. CONCLUSION This study indicates potential formal support shortages for persons with young-onset dementia in some areas of dementia care. Despite equal support across most characteristics, disparities based on care setting highlight the importance of specialised dementia care. Pre-diagnostic support is minimal, indicating challenges for persons with young-onset dementia to access these services before diagnosis. While our study has identified areas in need of improvement, we recommend further research to understand the changing support needs of those with young-onset dementia.
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Affiliation(s)
- Fanny Kårelind
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Deborah Finkel
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Center for Economic and Social Research, University of Southern California, Los Angeles, USA
| | - Steven H Zarit
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Human Development and Family Studies, Penn State University, University Park, USA
| | - Helle Wijk
- Institute of Health and Care Science, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Therese Bielsten
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Linda Johansson
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Faulkner T, Dickinson J, Limbert S, Giebel C. The experiences and perspectives of older adult mental health professional staff teams when supporting people with young-onset dementia. DEMENTIA 2024; 23:567-583. [PMID: 38441077 DOI: 10.1177/14713012241236106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background. The diagnosis of young-onset dementia presents significant challenges both for the person and their families, which often differ from the challenges faced with late-onset dementia. Evidence of the experience of service users and carers tends to reveal a negative appraisal of the care received, citing longer diagnosis times, poor clinician knowledge and lack of age-appropriate care. However, evidence looking into staff experiences of supporting someone with young-onset dementia is relatively scarce. The aim of this study was to explore the experiences and reflections of health and social care staff who support people with young-onset dementia within older adult mental health services, and whether their knowledge of the systems they work in could reveal the existence of barriers or facilitators to young-onset dementia care. Methods. Health and social care professionals working with people and carers with young-onset dementia across England were remotely interviewed between September and December 2021. Data were analysed using inductive thematic analysis. Findings. Sixteen staff members were interviewed. Three themes were constructed with six sub-themes. The first theme related to the perception of greater complexity around young-onset dementia support. The second theme describes staff fears around their ability to effectively support people with young-onset dementia, including the perception that young-onset dementia requires specialist input. The final theme describes systemic and structural inefficiencies which provide additional challenges for staff. Conclusions. Providing effective support for people with young-onset dementia and their families requires adjustments both within the clinician role and mental health services. Staff considered young-onset dementia support to be a specialist intervention and felt the services they work for are suited to generic mental health and dementia provision. Findings are discussed with recommendations relating to developing a standardised model of dementia care for young-onset dementia which recognises and responds to the unique experiences of young-onset dementia.
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Affiliation(s)
- Thomas Faulkner
- Mersey Care NHS Foundation Trust, UK
- NIHR Applied Research Collaboration North-West Coast, UK
| | | | - Stan Limbert
- NIHR Applied Research Collaboration North-West Coast, UK
| | - Clarissa Giebel
- NIHR Applied Research Collaboration North-West Coast, UK
- Department of Primary Care and Mental Health, University of Liverpool, UK
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3
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Smeets B, Janssen N, Peetoom K, Boots L, Bakker C, de Vugt M. 'Too young to sit at home': a qualitative study conducted among employees with young-onset dementia and their relatives. Aging Ment Health 2024:1-10. [PMID: 38669151 DOI: 10.1080/13607863.2024.2345132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Young-onset dementia (YOD) symptoms often first present in the workplace, resulting in work performance challenges and eventually loss of employment. This study aims to investigate the experiences, work values, and support needs of employees with YOD and their relatives. METHOD Semi-structured interviews were conducted to explore the experiences, work values, and support needs of (former) employees with YOD and their relatives. Subsequently, separate focus group discussions were conducted for employees and relatives to review and prioritize interview findings. Inductive thematic analysis was applied to both datasets. RESULTS A total of 15 interviews (six employees; nine relatives) and four focus group discussions (ten employees; six relatives) were conducted. Six themes emerged, with five revolving around the central theme: desire to work. The other themes represent essential contributing factors, including importance of receiving a YOD diagnosis; knowledge, awareness, and understanding regarding YOD; open communication, joint decision making, and collaboration; work adjustments, involvement, and support; phasing out work and future perspectives. CONCLUSION The findings highlight a strong desire to work post-YOD diagnosis, serving as a foundation for developing workplace support tools and guidance. This has the potential to help individuals with YOD preserve their self-confidence and identity while working within their capabilities.
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Affiliation(s)
- Bo Smeets
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Niels Janssen
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Lizzy Boots
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christian Bakker
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
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4
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Yang Y, Song JA. Factors associated with the quality of life of persons with young-onset dementia: A systematic literature review. Int J Ment Health Nurs 2024. [PMID: 38661362 DOI: 10.1111/inm.13338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
This review examines factors associated with quality of life (QoL) in persons with young-onset dementia (YOD). Studies investigating and analysing factors related to QoL in persons with YOD were included. Databases searched included PubMed, CINAHL, Web of Science, EMBASE, and SCOPUS. Due to inconsistent outcome variables across studies, synthesis without meta-analysis was used for data integration. Methodological quality was assessed, and results were synthesised. Eleven studies were included in this review, identifying different factors influencing QoL in persons with YOD, which could be categorised into six groups. Behavioural and psychiatric factors showed the highest significant findings ratio (SFR), as determined by the ratio of 'studies finding significance' to the 'total number of studies addressing the factor'. Following in terms of SFR were care-related and physical factors. Demographic and dementia-characteristic factors had the lowest SFR. Among single factors, depressive symptoms, and neuropsychiatric symptoms, both included in behavioural and psychiatric factors, had the highest SFR. This systematic review highlights the importance of behavioural and psychiatric elements in QoL in persons with young onset and points to depressive symptoms and neuropsychiatric symptoms as potential therapeutic targets. However, as research on QoL in persons with YOD continues to expand, the inclusion of methods such as meta-analysis may be beneficial.
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Affiliation(s)
- Yoosun Yang
- College of Nursing, Korea University, Seoul, South Korea
| | - Jun-Ah Song
- College of Nursing, Korea University, Seoul, South Korea
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5
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Libri I, Altomare D, Bracca V, Rivolta J, Cantoni V, Mattioli I, Alberici A, Borroni B. Time to Diagnosis and Its Predictors in Syndromes Associated With Frontotemporal Lobar Degeneration. Am J Geriatr Psychiatry 2024:S1064-7481(24)00271-9. [PMID: 38521735 DOI: 10.1016/j.jagp.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Frontotemporal Lobar Degeneration (FTLD) causes a heterogeneous group of neurodegenerative disorders with a wide range of clinical features. This might delay time to diagnosis. The aim of the present study is to establish time to diagnosis and its predictors in patients with FTLD-associated syndromes. DESIGN Retrospective study. SETTING Tertiary referral center. PARTICIPANTS A total of 1029 patients with FTLD-associated syndromes (age: 68 [61-73] years, females: 46%) from 1999 to 2023 were included in the present study. MEASUREMENTS Time to diagnosis was operationalized as the time between symptom onset and the diagnosis of a FTLD-associated syndrome. The associations between time to diagnosis and possible predictors (demographic and clinical variables) were investigated through univariate and multivariate linear models. RESULTS Median time to diagnosis was 2 [1-3] years. We observed that younger age at onset (β = -0.03, p <0.001), having worked as a professional rather than as a blue (β = 0.52, p = 0.024) or a white (β = 0.46, p = 0.050) collar, and having progressive supranuclear palsy (p <0.05) or the semantic variant of primary progressive aphasia (p <0.05) phenotypes were significantly associated with increased time to diagnosis. No significant changes of time to diagnosis have been observed over 20 years. CONCLUSIONS The identification of predictors of time to diagnosis might improve current diagnostic algorithms, resulting in a timely initiation of symptomatic treatments, early involvement in clinical trials, and more adequate public health policies for patients and their families.
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Affiliation(s)
- Ilenia Libri
- Department of Clinical and Experimental Sciences (IL,DA, VB, JR, VC, IM, AA, BB), University of Brescia, Brescia, Italy; Department of Continuity of Care and Frailty (IL, IM, AA, BB), Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Daniele Altomare
- Department of Clinical and Experimental Sciences (IL,DA, VB, JR, VC, IM, AA, BB), University of Brescia, Brescia, Italy
| | - Valeria Bracca
- Department of Clinical and Experimental Sciences (IL,DA, VB, JR, VC, IM, AA, BB), University of Brescia, Brescia, Italy
| | - Jasmine Rivolta
- Department of Clinical and Experimental Sciences (IL,DA, VB, JR, VC, IM, AA, BB), University of Brescia, Brescia, Italy
| | - Valentina Cantoni
- Department of Clinical and Experimental Sciences (IL,DA, VB, JR, VC, IM, AA, BB), University of Brescia, Brescia, Italy
| | - Irene Mattioli
- Department of Clinical and Experimental Sciences (IL,DA, VB, JR, VC, IM, AA, BB), University of Brescia, Brescia, Italy; Department of Continuity of Care and Frailty (IL, IM, AA, BB), Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Antonella Alberici
- Department of Clinical and Experimental Sciences (IL,DA, VB, JR, VC, IM, AA, BB), University of Brescia, Brescia, Italy; Department of Continuity of Care and Frailty (IL, IM, AA, BB), Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences (IL,DA, VB, JR, VC, IM, AA, BB), University of Brescia, Brescia, Italy; Department of Continuity of Care and Frailty (IL, IM, AA, BB), Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy.
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Kang MJY, Eratne D, Dobson H, Malpas CB, Keem M, Lewis C, Grewal J, Tsoukra V, Dang C, Mocellin R, Kalincik T, Santillo AF, Zetterberg H, Blennow K, Stehmann C, Varghese S, Li QX, Masters CL, Collins S, Berkovic SF, Evans A, Kelso W, Farrand S, Loi SM, Walterfang M, Velakoulis D. Cerebrospinal fluid neurofilament light predicts longitudinal diagnostic change in patients with psychiatric and neurodegenerative disorders. Acta Neuropsychiatr 2024; 36:17-28. [PMID: 37114460 DOI: 10.1017/neu.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE People with neuropsychiatric symptoms often experience delay in accurate diagnosis. Although cerebrospinal fluid neurofilament light (CSF NfL) shows promise in distinguishing neurodegenerative disorders (ND) from psychiatric disorders (PSY), its accuracy in a diagnostically challenging cohort longitudinally is unknown. METHODS We collected longitudinal diagnostic information (mean = 36 months) from patients assessed at a neuropsychiatry service, categorising diagnoses as ND/mild cognitive impairment/other neurological disorders (ND/MCI/other) and PSY. We pre-specified NfL > 582 pg/mL as indicative of ND/MCI/other. RESULTS Diagnostic category changed from initial to final diagnosis for 23% (49/212) of patients. NfL predicted the final diagnostic category for 92% (22/24) of these and predicted final diagnostic category overall (ND/MCI/other vs. PSY) in 88% (187/212), compared to 77% (163/212) with clinical assessment alone. CONCLUSIONS CSF NfL improved diagnostic accuracy, with potential to have led to earlier, accurate diagnosis in a real-world setting using a pre-specified cut-off, adding weight to translation of NfL into clinical practice.
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Affiliation(s)
- Matthew J Y Kang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Hannah Dobson
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Charles B Malpas
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Michael Keem
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Courtney Lewis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jasleen Grewal
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Vivian Tsoukra
- Department of Neurology, Evangelismos Hospital, Athens, Greece
| | - Christa Dang
- National Ageing Research Institute, University of Melbourne, Parkville, VIC, Australia
| | | | - Tomas Kalincik
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alexander F Santillo
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Christiane Stehmann
- The Australian National CJD Registry, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Shiji Varghese
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Qiao-Xin Li
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Colin L Masters
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Steven Collins
- Department of Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia
- National Dementia Diagnostic Laboratory, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Samuel F Berkovic
- Department of Medicine, Austin Health, Epilepsy Research Centre, The University of Melbourne, Heidelberg, VIC, Australia
| | - Andrew Evans
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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7
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Velayudhan L, Mueller C. Diagnostic challenges and disparities in young-onset dementia: insights from a Southeast London memory clinic study. Int Psychogeriatr 2024:1-3. [PMID: 38299381 DOI: 10.1017/s1041610224000073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Latha Velayudhan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Brown AD, Kelso W, Eratne D, Loi SM, Farrand S, Summerell P, Neath J, Walterfang M, Velakoulis D, Stolwyk RJ. Investigating Equivalence of In-Person and Telehealth-Based Neuropsychological Assessment Performance for Individuals Being Investigated for Younger Onset Dementia. Arch Clin Neuropsychol 2024:acad108. [PMID: 38251841 DOI: 10.1093/arclin/acad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/24/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Given the rapid shift to in-home teleneuropsychology models, more research is needed to investigate the equivalence of non-facilitator models of teleneuropsychology delivery for people with younger onset dementia (YOD). This study aimed to determine whether equivalent performances were observed on neuropsychological measures administered in-person and via teleneuropsychology in a sample of people being investigated for YOD. METHOD Using a randomized counterbalanced cross-over design, 43 participants (Mage = 60.26, SDage = 7.19) with a possible or probable YOD diagnosis completed 14 neuropsychological tests in-person and via teleneuropsychology, with a 2-week interval. Repeated measures t-tests, intraclass correlation coefficients (ICC), and Bland Altman analyses were used to investigate equivalence across the administration conditions. RESULTS No statistical differences were found between in-person and teleneuropsychology conditions, except for the Hospital Anxiety and Depression Scale Anxiety subtest. Small to negligible effect sizes were observed (ranging from .01 to .20). ICC estimates ranged from .71 to .97 across the neuropsychological measures. Bland Altman analyses revealed that the Wechsler Adult Intelligence Scale-Fourth Edition Block Design subtest had slightly better overall performance in the in-person condition and participants reported higher levels of anxiety symptoms during the teleneuropsychology condition; however, average anxiety symptoms remained within the clinically normal range. Participants reported a high level of acceptability for teleneuropsychology assessments. CONCLUSIONS These results suggest that performances are comparable between in-person and teleneuropsychology assessment modalities. Our findings support teleneuropsychology as a feasible alternative to in-person neuropsychological services for people under investigation of YOD, who face significant barriers in accessing timely diagnoses and treatment options.
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Affiliation(s)
- Aimee D Brown
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Wendy Kelso
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | | | - Joanna Neath
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | | | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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9
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Eratne D, Kang M, Malpas C, Simpson-Yap S, Lewis C, Dang C, Grewal J, Coe A, Dobson H, Keem M, Chiu WH, Kalincik T, Ooi S, Darby D, Brodtmann A, Hansson O, Janelidze S, Blennow K, Zetterberg H, Walker A, Dean O, Berk M, Wannan C, Pantelis C, Loi SM, Walterfang M, Berkovic SF, Santillo AF, Velakoulis D. Plasma neurofilament light in behavioural variant frontotemporal dementia compared to mood and psychotic disorders. Aust N Z J Psychiatry 2024; 58:70-81. [PMID: 37477141 DOI: 10.1177/00048674231187312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Blood biomarkers of neuronal injury such as neurofilament light (NfL) show promise to improve diagnosis of neurodegenerative disorders and distinguish neurodegenerative from primary psychiatric disorders (PPD). This study investigated the diagnostic utility of plasma NfL to differentiate behavioural variant frontotemporal dementia (bvFTD, a neurodegenerative disorder commonly misdiagnosed initially as PPD), from PPD, and performance of large normative/reference data sets and models. METHODS Plasma NfL was analysed in major depressive disorder (MDD, n = 42), bipolar affective disorder (BPAD, n = 121), treatment-resistant schizophrenia (TRS, n = 82), bvFTD (n = 22), and compared to the reference cohort (Control Group 2, n = 1926, using GAMLSS modelling), and age-matched controls (Control Group 1, n = 96, using general linear models). RESULTS Large differences were seen between bvFTD (mean NfL 34.9 pg/mL) and all PPDs and controls (all < 11 pg/mL). NfL distinguished bvFTD from PPD with high accuracy, sensitivity (86%), and specificity (88%). GAMLSS models using reference Control Group 2 facilitated precision interpretation of individual levels, while performing equally to or outperforming models using local controls. Slightly higher NfL levels were found in BPAD, compared to controls and TRS. CONCLUSIONS This study adds further evidence on the diagnostic utility of NfL to distinguish bvFTD from PPD of high clinical relevance to a bvFTD differential diagnosis, and includes the largest cohort of BPAD to date. Using large reference cohorts, GAMLSS modelling and the interactive Internet-based application we developed, may have important implications for future research and clinical translation. Studies are underway investigating utility of plasma NfL in diverse neurodegenerative and primary psychiatric conditions in real-world clinical settings.
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Affiliation(s)
- Dhamidhu Eratne
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Kang
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Charles Malpas
- CORe, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Steve Simpson-Yap
- CORe, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Courtney Lewis
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Christa Dang
- National Ageing Research Institute, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Jasleen Grewal
- Department of Psychiatry, Alfred Hospital, Melbourne, VIC, Australia
| | - Amy Coe
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
| | - Hannah Dobson
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Keem
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Wei-Hsuan Chiu
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Tomas Kalincik
- CORe, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Suyi Ooi
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - David Darby
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Neuroscience Department, Alfred Health, Melbourne, VIC, Australia
- Department of Eastern Neurosciences, Box Hill Hospital, Melbourne, VIC, Australia
| | - Amy Brodtmann
- Department of Eastern Neurosciences, Box Hill Hospital, Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden
- The Memory Clinic, Skåne University Hospital, Lund, Sweden
| | - Shorena Janelidze
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Dahlgren's Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Dahlgren's Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
- UK Dementia Research Institute, University College London, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Adam Walker
- IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Olivia Dean
- IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Michael Berk
- IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Cassandra Wannan
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- NorthWestern Mental Health, Sunshine Hospital, Melbourne, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alexander F Santillo
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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10
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Perry M, Michgelsen J, Timmers R, Peetoom K, Koopmans R, Bakker C. Perceived barriers and solutions by generalist physicians to work towards timely young-onset dementia diagnosis. Aging Ment Health 2024; 28:262-267. [PMID: 37608741 DOI: 10.1080/13607863.2023.2248026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Objectives: Timely diagnosis of young-onset dementia (YOD) is an important prerequisite to initiate appropriate support. However, YOD diagnosis is often late. We aimed to explore the perspectives of referring general practitioners and occupational physicians, to better understand their barriers to YOD diagnosis and reveal potential solutions to facilitate timely diagnosis.Methods: We conducted 16 semi-structured qualitative interviews with general practitioners and occupational physicians in the Netherlands. Inductive thematic analysis was applied to the transcripts with a team including researchers from various (clinical) backgrounds.Results: Thematic analysis revealed three themes related to: (1) disease characteristics that hinder YOD recognition, being the low incidence and the fact that they mimic other prevalent conditions like burn-out and depression; (2) physicians' attitudes that delay YOD diagnosis, as fear of mis-diagnosis and therapeutic nihilism; and (3) proposed solutions to navigate the challenging YOD diagnostic trajectory including monitoring people with depression and burn-out to consider YOD when recovery stagnates, and more effective interprofessional collaboration.Conclusion: In this study, referring physicians confirmed barriers known to YOD diagnosis and suggested potential solutions to improve YOD diagnosis. Future prospective studies in people with a primary diagnosis of depression or burn-out may show whether these interventions are potentially effective.
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Affiliation(s)
- M Perry
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Center, Nijmegen, The Netherlands
| | - J Michgelsen
- Vilans, National Knowledge Centre for Expertise in Long-Term Care, Utrecht, The Netherlands
| | - R Timmers
- De Wever, Nursing Home, Tilburg, The Netherlands
| | - K Peetoom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - R Koopmans
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Center, Nijmegen, The Netherlands
| | - C Bakker
- Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen, Medical Center, Nijmegen, The Netherlands
- Florence, Mariahoeve, Center for Specialized Care in Early Onset Dementia, Den Haag, The Netherlands
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11
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Chou YT, Sun ZJ, Shao SC, Yang YC, Lu FH, Chang CJ, Liao TC, Li CY, Chen THH, Wu JS, Lai ECC. Autonomic modulation and the risk of dementia in a middle-aged cohort: A 17-year follow-up study. Biomed J 2023; 46:100576. [PMID: 36581249 PMCID: PMC10749883 DOI: 10.1016/j.bj.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Altered autonomic modulation, measured by heart rate variability (HRV), has been found to be associated with dementia risk in the elderly. However, long-term follow-up study evaluating the association between autonomic modulation from middle-age and the incidence of dementia has been limited. METHODS This retrospective cohort analyzed data from Taiwan's National Health Insurance Database covering the period from 2001 to 2017, with a linkage to citywide health examinations conducted by Tainan Metropolitan City, Taiwan. We included subjects aged 45-64 years. The mean follow-up period was 15.75 ± 3.40 years. The measurements of HRV included resting heart rate, high frequency (HF), low frequency (LF), standard deviation of normal-to-normal R-R intervals (SDNN), ratio between the 30th and 15th R-R interval after standing up from the supine position (30/15 ratio), ratio between the R-R intervals during expiration and inspiration, and the ratio between the high- and low-frequency components (LF/HF). The main study outcome was the incidence of dementia. We performed multivariable Cox proportional hazard regression models to compare the risk of dementia among different HRV subgroups. RESULTS We included 565 participants with a mean age of 53 (SD: 6) years, of whom 44% were male. The risk of dementia was significantly increased in association with lower parasympathetic HRV modulation, including SDNN (HR: 3.23, 95% CI: 1.55-6.73) and 30/15 ratio (HR: 3.52, 95%CI: 1.67-7.42). Moreover, the risk of dementia was increased in subjects with higher LF/HF ratios (HR: 2.05, 95% CI: 1.12-3.72). CONCLUSIONS Lower parasympathetic activity and higher sympathetic-vagal imbalance in middle-age were associated with dementia risk.
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Affiliation(s)
- Yu-Tsung Chou
- Department of Health Management Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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12
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Gerritzen EV, McDermott O, Orrell M. Online peer support: views and experiences of people with young onset dementia (YOD). Aging Ment Health 2023; 27:2386-2394. [PMID: 37162440 DOI: 10.1080/13607863.2023.2205833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/09/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES This study explores (1) which platforms people with YOD use for online peer support, (2) reasons for using or not using online peer support, and (3) how to optimise potential benefits and accessibility. METHODS A mixed-methods online survey was conducted including fixed-choice and open questions. Participants were people with YOD recruited through dementia organisations, Join Dementia Research and the NHS using convenience sampling. Fixed-choice questions were analysed with Chi-square test of significance and free-text responses with thematic analysis. RESULTS A total of 69 completed surveys were analysed. Zoom was most popular for online peer support, followed by Facebook and Twitter. Positives included sharing social support, joining from home, and the option to choose a preferred platform. However, it can be difficult to follow the conversation or understand others. Many were unaware about online peer support and some felt uncomfortable talking to strangers online. To improve access and benefits of online peer support organisations and healthcare professionals should advertise and signpost more and groups should have a clear description. CONCLUSION Online platforms facilitate social support and make peer support accessible to those who do not have access to in-person options. Future research and practice should focus on raising awareness about online peer support.
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Affiliation(s)
- E V Gerritzen
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - O McDermott
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - M Orrell
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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13
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Yoo MJ, Kang M, Tsoukra P, Chen Z, Farrand S, Kelso W, Evans A, Eratne D, Walterfang M, Velakoulis D, Loi SM. Comparing survival and mortality in patients with late-onset and young-onset vascular dementia. Int Psychogeriatr 2023; 35:519-527. [PMID: 37052303 DOI: 10.1017/s1041610223000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES Vascular dementia (VD) is one of the more common types of dementia. Much is known about VD in older adults in terms of survival and associated risk factors, but comparatively less is known about VD in a younger population. This study aimed to investigate survival in people with young-onset VD (YO-VD) compared to those with late-onset VD (LO-VD) and to investigate predictors of mortality. DESIGN Retrospective file review from 1992 to 2014. SETTING The inpatient unit of a tertiary neuropsychiatry service in Victoria, Australia. PARTICIPANTS Inpatients with a diagnosis of VD. MEASUREMENTS AND METHODS Mortality information was obtained from the Australian Institute of Health and Welfare. Clinical variables included age of onset, sex, vascular risk factors, structural neuroimaging, and Hachinksi scores. Statistical analyses used were Kaplan-Meier curves for median survival and Cox regression for predictors of mortality. RESULTS Eighty-four participants were included with few clinical differences between the LO-VD and YO-VD groups. Sixty-eight (81%) had died. Median survival was 9.9 years (95% confidence interval 7.9, 11.7), with those with LO-VD having significantly shorter survival compared to those with YO-VD (6.1 years and 12.8 years, respectively) and proportionally more with LO-VD had died (94.6%) compared to those with YO-VD (67.5%), χ2(1) = 9.16, p = 0.002. The only significant predictor of mortality was increasing age (p = 0.001). CONCLUSION While there were few clinical differences, and older age was the only factor associated with survival, further research into the effects of managing cardiovascular risk factors and their impact on survival are recommended.
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Affiliation(s)
- M J Yoo
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Matthew Kang
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | | | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne and Melbourne Health, Parkville, VIC, Australia
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14
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Seath P, Macedo-Orrego LE, Velayudhan L. Clinical characteristics of early-onset versus late-onset Alzheimer's disease: a systematic review and meta-analysis. Int Psychogeriatr 2023:1-17. [PMID: 37431284 DOI: 10.1017/s1041610223000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVES A number of studies have compared Alzheimer's disease (AD), the commonest form of dementia, based on their age of onset, i.e. before the age of 65 years (early-onset AD, EO-AD) to those developing after 65 years of age (late-onset AD, LO-AD), but the differences are not clear. We performed a systematic review and meta-analysis to compare clinical characteristics between EO-AD and LO-AD. DESIGN, MEASUREMENTS, AND PARTICIPANTS Medline, Embase, PsycINFO, and CINAHL databases were systematically searched for studies comparing time to diagnosis, cognitive scores, annual cognitive decline, activities of daily living (ADLs), neuropsychiatric symptoms (NPS), quality of life (QoL), and survival time for EO-AD and LO-AD patients. RESULTS Forty-two studies were included (EO-AD participants n = 5,544; LO-AD participants n = 16,042). An inverse variance method with random effects models was used to calculate overall effect estimates for each outcome. People with EO-AD had significantly poorer baseline cognitive performance and faster cognitive decline but longer survival times than people with LO-AD. There was no evidence that EO-AD patients differ from people with LO-AD in terms of symptom onset to diagnosis time, ADLs, and NPS. There were insufficient data to estimate overall effects of differences in QoL in EO-AD compared to LO-AD. CONCLUSIONS Our findings suggest that EO-AD differs from LO-AD in baseline cognition, cognitive decline, and survival time but otherwise has similar clinical characteristics to LO-AD. Larger studies using standardized questionnaires focusing on the clinical presentations are needed to better understand the impact of age of onset in AD.
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Affiliation(s)
- Paige Seath
- Academic Psychiatry Division, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Luis Enrique Macedo-Orrego
- Departamento de Psiquiatría, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Departamento de atencion especializada de adultos mayores, Instituto Nacional de Salud Mental, Lima, Peru
| | - Latha Velayudhan
- Academic Psychiatry Division, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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15
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Lai M, Jeon YH, McKenzie H, Withall A. Journey to Diagnosis of Young-Onset Dementia: A Qualitative Study of People with Young-Onset Dementia and their Family Caregivers in Australia. DEMENTIA 2023:14713012231173013. [PMID: 37126513 DOI: 10.1177/14713012231173013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES This study aims to explore the journey to dementia diagnosis and reaction to the diagnosis from the perspective of people with young-onset dementia living in the community from diverse areas in Australia (metropolitan, regional, rural) and their family caregivers. METHODS Semi-structured interviews were conducted with community-dwelling people with early to moderate young-onset Alzheimer's disease (n = 8) or frontotemporal dementia (n = 5) and one person with both Alzheimer's disease and frontotemporal dementia, and family caregivers of community-dwelling people with young-onset Alzheimer's disease and/or frontotemporal dementia (n = 28). This study employed interpretive description. Thematic analysis was conducted for emergent themes, comparisons and interplay between themes. FINDINGS The journey to the diagnosis is characterised as involving an extensive period of the gradual worsening of symptoms, drawn out investigations, and difficulties facing the prospect of a diagnosis of young-onset dementia. Participants with young-onset dementia struggled to manage their symptoms and the process of seeking a diagnosis was often slow due to difficulties during the course of their medical investigations and feeling reluctance to face the possibility of having dementia. Once participants finally received the diagnosis of young-onset dementia, participants with young-onset dementia and their family caregivers experienced feelings of devastation and shock, in some cases denial and avoidance, and even, confirmation and relief at having received a diagnosis. In some instances, participants experienced more than one of these reactions. There was a profound realisation by participants that a diagnosis of young-onset dementia had serious implications on their life and future. CONCLUSION The journey to diagnosis was found to be a drawn-out process and receiving the diagnosis was a shock for both people with young-onset dementia and their family caregivers. The findings highlight the significance of the role healthcare professionals play in both the diagnostic and post-diagnostic journey, particularly in terms of supporting patients with young-onset dementia and their family caregivers.
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Affiliation(s)
- Michelle Lai
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Heather McKenzie
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Adrienne Withall
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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16
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Loi SM, Cations M, Velakoulis D. Young-onset dementia diagnosis, management and care: a narrative review. Med J Aust 2023; 218:182-189. [PMID: 36807325 PMCID: PMC10952480 DOI: 10.5694/mja2.51849] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/21/2023]
Abstract
Young-onset dementia comprises a heterogeneous range of dementias, with onset at less than 65 years of age. These include primary dementias such as Alzheimer disease, frontotemporal and vascular dementias; genetic/familial dementias; metabolic disorders; and secondary dementias such as those that result from alcohol use disorder, traumatic brain injury, and infections. The presentation of young-onset dementia is varied and may include cognitive, psychiatric and neurological symptoms. Diagnostic delay is common, with a frequent diagnostic conundrum being, "Is this young-onset dementia or is this psychiatric?". For assessment and accurate diagnosis, a thorough screen is recommended, such as collateral history and investigations such as neuroimaging, lumbar puncture, neuropsychology, and genetic testing. The management of young-onset dementia needs to be age-appropriate and multidisciplinary, with timely access to services and consideration of the family (including children).
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Affiliation(s)
- Samantha M Loi
- University of MelbourneMelbourneVIC
- Royal Melbourne HospitalMelbourneVIC
| | | | - Dennis Velakoulis
- University of MelbourneMelbourneVIC
- Royal Melbourne HospitalMelbourneVIC
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17
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Abstract
PURPOSE OF REVIEW Young-onset dementia (YOD) refers to a dementia for which symptom onset occurs below the age of 65. This review summarizes the recent literature in this area, focusing on updates in epidemiology, diagnosis and service provision. RECENT FINDINGS In the last year, internationally, the prevalence of YOD was reported as 119 per 100 000, but this may vary according to population types. Although the commonest causes of YOD are Alzheimer's disease (AD) and frontotemporal dementia (FTD), there is increasing recognition that YOD is diagnostically and phenotypically broader than AD and FTD. YOD may be due to many other diseases (e.g. Huntington's disease, vascular dementia) whereas accumulation of the same protein (e.g. amyloid protein) may lead to different phenotypes of Alzheimer's disease (such as posterior cortical atrophy and behavioural-variant/frontal-variant AD). This heterogeneity of phenotypic presentation is also seen in YOD due to known genetic mutations. Biomarkers such as plasma and cerebrospinal fluid proteins, neuroimaging and genetics have shown promise in the early identification of YOD as well as providing further understanding behind the overlap between psychiatric and neurodegenerative conditions occurring in younger people. The management of YOD needs to consider age-specific issues for younger people with dementia and their family networks together with better integration with other health services such as aged, disability and improved access to services and financial assistance. SUMMARY These findings emphasize the need for early identification and appropriate age-specific and person-centred management for people with young-onset dementia.
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Affiliation(s)
- Samantha M Loi
- Department of Neuropsychiatry, Royal Melbourne Hospital
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Dennis Velakoulis
- Department of Neuropsychiatry, Royal Melbourne Hospital
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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18
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Kang MJY, Farrand S, Evans A, Chiu WH, Eratne D, Kelso W, Walterfang M, Velakoulis D, Loi SM. Carer burden and behavioral disturbance is similar between younger-onset Alzheimer's disease and behavioral variant frontotemporal dementia. Int Psychogeriatr 2023:1-8. [PMID: 36756758 DOI: 10.1017/s1041610222001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES Carer burden is common in younger-onset dementia (YOD), often due to the difficulty of navigating services often designed for older people with dementia. Compared to Alzheimer's disease (AD), the burden is reported to be higher in behavioral variant frontotemporal dementia (bvFTD). However, there is little literature comparing carer burden specifically in YOD. This study hypothesized that carer burden in bvFTD would be higher than in AD. DESIGN Retrospective cross-sectional study. SETTING Tertiary neuropsychiatry service in Victoria, Australia. PARTICIPANTS Patient-carer dyads with YOD. MEASUREMENTS We collected patient data, including behaviors using the Cambridge Behavioral Inventory-Revised (CBI-R). Carer burden was rated using the Zarit Burden Inventory-short version (ZBI-12). Descriptive statistics and Mann-Whitney U tests were used to analyze the data. RESULTS Carers reported high burden (ZBI-12 mean score = 17.2, SD = 10.5), with no significant difference in burden between younger-onset AD and bvFTD. CBI-R stereotypic and motor behaviors, CBI-R everyday skills, and total NUCOG scores differed between the two groups. There was no significant difference in the rest of the CBI-R subcategories, including the behavior-related domains. CONCLUSION Carers of YOD face high burden and are managing significant challenging behaviors. We found no difference in carer burden between younger-onset AD and bvFTD. This could be due to similarities in the two subtypes in terms of abnormal behavior, motivation, and self-care as measured on CBI-R, contrary to previous literature. Clinicians should screen for carer burden and associated factors including behavioral symptoms in YOD syndromes, as they may contribute to carer burden regardless of the type.
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Affiliation(s)
- Matthew J Y Kang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Evans
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wei-Hsuan Chiu
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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19
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Burkinshaw K, Tsourtos G, Cations M. System and policy-level barriers and facilitators for timely and accurate diagnosis of young onset dementia. Int J Geriatr Psychiatry 2023; 38:e5859. [PMID: 36484460 DOI: 10.1002/gps.5859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The multiyear diagnostic journey for young onset dementia (YOD) is fraught with clinical and personal difficulties and poses significant uncertainty for people living with YOD and their families. Most existing research has examined the personal and/or clinical barriers to a timely diagnosis of YOD, but less evidence exists regarding system level factors. The aim of this study is to investigate health professionals' insights for a timely and accurate YOD diagnosis at the system level. DESIGN Grounded theory qualitative study. SETTING AND PARTICIPANTS Semi-structured in-depth interviews with 11 health professionals working across varied healthcare settings were conducted online via videoconference. MEASUREMENTS Data were contrasted and compared within and between transcripts using the constant comparative method. RESULTS Seven themes emerged about barriers and facilitators for timely and accurate diagnosis of YOD: (1) stigma and awareness of YOD; (2) mismatched policy; (3) fractured health system; (4) inadequate pathways for YOD diagnostic care; (5) effective use of General Practitioners; (6) inequitable access and fragmented service navigation; (7) diverse and marginalised groups. CONCLUSION A complex web of systemic and system level barriers contributes to the delay of accurate and timely diagnosis for YOD. Diverse and marginalised groups experience greater inequitable disadvantage regarding YOD diagnostic care. There is an urgent need to focus on YOD diagnosis facilitators at the broader health system level.
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Affiliation(s)
- Kirsty Burkinshaw
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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20
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Ellajosyula R, Narayanan J, Hegde S, Kamath V, Murgod U, Easwaran V, Seetharam R, Srinivasan M, Watson P. Delay in the diagnosis of dementia in urban India: Role of dementia subtype and age at onset. Int J Geriatr Psychiatry 2022; 37. [PMID: 36383431 DOI: 10.1002/gps.5843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Early diagnosis of dementia is crucial for timely intervention. However, frequently, there is a substantial delay in diagnosis. Therefore, it is essential to recognise and address the barriers to early diagnosis. These have not been systematically studied in India. We at a specialist memory clinic in India investigated the time from symptom onset to diagnosis of dementia and factors contributing to the delay. METHODS In this cross-sectional study, consecutive patients with dementia (n = 855) seen at a private hospital underwent a standard clinical assessment and investigations. The primary outcome variable was time from symptom onset to diagnosis (TTD). The association of age, education, gender, dementia subtype, and age of onset on TTD were examined using a univariate analysis of covariance. RESULTS The median TTD was 24 months; 43% were diagnosed after 24 months. There was a significant association between TTD and age at onset (young onset-median 36 months vs. late onset-24 months) and dementia subtype. Patients with vascular dementia were diagnosed significantly earlier as compared to patients with Alzheimer's disease (AD) and frontotemporal dementia (FTD) [median 18, 24, and 30 months, respectively]. There was no effect of gender or education on the TTD. CONCLUSION About 40% of patients with dementia were diagnosed more than 2 years after symptom onset, particularly young onset dementias and FTD. Our study findings highlight the gaps in diagnosing patients with dementia in urban India and have significant implications for developing and implementing multifaceted interventions to improve the early diagnosis of dementia.
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Affiliation(s)
- Ratnavalli Ellajosyula
- Department of Neurology, Manipal Hospitals, Bangalore, India.,Department of Neurology, Annasawmy Mudaliar Hospital, Bangalore, India
| | - Jwala Narayanan
- Department of Neurology, Manipal Hospitals, Bangalore, India.,Department of Neuropsychology, Annasawmy Mudaliar Hospital, Bangalore, India
| | - Soumya Hegde
- Department of Psychiatry, Annasawmy Mudaliar Hospital, Bangalore, India
| | - Vikram Kamath
- Department of Neurology, Apollo Hospitals, Bangalore, India
| | - Uday Murgod
- Department of Neurology, Manipal Hospitals, Bangalore, India
| | - Vandhana Easwaran
- Department of Neuropsychology, Annasawmy Mudaliar Hospital, Bangalore, India
| | | | | | - Peter Watson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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21
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Brown AD, Kelso W, Velakoulis D, Farrand S, Stolwyk RJ. Understanding Clinician's Experiences with Implementation of a Younger Onset Dementia Telehealth Service. J Geriatr Psychiatry Neurol 2022:8919887221141653. [PMID: 36433702 DOI: 10.1177/08919887221141653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The successful implementation of telehealth services depends largely on clinician acceptance of telehealth as a viable healthcare option and their adoption of telehealth methods into their clinical practice. While growing research supports the feasibility of telehealth services, no research has evaluated clinicians' experiences during the implementation of a younger onset dementia telehealth service. Semi-structured group interviews were conducted with 7 metropolitan (hub) clinicians and 16 rural (spoke) clinicians during the pre-and post-implementation phases of a novel Younger onset dementia (YOD) telehealth service. Reflexive thematic analysis identified five themes at pre-implementation: clinical need, previous experiences and views, potential telehealth barriers, solutions to potential telehealth barriers, and potential clinical outcomes. At post-implementation, nine themes were identified: clinical need, clinical relationships, concerns about the future of rural healthcare, clinical practice and resourcing factors, patient suitability, difficulties with technology, service quality, the way forward, and the impact of COVID-19. Most clinicians held positive views regarding the service, particularly the ability to provide more options to rural-dwelling patients. However, some concerns about threats to rural healthcare and the validity of telehealth assessments remained. Overall, this study has identified service implementation barriers and facilitators and contributes to the long-term sustainability of current and future telehealth YOD services.
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Affiliation(s)
- Aimee D Brown
- Turner Institute for Brain and Mental Health, 2541School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| | - Wendy Kelso
- Neuropsychiatry, North Western Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, North Western Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sarah Farrand
- Neuropsychiatry, North Western Mental Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, 2541School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
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22
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How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer's Disease and Related Dementias? A Narrative Review. Medicina (B Aires) 2022; 58:medicina58121705. [PMID: 36556907 PMCID: PMC9783876 DOI: 10.3390/medicina58121705] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer's disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.
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23
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Eratne D, Loi SM, Li QX, Stehmann C, Malpas CB, Santillo A, Janelidze S, Cadwallader C, Walia N, Ney B, Lewis V, Senesi M, Fowler C, McGlade A, Varghese S, Ravanfar P, Kelso W, Farrand S, Keem M, Kang M, Goh AMY, Dhiman K, Gupta V, Watson R, Yassi N, Kaylor-Hughes C, Kanaan R, Perucca P, Dobson H, Vivash L, Ali R, O'Brien TJ, Hansson O, Zetterberg H, Blennow K, Walterfang M, Masters CL, Berkovic SF, Collins S, Velakoulis D. Cerebrospinal fluid neurofilament light chain differentiates primary psychiatric disorders from rapidly progressive, Alzheimer's disease and frontotemporal disorders in clinical settings. Alzheimers Dement 2022; 18:2218-2233. [PMID: 35102694 DOI: 10.1002/alz.12549] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Many patients with cognitive and neuropsychiatric symptoms face diagnostic delay and misdiagnosis. We investigated whether cerebrospinal fluid (CSF) neurofilament light (NfL) and total-tau (t-tau) could assist in the clinical scenario of differentiating neurodegenerative (ND) from psychiatric disorders (PSY), and rapidly progressive disorders. METHODS Biomarkers were examined in patients from specialist services (ND and PSY) and a national Creutzfeldt-Jakob registry (Creutzfeldt-Jakob disease [CJD] and rapidly progressive dementias/atypically rapid variants of common ND, RapidND). RESULTS A total of 498 participants were included: 197 ND, 67 PSY, 161 CJD, 48 RapidND, and 20 controls. NfL was elevated in ND compared to PSY and controls, with highest levels in CJD and RapidND. NfL distinguished ND from PSY with 95%/78% positive/negative predictive value, 92%/87% sensitivity/specificity, 91% accuracy. NfL outperformed t-tau in most real-life clinical diagnostic dilemma scenarios, except distinguishing CJD from RapidND. DISCUSSION We demonstrated strong generalizable evidence for the diagnostic utility of CSF NfL in differentiating ND from psychiatric disorders, with high accuracy.
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Affiliation(s)
- Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia.,National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia.,National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Qiao-Xin Li
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Christiane Stehmann
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Charles B Malpas
- Department of Medicine, Department of Neurology, Clinical Outcomes Research Unit (CORe), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alexander Santillo
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Shorena Janelidze
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Claire Cadwallader
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nirbaanjot Walia
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Blair Ney
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Victoria Lewis
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Matteo Senesi
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Christopher Fowler
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Amelia McGlade
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Shiji Varghese
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Parsa Ravanfar
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Wendy Kelso
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Keem
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Matthew Kang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anita M Y Goh
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Kunal Dhiman
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Veer Gupta
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rosie Watson
- Population Health and Immunity Division, the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Nawaf Yassi
- Population Health and Immunity Division, the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Cath Kaylor-Hughes
- Department of General Practice, Integrated Mental Health Team, University of Melbourne, Parkville, Victoria, Australia
| | - Richard Kanaan
- Department of Psychiatry, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Piero Perucca
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Comprehensive Epilepsy Program, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Hannah Dobson
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Rashida Ali
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Oskar Hansson
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Colin L Masters
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Samuel F Berkovic
- Department of Medicine, Austin Health, Epilepsy Research Centre, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Steven Collins
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
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24
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Day S, Couzner L, Laver KE, Withall A, Draper B, Cations M. Cross-sector learning collaboratives can improve post-diagnosis care integration for people with young onset dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6135-e6144. [PMID: 36177663 DOI: 10.1111/hsc.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Post-diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross-sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six-module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross-sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change.
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Affiliation(s)
- Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Leah Couzner
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
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25
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Tadd K, Rego T, Gaillard F, Malpas CB, Walterfang M, Velakoulis D, Farrand S. Neuroimaging in the Acute Psychiatric Setting: Associations With Neuropsychiatric Risk Factors. J Neuropsychiatry Clin Neurosci 2022; 35:184-191. [PMID: 36128679 DOI: 10.1176/appi.neuropsych.21110269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The appropriateness and clinical utility of neuroimaging in psychiatric populations has been long debated, and the ambiguity of guideline recommendations is well established. Most of the literature is focused on first-episode psychosis. The investigators aimed to review ordering practices and identify risk factors associated with neuroradiological MRI abnormalities and their clinical utility in a general psychiatric population. METHODS A retrospective file review was undertaken for 100 consecutive brain MRI scans for adult psychiatric inpatients who received scanning as part of their clinical care in an Australian hospital. RESULTS Brain MRI was abnormal in 79.0% of scans; in these cases, 72.2% of patients required further investigation or follow-up, with 17.7% requiring urgent referral within days to weeks, despite only 3.7% of admitted patients undergoing MRI during the study period. Psychiatrically relevant abnormalities were found in 32.0% of scans. Abnormalities were more likely to be found in the presence of cognitive impairment, older age, and longer duration of psychiatric disorder. Psychiatrically relevant abnormalities had further associations with older age at onset of the psychiatric disorder and a weak association with abnormal neurological examination. Multiple indications for imaging were present in 57.0% of patients; the most common indications were physical, neurological, and cognitive abnormalities. CONCLUSIONS Brain MRI is a useful part of psychiatric management in the presence of certain neuropsychiatric risk factors. The present findings suggest that treating teams can judiciously tailor radiological investigations while limiting excessive imaging. Future research in larger cohorts across multiple centers may contribute to shaping more consistent neuroimaging guidelines in psychiatry.
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Affiliation(s)
- Katelyn Tadd
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Thomas Rego
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Frank Gaillard
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Charles B Malpas
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Mark Walterfang
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Dennis Velakoulis
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
| | - Sarah Farrand
- Mental Health Program, NorthWestern Mental Health (Tadd, Rego, Farrand) and Eastern Health (Tadd), Melbourne, Victoria, Australia; Department of Psychiatry (Rego), Faculty of Medicine, Dentistry and Health Sciences (Gaillard), and Melbourne School of Psychological Sciences (Malpas), University of Melbourne; Department of Radiology (Gaillard), Clinical Outcomes Research Unit, Department of Medicine (Malpas), Department of Neurology (Malpas), and Department of Neuropsychiatry (Walterfang, Velakoulis, Farrand), Royal Melbourne Hospital; Melbourne Neuropsychiatry Center, University of Melbourne and NorthWestern Mental Health (Walterfang, Velakoulis); Florey Institute of Neuroscience and Mental Health, Melbourne (Walterfang)
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26
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How long does it take to diagnose young-onset dementia? A comparison with late-onset dementia. Neurol Sci 2022; 43:4729-4734. [DOI: 10.1007/s10072-022-06056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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27
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Eratne D, Li QX, Loi SM, Walterfang M, Farrand S, Evans A, Mocellin R, Masters CL, Collins S, Velakoulis D. Cerebrospinal fluid Alzheimer disease biomarkers for assessing cognitive and neuropsychiatric symptoms: Expanding the 'toolkit' in the psychiatrist's diagnostic armamentarium. Aust N Z J Psychiatry 2022; 56:865-866. [PMID: 35257595 DOI: 10.1177/00048674221084245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dhamidhu Eratne
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne & NorthWestern Mental Health, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Qiao-Xin Li
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne & NorthWestern Mental Health, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne & NorthWestern Mental Health, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne & NorthWestern Mental Health, Melbourne, VIC, Australia
| | - Andrew Evans
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Colin L Masters
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Steven Collins
- National Dementia Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne & NorthWestern Mental Health, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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Loi SM, Flynn L, Cadwallader C, Stretton-Smith P, Bryant C, Baker FA. Music and Psychology & Social Connections Program: Protocol for a Novel Intervention for Dyads Affected by Younger-Onset Dementia. Brain Sci 2022; 12:brainsci12040503. [PMID: 35448034 PMCID: PMC9031190 DOI: 10.3390/brainsci12040503] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Psychosocial interventions targeting the specific needs of people affected by younger-onset dementia are lacking. Younger-onset dementia refers to dementia where symptom onset occurs at less than 65 years old. Because of its occurrence in middle age, the impact on spouses is particularly marked and dyadic-based interventions are recommended. Music And Psychology & Social Connections (MAPS) is a novel online intervention, informed by the theory of adaptive coping by Bannon et al. (2021) for dyads affected by younger-onset dementia. MAPS combines therapeutic songwriting, cognitive behaviour therapy, and a private social networking group that focuses on the dyads. This will be a randomised controlled trial with a waitlist control. The primary aims are to assess whether MAPS improves depressive, anxiety, and stress symptoms in caregivers, with secondary aims to assess whether MAPS improves depressive symptoms in people with younger-onset dementia. The trial also aims to assess dyadic social connectedness; caregiver coping skills; and neuropsychiatric symptoms in people with younger-onset dementia. We will recruit 60 dyads to participate in a group-based weekly online program for 8 weeks facilitated by a credentialed music therapist and psychologist. Sessions 1 and 8 will include both caregivers and people with younger-onset dementia and Sessions 2–7 will involve separate group sessions for caregivers and those with dementia. There will be focus groups for qualitative feedback. Due to its online administration, MAPS has the potential to reach many dyads affected by younger-onset dementia.
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Affiliation(s)
- Samantha M. Loi
- Department of Psychiatry, The University of Melbourne, Parkville, VIC 3052, Australia
- Neuropsychiatry, John Cade Level 2, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Correspondence: ; Tel.: +613-9342-8750
| | - Libby Flynn
- Department of Fine Arts and Music, The University of Melbourne, Parkville, VIC 3052, Australia; (L.F.); (C.C.); (P.S.-S.); (F.A.B.)
| | - Claire Cadwallader
- Department of Fine Arts and Music, The University of Melbourne, Parkville, VIC 3052, Australia; (L.F.); (C.C.); (P.S.-S.); (F.A.B.)
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Phoebe Stretton-Smith
- Department of Fine Arts and Music, The University of Melbourne, Parkville, VIC 3052, Australia; (L.F.); (C.C.); (P.S.-S.); (F.A.B.)
| | - Christina Bryant
- Department of Psychology, The University of Melbourne, Parkville, VIC 3052, Australia;
| | - Felicity A. Baker
- Department of Fine Arts and Music, The University of Melbourne, Parkville, VIC 3052, Australia; (L.F.); (C.C.); (P.S.-S.); (F.A.B.)
- Music Education and Music Therapy Department, Norwegian Academy of Music, 0369 Oslo, Norway
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Mehrani I, Sachdev PS. The role of Memory Clinics in the assessment and management of dementia, now and into the future. Curr Opin Psychiatry 2022; 35:118-122. [PMID: 35026801 DOI: 10.1097/yco.0000000000000777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The diagnosis of dementia is often delayed and many individuals with the disorder go undiagnosed or receive an inadequate assessment. Specialist Memory Clinics have long been at the centre of such assessments. Recent developments in biomarkers and disease-modifying treatments are likely increase the need for specialist assessments. It is therefore timely to review the role of Memory Clinics internationally. RECENT FINDINGS The timely diagnosis of dementia and cognitive decline is the main responsibility of Memory Clinics. These clinics can diagnose dementia up to 4 years earlier than primary care services, but their low numbers and capacity of leads to long waiting times and a focus on complex cases. Few clinics are resourced to offer specific postdiagnostic support services, and their roles in clinical trials and research have not been realised. They are often well integrated with primary care and aged care services. SUMMARY Memory Clinics play an important role in bridging the gap between research and clinical practice and providing high-quality assessment and care. Additional Memory Clinic services and greater harmonisation of their responsibilities and procedures are needed to exploit their full potential.
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Affiliation(s)
- Inga Mehrani
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and Health, The University of New South Wales
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and Health, The University of New South Wales
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
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Cations M, Day S, Laver K, Withall A, Draper B. Post-diagnosis young-onset dementia care in the National Disability Insurance Scheme. Aust N Z J Psychiatry 2022; 56:270-280. [PMID: 33982630 DOI: 10.1177/00048674211011699] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Post-diagnosis service delivery for young-onset dementia (with onset prior to 65 years) recently moved to the disability system in an attempt to address systemic barriers to best practice in aged care. The objective of this study was to examine experiences and satisfaction with disability services so far among people with young-onset dementia and their care partners and identify strategies for service and system improvement. METHODS The 151 participating Australians living with young-onset dementia or providing informal care to a person with young-onset dementia were recruited via social media, advocacy bodies and specialist medical clinics. A cross-sectional online survey asked participants to provide a timeline of their interactions with the disability system so far and rate their satisfaction with the disability system, aged care and disability services. RESULTS Participants reported a mean age at symptom onset of 55 years. In all, 53% were diagnosed with Alzheimer's disease and 25% were diagnosed with frontotemporal dementia. Sixty percent had received an approved plan from the National Disability Insurance Scheme, although 3% were rejected. More than 27% waited longer than 6 months to receive their plan, and half waited at least a month post-approval to access services. Less than 30% agreed that the National Disability Insurance Scheme understands dementia, and fewer than half felt that the process of accessing National Disability Insurance Scheme funding is easy and fast enough. Nonetheless, respondents remained overwhelmingly in favour of young-onset dementia services remaining in the disability system rather than in aged care. CONCLUSIONS While people with young-onset dementia and their care partners strongly agree with their inclusion in the National Disability Insurance Scheme, a relatively low level of experience with dementia in the disability workforce and a lack of integration with the healthcare and aged care systems continue to create important barriers for accessing the services they need.
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Affiliation(s)
- Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, SA, Australia
| | - Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
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Day S, Roberts S, Launder NH, Goh AMY, Draper B, Bahar-Fuchs A, Loi SM, Laver K, Withall A, Cations M. Age of Symptom Onset and Longitudinal Course of Sporadic Alzheimer's Disease, Frontotemporal Dementia, and Vascular Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 85:1819-1833. [PMID: 34958038 DOI: 10.3233/jad-215360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding how the age of dementia symptom onset affects the longitudinal course of dementia can assist with prognosis and care planning. OBJECTIVE To synthesize evidence regarding the relationship of age of symptom onset with the longitudinal course of sporadic Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). METHODS We searched Medline, CINAHL, Embase, PsycINFO, PubMed, and Scopus for longitudinal studies that examined the impact of sporadic AD, VaD, or FTD symptom onset age on measures of cognition, function, or behavioral symptoms. Studies that examined age at diagnosis only were excluded. Quantitative meta-analysis was conducted where studies reported sufficient data for pooling. RESULTS Thirty studies met all inclusion criteria (people with AD (n = 26), FTD (n = 4)) though no studies examined VaD. Earlier onset of AD was associated with more rapid annual cognitive decline (estimate = -0.07; 95% CI -0.14 to 0.00; p = 0.045). Most studies that stratified their sample reported that younger AD onset (usually < 65 years) was associated with more rapid cognitive decline. Other evidence was inconclusive. CONCLUSION Younger people with AD appear to have a poorer prognosis in terms of faster cognitive decline than older people with AD. More research is required to determine the impact of symptom onset age in VaD and FTD, and on functional decline in all dementias.
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Affiliation(s)
- Sally Day
- College of Education, Psychology and Social Work, Flinders University, Adelaide SA, Australia
| | - Stefanie Roberts
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,National Ageing Research Institute, Melbourne VIC, Australia
| | - Nathalie H Launder
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia
| | - Anita M Y Goh
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,National Ageing Research Institute, Melbourne VIC, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, New South Wales, Australia
| | - Alex Bahar-Fuchs
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia
| | - Samantha M Loi
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville VIC, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Adrienne Withall
- School of Population Health, UNSW Sydney, New South Wales, Australia.,Ageing Futures Institute, UNSW Sydney, New South Wales, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide SA, Australia
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Loi SM, Tsoukra P, Chen Z, Wibawa P, Eratne D, Kelso W, Walterfang M, Velakoulis D. Risk factors to mortality and causes of death in frontotemporal dementia: An Australian perspective. Int J Geriatr Psychiatry 2021; 37. [PMID: 34921446 DOI: 10.1002/gps.5668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Frontotemporal dementia (FTD) is a common cause of dementia in younger people. There is less information known about risk factors to mortality such as the type of symptom onset and cause of death in this group. METHOD This was a retrospective file review of inpatients with FTD admitted to a tertiary neuropsychiatry unit located in Australia from 1992 to 2014. Mortality information including linkage of names and causes of death were obtained from the Australian Institute Health and Welfare National Death Index. RESULTS One hundred inpatients were diagnosed with FTD, including behavioural-variant, language-variant FTDs and FTD-motor neuron disease (FTD-MND). Mean age was 52.8 years (SD = 10, range 31-76 years). Sixty-seven of them had died at linkage. Median survival of the sample was 10.5 years and FTD-MND had the shortest survival, 3.5 years. Increasing age of onset and FTD-MND were found to be significant predictors of association for mortality. Compared to the general population, having a FTD had an 8× increased risk of death. Females had double the standardised mortality ratio compared to males. DISCUSSION This study provides important prognostic information for people diagnosed with FTD living in Australia. It highlights the importance of obtaining a definitive diagnosis as early as possible for future planning. More investigation into the relationship of symptom onset type and sex differences in FTD is required.
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Affiliation(s)
- Samantha M Loi
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Zhibin Chen
- School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Pierre Wibawa
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Wendy Kelso
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mark Walterfang
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, NorthWestern Mental Health, Melbourne Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
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Ruiz-Adame M. A Systematic Review of the Indirect and Social Costs in Early and Young Onset Dementias. J Alzheimers Dis 2021; 85:21-29. [PMID: 34806610 DOI: 10.3233/jad-215204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The World Health Organization has estimated that worldwide around 50 million people have dementia. The World Alzheimer Report estimated that between 2 and 10% of all cases of dementia begin before the age of 65. Early and young onset dementias (EYOD) provoke more working, social, family, and economic consequences than late onset dementias. All general studies about costs of dementias show that most of them are indirect or social costs. Despite that, very few studies have been performed in EYOD. OBJECTIVE To do a systematic review of literature about indirect or social costs in EYOD to know the state of knowledge and to discover gaps that should be filled. METHODS A systematic review was performed in the main database: Scopus, PsychInfo, Web of Science (Web of Science Core Collection, Medline and SciELO), and CINAHL. Additionally, we looked for reviews in Cochrane and in the International Prospective Register Of Systematic Reviews (PROSPERO). RESULTS Most of the studies are about costs of dementias in general, but they do no differentiate costs for the case of EYOD. Many studies highlight the increased costs for EYOD but very little included evidence of that. 135 papers were selected. Finally, only two were studies providing data. EYOD reduce the odds to get or maintain a job. Most of the care is provided by informal caregivers. The costs in EYOD are 39.26% higher among EYOD than in late onset. CONCLUSION There is a lack of studies about social and indirect costs in EYOD. More evidence is needed.
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Cations M, Loi SM, Draper B, Swaffer K, Velakoulis D, Goh AM. A call to action for the improved identification, diagnosis, treatment and care of people with young onset dementia. Aust N Z J Psychiatry 2021; 55:837-840. [PMID: 34382425 DOI: 10.1177/00048674211037542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Brian Draper
- Faculty of Medicine School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Kate Swaffer
- Faculty of Science, Medicine, and Health School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Anita My Goh
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,National Ageing Research Institute, Melbourne, VIC, Australia
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Kvello-Alme M, Bråthen G, White LR, Sando SB. Time to Diagnosis in Young Onset Alzheimer's Disease: A Population-Based Study from Central Norway. J Alzheimers Dis 2021; 82:965-974. [PMID: 34120901 PMCID: PMC8461696 DOI: 10.3233/jad-210090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Young onset dementia is associated with a longer time to diagnosis compared to late onset dementia. Earlier publications have indicated that atypical presentation is a key contributing factor to the diagnostic delay. Our hypothesis was that even the most common presentation of Alzheimer’s disease is associated with a substantial diagnostic delay in patients < 65 years. Objective: To determine the time to diagnosis, and time lags in the diagnostic pathway in typical young onset Alzheimer’s disease in central Norway. Methods: The main sources of patients were the databases at the Department of Neurology, University Hospital of Trondheim (St. Olav’s Hospital), and Department of Psychiatry, Levanger Hospital. Other sources included key persons in the communities, collaborating hospital departments examining patients with suspected cognitive impairment, and review of hospital records of all three hospitals in the area. Information on the time lags, and the clinical assessment, including the use of biomarkers, was collected from hospital notes. Caregivers were interviewed by telephone. Results: Time from first symptom to diagnosis in typical young onset Alzheimer’s disease was 5.5 years (n = 223, SD 2.8). Time from onset to contact with healthcare services (usually a general practitioner) was 3.4 years (SD 2.3). Time from contact with healthcare services to the first visit at a hospital was 10.3 months (SD 15.5). Time from first visit at a hospital to diagnosis was 14.8 months (SD 22.6). The analysis of cerebrospinal fluid core biomarkers was performed after 8.3 months (SD 20.9). Conclusion: Typical Alzheimer’s disease is associated with a substantial diagnostic delay in younger patients. Raising public awareness, and education of healthcare professionals on the aspects of young onset Alzheimer’s disease is warranted. CSF core biomarkers should be performed earlier in the hospital evaluation process.
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Affiliation(s)
- Marte Kvello-Alme
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.,Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
| | - Geir Bråthen
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, University Hospital of Trondheim, Trondheim, Norway
| | - Linda R White
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Sigrid Botne Sando
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, University Hospital of Trondheim, Trondheim, Norway
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Giebel C, Hollinghurst J, Akbari A, Schnier C, Wilkinson T, North L, Gabbay M, Rodgers S. Socio-economic predictors of time to care home admission in people living with dementia in Wales: A routine data linkage study. Int J Geriatr Psychiatry 2021; 36:511-520. [PMID: 33045103 PMCID: PMC7984448 DOI: 10.1002/gps.5446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Limited research has shown that people with dementia (PwD) from lower socio-economic backgrounds can face difficulties in accessing the right care at the right time. This study examined whether socio-economic status (SES) and rural versus urban living location are associated with the time between diagnosis and care home admission in PwD living in Wales, UK. METHODS/DESIGN This study linked routine health data and an e-cohort of PwD who have been admitted into a care home between 2000 and 2018 living in Wales. Survival analysis explored the effects of SES, living location, living situation, and frailty on the time between diagnosis and care home admission. RESULTS In 34,514 PwD, the average time between diagnosis and care home admission was 1.5 (±1.4) years. Cox regression analysis showed that increased age, living alone, frailty, and living in less disadvantaged neighbourhoods were associated with faster rate to care home admission. Living in rural regions predicted a slower rate until care home admission. CONCLUSIONS This is one of the first studies to show a link between socio-economic factors on time to care home admission in dementia. Future research needs to address variations in care needs between PwD from different socio-economic and geographical backgrounds.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
| | - Joe Hollinghurst
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK
| | - Ashley Akbari
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK,Administrative Data Research WalesSwansea UniversitySwanseaUK,Dementia PlatformLondonUK
| | - Christian Schnier
- Dementia PlatformLondonUK,Usher InstituteUniversity of EdinburghEdinburghUK
| | - Tim Wilkinson
- Dementia PlatformLondonUK,Usher InstituteUniversity of EdinburghEdinburghUK,Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Laura North
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK,Dementia PlatformLondonUK
| | - Mark Gabbay
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
| | - Sarah Rodgers
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
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