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Lindhout JE, Richard E, Hafdi M, Perry M, Moll van Charante E, van Gool WA. The Association of Ancillary Diagnostic Tests With Outcome in Dementia. J Am Med Dir Assoc 2024; 25:105040. [PMID: 38796169 DOI: 10.1016/j.jamda.2024.105040] [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: 09/01/2023] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES Dementia is a clinical diagnosis without curative treatment. It is uncertain whether ancillary testing is beneficial for patients. This study investigates the association between use of diagnostic tests and time to poor outcome and health care costs. DESIGN Nationwide register-based cohort study using health care reimbursement data in the Netherlands. SETTING AND PARTICIPANTS All Dutch hospitals, including 13,312 patients diagnosed with dementia in 2018. METHODS Diagnostic testing included computed tomography or magnetic resonance imaging (CT/MRI), neuropsychological examination (NPE), nuclear imaging (PET/SPECT), electroencephalography (EEG), and cerebrospinal fluid (CSF) testing. We compared time to poor outcome (institutionalization or death) and costs per month from 2018 to 2021 between those who underwent a specific diagnostic test in previous years to controls, propensity score matched for age, sex, type of hospital, and comorbidity. RESULTS Time to poor outcome in those who underwent CT/MRI, EEG, or CSF testing was similar to those who did not, but was longer for those who underwent NPE. Time to poor outcome was shorter in patients who underwent PET/SPECT. Patients who underwent CSF testing or PET/SPECT had higher mean total health care costs as compared to controls (CSF €248, 95% CI 64-433; PET/SPECT: €315, 95% CI 179-451). NPE during the diagnostic trajectory was associated with lower total health care cost (-€127, 95% CI -62, -193). CONCLUSION AND IMPLICATIONS NPE was associated with longer time to poor outcome and lower health care costs, potentially due to confounding by indication. Patients who underwent neuroimaging (CT, MRI, SPECT/PET), CSF testing, or EEG for dementia diagnostics did not experience a longer time to poor outcome or lower health care costs. This emphasizes the importance of clinical examination as anchor for the diagnosis of dementia.
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Affiliation(s)
- Josephine E Lindhout
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Edo Richard
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Melanie Hafdi
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke Perry
- Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Primary and Community Care, Donders Institute for Brain, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Moll van Charante
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem A van Gool
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Gengeswaran N, Brandwood A, Anderson NN, Ramlakhan JU, Gagliardi AR. Do clinical guidelines support person-centred care for women affected by dementia: A content analysis. DEMENTIA 2024; 23:525-549. [PMID: 38567809 PMCID: PMC11059842 DOI: 10.1177/14713012241244982] [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 Dementia disproportionately affects women including persons living with dementia and caregivers. Person-centered care, rather than disease-focused, is recommended to improve care for affected persons including caregivers. General practitioners play a central role in dementia care but find it challenging due to inadequate training. The study aimed to assess if and how dementia guidelines provide clinicians with guidance on person-centred care for women affected by dementia. METHODS We searched for publicly available English-language guidelines on the overall management of dementia in MEDLINE, EMBASE and the Guidelines International Network repository. We employed deductive and summative content analysis, and categorized person-centered care guideline content based on established frameworks, and conveyed our results using summary statistics, text, and tables. RESULTS We reviewed 15 guidelines published from 2006 to 2020 in eight countries. Few (4, 23%) involved persons living with dementia or caregivers in guideline development. Regarding general person-centred care, guidelines mostly addressed the domains of exchange information (93%), share decisions (93%), enable self-management (93%) and address emotions (87%), while few offered content on manage uncertainty (33%) or foster a healing relationship (13%). Regarding dementia-specific person-centred care, most guidelines addressed intersectionality (tailoring care for diverse characteristics) (80%), but few included content on the domains of quality of life (67%), dignity (53%) or sex/gender issues (20%). Even when mentioned, the guidance was typically brief. We identified 32 general and 18 dementia-specific strategies to achieve person-centered care by compiling information from these guidelines. CONCLUSIONS This study identified inconsistent and insufficient guideline content on person-centred care for women with dementia. Compiled strategies for achieving person-centred care could be used by developers to enhance existing and future dementia guidelines; and inform the development of policies or programs, education, tools for clinicians, and quality improvement measures for evaluating dementia care. Future research is crucial for promoting person-centred dementia care for women living with dementia.
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Affiliation(s)
- Nevetda Gengeswaran
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Alec Brandwood
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Jessica U Ramlakhan
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Canada
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Watt JA, Porter J, Tavilsup P, Chowdhury M, Hatch S, Ismail Z, Kumar S, Kirkham J, Goodarzi Z, Seitz D. Guideline Recommendations on Behavioral and Psychological Symptoms of Dementia: A Systematic Review. J Am Med Dir Assoc 2024; 25:837-846.e21. [PMID: 38640961 DOI: 10.1016/j.jamda.2024.03.007] [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] [Received: 11/14/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To synthesize recommendations on assessing and managing behavioral and psychological symptoms of dementia (BPSDs) in existing clinical practice guidelines on dementia care to learn from and adapt recommendations to a Canadian context and language for describing BPSDs. DESIGN Systematic review. SETTING AND PARTICIPANTS Moderate to high-quality clinical practice guidelines on dementia care that made 1 or more recommendations on BPSD assessment or management. METHODS We searched MEDLINE, Embase, JBI EBM, PsycINFO, AgeLine, and gray literature for clinical practice guidelines on dementia care making recommendations on BPSD, published between January 1, 2011, and October 13, 2022. Two independent reviewers conducted study screening and data abstraction. Four independent reviewers completed quality appraisal using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool; included guidelines had a mean overall AGREE II score ≥4. RESULTS Our systematic review identified 23 moderate to high-quality clinical practice guidelines (264 recommendations). The mean overall quality score on the AGREE II tool ranged from 4 to 6.5. Recommendations were clearly presented (mean clarity of presentation score 73.5%), but guideline applicability was not consistently addressed (mean applicability score 39.3%). BPSD was the most prevalent term describing neuropsychiatric symptoms (number of guidelines [n] = 14). People with lived experience contributed to 6 guidelines (26.1%). Ten guidelines (43.5%) described 1 or more health equity considerations. Guidelines made recommendations for assessing and managing agitation (n = 12), aggression (n = 10), psychosis (n = 11), depression (n = 9), anxiety (n = 5), apathy (n = 6), inappropriate sexual behavior (n = 3), nighttime behavior (n = 5), and eating disturbances (n = 3). There was substantial variability in recommendation statements, evidence quality assigned to each statement, and strength of recommendations. CONCLUSIONS AND IMPLICATIONS There are several moderate to high-quality clinical practice guidelines making recommendations on BPSD assessment and management, but variability in recommendation statements across guidelines and insufficient consideration of guideline applicability may hamper guideline dissemination and implementation in clinical practice.
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Affiliation(s)
- Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Jennifer Porter
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pattara Tavilsup
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mohammad Chowdhury
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stacey Hatch
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kirkham
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dallas Seitz
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Gibson C, Goeman D, Yates M, Pond D. Best-practice recommendations to inform general practice nurses in the provision of dementia care: a Delphi study. Aust J Prim Health 2023; 29:643-649. [PMID: 37345268 DOI: 10.1071/py22276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Worldwide, responsibility for dementia diagnosis and management is shifting to primary care, in particular to the general practitioner (GP). It has been acknowledged that primary care nurses, working collaboratively with GPs, have a role in dementia care by utilising their unique knowledge and skills. However, there are no best-practice guidelines or care pathways to inform nurses in general practice on what best-practice dementia care comprises and how to implement this into their practice. This study identified the recommendations in the Australian guidelines for dementia management most relevant to the role of the nurse working in general practice. METHODS Seventeen experts active in clinical practice and/or research in primary care nursing in general practice participated in an online three-round Delphi study. RESULTS All 17 participants were female with a nursing qualification and experienced in general practice clinical nursing and/or general practice nursing research. Five recommendations were identified as the most relevant to the role of the nurse in general practice. These recommendations all contained elements of person-centred care: the delivery of individualised information, ongoing support, including the carer in decision-making, and they also align with the areas where GPs want support in dementia care provision. CONCLUSION This novel study identified best-practice dementia care recommendations specific to nurses in general practice. These recommendations will inform a model of care for nurses in the provision of dementia care that supports GPs and better meets the needs of people living with dementia and their carer(s).
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Affiliation(s)
- Caroline Gibson
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; and Grampians Health, Ballarat, Vic. 3350, Australia
| | - Dianne Goeman
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; and Central Clinical School, Monash University, The Alfred Centre, Melbourne, Vic. 3004, Australia
| | - Mark Yates
- Grampians Health, Ballarat, Vic. 3350, Australia; and Deakin University School of Medicine, Ballarat Clinical School, Ballarat, Vic. 3350, Australia
| | - Dimity Pond
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
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Non-pharmacological, psychosocial MAKS-s intervention for people with severe dementia in nursing homes: results of a cluster-randomised trial. BMC Geriatr 2022; 22:1001. [PMID: 36577973 PMCID: PMC9795142 DOI: 10.1186/s12877-022-03695-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Severe dementia is one of the most challenging conditions when caring for people in nursing homes. A manualised non-pharmacological, psychosocial group intervention especially adapted to the needs of people with severe dementia (PWSDs) is currently still lacking. To close this gap, we adapted the evidence-based multicomponent non-pharmacological MAKS intervention (Motor stimulation, ADL stimulation, Cognitive [german: Kognitive] stimulation, and Social functioning in a group setting) to the special needs of PWSDs called the MAKS-s intervention, where the s stands for severe dementia. METHODS In a prospective, multicentre, cluster-randomised trial with a waitlist control group design, 26 nursing homes comprising 152 PWSDs were randomly assigned to either the MAKS-s intervention group (IG) or control group (CG) - 121 PWSDs were still alive after the 6-month intervention period (t6) and included in the intention-to-treat (ITT) sample. The two primary outcomes, behavioural and psychological symptoms (BPSDs, measured with NPI-NH) and quality of life (QoL, measured with QUALIDEM), and the secondary outcome, activities of daily living (ADLs, measured with ADCS-ADL-sev), were assessed at baseline (t0) and at t6. Mixed ANOVAs were computed to investigate possible effects of the MAKS-s intervention on the outcomes. RESULTS In the ITT sample, BPSDs and QoL did not change significantly over time, and group assignment did not affect them, although the IG participants had significantly better overall QoL than the CG participants. ADLs decreased significantly over time, but group assignment did not affect them. Analyses in the per protocol (PP) sample showed comparable results, with the exception that the IG participants showed a significantly greater increase in BPSDs than the CG participants did. DISCUSSION Under the situational conditions of the Covid-19 pandemic, no beneficial effects of the MAKS-s intervention on BPSDs, QoL, or ADLs were observed. This finding also means that under 'normal circumstances' (i.e., if there had been no pandemic), we could not make any statements about the effect or non-effect of MAKS-s. In order to be able to address the hypotheses formulated here, the study will have to be repeated incorporating helpful experiences of the present study. TRIAL REGISTRATION https://doi.org/10.1186/ISRCTN15722923 (Registered prospectively, 07. August 2019).
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Roheger M, Xu H, Hoang MT, Eriksdotter M, Garcia-Ptacek S. Conversion Between the Mini-Mental State Examination and the Montreal Cognitive Assessment for Patients With Different Forms of Dementia. J Am Med Dir Assoc 2022; 23:1986-1989.e1. [PMID: 35561758 DOI: 10.1016/j.jamda.2022.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/04/2022] [Accepted: 03/26/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The Mini-Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are 2 frequently used brief cognitive screening tasks. Here, we provide a conversion method from MMSE to MoCA for patients with Alzheimer's dementia, frontotemporal dementia, and Parkinson dementia/Lewy body dementia, as well as for patients with dementia and with or without previous stroke. This conversion is needed as everyday clinical practice varies in their use of the 2 scales, which makes comparisons between studies, meta-analysis, and patient cohorts difficult. DESIGN Observational cohort study. SETTING AND PARTICIPANTS A total of 387 patients with recently diagnosed dementia in memory clinics from the Swedish registry for cognitive/dementia disorders (SveDem) from 2007 to 2018. METHODS Overall, 387 patients of the Swedish registry for cognitive/dementia disorders with both MMSE and MoCA scores were evaluated. An equipercentile equating method was used to convert MMSE to MoCA scores in the different patient populations. Furthermore, receiver operating curves were used to examine whether MMSE or MoCA scores can distinguish between patients with different dementia types. RESULTS MMSE scores were converted to MoCA scores for all dementia types and depicted in a conversion table. Results show that the equipercentile equating method and log-linear smoothing allow the creation of a conversion table in which for each test score of the MMSE, the equivalent score of the MoCA for each investigated group can be looked up (and vice-versa). CONCLUSIONS AND IMPLICATIONS This study reports a reliable and easy conversion for transforming MMSE to MoCA scores (and vice-versa) in patients with Alzheimer's dementia, frontotemporal dementia, Parkinson dementia or Lewy body dementia, as well as patients with dementia with and without previous stroke.
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Affiliation(s)
- Mandy Roheger
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden.
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Chan AHY, Hikaka JA, To E, Cullum S, Ma'u E, Ryan B, Rivera-Rodriguez C, Cheung G. Anti-dementia medication use in Aotearoa New Zealand: An exploratory study using health data from the Integrated Data Infrastructure (IDI). Aust N Z J Psychiatry 2022; 57:895-903. [PMID: 36053008 DOI: 10.1177/00048674221121091] [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: 11/15/2022]
Abstract
OBJECTIVE Anti-dementia medications such as acetylcholinesterase inhibitors are an important part of the management pathway for dementia. However, there are limited data in New Zealand that have examined the rates and patterns of use of funded anti-dementia medication and how use differs with ethnicity, age and sex. METHODS This was a retrospective population-based descriptive study. Using the Integrated Data Infrastructure, we identified individuals of all ages coded for a diagnosis of dementia and estimated the proportion dispensed funded anti-dementia medication - donepezil tablets and rivastigmine patches - between 1 July 2016 and 30 June 2020. Rates of medication use in five main ethnic groups (Māori, Pacific peoples, Asian, European, and Middle Eastern, Latin American and African) in the <65, 65-79 and 80 and over (80+) age groups were compared and also between males and females in all sub-groups. Log-binomial models were used to calculate relative risks to determine any differences in anti-dementia medication use in the five ethnic groups and the three age groups and between males and females in each of the four study years. RESULTS Overall, one-third of the dementia population received a funded anti-dementia medication in the total population (all ages) between 2016 and 2020. Donepezil tablets were dispensed in 31.6-34.0% and rivastigmine patches in 1.4-2.1% across the four study years. Compared to people of European ethnicity, Māori, Pacific peoples, and Middle Eastern, Latin American and African groups were less likely to be dispensed an anti-dementia medication (Māori: relative risk = 0.79-0.81, p < 0.0001; Pacific peoples: relative risk = 0.72-0.74, p < 0.0001; Middle Eastern, Latin American and African: relative risk = 0.73-0.78, p < 0.05). Compared to the age 80+ group, the 65-79 age group was more likely (relative risk = 1.50-1.54, p < 0.0001), while the age <65 group was less likely (relative risk = 0.67-0.71, p < 0.0001) to be dispensed an anti-dementia medication. There were no statistically significant differences in anti-dementia medication use between males and females. CONCLUSION This study provides important information about funded anti-dementia medication use in New Zealand and how this differs by ethnicity, age and sex. Despite higher dementia prevalence in Māori and Pacific peoples, these groups were less likely to receive funded anti-dementia medication.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jo Anna Hikaka
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Edith To
- Department of Statistics, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Etuini Ma'u
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Brigid Ryan
- Department of Anatomy and Medical Imaging, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Polypharmacy in Treatment of Behavioral Issues in Dementia—Use of Atypical Antipsychotics. Clin Geriatr Med 2022; 38:641-652. [DOI: 10.1016/j.cger.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nowroozpoor A, Dussetschleger J, Perry W, Sano M, Aloysi A, Belleville M, Brackett A, Hirshon JM, Hung W, Moccia JM, Ohuabunwa U, Shah MN, Hwang U. Detecting Cognitive Impairment and Dementia in the Emergency Department: A Scoping Review. J Am Med Dir Assoc 2022; 23:1314.e31-1314.e88. [PMID: 35940682 PMCID: PMC10804640 DOI: 10.1016/j.jamda.2022.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED). DESIGN Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners. SETTING AND PARTICIPANTS Scoping reviews focused on adult ED patients. METHODS Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and abstracted for relevant information and presented at the stakeholder consensus conference for discussion and ranked prioritization. RESULTS We identified a total of 1464 publications and included 45 to review for accurate tools and approaches for detecting cognitive impairment and dementia. Twenty-seven different assessments and instruments have been studied in the ED setting to evaluate cognitive impairment and dementia, with many focusing on sensitivity and specificity of instruments to screen for cognitive impairment. For pragmatic tools, we identified a total of 2166 publications and included 66 in the review. Most extensively studied tools included the Ottawa 3DY and Six-Item Screener (SIS). The SIS was the shortest to administer (1 minute). Instruments with the highest negative predictive value were the SIS (vs MMSE) and the 4 A's Test (vs expert diagnosis). The GEAR 2.0 Advancing Dementia Care Consensus conference ranked research priorities that included the need for more approaches to recognize more effectively and efficiently persons who may be at risk for cognitive impairment and dementia, while balancing the importance of equitable screening, purpose, and consequences of differentiating various forms of cognitive impairment. CONCLUSIONS AND IMPLICATIONS The scoping review and consensus process identified gaps in clinical care that should be prioritized for research efforts to detect cognitive impairment and dementia in the ED setting. These gaps will be addressed as future GEAR 2.0 research funding priorities.
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Affiliation(s)
- Armin Nowroozpoor
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jeff Dussetschleger
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - William Perry
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Mary Sano
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Research and Development, James J. Peters VAMC, Bronx, NY, USA
| | - Amy Aloysi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Hung
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
| | | | - Ugochi Ohuabunwa
- Division of General Medicine and Geriatrics, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Manish N Shah
- Berbee Walsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine (Geriatrics and Gerontology), University of Wisconsin-Madison, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.
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Sugiura A, Onoguchi M, Shibutani T, Kouno Y. Influence of minimum counts in brain perfusion SPECT: phantom and clinical studies. J Nucl Med Technol 2022; 50:jnmt.122.264058. [PMID: 35772965 DOI: 10.2967/jnmt.122.264058] [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: 02/23/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
The counts per pixel of brain perfusion single photon emission computed tomography (SPECT) images depend on the administration dose, acquisition time or patient condition, and they sometimes become poor acquisition counts in daily clinical study. The aim of this study was to evaluate the effect of different acquisition counts on qualitative images and statistical imaging analysis and to determine the minimum acquisition counts necessary for accurate examinations. Methods: We performed a brain phantom experiment simulating normal accumulation of 99mTc -ethyl-cysteinate dimer (99mTc-ECD) as a brain uptake of 5.5 %. The SPECT data were acquired in a continuous repetitive rotation. Ten types of SPECT images with different acquisition counts were created by varying the addition of the number of rotations. We used the normalized mean squared error (NMSE) and visual analysis. For the clinical study, we used 25 patients acquired in a continuous repetitive rotation, and created six brain images with different acquisition counts by varying the number of rotations added from 1 to 6. The contrast-to-noise ratio (CNR) was calculated from the mean counts with ROIs in gray and white matter. In addition, the severity, extent and ratio of disease-specific regions were evaluated as indices of statistical imaging analysis. Results: For the phantom study, the curve of NMSE showed a tendency of convergence from approximately 23.6 counts/pixel. Furthermore, the visual score showed that images with 23.6 counts/pixel or more were barely diagnosable. For the clinical study, the CNR was significantly decreased at 11.5 counts/pixel or less. Severity and extent tended to increase with decreasing acquisition counts, and a significant increase was shown at 5.9 counts/pixel. On the other hand, there was no significant difference in ratio values among defferent acquisition counts. Conclusion: Based on comprehensive assessment of phantom and clinical studies, we suggested that 23.6 counts/pixel or more were necessary to keep image quality of qualitative images and to accurately calculate indices of statistical imaging analysis.
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Rapid cognitive assessment tools for screening of mild cognitive impairment in the preoperative setting: A systematic review and meta-analysis. J Clin Anesth 2022; 78:110682. [DOI: 10.1016/j.jclinane.2022.110682] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 12/29/2022]
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O’Sullivan JL, Schweighart R, Lech S, Kessler EM, Tegeler C, Teti A, Nordheim J, Gellert P. Concordance of self- and informant-rated depressive symptoms in nursing home residents with Dementia: cross-sectional findings. BMC Psychiatry 2022; 22:241. [PMID: 35382790 PMCID: PMC8981933 DOI: 10.1186/s12888-022-03876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia. METHODS Cross-sectional data was collected from N = 162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the depression and anxiety items of the Neuropsychiatric Inventory were used for informant-ratings. Cohen's Kappa was calculated to determine the concordance of both measures and of each with antidepressant medication. Multivariate associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with linear mixed models and generalized estimating equations. RESULTS Concordance between self- and single item informant-rated depressive symptoms was minimal (Cohen's Kappa = .22, p = .02). No concordance was found for self-reported depressive symptoms and the combined informant-rated depression-anxiety score. Self-reported depression was negatively associated with self-rated quality of life (β = -.32; 95%CI: -.45 to -.19, p < .001), informant-rated quality of life (β = -.25; 95%CI: -.43 to -.07, p = .005) and functional status (β = -.16; 95%CI: -.32 to -.01, p = .04), whilst single item informant-rated depression revealed negative associations with informant-rated quality of life (β = -.32; 95%CI: -.52 to -.13, p = .001) and dementia stage (β = -.31; 95%CI: -.52 to -.10, p = .004). The combined informant-rated depression-anxiety score showed negative associations with self-rated quality of life (β = -.12; 95%CI: -.22 to -.03, p = .01) and dementia stage (β = -.37; 95%CI: -.67 to -.07, p = .02) and a positive association with neuropsychiatric symptoms (β = .30; 95%CI: .10 to .51, p = .004). No concordance was found with antidepressant medication. CONCLUSIONS In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. TRIAL REGISTRATION The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160 ).
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Affiliation(s)
- Julie L. O’Sullivan
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Roxana Schweighart
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Sonia Lech
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany ,grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Eva-Marie Kessler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Christina Tegeler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Andrea Teti
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Johanna Nordheim
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Analysis of treatment pattern of anti-dementia medications in newly diagnosed Alzheimer's dementia using OMOP CDM. Sci Rep 2022; 12:4451. [PMID: 35292697 PMCID: PMC8924152 DOI: 10.1038/s41598-022-08595-1] [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: 11/14/2021] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
Anti-dementia medications are widely prescribed to patients with Alzheimer's dementia (AD) in South Korea. This study investigated the pattern of medical management in newly diagnosed patients with AD using a standardized data format-the Observational Medical Outcome Partnership Common Data Model from five hospitals. We examined the anti-dementia treatment patterns from datasets that comprise > 5 million patients during 2009-2019. The medication utility information was analyzed with respect to treatment trends and persistence across 11 years. Among the 8653 patients with newly diagnosed AD, donepezil was the most commonly prescribed anti-dementia medication (4218; 48.75%), followed by memantine (1565; 18.09%), rivastigmine (1777; 8.98%), and galantamine (494; 5.71%). The rising prescription trend during observation period was found only with donepezil. The treatment pathways for the three cholinesterase inhibitors combined with N-methyl-D-aspartate receptor antagonist were different according to the drugs (19.6%; donepezil; 28.1%; rivastigmine, and 17.2%; galantamine). A 12-month persistence analysis showed values of approximately 50% for donepezil and memantine and approximately 40% for rivastigmine and galantamine. There were differences in the prescribing pattern and persistence among anti-dementia medications from database using the Observational Medical Outcome Partnership Common Data Model on the Federated E-health Big Data for Evidence Renovation Network platform in Korea.
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Gao W, Zhang T, Wang H, Wang S, Liu Y, Pang X. Supporting caregivers of people with dementia: A systematic review of guidelines. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e305-e324. [PMID: 34750910 DOI: 10.1111/hsc.13513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
Caregivers of people with dementia (PwD) frequently experience poor physical, mental and social health. Over the past decade, several guidelines have offered recommendations on supporting caregivers to improve their health outcomes. This systematic review aimed to assess the quality and evidence base of guidelines on supporting caregivers of PwD and review the content of their recommendations on caregiver support to facilitate the adoption and implementation of a specific guideline among policymakers and practitioners. A systematic search for guidelines on supporting caregivers of PwD was performed using journal databases, websites of guideline development organisations and professional dementia-related societies from inception to 30 June 2020. Four independent reviewers performed the quality assessment of the included guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. A thematic synthesis was used to analyse the content of recommendations on caregiver support extracted from the included guidelines by two independent reviewers. The strength of recommendations and level of evidence were reclassified and analysed. Literature searches identified nine guidelines. Their quality was variable. The applicability domain on AGREE II yielded the lowest median score (62.2%; range: 18.6%-86.6%), suggesting that some guidelines lacked applicability in certain fields, leaving them open to interpretation. Most evidence underlying the extracted recommendations was rated as Levels 3 (51.3%) and 4 (31.1%). High-quality evidence is required to fortify these recommendations. The nine guidelines covered six themes-assessment, education, skill training, information provision, psychosocial support and general support policies-which can guide future policies and interventions of caregiver support. The recommendations extracted were consistent across guidelines, but each guideline failed to cover all six themes. Thus, more applicable and comprehensive guidelines that fully address all themes of support for caregivers of PwD are needed.
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Affiliation(s)
- Weijie Gao
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tieling Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongyun Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shanshan Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuling Liu
- Community Health Service Centers of Jieyuan Dao, Tianjin, China
| | - Xiaoli Pang
- Office of Academic Studies, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Koch J, Amos JG, Beattie E, Lautenschlager NT, Doyle C, Anstey KJ, Mortby ME. Non-pharmacological interventions for neuropsychiatric symptoms of dementia in residential aged care settings: An umbrella review. Int J Nurs Stud 2022; 128:104187. [DOI: 10.1016/j.ijnurstu.2022.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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James T, Mukadam N, Sommerlad A, Pour HR, Knowles M, Azocar I, Livingston G. Protection against discrimination in national dementia guideline recommendations: A systematic review. PLoS Med 2022; 19:e1003860. [PMID: 35015760 PMCID: PMC8752020 DOI: 10.1371/journal.pmed.1003860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND National dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. METHODS AND FINDINGS We searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country's official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded. CONCLUSIONS National guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world's countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services.
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Affiliation(s)
- Tiffeny James
- Division of Psychiatry, University College London, London, United Kingdom
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, United Kingdom
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Melanie Knowles
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Ignacia Azocar
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
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Fan F, Liu H, Shi X, Ai Y, Liu Q, Cheng Y. The Efficacy and Safety of Alzheimer's Disease Therapies: An Updated Umbrella Review. J Alzheimers Dis 2021; 85:1195-1204. [PMID: 34924395 DOI: 10.3233/jad-215423] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Evidence summaries for efficacy and safety of frequently employed treatments of Alzheimer's disease (AD) are sparse. OBJECTIVE We aimed to perform an updated umbrella review to identify an efficacious and safe treatment for AD patients. METHODS We conducted a search for meta-analyses and systematic reviews on the Embase, PubMed, The Cochrane Library, and Web of Science to address this knowledge gap. We examined the cognitive functions, behavioral symptoms, global clinical assessment, and Activities of Daily Living as efficacy endpoints, and the incidence of adverse events as safety profiles. RESULTS Sixteen eligible papers including 149 studies were included in the umbrella review. The results showed that AChE inhibitors (donepezil, galantamine, rivastigmine, Huperzine A), Ginkgo biloba, and cerebrolysin appear to be beneficial for cognitive, global performances, and activities of daily living in patients with AD. Furthermore, anti-Aβ agents are unlikely to have an important effect on slowing cognitive or functional impairment in mild to moderate AD. CONCLUSION Our study demonstrated that AChE inhibitors, Ginkgo biloba, and cerebrolysin are the optimum cognitive and activities of daily living medication for patients with AD.
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Affiliation(s)
- Fangcheng Fan
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Hua Liu
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Xiaojie Shi
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Yangwen Ai
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Qingshan Liu
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China
| | - Yong Cheng
- Key Laboratory of Ethnomedicine of Ministry of Education, Center on Translational Neuroscience, School of Pharmacy, Minzu University of China, Beijing, China.,College of Life and Environmental Sciences, Minzu University of China, Beijing, China
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Armstrong MJ. Advances in dementia with Lewy bodies. Ther Adv Neurol Disord 2021; 14:17562864211057666. [PMID: 34840608 PMCID: PMC8613883 DOI: 10.1177/17562864211057666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is a clinical diagnosis representing a specific presentation of a pathological α-synucleinopathy (Lewy body disease). DLB is one entity under the broader term Lewy body dementia, which also includes Parkinson’s disease dementia. Recent advances in DLB include publication of updated diagnostic criteria and recognition of prodromal DLB states, including mild cognitive impairment, delirium-onset, and psychiatric-onset forms. Research criteria for the mild cognitive impairment form of DLB were published in 2020. Increasing research shows that concomitant Alzheimer’s disease pathology in individuals with DLB is common in addition to the α-synucleinopathy pathology. This has implications for biomarker use and expected progression. Identifying biomarkers for DLB is an area of active research. Cerebrospinal fluid and skin biopsy tests are now commercially available in the United States, but their role in routine clinical care is not yet established. Additional research and biomarkers are needed. Research suggests that median survival after DLB diagnosis is 3–4 years, but there are rapidly and slowly progressive forms. Most individuals with DLB die of complications of the disease. Clinical trials for individuals with DLB have increased over the last 5 years, targeting both symptoms and underlying pathology. Effective therapies remain an unmet need, however. This review focuses on recent advances with an emphasis on literature that informs clinical care.
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Affiliation(s)
- Melissa J Armstrong
- Department of Neurology, College of Medicine, University of Florida, P.O. Box 100268, Gainesville, FL 32611, USA
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Validation of Four Methods for Converting Scores on the Montreal Cognitive Assessment to Scores on the Mini-Mental State Examination-2. Dement Neurocogn Disord 2021; 20:41-51. [PMID: 34795767 PMCID: PMC8585534 DOI: 10.12779/dnd.2021.20.4.41] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/29/2021] [Accepted: 08/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose There are many methods for converting scores from the Montreal Cognitive Assessment (MoCA) to those on the Mini-Mental State Examination (MMSE). In this study we aimed to validate 4 methods that convert the full score range (0–30 points) of the MoCA to an equivalent range for the MMSE. Methods We examined the medical records of 506 subjects who completed the MoCA and MMSE-second edition (MMSE-2) on the same day. For the validation index, we calculated mean, median, and root-mean-squared error (RMSE) of the difference between true and equivalent MMSE-2 scores. We also calculated intraclass correlation coefficients (ICCs), the Bland-Altman plot, and the generalizability coefficient between true and equivalent MMSE-2 scores for reliability. We compared the ICCs according to age, sex, education, MMSE, and cognitive-status subgroups. For accuracy, we evaluated a ±2 point difference between the true and equivalent MMSE-2 scores. Results The 4 conversion methods had a mean of −0.79 to −0.05, a median of −1 to 0, and an RMSE of 2.61–2.94 between true and equivalent MMSE-2 scores. All conversion methods had excellent reliability, with an ICC greater than 0.75 between true and equivalent MMSE-2 scores. These results were almost maintained in the subgroup analyses. These conversion methods provided more than 65% accuracy within ±2 points of the true MMSE-2 scores. Conclusions We suggest that these 4 conversion methods are applicable for converting MoCA scores to MMSE-2 scores. They will greatly enhance the usefulness of existing cognitive data in clinical and research settings.
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Thomas JM, Sezgin D. Effectiveness of reminiscence therapy in reducing agitation and depression and improving quality of life and cognition in long-term care residents with dementia: A systematic review and meta-analysis. Geriatr Nurs 2021; 42:1497-1506. [PMID: 34735996 DOI: 10.1016/j.gerinurse.2021.10.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 12/28/2022]
Abstract
This paper assesses the effectiveness of reminiscence therapy (RT) in people with mild to moderate dementia in long-term care facilities. A literature search was conducted in CINAHL, MEDLINE, PsychINFO, and Embase from inception to December 2020. Five RCTs with 267 participants were included; two were meta-analysed. Cochrane collaboration's risk of bias tool was used to evaluate the methodological quality of the included RCTs, and the risk of bias across studies was assessed using the GRADE method. The overall quality of evidence was moderate to low. Among the five trials, none measured the efficacy of RT on agitation. Reminiscence therapy was effective in reducing depression and improving autobiographical memory, but its effects were inconsistent. There was a significant improvement in quality of life (QoL) following RT. The meta-analysis showed no statistical significance on the pre-post intervention differences in depression (SMD -0.28, 95%CI -0.91-0.35, p > 0.05) and autobiographical memory scores (SMD 0.57, 95%CI -0.07-1.21, p > 0.05). Reminiscence therapy may have some benefits in reducing depression and improving the QoL and cognition in this population; however, its effectiveness should be tested further.
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Affiliation(s)
- Jeena Mary Thomas
- St. Josephs Care Centre, Longford, Ireland; School of Nursing and Midwifery, National University of Ireland, Galway, Aras Moyola, Newcastle Road, Galway, Ireland
| | - Duygu Sezgin
- School of Nursing and Midwifery, National University of Ireland, Galway, Aras Moyola, Newcastle Road, Galway, Ireland.
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Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies. Int Psychogeriatr 2021; 33:947-975. [PMID: 33190660 DOI: 10.1017/s1041610220001702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to identify the nature and effects of implementation strategies to increase the use of evidence-based, non-pharmacological interventions designed to reduce the frequency and/or severity of behavioral and psychological symptoms associated with dementia, for people living in the community. DESIGN This was a systematic review of implementation studies. We searched six databases (in January 2019) and hand-searched reference lists of reports. Studies were included if they used quantitative methods evaluating the use of implementation strategies to increase the use of non-pharmacological interventions. These interventions had to have been tested in a randomized controlled trial (RCT) and found to reduce behavioral and psychological symptoms of dementia, for those living in the community. Studies needed to report the effect of the implementation on clinical practice, for example, a change in practice or the adoption of the intervention in community settings. RESULTS Twelve studies were included: 11 one-group pre-post design studies and 1 cluster RCT. All studies reported practice change - the majority implementing a new intervention, with six different types of interventions implemented. All studies reported including using partnerships, new funding, educational strategies, and ongoing support and consultation. Seven implementation studies reported positive outcomes for clients on some aspect of behavior or depression for the person with dementia. CONCLUSIONS Implementation studies using multiple implementation strategies to increase the use of non-pharmacological interventions have demonstrated improvements in behavioral and psychological symptoms common in people with dementia, when provided by clinicians as part of their everyday work routines.
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Rao CB, Peatfield JC, McAdam KPWJ, Nunn AJ, Georgieva DP. A Focus on the Reminiscence Bump to Personalize Music Playlists for Dementia. J Multidiscip Healthc 2021; 14:2195-2204. [PMID: 34421303 PMCID: PMC8374316 DOI: 10.2147/jmdh.s312725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Music and memory are inextricably linked, and the recollection of music varies according to age. In order to create personalized music playlists tailored for people living with dementia, this study aimed to determine the age at which healthy individuals could best recall music that was popular at the time. Methods A survey was designed asking participants to identify the number of songs they recalled from a random selection of 10 from the 100 most popular songs from each year, presented in random order of years, from 1945 to 2015. Of the 311 individuals born between 1929 and 2002, who responded to the survey, 157 met the inclusion criteria. Results The median peak of recollection was between the ages of 13 and 19 across all age-cohorts, with participants recalling a maximum median number of 6–8 songs in all of the age-cohorts. There was no evidence of a difference in the peak age of recollection between those who recognized seven or more songs in at least 1 year and those who recognized fewer than seven songs in all years. Conclusion The peak of recollection of popular music occurs in the teenage years, regardless of era of birth. Music from this “reminiscence bump” provides a rich source of retained music that should be tapped when creating playlists of meaningful music for people living with dementia.
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Affiliation(s)
- Chirag B Rao
- UCL Medical School, University College London, London, UK
| | - John C Peatfield
- The Department of English Language and Literature, University College London, London, UK
| | | | - Andrew J Nunn
- Medical Research Council Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, UK
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Jan DL, Delfine D, Eileen VDP, Herlinde VE, Jan S, Birgitte S. The management of dementia by flemish GPs: it remains a difficult job. Acta Clin Belg 2021; 76:264-271. [PMID: 31996112 DOI: 10.1080/17843286.2020.1716462] [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: 10/25/2022]
Abstract
Objective: The following study examines how GPs in Flanders deal with dementia in terms of detection, diagnosis, care diagnosis and treatment.Methods: An online survey was sent out by mail to 5113 Flemish GP's. Data were collected in 2016. The results were processed in a univariate and multivariate analysis with SAS 9.4Results: 331 GPs completed the survey in full (response rate 6.47%). The results are representative of GPs of the Flemish Region in terms of distribution across the provinces and university of graduation. 82.78% use the MMSE and 5.44% the DSM criteria. A blood analysis was performed by 80.97%, aCT or MRI by 23.56% and 17,22% respectively. Nine out of 331 mapped out the full care planning. The Katz scale was used rarely or never by 25.38%. The physical condition of the caregivers was enquired about by 91.69% and their mental state by 96.92%. Acetylcholinesterase inhibitors were prescribed by 94.56%, memantine by 57.70%, ginkgo biloba by 49.85%. 89.73% prefers a medical approach for hallucinations and delusions, 65.26% for aggression, 50.78% for agitation, 71.30% for depression and 48.34% for sleep disorders. Older GPs felt their knowledge was insufficient and used more pharmacological treatments.Conclusion: GPs are unfamiliar with available detection and diagnostic possibilities. GPs include history taking of carers but underuse available support tools, biochemical analyses and imaging. Post diagnostic care is mapped out insufficiently, despite the fact that GPs focus adequately on their patients' caregivers. In the pharmacological treatment there is a notable discrepancy between what GPs think and do. Pharmacological policy in behavioural bymptoms is most common. GPs highly value the possibility of receiving support by reference physicians.
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Affiliation(s)
- De Lepeleire Jan
- Department General Practice, University Leuven, Belgium
- University Psychiatric Hospital KU Leuven (UPC), Belgium
| | - Despriet Delfine
- Department General Practice, Master Education Program, University Leuven, Belgium
| | - Van De Putte Eileen
- Department General Practice, Master Education Program, University Leuven, Belgium
| | - Van Eecke Herlinde
- Department General Practice, Master Education Program, University Leuven, Belgium
| | - Steyaert Jan
- Department of Sociology, Expertisecentrum Dementie, Antwerp, Belgium
- University Antwerp
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Reinhardt F, Scarmeas N, Karan R, Veldandi UK, Modali S, Duvvuri K, Pathan RK. Real-world Utilisation of the Rivastigmine Transdermal Patches Accompanying the use of Risk Minimisation Tools in Patients with Dementia. Curr Alzheimer Res 2021; 18:273-282. [PMID: 34279198 DOI: 10.2174/1567205018666210716120540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 01/14/2021] [Accepted: 03/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transdermal patches are convenient to use, especially in patients with Alzheimer's disease (AD)-associated dementia. However, various identified risks of errors in ad- ministering the patches cannot be disregarded. Patient Reminder Cards (PRCs, included a Medica- tion record sheet [MRS]) have been recently introduced as a risk minimisation tool to prevent incor- rect patch use (IU). OBJECTIVES This study aimed to assess the effectiveness of PRCs to prevent IU and to investigate the dose titration pattern of rivastigmine patches in a real-world setting. METHODS This multinational, observational, 11-month study included patients with AD currently using rivastigmine patches (4.6 mg/day, 9.5 mg/day, 13.3 mg/day) accompanied by a caregiver. Study outcomes were IU, including multiple patch use (MPU), incorrect patch placement, other IUs, perceived usefulness of the PRCs, and titration patterns of the patches. RESULTS Of the total 614 patients included, most were aged ≥65 years and had mild-to-moderate AD. Before and during the study, 27.7% and 18.0% of patients reported IU, respectively. Most pa- tients used MRS, and 73.5% rated it 'helpful' and reported lower rates of IU than those who report- ed it 'not helpful' (13.9%-16.5% vs. 20.2%). Overall, 141 patients had dose titrations, with 75.8% being up-titrated from 4.6 mg/day to 9.5 mg/day after a mean duration of 58 days. Safety findings were consistent with the established profile for the rivastigmine patch. CONCLUSION PRC was effective as a risk minimisation tool in limiting the inappropriate use of ri- vastigmine patches. The majority of patients requiring dose-change were up-titrated to 9.5 mg/day patches.
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Affiliation(s)
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens. Greece
| | - Rajesh Karan
- Global Program Clinical Head, Novartis Pharma AG. Switzerland
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Yang H, Yim D, Park MH. Converting from the Montreal Cognitive Assessment to the Mini-Mental State Examination-2. PLoS One 2021; 16:e0254055. [PMID: 34237113 PMCID: PMC8266092 DOI: 10.1371/journal.pone.0254055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination-2 (MMSE-2) are useful psychometric tests for cognitive screening. Many clinicians want to predict the MMSE-2 score based on the MoCA score. To facilitate the transition from the MoCA to the MMSE-2, this study developed a conversion method. METHODS This study retrospectively examined the relationship between the MoCA and MMSE-2. Overall, 303 participants were evaluated. We produced a conversion table using the equipercentile equating method with log-linear smoothing. Then, we evaluated the reliability and accuracy of this algorithm to convert the MoCA to the MMSE-2. RESULTS MoCA scores were converted to MMSE-2 scores according to a conversion table that achieved a reliability of 0.961 (intraclass correlation). The accuracy of this algorithm was 84.5% within 3 points difference from the raw score. CONCLUSIONS This study reports a reliable and easy conversion algorithm for transforming MoCA scores into converted MMSE-2 scores. This method will greatly enhance the utility of existing cognitive data in clinical and research settings.
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Affiliation(s)
- Hwabeen Yang
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Daehyuk Yim
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Moon Ho Park
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
- * E-mail:
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26
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A third of dying patients do not have end-of-life discussions with a physician: A nationwide registry study. Palliat Support Care 2021; 20:357-362. [PMID: 34158146 DOI: 10.1017/s1478951521000973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the study was to explore the proportion of adult patients and next-of-kin who had end-of-life (EOL) discussions and associated factors. METHOD A retrospective nationwide registry study was reported with data from the Swedish Register of Palliative Care. All patients in Sweden in hospitals, nursing homes, own homes, community, and palliative care units during 2015-2017 and their next-of-kin were included. Data were reported to the register by healthcare staff, based on diseased patients' records regarding their last days of life, and were voluntary. Descriptive statistics illustrated the proportion of patients/next-of-kin who had EOL discussions and logistic regressions were used to examine associated factors. RESULTS About half of the patients (46%) did have an EOL discussion, but a third (32%) did not. Associated factors of those who did not have an EOL discussion were dementia (48.5%) or stroke (47.5%), older age (38.4%), being female (33.6%), being cared for in a nursing home (41.3%), or hospital (40.3%), having lost decision-making ability months before death (58.9%), and not having a documented decision to shift to EOL care (82.7%). Younger patients diagnosed with cancer and cared for at a palliative unit were more likely to have EOL discussions. The regression analysis showed similar results for next-of-kin. SIGNIFICANCE OF RESULTS The result shows that not all patients with palliative care needs have equal access to EOL discussions, despite efforts at a national level and the recognized benefits of timely communication about the EOL care. Further efforts must be made to achieve EOL discussions for all patients.
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27
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Quail Z, Bolton L, Massey K. Digital delivery of non-pharmacological intervention programmes for people living with dementia during the COVID-19 pandemic. BMJ Case Rep 2021; 14:e242550. [PMID: 34140328 PMCID: PMC8212172 DOI: 10.1136/bcr-2021-242550] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 01/10/2023] Open
Abstract
The COVID-19 pandemic significantly impeded face-to-face health and social care delivery for people living with dementia and their carers. Interruption of meaningful activity engagement along with increased social isolation is known to be associated with loss of skills, increased loneliness, physical deterioration and decline in cognition and mood in people with dementia. To ensure continuity of care for people living with dementia, for whom multimodal, non-pharmacological intervention programmes were being provided, there was an urgent need to adopt a remote delivery model. Guidance on digitally delivered assessment and care specific to non-pharmacological interventions for dementia is lacking. Adoption of technology-enabled care for people with dementia requires overcoming barriers to technology use, adaptation of therapeutic guidelines, adaptation of communication methods and carer support. Despite these challenges, therapists successfully transitioned from in-person to digital delivery of therapeutic interventions with associated benefits of continued meaningful activity engagement discussed.
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Affiliation(s)
- Zara Quail
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
| | - Laura Bolton
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
| | - Karina Massey
- Care Visions Healthy Ageing, Care Visions Limited, Stirling, UK
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Moo LR, Martinez E, Padala K, Dunay MA, Scali RR, Chen S, Thielke SM. Unexpected Findings During Double-blind Discontinuation of Acetylcholinesterase Inhibitor Medications. Clin Ther 2021; 43:942-952. [PMID: 34127273 DOI: 10.1016/j.clinthera.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The long-term effects of acetylcholinesterase inhibitors (AChEIs) used in the treatment of patients with various types of dementia remain unclear, largely due to challenges in the study of their discontinuation. We present several unexpected results from a discontinuation trial that might merit further investigation. METHODS This double-blind, placebo-controlled study of the discontinuation of AChEI medications was conducted in 62 US veterans. Participants were randomized to receive continued treatment with their medication (sham-taper group) or to treatment discontinuation via tapering (real-taper group), over a period of 6 weeks. The primary end point was the patient's/family caregiver's decision to discontinue the study medication. FINDINGS The study was underpowered to detect a significant between-group difference in the primary end point, but examination of the discontinuation process generated several unexpected results: (1) recruitment proved extremely challenging for a variety of reasons, with <5% of potentially eligible participants enrolled; (2) all 3 patients with Parkinson disease-associated dementia showed a worsening of symptoms when they discontinued their AChEI medication, but they showed improvement after they restarted it; (3) changes in symptom-scale scores varied quite broadly across participants, regardless of treatment arm; (4) unusual effects were noted in the sham-taper arm; and (5) the only significant predictor of the decision to discontinue the study medication was a worsening in the caregiver's mood. IMPLICATIONS These findings argue for the use of caution in discontinuing AChEIs in patients with Parkinson disease-associated dementia, although there may be potential benefits of a "drug holiday." The findings also urge the consideration of distress on the part of the caregiver while making medication treatment decisions in dementia. Future research must address challenges with recruitment and symptom fluctuations. (Clin Ther. 2021;43:XXX-XXX) © 2021 Elsevier Inc.
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Affiliation(s)
- Lauren R Moo
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Bedford Healthcare System, Bedford, Massachusetts; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Erica Martinez
- Puget Sound Veterans Affairs Medical Center, Seattle, Washington.
| | - Kalpana Padala
- Geriatric Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Megan A Dunay
- Boise Veterans Affairs Medical Center, Boise, Idaho.
| | - Rachael R Scali
- The Department of Biomedical Sciences, Tufts University School of Medicine, Medford, Massachusetts.
| | - Sunny Chen
- Puget Sound Veterans Affairs Medical Center, Seattle, Washington.
| | - Stephen M Thielke
- Puget Sound Veterans Affairs Medical Center, Seattle, Washington; The Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
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Tini G, Cannatà A, Canepa M, Masci PG, Pardini M, Giacca M, Sinagra G, Marchionni N, Del Monte F, Udelson JE, Olivotto I. Is heart failure with preserved ejection fraction a 'dementia' of the heart? Heart Fail Rev 2021; 27:587-594. [PMID: 33907929 DOI: 10.1007/s10741-021-10114-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 01/09/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) remains an elusive entity, due to its heterogeneous clinical profile and an arbitrarily defined nosology. Several pathophysiological mechanisms recognized as central for the development of HFpEF appear to be in common with the process of physiological aging of the heart. Both conditions are characterized by progressive impairment in cardiac function, accompanied by left ventricular hypertrophy, diastolic dysfunction, sarcomeric, and metabolic abnormalities. The neurological paradigm of dementia-intended as a progressive, multifactorial organ damage with decline of functional reserve, eventually leading to irreversible dysfunction-is well suited to represent HFpEF. In such perspective, certain phenotypes of HFpEF may be viewed as a maladaptive response to environmental modifiers, causing premature and pathological aging of the heart. We here propose that the 'HFpEF syndrome' may reflect the interplay of adverse structural remodelling and erosion of functional reserve, mirroring the processes leading to dementia in the brain. The resulting conceptual framework may help advance our understanding of HFpEF and unravel potential therapeutical targets.
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Affiliation(s)
- Giacomo Tini
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy. .,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.
| | - Antonio Cannatà
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University of Trieste, Trieste, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Pier Giorgio Masci
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Mauro Giacca
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre, London, UK
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata Di Trieste, University of Trieste, Trieste, Italy
| | - Niccolò Marchionni
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Federica Del Monte
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - James E Udelson
- Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
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Brisson M, Brodeur C, Létourneau‐Guillon L, Masellis M, Stoessl J, Tamm A, Zukotynski K, Ismail Z, Gauthier S, Rosa‐Neto P, Soucy J. CCCDTD5: Clinical role of neuroimaging and liquid biomarkers in patients with cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 6:e12098. [PMID: 33532543 PMCID: PMC7821956 DOI: 10.1002/trc2.12098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 04/21/2023]
Abstract
Since 1989, four Canadian Consensus Conferences on the Diagnosis and Treatment of Dementia (CCCDTDs) have provided evidence-based dementia diagnostic and treatment guidelines for Canadian clinicians and researchers. We present the results from the Neuroimaging and Fluid Biomarkers Group of the 5th CCCDTD (CCCDTD5), which addressed topics chosen by the steering committee to reflect advances in the field and build on our previous guidelines. Recommendations on Imaging and Fluid Biomarker Use from this Conference cover a series of different fields. Prior structural imaging recommendations for both computerized tomography (CT) and magnetic resonance imaging (MRI) remain largely unchanged, but MRI is now more central to the evaluation than before, with suggested sequences described here. The use of visual rating scales for both atrophy and white matter anomalies is now included in our recommendations. Molecular imaging with [18F]-fluorodeoxyglucose ([18F]-FDG) Positron Emisson Tomography (PET) or [99mTc]-hexamethylpropyleneamine oxime/ethylene cysteinate dimer ([99mTc]-HMPAO/ECD) Single Photon Emission Tomography (SPECT), should now decidedly favor PET. The value of [18F]-FDG PET in the assessment of neurodegenerative conditions has been established with greater certainty since the previous conference, and it has now been recognized as a useful biomarker to establish the presence of neurodegeneration by a number of professional organizations around the world. Furthermore, the role of amyloid PET has been clarified and our recommendations follow those from other groups in multiple countries. SPECT with [123I]-ioflupane (DaTscanTM) is now included as a useful study in differentiating Alzheimer's disease (AD) from Lewy body disease. Finally, liquid biomarkers are in a rapid phase of development and, could lead to a revolution in the assessment AD and other neurodegenerative conditions at a reasonable cost. We hope these guidelines will be useful for clinicians, researchers, policy makers, and the lay public, to inform a current and evidence-based approach to the use of neuroimaging and liquid biomarkers in clinical dementia evaluation and management.
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Affiliation(s)
- Mélanie Brisson
- Centre hospitalier de l'université de QuébecQuebec CityCanada
| | | | | | | | - Jon Stoessl
- Vancouver Coastal Health, University of British‐ColumbiaVancouverCanada
| | | | | | - Zahinoor Ismail
- Department of Psychiatry, Hotchkiss Brain Institute and O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada
| | | | - Pedro Rosa‐Neto
- McGill Center for Studies in AgingCanada
- McConnell Brain Imaging Centre, Montreal Neurological InstituteMontrealCanada
| | - Jean‐Paul Soucy
- Centre hospitalier de l'université de MontréalMontrealCanada
- McConnell Brain Imaging Centre, Montreal Neurological InstituteMontrealCanada
- PERFORM Center, Concordia UniversityMontrealCanada
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Armstrong MJ, Irwin DJ, Leverenz JB, Gamez N, Taylor A, Galvin JE. Biomarker Use for Dementia With Lewy Body Diagnosis: Survey of US Experts. Alzheimer Dis Assoc Disord 2021; 35:55-61. [PMID: 33009039 PMCID: PMC7904569 DOI: 10.1097/wad.0000000000000414] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dementia with Lewy body (DLB) diagnostic criteria define "indicative" and "supportive" biomarkers, but clinical practice patterns are unknown. METHODS An anonymous survey querying clinical use of diagnostic tests/biomarkers was sent to 38 center of excellence investigators. The survey included "indicative" biomarkers (dopamine transporter scan, myocardial scintigraphy, polysomnography), "supportive" biomarkers [magnetic resonance imaging (MRI)], positron emission tomography, or single-photon emission computed tomography perfusion/metabolism scans, quantitative electroencephalography), and other diagnostic tests (neuropsychological testing, cerebrospinal fluid analysis, genetics). Responses were analyzed descriptively. RESULTS Of the 22 respondents (58%), all reported the capability to perform neuropsychological testing, MRI, polysomnography, dopamine transporter scans, positron emission tomography/single-photon emission computed tomography scans, and cerebrospinal fluid analysis; 96% could order genetic testing. Neuropsychological testing and MRI were the most commonly ordered tests. Diagnostic testing beyond MRI and neuropsychological testing was most helpful in the context of "possible" DLB and mild cognitive impairment and to assist with differential diagnosis. Myocardial scintigraphy and electroencephalograpy use were rare. CONCLUSIONS AND RELEVANCE Neuropsychological testing and MRI remain the most widely used diagnostic tests by DLB specialists. Other tests-particularly indicative biomarkers-are used only selectively. Research is needed to validate existing potential DLB biomarkers, develop new biomarkers, and investigate mechanisms to improve DLB diagnosis.
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Affiliation(s)
- Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, McKnight Brain Institute
| | | | - James B. Leverenz
- Cleveland Lou Ruvo Center for Brain Health – Neurological Institute, Cleveland Clinic
| | - Noheli Gamez
- Department of Neurology, University of Florida College of Medicine, McKnight Brain Institute
| | | | - James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine
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Koriath CAM, Kenny J, Ryan NS, Rohrer JD, Schott JM, Houlden H, Fox NC, Tabrizi SJ, Mead S. Genetic testing in dementia - utility and clinical strategies. Nat Rev Neurol 2021; 17:23-36. [PMID: 33168964 DOI: 10.1038/s41582-020-00416-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
Techniques for clinical genetic testing in dementia disorders have advanced rapidly but remain to be more widely implemented in practice. A positive genetic test offers a precise molecular diagnosis, can help members of an affected family to determine personal risk, provides a basis for reproductive choices and can offer options for clinical trials. The likelihood of identifying a specific genetic cause of dementia depends on the clinical condition, the age at onset and family history. Attempts to match phenotypes to single genes are mostly inadvisable owing to clinical overlap between the dementias, genetic heterogeneity, pleiotropy and concurrent mutations. Currently, the appropriate genetic test in most cases of dementia is a next-generation sequencing gene panel, though some conditions necessitate specific types of test such as repeat expansion testing. Whole-exome and whole-genome sequencing are becoming financially feasible but raise or exacerbate complex issues such as variants of uncertain significance, secondary findings and the potential for re-analysis in light of new information. However, the capacity for data analysis and counselling is already restricting the provision of genetic testing. Patients and their relatives need to be given reliable information to enable them to make informed choices about tests, treatments and data sharing; the ability of patients with dementia to make decisions must be considered when providing this information.
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Affiliation(s)
| | - Joanna Kenny
- South West Thames Regional Genetics Service, London, UK
| | - Natalie S Ryan
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Henry Houlden
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, London, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UK Dementia Research Institute, UCL Queen Square Institute of Neurology, London, UK
| | - Sarah J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Simon Mead
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, London, UK.
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Diehl K, Kratzer A, Graessel E. The MAKS-s study: multicomponent non-pharmacological intervention for people with severe dementia in inpatient care - study protocol of a randomised controlled trial. BMC Geriatr 2020; 20:405. [PMID: 33059610 PMCID: PMC7559466 DOI: 10.1186/s12877-020-01807-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/30/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nursing homes accommodate a large number of people with severe dementia. More than 80% of residents with dementia suffer from behavioural and psychological symptoms, that can have consequences on the perceived burden of the formal caregivers. Internationally, the number of studies on non-pharmacological interventions for people with severe dementia is very small. One way to reduce these symptoms is to meet the needs of people with severe dementia. The non-pharmacological group intervention MAKS-s, which we will investigate in this study, is intended to reduce the behavioural and psychological symptoms and to improve the quality of life of such people. Additionally, we will investigate the effects on the burden carried by formal caregivers. METHODS With the present study, we will investigate the effectiveness of a multicomponent non-pharmacological intervention for people with severe dementia living in nursing homes (primary target group). A power analysis indicated that 144 dementia participants should initially be included. In addition, a secondary target group (nursing home staff) will be examined with respect to their dementia-related stress experiences. The study will be conducted as a cluster randomised controlled trail in Germany with a 6-month intervention phase. The nursing homes in the waitlist control group will provide "care as usual." The primary endpoints of the study will be the behavioural and psychological symptoms of dementia and the quality of life of people with severe dementia. The total duration of the study will be 18 months. Data will be collected by using observer rating scales. DISCUSSION The project has some outstanding quality features. The external validity is high, because it is situated in a naturalistic setting in nursing homes and is being carried out with available nursing employees. Due to this fact, a permanent implementation also seems to be possible. Since the participating nursing homes are disseminated across several German federal states and rural and urban regions, the results should be transferable to the entire population. TRIAL REGISTRATION ISRCTN15722923 (Registration date: 07 August 2019).
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Affiliation(s)
- Kristina Diehl
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - André Kratzer
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Elmar Graessel
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
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Nguyen TA, Gilmartin-Thomas J, Tan ECK, Kalisch-Ellett L, Eshetie T, Gillam M, Reeve E. The Impact of Pharmacist Interventions on Quality Use of Medicines, Quality of Life, and Health Outcomes in People with Dementia and/or Cognitive Impairment: A Systematic Review. J Alzheimers Dis 2020; 71:83-96. [PMID: 31356204 DOI: 10.3233/jad-190162] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medication use in people with dementia and/or cognitive impairment (PWD/CI) is challenging. As medication experts, pharmacists have an important role in improving care of this vulnerable population. OBJECTIVE Systematically review evidence for the effectiveness of pharmacist-led interventions on quality use of medicines, quality of life, and health outcomes of PWD/CI. METHODS A systematic review was conducted using MEDLINE, EMBASE, PsycINFO, Allied and Complementary Medicine (AMED) and Cumulative index to Nursing and Allied Health Literature (CINAHL) databases from conception to 20 March 2017. Full articles published in English were included. Data were synthesized using a narrative approach. RESULTS Nine studies were eligible for inclusion. All studies were from high-income countries and assessed pharmacist-led medication management services. There was great variability in the content and focus of services described and outcomes reported. Pharmacists were found to provide a number of cognitive services including medication reconciliation, medication review, and medication adherence services. These services were generally effective with regards to improving quality use of medicines and health outcomes for PWD/CI and their caregivers, and for saving costs to the healthcare system. Pharmacist-led medication and dementia consultation services may also improve caregiver understanding of dementia and the different aspects of pharmacotherapy, thus improving medication adherence. CONCLUSION Emerging evidence suggests that pharmacist-led medication management services for PWD/CI may improve outcomes. Future research should confirm these findings using more robust study designs and explore additional roles that pharmacists could undertake in the pursuit of supporting PWD/CI.
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Affiliation(s)
- Tuan Anh Nguyen
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Health Strategy and Policy Institute, Ministry of Health of Vietnam
| | - Julia Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Parkville, Australia
| | - Edwin Chin Kang Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, NSW, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.,Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Tesfahun Eshetie
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Marianne Gillam
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Geriatric Medicine Research and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, NS, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Lin X, Wallis K, Ward SA, Brodaty H, Sachdev PS, Naismith SL, Krysinska K, McNeil J, Rowe CC, Ahern S. The protocol of a clinical quality registry for dementia and mild cognitive impairment (MCI): the Australian dementia network (ADNeT) Registry. BMC Geriatr 2020; 20:330. [PMID: 32894049 PMCID: PMC7487842 DOI: 10.1186/s12877-020-01741-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background Dementia was identified as a priority area for the development of a Clinical Quality Registry (CQR) in Australia in 2016. The Australian Dementia Network (ADNeT) Registry is being established as part of the ADNeT initiative, with the primary objective of collecting data to monitor and enhance the quality of care and patient outcomes for people diagnosed with either dementia or Mild Cognitive Impairment (MCI). A secondary aim is to facilitate the recruitment of participants into dementia research and trials. This paper describes the Registry protocol. Methods The ADNeT Registry is a prospective CQR of patients newly diagnosed with either dementia or MCI. Eligible patients will be identified initially from memory clinics and individual medical specialists (e.g., geriatricians, psychiatrists and neurologists) involved in the diagnosis of dementia. Participants will be recruited using either an opt-out approach or waiver of consent based on three key determinants (capacity, person responsible, and communication of diagnosis). Data will be collected from four sources: participating sites, registry participants, carers, and linkage with administrative datasets. It is anticipated that the Registry will recruit approximately 10,000 participants by the end of 2023. The ADNeT registry will be developed and implemented to comply with the national operating principles for CQRs and governed by the ADNeT Registry Steering Committee. Discussion The ADNeT Registry will provide important data on current clinical practice in the diagnosis, treatment and care of people with dementia and MCI in Australia as well as long-term outcomes among these people. These data will help to identify variations in clinical practice and patient outcomes and reasons underlying these variations, which in turn, will inform the development of interventions to improve care and outcomes for people with dementia and MCI.
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Affiliation(s)
- Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Karolina Krysinska
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.,Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
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Robinson L, Poole M, McLellan E, Lee R, Amador S, Bhattarai N, Bryant A, Coe D, Corbett A, Exley C, Goodman C, Gotts Z, Harrison-Dening K, Hill S, Howel D, Hrisos S, Hughes J, Kernohan A, Macdonald A, Mason H, Massey C, Neves S, Paes P, Rennie K, Rice S, Robinson T, Sampson E, Tucker S, Tzelis D, Vale L, Bamford C. Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.
Objective
The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.
Design
The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).
Setting
The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.
Results
Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.
Limitations
The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.
Conclusions
Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.
Future work
There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.
Trial registration
Current Controlled Trials ISRCTN21390601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Lee
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Coe
- North East and North Cumbria Local Clinical Research Network, Newcastle upon Tyne, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Goodman
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Zoe Gotts
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Hrisos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Massey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Faculty of Medical Sciences, Professional Services, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Chan YLE, Chen MH, Tsai SJ, Bai YM, Tsai CF, Cheng CM, Su TP, Chang WH, Chen TJ, Li CT. Treatment-Resistant depression enhances risks of dementia and alzheimer's disease: A nationwide longitudinal study. J Affect Disord 2020; 274:806-812. [PMID: 32664018 DOI: 10.1016/j.jad.2020.05.150] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/17/2020] [Accepted: 05/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous evidence indicates late-onset depression or depression with greater severity are associated with subsequent risk of dementia or Alzheimer's disease (AD). However, whether treatment-resistant depression is associated with such risks remain elusive. METHODS Using the Taiwan Nationwide Health Insurance Research Database, 3,345 patients with newly-diagnosed major depressive disorder (MDD) and 13,380 well-matched controls were enrolled between 2002 and 2004. MDD patients were stratified according to their treatment response to adequate antidepressant trials, and all participants were followed up until the end of 2013. Those who developed dementia and AD were identified. RESULTS MDD patients were more likely to develop dementia and AD than controls. Difficult-to-treat patients (i.e., DTT; those who failed to respond to at least two adequate antidepressant trials) had the highest risk of developing dementia (hazard ratio [HR] = 5.19) and AD (HR 4.44), whereas easy-to-treat patients (i.e., ETT-1; those who had no prescription of antidepressants) had the lowest risk of developing dementia (HR 2.37) and AD (HR 2.59) compared with controls. Subsequent analysis demonstrated that only among patients with late-onset depression (age > 65 years), DTT patients consistently showed higher risks and faster development of dementia (HR 6.64, mean: 1.45 yr) and AD (HR 4.97, mean: 1.67 yr) than did ETT-1 patients and controls. LIMITATIONS Subjects who have not received medical examination were not included as diagnosis were determined by ICD codes. Also, longer follow-up period might be needed for the younger group. CONCLUSIONS Late-onset treatment-resistant depression is associated with an elevated risk of dementia and AD.
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Affiliation(s)
- Yee-Lam E Chan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Ming Cheng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Yuanshan Branch, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Wen-Han Chang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan.
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38
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Möhler R, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in community settings. Cochrane Database Syst Rev 2020; 8:CD010515. [PMID: 32786083 PMCID: PMC8094398 DOI: 10.1002/14651858.cd010515.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND People with dementia living in the community, that is in their own homes, are often not engaged in meaningful activities. Activities tailored to their individual interests and preferences might be one approach to improve quality of life and reduce challenging behaviour. OBJECTIVES To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in the community and their caregivers. To describe the components of the interventions. To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 11 September 2019 using the terms: activity OR activities OR occupation* OR "psychosocial intervention" OR "non-pharmacological intervention" OR "personally-tailored" OR "individually-tailored" OR individual OR meaning OR involvement OR engagement OR occupational OR personhood OR "person-centred" OR identity OR Montessori OR community OR ambulatory OR "home care" OR "geriatric day hospital" OR "day care" OR "behavioural and psychological symptoms of dementia" OR "BPSD" OR "neuropsychiatric symptoms" OR "challenging behaviour" OR "quality of life" OR depression. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. SELECTION CRITERIA We included randomised controlled trials and quasi-experimental trials including a control group offering personally tailored activities. All interventions comprised an assessment of the participant's present or past interests in, or preferences for, particular activities for all participants as a basis for an individual activity plan. We did not include interventions offering a single activity (e.g. music or reminiscence) or activities that were not tailored to the individual's interests or preferences. Control groups received usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two review authors independently checked the articles for inclusion, extracted data, and assessed the methodological quality of all included studies. We assessed the risk of selection bias, performance bias, attrition bias, and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS We included five randomised controlled trials (four parallel-group studies and one cross-over study), in which a total of 262 participants completed the studies. The number of participants ranged from 30 to 160. The mean age of the participants ranged from 71 to 83 years, and mean Mini-Mental State Examination (MMSE) scores ranged from 11 to 24. One study enrolled predominantly male veterans; in the other studies the proportion of female participants ranged from 40% to 60%. Informal caregivers were mainly spouses. In four studies family caregivers were trained to deliver personally tailored activities based on an individual assessment of interests and preferences of the people with dementia, and in one study such activities were offered directly to the participants. The selection of activities was performed with different methods. Two studies compared personally tailored activities with an attention control group, and three studies with usual care. Duration of follow-up ranged from two weeks to four months. We found low-certainty evidence indicating that personally tailored activities may reduce challenging behaviour (standardised mean difference (SMD) -0.44, 95% confidence interval (CI) -0.77 to -0.10; I2 = 44%; 4 studies; 305 participants) and may slightly improve quality of life (based on the rating of family caregivers). For the secondary outcomes depression (two studies), affect (one study), passivity (one study), and engagement (two studies), we found low-certainty evidence that personally tailored activities may have little or no effect. We found low-certainty evidence that personally tailored activities may slightly improve caregiver distress (two studies) and may have little or no effect on caregiver burden (MD -0.62, 95% CI -3.08 to 1.83; I2 = 0%; 3 studies; 246 participants), caregivers' quality of life, and caregiver depression. None of the studies assessed adverse effects, and no information about adverse effects was reported in any study. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia living in the community may be one approach for reducing challenging behaviour and may also slightly improve the quality of life of people with dementia. Given the low certainty of the evidence, these results should be interpreted with caution. For depression and affect of people with dementia, as well as caregivers' quality of life and burden, we found no clear benefits of personally tailored activities.
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Affiliation(s)
- Ralph Möhler
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Anna Renom
- Department of Geriatrics, Parc de Salut Mar, Barcelona, Spain
| | - Helena Renom
- Physical Medicine and Rehabilitation (MFRHB), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Efficacy of Mealtime Interventions for Malnutrition and Oral Intake in Persons With Dementia: A Systematic Review. Alzheimer Dis Assoc Disord 2020; 34:366-379. [PMID: 32530831 DOI: 10.1097/wad.0000000000000387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malnutrition and weight loss are highly prevalent in persons with Alzheimer's disease and related dementias. Oral intake is an important interventional target for addressing these nutritional consequences. However, the efficacy of interventions remains poorly understood as prior syntheses have failed to examine the impact of intervention approaches on malnutrition and hypothesized mechanisms of action in persons with dementia. This review aimed to determine the efficacy of mealtime interventions to improve oral intake and nutritional outcomes in persons with dementia. Four databases yielded 1712 studies, resulting in 32 studies that met inclusion criteria. Studies included education, environmental modifications, feeding, oral supplementation, and other pharmacologic/ecopsychological interventions. While the majority of studies reported statistically significant improvements in at least 1 nutritional outcome, study design and outcome measures were heterogenous with many lacking adequate statistical power or blinding. Collectively, we found moderate evidence to suggest the efficacy of oral supplementation, and preliminary evidence to suggest that feeding interventions, education, and environmental modifications may confer improvements. Findings clarify the state of existing evidence regarding various interventional strategies for improving malnutrition in persons with dementia. While some approaches are promising, adequately powered and rigorously designed multidimensional intervention trials are needed to inform clinical decision-making in real-world contexts.
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40
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The role of the neuropsychologist in memory clinics. Neurol Sci 2020; 41:1483-1488. [PMID: 31950460 DOI: 10.1007/s10072-020-04253-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
International recommendations and guidelines on the diagnosis and management of cognitive impairment highlight the relevance of a multidimensional approach with increasing attention to well-established cognitive evaluations and interventions. Memory clinics represent a model that offers the expertise of several health specialties. This commentary aims at detailing the contribution of the neuropsychologist in this setting, and highlighting the need of implementing its presence in all the dedicated services. The neuropsychologist can offer an expertise that can be employed both in clinical routes and research, being able to synergistically interact with all the other health specialists involved in memory clinics. The role of the neuropsychologist in cognitive impairment diagnosis includes the development and the administration of comprehensive test batteries and the determination of both the degree of impairment and the cognitive profile, thus contributing to differential diagnoses. In the management of cognitive impairment, the neuropsychologist expertise can contribute in care planning and monitoring, in administering cognition-focused interventions, and in measuring treatment response. In cognitive impairment research, beyond the development and administration of test batteries, the neuropsychologist can contribute actively to the choice of cognitive study outcomes, data analysis, and results interpretation within an interdisciplinary framework. An overview of the actual weight of neuropsychologists in Italian memory clinics shows that, despite the presence of a psychologist in the team could be felt as an added value, several difficulties are still encountered in the integration of this figure as a permanent member. Efforts need to be made in this direction.
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Kamoga R, Rukundo GZ, Wakida EK, Nakidde G, Obua C, Buss SS. Dementia assessment and diagnostic practices of healthcare workers in rural southwestern Uganda: a cross-sectional qualitative study. BMC Health Serv Res 2019; 19:1005. [PMID: 31881885 PMCID: PMC6935120 DOI: 10.1186/s12913-019-4850-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/18/2019] [Indexed: 01/03/2023] Open
Abstract
Background An estimated 50 million people worldwide have Alzheimer’s disease and related dementias (ADRD), and this number is projected to increase with the growth of the aging population, with the largest growth occurring in low and middle-income countries. Diagnostic coverage for dementia is estimated to be only 5–10% in low- and middle-income countries. Timely diagnosis of ADRD could prompt early access to information, medical treatments, and support for caregivers. The aim of this study was to assess how healthcare workers in rural southwestern Uganda assess for and diagnose ADRD. Methods We used in-depth interviews to investigate the medical knowledge and clinical practices surrounding ADRD diagnoses among 42 healthcare workers employed at mid-tier health facilities in southwestern Uganda. Qualitative content analysis was used to identify distinct categories and themes. Results Our findings show that healthcare workers without specific mental health training assessed and diagnosed dementia based on history and physical examination alone. On the other hand, healthcare workers with some specialized training in mental health were more likely to use neuropsychological tests, blood tests, urine tests, and brain imaging in the diagnosis of dementia. Collateral history from caregivers was noted to be very important in proper assessment and diagnosis of dementia among all categories of healthcare workers. The majority of healthcare workers regarded memory loss as part of the normal aging process and reported that it does not need any specific treatment. Other healthcare workers could recognize signs and symptoms of dementia, but focused on managing other medical problems at the expense of assessing cognitive decline and mental health. Diagnostic practices did not differ based on age, years of experience, or gender of the healthcare workers. Conclusion These results indicate that specialized training in mental health among healthcare workers is crucial for the assessment and diagnosis of ADRD in rural southwestern Uganda.
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Affiliation(s)
- Ronald Kamoga
- Mbarara Alzheimer's and Related Dementias Research Initiative (MADRI) fellow, Department of Anatomy, Faculty of Medicine Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Godfrey Z Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Edith K Wakida
- Office of Research Administration, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Gladys Nakidde
- Department of Nursing, Faculty of Applied Science, Bishop Stuart University, P. O. Box 09, Mbarara, Uganda
| | - Celestino Obua
- Department of Pharmacology, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Stephanie S Buss
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Beishon LC, Batterham AP, Quinn TJ, Nelson CP, Panerai RB, Robinson T, Haunton VJ. Addenbrooke's Cognitive Examination III (ACE-III) and mini-ACE for the detection of dementia and mild cognitive impairment. Cochrane Database Syst Rev 2019; 12:CD013282. [PMID: 31846066 PMCID: PMC6916534 DOI: 10.1002/14651858.cd013282.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The number of new cases of dementia is projected to rise significantly over the next decade. Thus, there is a pressing need for accurate tools to detect cognitive impairment in routine clinical practice. The Addenbrooke's Cognitive Examination III (ACE-III), and the mini-ACE are brief, bedside cognitive screens that have previously reported good sensitivity and specificity. The quality and quantity of this evidence has not, however, been robustly investigated. OBJECTIVES To assess the diagnostic test accuracy of the ACE-III and mini-ACE for the detection of dementia, dementia sub-types, and mild cognitive impairment (MCI) at published thresholds in primary, secondary, and community care settings in patients presenting with, or at high risk of, cognitive decline. SEARCH METHODS We performed the search for this review on 13 February 2019. We searched MEDLINE (OvidSP), Embase (OvidSP), BIOSIS Previews (ISI Web of Knowledge), Web of Science Core Collection (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We applied no language or date restrictions to the electronic searches; and to maximise sensitivity we did not use methodological filters. The search yielded 5655 records, of which 2937 remained after we removed duplicates. We identified a further four articles through PubMed 'related articles'. We found no additional records through reference list citation searching, or grey literature. SELECTION CRITERIA Cross-sectional studies investigating the accuracy of the ACE-III or mini-ACE in patients presenting with, or at high risk of, cognitive decline were suitable for inclusion. We excluded case-control, delayed verification and longitudinal studies, and studies which investigated a secondary cause of dementia. We did not restrict studies by language; and we included those with pre-specified thresholds (88 and 82 for the ACE-III, and 21 or 25 for the mini-ACE). DATA COLLECTION AND ANALYSIS We extracted information on study and participant characteristics and used information on dementia and MCI prevalence, sensitivity, specificity, and sample size to generate 2×2 tables in Review Manager 5. We assessed methodological quality of included studies using the QUADAS-2 tool; and we assessed the quality of study reporting with the STARDdem tool. Due to significant heterogeneity in the included studies and an insufficient number of studies, we did not perform meta-analyses. MAIN RESULTS This review identified seven studies (1711 participants in total) of cross-sectional design, four examining the accuracy of the ACE-III, and three of the mini-ACE. Overall, the majority of studies were at low or unclear risk of bias and applicability on quality assessment. Studies were at high risk of bias for the index test (n = 4) and reference standard (n = 2). Study reporting was variable across the included studies. No studies investigated dementia sub-types. The ACE-III had variable sensitivity across thresholds and patient populations (range for dementia at 82 and 88: 82% to 97%, n = 2; range for MCI at 88: 75% to 77%, n = 2), but with more variability in specificity (range for dementia: 4% to 77%, n = 2; range for MCI: 89% to 92%, n = 2). Similarly, sensitivity of the mini-ACE was variable (range for dementia at 21 and 25: 70% to 99%, n = 3; range for MCI at 21 and 25: 64% to 95%, n = 3) but with more variability specificity (range for dementia: 32% to 100%, n = 3; range for MCI: 46% to 79%, n = 3). We identified no studies in primary care populations: four studies were conducted in outpatient clinics, one study in an in-patient setting, and in two studies the settings were unclear. AUTHORS' CONCLUSIONS There is insufficient information in terms of both quality and quantity to recommend the use of either the ACE-III or mini-ACE for the screening of dementia or MCI in patients presenting with, or at high risk of, cognitive decline. No studies were conducted in a primary care setting so the accuracy of the ACE-III and mini-ACE in this setting are not known. Lower thresholds (82 for the ACE-III, and 21 for the mini-ACE) provide better specificity with acceptable sensitivity and may provide better clinical utility. The ACE-III and mini-ACE should only be used to support the diagnosis as an adjunct to a full clinical assessment. Further research is needed to determine the utility of the ACE-III and mini-ACE for the detection of dementia, dementia sub-types, and MCI. Specifically, the optimal thresholds for detection need to be determined in a variety of settings (primary care, secondary care (inpatient and outpatient), and community services), prevalences, and languages.
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Affiliation(s)
- Lucy C Beishon
- University of LeicesterDepartment of Cardiovascular SciencesClinical Sciences BuildingLeicester Royal InfirmaryLeicesterUKLE2 7LX
| | - Angus P Batterham
- University of LeicesterLeicester Medical SchoolMaurice Shock Building, University RoadLeicesterUKLE1 7RH
| | - Terry J Quinn
- University of GlasgowInstitute of Cardiovascular and Medical SciencesNew Lister CampusGlasgow Royal InfirmaryGlasgowUKG4 0SF
| | - Christopher P Nelson
- University of LeicesterDepartment of Cardiovascular SciencesClinical Sciences BuildingLeicester Royal InfirmaryLeicesterUKLE2 7LX
| | - Ronney B Panerai
- University of LeicesterDepartment of Cardiovascular SciencesClinical Sciences BuildingLeicester Royal InfirmaryLeicesterUKLE2 7LX
| | - Thompson Robinson
- University of LeicesterDepartment of Cardiovascular SciencesClinical Sciences BuildingLeicester Royal InfirmaryLeicesterUKLE2 7LX
| | - Victoria J Haunton
- University of LeicesterDepartment of Cardiovascular SciencesClinical Sciences BuildingLeicester Royal InfirmaryLeicesterUKLE2 7LX
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Zhu L, Rochon PA, Gruneir A, Wu W, Giannakeas V, Austin PC, Stall NM, McCarthy L, Alberga A, Herrmann N, Gill SS, Bronskill SE. Sex Differences in the Prevalent Use of Oral Formulations of Cholinesterase Inhibitors in Older Adults with Dementia. Drugs Aging 2019; 36:875-884. [PMID: 31309528 DOI: 10.1007/s40266-019-00690-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cholinesterase inhibitors (ChEIs) are one of only two drug therapies available to manage cognitive decline in dementia. Given sex-specific differences in medication access and effects, it is important to understand how ChEIs are used by women and men. OBJECTIVE The objective of this study was to provide contemporary sex-stratified evidence on patterns of ChEI use by community-dwelling older adults with dementia to inform opportunities to optimize drug prescribing. METHODS We conducted a population-based cross-sectional study examining ChEI use in older adults with dementia in Ontario, Canada. We identified all community-dwelling individuals aged 66 years and older with a pre-existing diagnosis of dementia as of 1 April, 2016. We examined the prevalence of ChEI use among women and men separately, and explored the association between ChEI use and age, sex, income status, geographic location of residence, use of palliative care services, comorbidity, and polypharmacy. Concurrent use of drugs known to impair cognition (including antipsychotics, benzodiazepines, and medications with strong anticholinergic properties) was separately assessed among women and men using multivariable analyses and prevalence risk ratios. RESULTS Of 74,799 women and 52,231 men living with dementia in the community, nearly 30% currently were using a ChEI (29.3% women, 28.6% men). Close to 70% of users were receiving the target therapeutic dose. Compared to men, women were less often taking the target therapeutic dose (67.8% women vs. 71.6% men, p < 0.001). Over 20% of users also were using drugs known to impair cognition, while being treated for cognitive decline using ChEIs. Compared to men, women were more often concurrently using drugs known to impair cognition (23.9% women vs. 21.8% men, p < 0.001). CONCLUSIONS This is one of the first studies of ChEI use to account for important sex differences. The results remind clinicians and researchers that patterns of ChEI therapy use differ by sex, as women were less likely to receive target therapeutic doses and more vulnerable to potentially problematic polypharmacy than men.
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Affiliation(s)
- Lynn Zhu
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Paula A Rochon
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Department of Medicine, University of Toronto, Room 2109, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada.,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Andrea Gruneir
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Peter C Austin
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada.,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Nathan M Stall
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Department of Medicine, University of Toronto, Room 2109, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Lisa McCarthy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada
| | - Amanda Alberga
- ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Sudeep S Gill
- ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Medicine, Queen's University, Etherington Hall, Rooms 3032-3043, 94 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Susan E Bronskill
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada. .,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Jesse MT, Eshelman A, Christian T, Abouljoud M, Denny J, Patel A, Kim DY. Psychiatric Profile of Patients Currently Listed for Kidney Transplantation: Evidence of the Need for More Thorough Pretransplant Psychiatric Evaluations. Transplant Proc 2019; 51:3227-3233. [DOI: 10.1016/j.transproceed.2019.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022]
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Abstract
BACKGROUND The main objective of this study was to conduct a meta-analysis to identify the effects of reminiscence therapy in people with dementia (PWD). METHODS A systematic search of randomized controlled trials (RCTs) was conducted using bibliographic databases. A total of 157 original published studies were identified in the search, and 24 complete articles were included in the final review to check for the level of evidence. Two of the study authors independently assessed the quality of the included studies using the "Risk of Bias" (ROB) tool developed by the Cochrane Collaboration. Depression, quality of life, and behavioral and psychological symptoms of dementia (BPSD) were selected to measure the effect of reminiscence therapy. To determine the effects of reminiscence therapy on these variables, each individual study was analyzed using Comprehensive Meta-Analysis Software® (Biostat, Englewood, NJ, USA). RESULTS The overall effect size was presented using standardized mean differences (SMDs) and 95% confidence intervals. Cohen's d effect size for depression was -0.541 (95% CI: -0.847 to -0.234, Z = -3.730, p<0.001), indicating that depression was significantly reduced in the reminiscence group compared to the control group. Increased quality of life and decreased BPSD were also found in the reminiscence group compared to the control group. CONCLUSION Reminiscence therapy has a moderate effect on depression and can be broadly used to decrease depression as an alternative to antipsychotics, which can have harmful side effects and high cost.
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Oh ST, Han KT, Choi WJ, Park J. Effect of drug compliance on health care costs in newly-diagnosed dementia: Analysis of nationwide population-based data. J Psychiatr Res 2019; 118:31-37. [PMID: 31476707 DOI: 10.1016/j.jpsychires.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The cost-effectiveness of both cholinesterase inhibitors and memantine by delaying nursing home placement has been supported by numerous studies. The importance of sustained pharmacological treatment in dementia has been relatively less recognized by public health policies compared to early diagnosis. We investigated the effect of the drug (donepezil, rivastigmine, galantamine, and memantine) compliance on the health care costs in newly-diagnosed dementia. METHODS National Health Insurance Service (NHIS) database which covers the entire population of South Korea was used for analysis. Health care expenditure of patients newly-diagnosed with dementia in between 2012 and 2014 was investigated for 3-5 years. For drug compliance, we used Medication Possession Ratio (MPR) that indicates the percentage of time a patient has access to medication. Multivariate linear regression analysis including generalized estimated equation and gamma distribution was used for statistical analysis. RESULTS We identified 252,594 patients who were both prescribed with cognitive enhancers and newly diagnosed with dementia. When initial MPR increased 20%, total health care costs decreased 8.4% (RR = 0.916, 95%; CI 0.914 to 0.916). Same relationship was shown with medical costs related to dementia, admission to a general hospital, and emergency room visits. When MPR increased 20% compared to the previous year, the total health care costs, admission to a general hospital, emergency room visits, and admission to a nursing hospital decreased. CONCLUSIONS This population-based retrospective cohort study provides evidence that patients newly-diagnosed with dementia who showed higher initial drug compliance or maintained antidementia drugs (Cholinesterase inhibitors and memantine) would benefit in total health-care costs.
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Affiliation(s)
- Seung-Taek Oh
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, South Korea
| | - Kyu-Tae Han
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Won-Jung Choi
- Yonsei Hana Psychiatry Clinic and Institute of Mental Health, Goyang, South Korea
| | - Jaesub Park
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, South Korea.
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Thancharoen O, Limwattananon C, Waleekhachonloet O, Rattanachotphanit T, Limwattananon P, Limpawattana P. Ginkgo biloba Extract (EGb761), Cholinesterase Inhibitors, and Memantine for the Treatment of Mild-to-Moderate Alzheimer's Disease: A Network Meta-Analysis. Drugs Aging 2019; 36:435-452. [PMID: 30937879 DOI: 10.1007/s40266-019-00648-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Cholinesterase inhibitors (ChEIs) and memantine have been reported to provide modest benefits for cognition and aspects of functioning in Alzheimer's disease (AD). Ginkgo biloba extract (EGb761), a phytomedicine, is widely used and expected to be well-tolerated. A few trials have compared EGb761 with ChEIs, and the results were inconclusive. OBJECTIVE A network meta-analysis was conducted to evaluate the therapeutic benefits and tolerability of EGb761, three ChEIs (donepezil, galantamine, and rivastigmine), and memantine in mild-to-moderate AD patients. METHODS Electronic databases were searched through 30 June 2017. We included randomized double-blinded trials with a minimum treatment duration of 22 weeks for EGb761 240 mg/day and 12 weeks for ChEIs or memantine. The study patients included AD or probable AD patients without other types of dementia or neurological disorders. Cognition, function, and behavior symptoms were compared between treatments using the standardized mean difference (SMD). Clinical global impression, treatment discontinuation, and adverse events were compared between treatments using the relative risk (RR). Statistical pooling of the individual trial results was conducted using a frequentist approach. The probability of being the best for a treatment was estimated using surface under the cumulative ranking. RESULTS EGb761 and memantine showed no therapeutic benefits in all study outcomes. For cognition, all ChEIs were significantly better than placebo (SMD from - 0.52 to - 0.26), and galantamine was better than rivastigmine in the oral and patch forms, EGb761, and memantine (SMD [95% confidence interval (CI)]: - 0.22 [- 0.40 to - 0.05]; - 0.26 [- 0.45 to - 0.07]; - 0.34 [- 0.56 to - 0.12]; and - 0.42 [- 0.71 to - 0.13], respectively). Compared to placebo, galantamine, the rivastigmine patch, and oral rivastigmine provided modest functional benefits (SMD, from 0.21 to 0.24), and galantamine provided behavioral benefits (SMD [95% CI]: - 0.15 [- 0.26 to - 0.04]). All ChEIs provided a better improvement in clinical global impression than placebo (RR from 1.20 to 1.69). The global impression ratings were more improved with donepezil than with galantamine (RR [95% CI]: 1.40 [1.09-1.80]) or with EGb761 (RR [95% CI]: 1.40 [1.06-1.85]), with a 96% probability of donepezil being more effective than the other study agents. Rivastigmine in oral and patch forms, galantamine, and donepezil had a higher risk of being discontinued than placebo (RR [95% CI]: 2.14 [1.49-3.06]; 2.04 [1.30-3.20]; 1.79 [1.28-2.49]; 1.49 [1.03-2.17], respectively). Discontinuation of EGb761 was not statistically lower than that of the ChEIs, in which donepezil had the lowest probability (38%) of being discontinued. CONCLUSION EGb761 and memantine showed no treatment benefits compared to placebo and ChEIs. Galantamine provided the highest beneficial effect on cognition and behavioral symptoms. Donepezil provided a better clinical global impression and tolerability than the other ChEIs and EGb761, with a similar benefit for cognition as galantamine.
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Affiliation(s)
- Onnita Thancharoen
- Pharmacy and Health System Graduate Program, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Chulaporn Limwattananon
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, 123 Moo 16 Mittraphap Road, Muang District, Khon Kaen, 40002, Thailand.
| | - Onanong Waleekhachonloet
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Maha Sarakham, Thailand
| | | | | | - Panita Limpawattana
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Ries N, Mansfield E, Sanson-Fisher R. Planning Ahead for Dementia Research Participation: Insights from a Survey of Older Australians and Implications for Ethics, Law and Practice. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:415-429. [PMID: 31297689 DOI: 10.1007/s11673-019-09929-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Abstract
People with dementia have commonly been excluded from research. The adverse impacts of this exclusion are now being recognized and research literature, position statements, and ethics guidelines increasingly call for inclusion of people with dementia in research. However, few published studies investigate the views of potential participants on taking part in research should they experience dementia-related cognitive impairment. This cross-sectional survey examined the views of people aged sixty and older (n=174) attending hospital outpatient clinics about clinical research participation if they had dementia and impaired decision-making ability. Over 90 percent of respondents were agreeable to participating in a wide range of research activities, such as cognitive testing, physical measurements, imaging procedures, and blood draws. For drug studies, however, agreement dropped to 60 percent. Altruism was a strong motivator for research participation. In regard to who should be involved in decisions about their participation in research during periods of incapacity, respondents mostly preferred the person they appoint as their substitute decision-maker for healthcare matters (88%) or a doctor or health professional on the research team (78%). Over three-quarters (79%) expressed interest in making an advance research directive. The study findings are discussed in relation to law reforms in Australia that aim to strengthen respect and inclusion for people with impaired decision-making capacity, especially by providing frameworks for advance planning for research participation.
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Affiliation(s)
- Nola Ries
- Faculty of Law, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Elise Mansfield
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Sinnott C, Foley T, Horgan L, McLoughlin K, Sheehan C, Bradley C. Shifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment. BMJ Open 2019; 9:e024452. [PMID: 31439594 PMCID: PMC6707695 DOI: 10.1136/bmjopen-2018-024452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE General practitioners (GPs) report finding consultations on fitness to drive (FtD) in people with cognitive impairment difficult and potentially damaging to the physician-patient relationship. We aimed to explore GP and patient experiences to understand how the negative impacts associated with FtD consultations may be mitigated. METHODS Individual qualitative interviews were conducted with GPs (n=12) and patients/carers (n=6) in Ireland. We recruited a maximum variation sample of GPs using criteria of length of time qualified, practice location and practice size. Patients with cognitive impairment were recruited via driving assessment services and participating general practices. Interviews were audio-recorded, transcribed and analysed thematically by the multidisciplinary research team using an approach informed by the framework method. RESULTS The issue of FtD arose in consultations in two ways: introduced by GPs to proactively prepare patients for future driving cessation or by patients who urgently needed a medical report for an expiring driving license. The former strategy, implementable by GPs who had strong relational continuity with their patients, helped prevent crisis consultations from arising. The latter scenario became acrimonious if cognition had not been openly discussed with patients previously and was now potentially impacting on their right to drive. Patients called for greater clarity and empathy for the threat of driving cessation from their GPs. CONCLUSION GPs used their longitudinal relationship with cognitively impaired patients to reduce the potential for conflict in consultations on FtD. These efforts could be augmented by explicit discussion of cognitive impairment at an earlier stage for all affected patients. Patients would benefit from greater input into planning driving cessation and acknowledgement from their GPs of the impact this may have on their quality of life.
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Affiliation(s)
- Carol Sinnott
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Linda Horgan
- Department of Occupational Therapy, University College Cork, Cork, Ireland
| | | | - Cormac Sheehan
- Department of General Practice, University College Cork, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
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Hwang AB, Boes S, Nyffeler T, Schuepfer G. Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. PLoS One 2019; 14:e0219569. [PMID: 31344048 PMCID: PMC6657852 DOI: 10.1371/journal.pone.0219569] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION As the population ages, Alzheimer's disease and other subtypes of dementia are becoming increasingly prevalent. However, in recent years, diagnosis has often been delayed or not made at all. Thus, improving the rate of diagnosis has become an integral part of national dementia strategies. Although screening for dementia remains controversial, the case is strong for screening for dementia and other forms of cognitive impairment in hospital inpatients. For this reason, the objective of this systematic review was to provide clinicians, who wish to implement screening, an up-to-date choice of cognitive tests with the most extensive evidence base for the use in elective hospital inpatients. METHODS For this systematic review, PubMed, PsycINFO and Cochrane Library were searched by using a multi-concept search strategy. The databases were accessed on April 10, 2019. All cross-sectional studies that utilized brief, multi-domain cognitive tests as index test and a reference standard diagnosis of dementia or mild cognitive impairment as comparator were included. Only studies conducted in the hospital setting, sampling from unselected, elective inpatients older than 64 were considered. RESULTS Six studies met the inclusion criteria, with a total of 2112 participants. Diagnostic accuracy data for the Six-Item Cognitive Impairment Test, Cognitive Performance Scale, Clock-Drawing Test, Mini-Mental Status Examination, and Time & Change test were extracted and descriptively analyzed. Clinical and methodological heterogeneity between the studies precluded performing a meta-analysis. DISCUSSION This review found only a small number of instruments and was not able to recommend a single best instrument for use in a hospital setting. Although it was not possible to estimate the pooled operating characteristics, the included description of instrument characteristics, the descriptive analysis of performance measures, and the critical evaluation of the reporting studies may contribute to clinician's choice of the screening instrument that fits best their purpose.
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Affiliation(s)
- Aljoscha Benjamin Hwang
- Clinic for Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Thomas Nyffeler
- Clinic for Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Guido Schuepfer
- Staff Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
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