1
|
Håkansson T, Svensson H, Karlsson S. Living with a person with young onset dementia - spousal experience. Int J Qual Stud Health Well-being 2024; 19:2330233. [PMID: 38493492 PMCID: PMC10946261 DOI: 10.1080/17482631.2024.2330233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/11/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Being of working age while at the same time needing to help a partner with young onset dementia has specific consequences for spouses. Research to date has been sparse concerning this particular group of spouses. The aim of the study was to explore spouses' everyday experiences when living with a person with young onset dementia. METHOD The study had a descriptive qualitative design with semi-structured interviews with nine spouses. The interviews were analysed using content analysis. RESULT The interviewed spouses experienced emotions that varied from feelings of loneliness, frustration, and worry to peace of mind. They said that they used coping strategies, which included adopting a positive mindset, adapting to inabilities, adopting an avoidant approach, and finding ways to recharge. Spouses also felt that they could use more support, both formal and informal. CONCLUSION The spouse of a person with young onset dementia has a range of emotional experiences and has resourceful ways of handling everyday life. Various types of support are offered to spouses, however, they seemed to desire more from health care services.
Collapse
Affiliation(s)
- Tania Håkansson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Hilda Svensson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Staffan Karlsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| |
Collapse
|
2
|
Smeets B, Janssen N, Peetoom K, Boots L, Bakker C, de Vugt M. 'Too young to sit at home': a qualitative study conducted among employees with young-onset dementia and their relatives. Aging Ment Health 2024; 28:1119-1128. [PMID: 38669151 PMCID: PMC11262426 DOI: 10.1080/13607863.2024.2345132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Young-onset dementia (YOD) symptoms often first present in the workplace, resulting in work performance challenges and eventually loss of employment. This study aims to investigate the experiences, work values, and support needs of employees with YOD and their relatives. METHOD Semi-structured interviews were conducted to explore the experiences, work values, and support needs of (former) employees with YOD and their relatives. Subsequently, separate focus group discussions were conducted for employees and relatives to review and prioritize interview findings. Inductive thematic analysis was applied to both datasets. RESULTS A total of 15 interviews (six employees; nine relatives) and four focus group discussions (ten employees; six relatives) were conducted. Six themes emerged, with five revolving around the central theme: desire to work. The other themes represent essential contributing factors, including importance of receiving a YOD diagnosis; knowledge, awareness, and understanding regarding YOD; open communication, joint decision making, and collaboration; work adjustments, involvement, and support; phasing out work and future perspectives. CONCLUSION The findings highlight a strong desire to work post-YOD diagnosis, serving as a foundation for developing workplace support tools and guidance. This has the potential to help individuals with YOD preserve their self-confidence and identity while working within their capabilities.
Collapse
Affiliation(s)
- Bo Smeets
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Niels Janssen
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Lizzy Boots
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christian Bakker
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center Limburg, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
3
|
Loi Franzcp PhD Mbbs SM, Cadwallader CJ, Stretton-Smith PA, Flynn L, Wand AP, Bryant C, Baker FA. A mixed methods evaluation of the music and psychology and social connections (MAPS) pilot - A dyadic intervention for couples affected by young-onset dementia. DEMENTIA 2024:14713012241263151. [PMID: 38904256 DOI: 10.1177/14713012241263151] [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: 06/22/2024]
Abstract
INTRODUCTION People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people. METHODOLOGY This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures. RESULTS Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS. CONCLUSION The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia.
Collapse
Affiliation(s)
- Samantha M Loi Franzcp PhD Mbbs
- Department of Psychiatry, The University of Melbourne, Australia
- Neuropsychiatry Centre, John Cade level 2, Royal Melbourne Hospital, Australia
| | - Claire J Cadwallader
- Neuropsychiatry Centre, John Cade level 2, Royal Melbourne Hospital, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | | | - Libby Flynn
- Faculty of Fine Arts and Music, The University of Melbourne, Australia
| | - Anne Pf Wand
- Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Heath, University of New South Wales, Australia
- Older Peoples Mental Health, Sydney Local Health District, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Felicity A Baker
- Faculty of Fine Arts and Music, The University of Melbourne, Australia
- Norwegian Academy of Music, Oslo
| |
Collapse
|
4
|
Loi SM. Cessation of driving has important psychosocial implications for people living with young-onset dementia and their families. Evid Based Nurs 2024; 27:103. [PMID: 37821209 DOI: 10.1136/ebnurs-2023-103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Samantha M Loi
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Neuropsychiatry Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
| |
Collapse
|
5
|
Tang X, Wang J, Wu B, Navarra AM, Cui X, Sharp E, Maiya S, Aytur S, Wang J. Navigating Both Roles: A Photovoice Exploration of the Young Adult Balancing Daughterhood and Caregiving for a Mother With Young-Onset Dementia. QUALITATIVE HEALTH RESEARCH 2024:10497323241244986. [PMID: 38885496 DOI: 10.1177/10497323241244986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Young adults thrust into the role of caregiving for parents with young-onset dementia (YOD) face unique challenges during their formative years. While existing research acknowledges the crucial role of young adult caregivers, a gap persists in understanding how this group experiences and redefines their identity amidst these circumstances, along with the psychological and societal challenges encountered. This knowledge deficit hinders the identification of suitable social support, adversely affecting the personal growth and well-being of these young adult caregivers. In this single-case study, we used a combination of a semi-structured interview and photovoice to explore the journey of a 19-year-old caregiver, Alice, whose mother had been diagnosed with dementia in the preceding 3 years. Through this unique perspective, we aimed to illuminate how caregiving for a mother with YOD may profoundly redefine familial roles and relationships. Over 3 months, Alice captured significant life moments through photography, selecting meaningful images for bi-weekly meetings. These images served as pivotal themes, triggering in-depth conversations during subsequent interviews to provide nuanced insights into her life experiences. Findings reveal four major themes faced by a young caregiver: (1) challenges adapting to an unexpected role, (2) navigating the complex emotional terrain of losing a loved one to YOD, (3) prioritizing the well-being of the healthy parent, and (4) expressing a profound desire for both informal and formal support. These results underscore the intricate identity and emotional challenges faced by young adult caregivers, emphasizing the urgency of addressing their unique needs through family-centered systemic support services.
Collapse
Affiliation(s)
- Xueting Tang
- School of Nursing, Fudan University, Shanghai, China
| | - Junqiao Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Xiaoyan Cui
- School of Nursing, Fudan University, Shanghai, China
| | - Erin Sharp
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Sahitya Maiya
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Semra Aytur
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Jing Wang
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| |
Collapse
|
6
|
Roberts JR, Windle G, MacLeod CA, Sullivan MP, Camic PM, Stott J, Brotherhood E, Jackson K, Crutch S. "It's a Postcode Lottery": How Do People Affected by Dementia in Wales Experience Their Diagnosis and Post-Diagnostic Support, and How May These Be Improved? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:709. [PMID: 38928955 PMCID: PMC11203760 DOI: 10.3390/ijerph21060709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
National dementia strategies are government policies that guide the provision of appropriate support for people living with dementia. These strategies, developed through extensive stakeholder engagement, should be tailored to the cultural and demographic needs of a country. Using a mixed methods survey design, this study explored the aims of the Dementia Action Plan (2018-2022) for Wales (UK) around assessment, diagnosis, and post-diagnostic support, and assessed whether these are being realized. Further, it sought to gain insight from people living with dementia and their carers around how the experience may be improved for others in the future, as the development of the next iteration of the Action Plan is anticipated. Respondents included 71 people, affected by typical and rarer types of dementia, living in both rural and urban areas. Findings suggest both positive and negative experiences, reflecting a 'postcode lottery' of service provision. Attainable recommendations for improvement were made by respondents, which would ultimately likely be cost-effective and reduce strain on formal services. The findings reported in this paper concur with those reported by people living with dementia in other countries, indicating their relevance for policymakers beyond Wales.
Collapse
Affiliation(s)
- Jennifer Rhiannon Roberts
- DSDC Wales Research Centre, School of Health Sciences, Bangor University, Ardudwy, Normal Site, Bangor LL57 2PZ, UK; (G.W.)
| | - Gill Windle
- DSDC Wales Research Centre, School of Health Sciences, Bangor University, Ardudwy, Normal Site, Bangor LL57 2PZ, UK; (G.W.)
| | - Catherine Anne MacLeod
- DSDC Wales Research Centre, School of Health Sciences, Bangor University, Ardudwy, Normal Site, Bangor LL57 2PZ, UK; (G.W.)
| | - Mary Pat Sullivan
- Faculty of Education and Professional Studies, School of Social Work, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Paul M. Camic
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London WC1N 3AR, UK
| | - Joshua Stott
- Department of Clinical, Educational and Health Psychology, University College London (UCL), London WC1E 6BT, UK
| | - Emilie Brotherhood
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London WC1N 3AR, UK
| | - Kiara Jackson
- DSDC Wales Research Centre, School of Health Sciences, Bangor University, Ardudwy, Normal Site, Bangor LL57 2PZ, UK; (G.W.)
| | - Sebastian Crutch
- Dementia Research Centre, Queen Square Institute of Neurology, University College London (UCL), London WC1N 3AR, UK
| |
Collapse
|
7
|
Kårelind F, Finkel D, Zarit SH, Wijk H, Bielsten T, Johansson L. Post-diagnostic support for persons with young-onset dementia - a retrospective analysis based on data from the Swedish dementia registry SveDem. BMC Health Serv Res 2024; 24:649. [PMID: 38773535 PMCID: PMC11110303 DOI: 10.1186/s12913-024-11108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/14/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Approximately 3.9 million persons worldwide have young-onset dementia. Symptoms related to young-onset dementia present distinct challenges related to finances, employment, and family. To provide tailored support, it is important to gain knowledge about the formal support available for persons with young-onset dementia. Therefore, this paper aims to describe formal support for persons with young-onset dementia in Sweden and the factors influencing this support. METHODS This retrospective study used data on persons under 65 years of age (n = 284) from The Swedish Registry for Cognitive/Dementia Disorders (SveDem) between 2021 and 2022. SveDem was established to monitor the quality of dementia care in Sweden. Characteristics of participants were obtained, including age, sex, dementia diagnosis, MMSE, medications, accommodation, and care setting. Descriptive statistics and logistic regression were used to test for associations between participant characteristics and post-diagnostic support. RESULTS Information and educational support were usually offered to the person with young-onset dementia (90.1%) and their family (78.9%). Approximately half of the sample were offered contact with a dementia nurse (49.3%), counsellor (51.4%), or needs assessor (47.9%). A minority (28.5%) were offered cognitive aids. Six regression models were conducted based on participant characteristics to predict the likelihood that persons were offered support. Support was not predicted by age, sex, children at home, accommodation, or medications. Lower MMSE scores (p < .05) and home help (p < .05) were significantly associated with offer of a needs assessor. Living together was a significant predictor (p < .01) for information and educational support offered to the family. Care setting significantly predicted (p < .01) an offer of information and educational support for the person and family members, as well as contact with a counsellor. CONCLUSION This study indicates potential formal support shortages for persons with young-onset dementia in some areas of dementia care. Despite equal support across most characteristics, disparities based on care setting highlight the importance of specialised dementia care. Pre-diagnostic support is minimal, indicating challenges for persons with young-onset dementia to access these services before diagnosis. While our study has identified areas in need of improvement, we recommend further research to understand the changing support needs of those with young-onset dementia.
Collapse
Affiliation(s)
- Fanny Kårelind
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Deborah Finkel
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Center for Economic and Social Research, University of Southern California, Los Angeles, USA
| | - Steven H Zarit
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Human Development and Family Studies, Penn State University, University Park, USA
| | - Helle Wijk
- Institute of Health and Care Science, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Therese Bielsten
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Linda Johansson
- Studies on Integrated Health and Welfare (SIHW), Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| |
Collapse
|
8
|
Reutens S, Karystianis G, Withall A, Butler T. Characteristics of domestic violence perpetrators with dementia from police records using text mining. Front Psychiatry 2024; 15:1331915. [PMID: 38812490 PMCID: PMC11135125 DOI: 10.3389/fpsyt.2024.1331915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
Aim Few studies have examined the characteristics of domestic violence (DV) committed by people with dementia. We provide an overview of DV perpetrated by people with dementia in the community based on police reports of attendances at DV events. Method A text mining method was used on 416,441 New South Wales (NSW) police narratives of DV events from January 2005 to December 2016 to extract information for Persons of Interest (POIs) with mentions of dementia. Results Events involving those with dementia accounted for a relatively low proportion of total DV events (<1%). Of the 260 DV events with a dementia mention for the POI, the most common abuse types were assault (49.7%) and verbal abuse (31.6%). Spouses were the largest group of victims (50.8%) followed by children (8.8%). Physical abuse was common, occurring in 82.4% of events, but injuries were relatively mild. Although weapons were infrequently used, they were involved in 5% of events, mostly by POIs aged 75 years and older. Similarly, the POIs were mainly aged 75+ years (60%), however the proportion of those aged <65 was relatively high (20.8%) compared to the reported prevalence of dementia in that age group. Conclusions This study demonstrates that some cases of DV perpetrated by people with reported dementia are significant enough to warrant police involvement. This highlights the need to proactively discuss the potential for violence as part of the holistic management and support family members, particularly those caring for people with young-onset dementias.
Collapse
Affiliation(s)
- Sharon Reutens
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - George Karystianis
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Adrienne Withall
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
| | - Tony Butler
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
9
|
Mitchell A, Kelso W, Paynter C, Hayes L, Velakoulis D, Loi SM. Peer Support for Caregivers of People Living with Posterior Cortical Atrophy in Melbourne, Australia: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:513. [PMID: 38673424 PMCID: PMC11050742 DOI: 10.3390/ijerph21040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
Posterior Cortical Atrophy (PCA) is a rare form of young-onset dementia that causes early visuospatial and visuoperceptual deficits. The symptom profile of Posterior Cortical Atrophy leads to very specific care needs for those affected, who often rely on informal caregivers (including friends and family). Rare dementia support groups can be useful for both patients and their caregivers to assist with knowledge sharing, psychoeducation, and the provision of psychosocial support. Despite this, few such support groups exist. The purpose of this study was to examine a PCA support group for caregivers of individuals living with PCA. We held a structured psychoeducation support group comprised of four sessions with the aim being to provide education, strategies for the management of the disease, and peer support. Caregivers' mental health and quality of life were assessed. The results of our study showed that support group participation was a positive experience and assisted with increasing the knowledge of caregivers and fostering social connections. We suggest that peer support groups may be beneficial for both people living with PCA and their caregivers. We recommend that future quantitative and qualitative research is conducted to further assess health-promotion benefits to people living with PCA and their caregivers, and to assess their development and implementation in different contexts.
Collapse
Affiliation(s)
- Alexander Mitchell
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Wendy Kelso
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Camille Paynter
- Melbourne School of Health Sciences, University of Melbourne, Parkville 3052, Australia;
| | - Leanne Hayes
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Dennis Velakoulis
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
- Department of Psychiatry, University of Melbourne, Parkville 3052, Australia
| | - Samantha M. Loi
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
- Department of Psychiatry, University of Melbourne, Parkville 3052, Australia
| |
Collapse
|
10
|
Tikkanen V, Krüger J, Heikkinen AL, Hänninen T, Hublin C, Koivisto AM, Virkkala J, Saari TT, Remes AM, Paajanen TI. A Novel Computerized Flexible Attention Test in Detecting Executive Dysfunction of Patients with Early-Onset Cognitive Impairment and Dementia. Arch Clin Neuropsychol 2024:acae026. [PMID: 38581151 DOI: 10.1093/arclin/acae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/06/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE The number of computer-based cognitive tests has increased in recent years, but there is a need for tests focusing on the assessment of executive function (EF), as it can be crucial for the identification of early-onset neurodegenerative disorders. This study aims to examine the ability of the Flexible Attention Test (FAT), a new computer-based test battery for detecting executive dysfunction of early-onset cognitive impairment and dementia patients. METHOD We analyzed the FAT subtask results in memory clinic patients with cognitive symptom onset at ≤65 years. The patients were divided into four groups: early onset dementia (EOD, n = 48), mild cognitive impairment due to neurological causes (MCI-n, n = 34), MCI due to other causes (MCI-o, n = 99), and subjective cognitive decline (SCD, n = 14). The test accuracy to distinguish EOD patients from other groups was examined, as well as correlations with pen-and-paper EF tests. We also reported the 12-months follow-up results. RESULTS The EOD and MCI-n patients performed significantly poorer (p ≤ .002) than those in the MCI-o and SCD groups in most of the FAT subtasks. The accuracies of the FAT subtasks to detect EOD from other causes were mainly moderate (0.34 ≤ area under the curve < 0.74). The FAT subtasks correlated logically with corresponding pen-and-paper EF tests (.15 ≤ r ≤ .75). No systematic learning effects were detected in the FAT performance at follow-up. CONCLUSIONS The FAT appears to be a promising method for the precise evaluation of EF and applicable distinguishing early-onset neurodegenerative disorders from patients with other causes of cognitive problems.
Collapse
Affiliation(s)
- Veera Tikkanen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
| | - Anna-Leena Heikkinen
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tuomo Hänninen
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Christer Hublin
- Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anne M Koivisto
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Jussi Virkkala
- Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland
- Clinical Neurophysiology and Clinical Neurosciences, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Toni T Saari
- Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Anne M Remes
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
- Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Teemu I Paajanen
- Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland
| |
Collapse
|
11
|
Tang X, Wang J, Wu B, Navarra AM, Cui X, Wang J. Lived experiences of maintaining self-identity among persons living with young-onset dementia: A qualitative meta-synthesis. DEMENTIA 2023; 22:1776-1798. [PMID: 37646673 DOI: 10.1177/14713012231193547] [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: 09/01/2023]
Abstract
BACKGROUND The self-identity of persons with young-onset dementia (YOD) is affected by the disease progression. However, the lived experience of maintaining self-identity along the disease trajectory is understudied. This meta-synthesis integrated qualitative data on the challenges, coping strategies, and needs of persons living with YOD and how their experiences affected their self-identity over time. METHODS Four English (PubMed, Scopus, CINAHL, PsycINFO) and two Chinese (CNKI and Wanfang) electronic databases were searched for published literature peer-reviewed from the time of database inception to 2022. We used thematic analysis to extract and synthesize data from the literature concerning the long-term lived experiences of persons living with YOD. RESULTS A total of five peer-reviewed publications were eligible for inclusion in this meta-synthesis study. We identified four themes: (1) declining cognitive function and a prolonged diagnostic process threaten the self-identity of persons living with YOD, (2) struggling to accept the diagnosis of YOD and maintain self-identity, (3) maintaining self-identity and the normalcy of life through social support and person-centered care, and (4) living with YOD through self-development and self-identity reshaping at a later stage of the disease. CONCLUSIONS Persons living with YOD experience challenges maintaining their self-identity throughout the disease trajectory. These challenges are affected by their cognitive function, experiences of personal and social stigma associated with the disease, perceived social support, and person-centered care. Study findings have implications for developing tailored supportive programs for persons living with YOD at various stages of the disease trajectory.
Collapse
Affiliation(s)
| | | | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | | | - Jing Wang
- University of New Hampshire, College of Health and Human Services, Durham, NH, USA
- Fudan University, Shanghai, China
| |
Collapse
|
12
|
Cadwallader CJ, Velakoulis D, Loi SM. Post-Diagnostic Support for Behaviour Changes in Young-Onset Dementia in Australia. Brain Sci 2023; 13:1529. [PMID: 38002489 PMCID: PMC10670083 DOI: 10.3390/brainsci13111529] [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: 10/04/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
Behaviour changes (BCs) are common in young-onset dementia (YOD). Access to knowledgeable and age-appropriate support services is needed to assist with the appropriate management of BCs. We sought to investigate the types of YOD-related BCs that most commonly require support, the formal services being accessed for support, and the experiences of those seeking support in Australia. We employed a cross-sectional online questionnaire for individuals living with YOD as well as individuals providing informal or formal care for someone with YOD. Thirty-six questionnaire responses were recorded. Of the total sample, 83% reported YOD-related BCs requiring support, the most common being appetite/eating changes, followed by agitation/aggression and apathy/indifference. Seventy-six percent of these individuals had attempted to seek support from a formal service, with Dementia Australia, Dementia Support Australia, and general practitioners most commonly approached. Responses suggested that the support access pathway is suboptimal, with a lack of clarity about what services to approach for support and long wait times. Furthermore, 28% of participants had not gained access to support utilizing non-pharmacological strategies. Individuals who need support for YOD-related BCs demonstrated a high rate of help-seeking from formal support services; however, the support access pathway is slow, is difficult to navigate, and does not result in the best-practice management of BCs. Formal services resourced to provide efficient support with the implementation of behavioural strategies are needed, along with clear, accessible guidelines on the pathway to access them.
Collapse
Affiliation(s)
- Claire J. Cadwallader
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (C.J.C.); (D.V.)
- The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3168, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (C.J.C.); (D.V.)
- Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia
| | - Samantha M. Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (C.J.C.); (D.V.)
- Department of Psychiatry, University of Melbourne, Parkville, VIC 3052, Australia
| |
Collapse
|
13
|
Cations M. A devastating loss: driving cessation due to young onset dementia. Age Ageing 2023; 52:afad174. [PMID: 37725970 DOI: 10.1093/ageing/afad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Sturt Road Bedford Park, Adelaide 5042, Australia
| |
Collapse
|
14
|
Walia N, Eratne D, Loi SM, Farrand S, Li QX, Malpas CB, Varghese S, Walterfang M, Evans AH, Parker S, Collins SJ, Masters CL, Velakoulis D. Cerebrospinal fluid neurofilament light and cerebral atrophy in younger-onset dementia and primary psychiatric disorders. Intern Med J 2023; 53:1564-1569. [PMID: 36314730 DOI: 10.1111/imj.15956] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/03/2022] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND AIMS Neurodegeneration underpins the pathological processes of younger-onset dementia (YOD) and has been implicated in primary psychiatric disorders (PSYs). Cerebrospinal fluid (CSF) neurofilament light (NfL) has been used to investigate neurodegeneration severity through correlation with structural brain changes in various conditions, but has seldom been evaluated in YOD and PSYs. METHODS This retrospective study included patients with YOD or PSYs with magnetic resonance imaging (MRI) of the brain and CSF NfL analysis. Findings from brain MRI were analysed using automated volumetry (volBrain) to measure white matter (WM), grey matter (GM) and whole brain (WB) volumes expressed as percentages of total intracranial volume. Correlations between NfL and brain volume measurements were computed whilst adjusting for age. RESULTS Seventy patients (47 with YOD and 23 with PSY) were identified. YOD types included Alzheimer disease and behavioural variant frontotemporal dementia. PSY included schizophrenia and major depressive disorder. MRI brain sequences were either fast spoiler gradient-echo (FSPGR) or magnetization-prepared rapid acquisition gradient-echo (MPRAGE). In the total cohort, higher NfL was associated with reduced WB in the FSPGR and MPRAGE sequences (r = -0.402 [95% confidence interval (CI), -0.593 to -0.147], P = 0.008 and r = -0.625 [95% CI, -0.828 to -0.395], P < 0.001, respectively). Higher NfL was related to reduced GM in FSPGR (r = 0.385 [95% CI, -0.649 to -0.014], P = 0.017) and reduced WM in MPRAGE (r = -0.650 [95% CI, -0.777 to -0.307], P < 0.001). Similar relationships were seen in YOD, but not in PSY. CONCLUSION Higher CSF NfL is related to brain atrophy in YOD, further supporting its use as a nonspecific marker of neurodegeneration severity.
Collapse
Affiliation(s)
- Nirbaanjot Walia
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Farrand
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Qiao-Xin Li
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Charles B Malpas
- Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shiji Varghese
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Walterfang
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew H Evans
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Shaun Parker
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Steven J Collins
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colin L Masters
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
van Gils AM, Rhodius‐Meester HFM, Leeuwis AE, Handgraaf D, Bakker C, Peetoom K, Bouwman FH, Pijnenburg YAL, Papma JM, Hoogendoorn T, Schoonenboom N, van Strien A, Verwey NA, Köhler S, de Vugt ME, van der Flier WM. Young-onset dementia in memory clinics in the Netherlands: Study design and description of PRECODE-GP. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12471. [PMID: 37609004 PMCID: PMC10441283 DOI: 10.1002/dad2.12471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
The disease trajectory and healthcare requirements of patients with young-onset dementia (YOD) differ from those of older patients. Accurate data about YOD is crucial to improve diagnosis and optimize care. PRECODE-GP aims to set up a prospective national database of patients with YOD to gain insight into the occurrence and characteristics of patients with YOD in memory clinics in the Netherlands. The national database includes data from dementia patients aged <70 years at diagnosis, collected by local memory clinics (MCs). Data included demographic information, clinical variables, and (etiological) diagnoses. Between July 2019 and December 2022, 781 patients with a mean age of 62±6y at diagnosis (range 37 to 69y) were included from 39 MCs. Most (n = 547,70%) were diagnosed with dementia due to Alzheimer's disease (AD). Patients with Frontotemporal lobe dementia (FTD, n = 87, 11%) were youngest (61±6.0y). Over half (55%) of patients were experiencing symptoms for ≥2 years. We initiated a Dutch national YOD database to improve diagnosis and care for this underrepresented and vulnerable patient group. The database provides a basis for future in-depth studies on YOD.
Collapse
Affiliation(s)
- Aniek M. van Gils
- Alzheimer Center AmsterdamDepartment of NeurologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Hanneke F. M. Rhodius‐Meester
- Alzheimer Center AmsterdamDepartment of NeurologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Department of Internal MedicineGeriatric Medicine SectionAmsterdam Cardiovascular Sciences InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Geriatric MedicineThe Memory ClinicOslo University HospitalOsloNorway
| | - Anna E. Leeuwis
- Alzheimer Center AmsterdamDepartment of NeurologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Dédé Handgraaf
- Alzheimer Center AmsterdamDepartment of NeurologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Christian Bakker
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
- Alzheimer CenterRadboud UMCNijmegenThe Netherlands
- Center for Specialized Geriatric CareGroenhuysenRoosendaalThe Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology/Alzheimer Center LimburgSchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Femke H. Bouwman
- Alzheimer Center AmsterdamDepartment of NeurologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center AmsterdamDepartment of NeurologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Janne M. Papma
- Department of Neurology and Alzheimer Center Erasmus MCErasmus MC University Medical CenterRotterdamThe Netherlands
| | | | - Niki Schoonenboom
- Department of Clinical Geriatrics Spaarne GasthuisHaarlemThe Netherlands
| | - Astrid van Strien
- Department of Geriatric MedicineJeroen Bosch Hospital‘s‐HertogenboschThe Netherlands
| | - Nicolaas A. Verwey
- Department of NeurologyMedical Center LeeuwardenLeeuwardenThe Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology/Alzheimer Center LimburgSchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology/Alzheimer Center LimburgSchool for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamDepartment of NeurologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Department of Epidemiology and Data ScienceVrije Universiteit AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
16
|
Scott TL, Rooney D, Liddle J, Mitchell G, Gustafsson L, Pachana NA. A qualitative study exploring the experiences and needs of people living with young onset dementia related to driving cessation: 'It's like you get your legs cut off'. Age Ageing 2023; 52:afad109. [PMID: 37481262 PMCID: PMC10362976 DOI: 10.1093/ageing/afad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND driving disruptions have significant impact on individuals living with dementia, their care partners and family members. Previous studies show that for older people with dementia, stopping driving is one of the hardest things that they cope with. To date, no studies exist that address the expressed needs and experiences of people living with young onset dementia (YOD) who are adjusting to life without driving, whose needs are not well understood and whose needs might be expected to differ from those of older people with dementia. METHODS a multi-perspective, qualitative descriptive phenomenological approach was undertaken. A topic guide was developed in consultation with lived experience experts. In-depth interviews (n = 18) with 10 people with YOD and eight family caregivers were conducted, to elicit lived experiences in relation to changing and cessation of driving. Interviews were recorded and transcribed verbatim. Data were analysed using a hybrid approach, employing deductive and inductive coding. RESULTS core findings reflected the impact and coping strategies employed by people with YOD and their care partners across four themes: (i) losses and burdens, (ii) the unique challenges of YOD, (iii) coping and adjustment and (iv) how to meet needs. CONCLUSIONS driving disruptions often come at a time when people living with YOD are likely to have significant financial and family commitments, or they/their partners may be employed or raising a family, negatively impacting individual's roles and self-identities. Intervention to support emotional and practical adjustment and reduce social isolation is essential for coping.
Collapse
Affiliation(s)
- Theresa L Scott
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Donna Rooney
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072 Australia
| | - Geoffrey Mitchell
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD 4111, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
| |
Collapse
|
17
|
Loi SM, Tsoukra P, Sun E, Chen Z, Wibawa P, Biase MD, Farrand S, Eratne D, Kelso W, Evans A, Walterfang M, Velakoulis D. Survival in Huntington's disease and other young-onset dementias. Int J Geriatr Psychiatry 2023; 38:e5913. [PMID: 37062919 PMCID: PMC10946957 DOI: 10.1002/gps.5913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES To compare survival and risk factors associated with mortality in common young-onset dementias (YOD) including Huntington's disease. METHODS This retrospective cohort study included inpatients from an Australian specialist neuropsychiatry service, over 20 years. Dementia diagnoses were based on consensus criteria and Huntington's disease (HD) was confirmed genetically. Mortality and cause of death were determined using linkage to the Australian Institute of Health and Welfare National Death Index. RESULTS There were 386 individuals with YOD included. The dementia types included frontotemporal dementia (FTD) (24.5%), HD (21.2%) and Alzheimer's disease (AD) (20.5%). 63% (n = 243) individuals had died. The longest median survival was for those who had HD, 18.8 years from symptom onset and with a reduced mortality risk compared to AD and FTD (hazard ratio 0.5). Overall, people with YOD had significantly increased mortality, of 5-8 times, compared to the general population. Females with a YOD had higher standardised mortality ratio compared to males (9.3 vs. 4.9) overall. The most frequent cause of death in those with HD was reported as HD, with other causes of death in the other YOD-subtypes related to dementia and mental/behavioural disorders. DISCUSSION This is the first Australian study to investigate survival and risk factors of mortality in people with YOD. YOD has a significant risk of death compared to the general population. Our findings provide useful clinical information for people affected by YOD as well as future planning and service provision.
Collapse
Affiliation(s)
- Samantha M. Loi
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
| | | | - Emily Sun
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Zhibin Chen
- School of Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Pierre Wibawa
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Maria di Biase
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
| | - Sarah Farrand
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Dhamidhu Eratne
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
| | - Wendy Kelso
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Andrew Evans
- Department of MedicineRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Mark Walterfang
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthParkvilleVictoriaAustralia
| | - Dennis Velakoulis
- NeuropsychiatryNorthWestern Mental Health, Melbourne HealthRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Department of PsychiatryThe University of MelbourneParkvilleVictoriaAustralia
| |
Collapse
|
18
|
Van Rickstal R, De Vleminck A, Engelborghs S, Van den Block L. Experiences with and perspectives on advance care planning in young- and late- onset dementia: A focus group study with physicians from various disciplines. Front Aging Neurosci 2023; 15:1130642. [PMID: 37056687 PMCID: PMC10088511 DOI: 10.3389/fnagi.2023.1130642] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionDespite the relevance of advance care planning (ACP) for people with dementia, its uptake in this population is particularly low. Several challenges for ACP in dementia have been identified from physicians’ perspectives. However, the literature available mainly includes general practitioners and focuses exclusively on the context of late-onset dementia. This is the first study to inquire physicians from four highly relevant specialisms in dementia care, with a focus toward potential specificities based on patients’ age. The research question of this study is: “What are physicians’ experiences with and perspectives on discussing ACP with people with young- and/or late-onset dementia?”.MethodsFive online focus groups were conducted with 21 physicians (general practitioners, psychiatrists, neurologists and geriatricians) in Flanders, Belgium. Verbatim transcripts were analyzed through the qualitative method of constant comparative analysis.ResultsPhysicians believed that the societal stigma related to dementia influences people’s reaction to their diagnosis, at times characterized by catastrophic expectations for the future. In this regard, they explained that the topic of euthanasia is sometimes addressed by patients very early in the disease trajectory. Respondents paid ample attention to actual end-of-life decisions, including DNR directives, when discussing ACP in dementia. Physicians felt responsible for providing accurate information on both dementia as a condition, and the legal framework of end-of-life decisions. Most participants felt that patients’ and caregivers’ wish for ACP was more driven by who their personality than by their age. Nonetheless, physicians identified specificities for a younger dementia population in terms of ACP: they believed that ACP covered more domains of life than for older persons. A high consistency regarding the viewpoints of physicians from differing specialisms was noted.DiscussionPhysicians acknowledge the added value of ACP for people with dementia and especially their caregivers. However, they face several challenges for engaging in the process. Attending to specific needs in young-onset, in comparison to late-onset dementia, requires ACP to entail more than solely medical domains. However, a medicalized view on ACP still appears to be dominant in practice as opposed to its broader conceptualization in academia.
Collapse
Affiliation(s)
- Romy Van Rickstal
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
- *Correspondence: Romy Van Rickstal,
| | - Aline De Vleminck
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology, University Hospital Brussels, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group (VUB/UGhent), Brussels, Belgium
- Research Foundation—Flanders (FWO), Brussels, Belgium
| |
Collapse
|
19
|
Loi SM, Cations M, Velakoulis D. Young-onset dementia diagnosis, management and care: a narrative review. Med J Aust 2023; 218:182-189. [PMID: 36807325 PMCID: PMC10952480 DOI: 10.5694/mja2.51849] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/21/2023]
Abstract
Young-onset dementia comprises a heterogeneous range of dementias, with onset at less than 65 years of age. These include primary dementias such as Alzheimer disease, frontotemporal and vascular dementias; genetic/familial dementias; metabolic disorders; and secondary dementias such as those that result from alcohol use disorder, traumatic brain injury, and infections. The presentation of young-onset dementia is varied and may include cognitive, psychiatric and neurological symptoms. Diagnostic delay is common, with a frequent diagnostic conundrum being, "Is this young-onset dementia or is this psychiatric?". For assessment and accurate diagnosis, a thorough screen is recommended, such as collateral history and investigations such as neuroimaging, lumbar puncture, neuropsychology, and genetic testing. The management of young-onset dementia needs to be age-appropriate and multidisciplinary, with timely access to services and consideration of the family (including children).
Collapse
Affiliation(s)
- Samantha M Loi
- University of MelbourneMelbourneVIC
- Royal Melbourne HospitalMelbourneVIC
| | | | - Dennis Velakoulis
- University of MelbourneMelbourneVIC
- Royal Melbourne HospitalMelbourneVIC
| |
Collapse
|
20
|
Amari N. Self-formulation in counselling psychology: The Power Threat Meaning Framework. JOURNAL OF HUMANISTIC PSYCHOLOGY 2023. [DOI: 10.1177/00221678231154292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This reflective report critically evaluates my developing professional identity as a counseling psychologist. Using the Power Threat Meaning Framework, I present a self-formulation to make sense of my experiences during the second stage of my training. To begin with, I consider how multiple forms of power were operating in the complex relationship between personal and professional spheres. As I appraise my professional development, I examine the threats posed by the negative use of power and the resulting challenges within my practice. Drawing from research, psychological theories, and relevant case examples, I explore the meaning I attached to my experiences while managing complex problems and professional issues. In my endeavor to act according to ethical and professional guidelines, I consider my threat responses to preserve my functioning within program learning and professional practice. By appreciating my access to power resources, I demonstrate my willingness and ability to engage with feedback and reflexivity as personal strengths that helped me navigate my ongoing training. Therefore, I integrate professional and ethical perspectives in the “meaning-making” of my development as a trainee counseling psychologist.
Collapse
|
21
|
Good practice in needs-based post-diagnostic support for people with young onset dementia: findings from the Angela Project. AGEING & SOCIETY 2023. [DOI: 10.1017/s0144686x22001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
Evidence on post-diagnostic support for people with young onset dementia is scarce. Previous studies have employed a problem-focused approach; however, evidence on ‘what works’ in real-life practice is essential to develop recommendations for service design and delivery. This study aimed to provide insight into ‘what works’ from the perspectives of people with young onset dementia and their supporters. We gathered free-text responses on positive service experiences via a UK cross-sectional survey. Inductive thematic analysis was used to identify the objectives of positive services and the needs these met. Follow-up interviews enabled in-depth insights from people with diverse diagnoses, ages and social situations. These were analysed using a template drawn from the survey. The 233 survey respondents gave 856 examples of positive support. Analysis of 24 follow-up interviews led to 16 themes clustered under three superordinate themes: ‘maintaining autonomy’, ‘being myself’ and ‘togetherness’. We found that positive services address the disruptions to sense of agency, selfhood and meaningful relationships that are experienced by those with young onset dementia. The study provides an in-depth understanding of the needs met by positive services for younger people with dementia. Our nuanced findings on good practice can inform age-specific guidelines for young onset dementia and indicate how personalisation can work in practice to help people with young onset dementia to maintain identity, autonomy and connections.
Collapse
|
22
|
Fisher AC, Cheung SC, O'Connor CMC, Piguet O. The Acceptability and Usefulness of Positive Behaviour Support Education for Family Carers of People With Frontotemporal Dementia: A Pilot Study. J Geriatr Psychiatry Neurol 2023; 36:73-83. [PMID: 35380488 DOI: 10.1177/08919887221090214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM This pilot study investigated the acceptability and usefulness of 4 weekly Positive Behaviour Support (PBS) education sessions (delivered face-to-face and online) for family carers of individuals diagnosed with behavioural-variant frontotemporal dementia (bvFTD). These sessions were adapted from the Family-directed Approach to Brain injury (FAB)-PBS program to the FTD population. METHODS A pre-test post-test mixed-methods design was utilized. Primary outcome measures included a Carer Confidence questionnaire and post-intervention Feedback Questionnaire. Assessments were conducted prior to the 4-week education program, immediately following the final session and a 3 months follow-up. RESULTS Ten family carers completed the 4 PBS education sessions and indicated that the program was helpful in providing behaviour support. No significant changes in confidence ratings were found before and following the education sessions. A majority of participants, however, reported positive changes to their approach in providing behaviour support, with key themes including 'recognising the function of behaviour', 'changing their own behaviour' and 'promoting a calmer approach'. CONCLUSIONS The FAB-PBS education sessions demonstrate to be an acceptable approach to increasing the capability of family carers in providing behaviour support to individuals with FTD, which will need to be confirmed in a larger feasibility study.
Collapse
Affiliation(s)
- Alinka C Fisher
- Disability and Community Inclusion, 64767College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Sau C Cheung
- School of Psychology and Brain & Mind Centre, 4334The University of Sydney, Sydney, Australia
| | - Claire M C O'Connor
- Centre for Positive Ageing, 94268HammondCare, Sydney, Australia.,School of Population Health, The University of New South Wales, Sydney, Australia
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, 4334The University of Sydney, Sydney, Australia
| |
Collapse
|
23
|
Burkinshaw K, Tsourtos G, Cations M. System and policy-level barriers and facilitators for timely and accurate diagnosis of young onset dementia. Int J Geriatr Psychiatry 2023; 38:e5859. [PMID: 36484460 DOI: 10.1002/gps.5859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The multiyear diagnostic journey for young onset dementia (YOD) is fraught with clinical and personal difficulties and poses significant uncertainty for people living with YOD and their families. Most existing research has examined the personal and/or clinical barriers to a timely diagnosis of YOD, but less evidence exists regarding system level factors. The aim of this study is to investigate health professionals' insights for a timely and accurate YOD diagnosis at the system level. DESIGN Grounded theory qualitative study. SETTING AND PARTICIPANTS Semi-structured in-depth interviews with 11 health professionals working across varied healthcare settings were conducted online via videoconference. MEASUREMENTS Data were contrasted and compared within and between transcripts using the constant comparative method. RESULTS Seven themes emerged about barriers and facilitators for timely and accurate diagnosis of YOD: (1) stigma and awareness of YOD; (2) mismatched policy; (3) fractured health system; (4) inadequate pathways for YOD diagnostic care; (5) effective use of General Practitioners; (6) inequitable access and fragmented service navigation; (7) diverse and marginalised groups. CONCLUSION A complex web of systemic and system level barriers contributes to the delay of accurate and timely diagnosis for YOD. Diverse and marginalised groups experience greater inequitable disadvantage regarding YOD diagnostic care. There is an urgent need to focus on YOD diagnosis facilitators at the broader health system level.
Collapse
Affiliation(s)
- Kirsty Burkinshaw
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
24
|
Kilty C, Cahill S, Foley T, Fox S. Young onset dementia: implications for employment and finances. DEMENTIA 2023; 22:68-84. [PMID: 36254673 PMCID: PMC9772889 DOI: 10.1177/14713012221132374] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND People with young onset dementia face unique challenges. Notably, at time of symptom presentation, many people affected by young onset dementia are still employed with significant financial obligations. The aim of this study was to explore the specific impact that young onset dementia has on continued employment and finances and to identify ways to optimise post-diagnostic approaches in this regard. METHODS Purposive sampling, with a maximum variation technique, was used to recruit a small but diverse range of people with young onset dementia in Ireland. In-depth semi-structured interviews were conducted, and data were analysed using Reflexive Thematic Analysis. In total, 22 interviews were conducted with 10 people with young onset dementia and 12 spouses and children. Two themes were constructed: impact of young onset dementia on (I) employment and (II) finances. FINDINGS Participants' lived accounts showed the devastating effect of a diagnosis of young onset dementia on working life, and the resultant financial, social, and psychological consequences. Participants reported having to leave paid employment early, reported losing contracts and retiring on medical grounds. There were financial implications caused by loss of income, and many additional expenses owing to dementia were incurred. In some families, spouses had to take up employment at the same time as a caring role to mitigate the loss of income, and young children were anxious at the resultant occupational and financial tensions. CONCLUSION People diagnosed with young onset dementia encounter significant challenges associated with employment, and individual and family finances. There is a need for more specific information and guidance from healthcare professionals around employment rights, income support and welfare benefits and the pension status for this group of people. Additionally, healthcare professionals should be cognisant of the additional financial burden people face in young onset dementia when advising on services which incur out-of-pocket costs.
Collapse
Affiliation(s)
- Caroline Kilty
- Caroline Kilty, School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland.
| | - Suzanne Cahill
- School of Social Work and Social Policy, Trinity College Dublin Centre for Economic and Social Research on Dementia, NUI Galway and Institute of Gerontology, Jonkoping University, Sweden
| | - Tony Foley
- Department of General Practice, 8795University College Cork, Republic of Ireland
| | - Siobhán Fox
- Centre for Gerontology and Rehabilitation, 8795University College Cork, Republic of Ireland
| |
Collapse
|
25
|
Novek S, Menec V. Conceptualizing access to community-based supports from the perspectives of people living with young onset dementia, family members and providers. DEMENTIA 2023; 22:180-196. [PMID: 36377262 PMCID: PMC9772890 DOI: 10.1177/14713012221138145] [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] [Indexed: 11/17/2022]
Abstract
People living with young onset dementia and their families have significant support needs, but experience difficulties accessing services. This study explored the process of accessing community-based services drawing on semi-structured interviews with people living with dementia, family members and providers in Winnipeg, Canada. Data analysis involved a combination of inductive coding and theoretical analysis using the candidacy framework as a conceptual lens. Forced to navigate services that do not recognize people with young onset dementia as a user group, participants experienced ongoing barriers that generated continuous work and stress for families. Access was constrained by information resources geared towards older adults and restrictive eligibility criteria that constructed people with young onset dementia as "not impaired enough" or "too impaired". At the organizational level, fragmentation and underrepresentation of young onset dementia diminished access. Our findings underscore the need for continuous, coordinated supports alongside broader representation of young onset dementia within research, policy, and practice. We conclude with a discussion of how the candidacy theory could be extended to account for the social and political status of user groups.
Collapse
Affiliation(s)
- Sheila Novek
- Sheila Novek, School of Nursing, University of British Columbia.
| | - Verena Menec
- Department of Community Health Sciences, Rady Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, Canada
| |
Collapse
|
26
|
Loi SM, Atee M, Morris T, Whiting D, Macfarlane S, Cunningham C, Velakoulis D. Clinico-demographics of people with younger-onset dementia and neuropsychiatric symptoms referred to an Australian dementia support service: A comparison study with older-onset dementia. Aust N Z J Psychiatry 2022; 56:1653-1663. [PMID: 35191354 DOI: 10.1177/00048674221080709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Younger-onset dementia accounts for about 5-10% of all dementias in Australia. Little data is available on neuropsychiatric symptoms in people with younger-onset dementia compared to those with older-onset dementia. This study aims to compare the types of neuropsychiatric symptoms and their clinico-demographic characteristics of people with younger-onset dementia and older-onset dementia who are referred to a specific dementia support service. METHODS A 2-year retrospective observational cross-sectional analysis was undertaken on referrals with neuropsychiatric symptoms from Dementia Support Australia programmes. Neuropsychiatric symptoms were measured using the Neuropsychiatric Inventory total severity scores and distress scores. Contributing factors to neuropsychiatric symptoms for dementia groups were examined. Logistic regression was used to examine the relationship between individual neuropsychiatric symptoms and having older-onset dementia vs younger-onset dementia. RESULTS Of the 15,952 referrals, about 5% (n = 729, mean age: 60.7 years, standard deviation = 5.4) were individuals with younger-onset dementia. Referrals with older-onset dementia were more likely to be female (56%), whereas referrals with younger-onset dementia were more likely to be male (54%). There was a four times greater rate of frontotemporal dementia for those with younger-onset dementia (16.0%, n = 117) compared to those with older-onset dementia (2.8%, n = 427), χ2 (1) = 366.2, p < 0.001. Referrals with younger-onset dementia were more likely to be referred from community settings and those with older-onset dementia were more likely to be from residential aged care. Overall, there was no difference in the severity and distress of neuropsychiatric symptoms between the two groups. Contributing factors to neuropsychiatric symptoms were different between the groups, with pain being more frequently endorsed for individuals with older-onset dementia whereas communication difficulties were more commonly identified for those with younger-onset dementia. CONCLUSION Clinico-demographics of referrals with younger-onset dementia differ from those with older-onset dementia. There were some differences in the characteristics of neuropsychiatric symptoms between younger-onset dementia and older-onset dementia. Our findings have implications for service provision and support for people with dementia at different ages.
Collapse
Affiliation(s)
- Samantha M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne and The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mustafa Atee
- HammondCare, The Dementia Centre, Osborne Park, WA, Australia
| | - Thomas Morris
- HammondCare, The Dementia Centre, St Leonards, NSW, Australia
| | - Daniel Whiting
- HammondCare, The Dementia Centre, St Leonards, NSW, Australia
| | - Stephen Macfarlane
- HammondCare, The Dementia Centre, St Leonards, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Colm Cunningham
- HammondCare, The Dementia Centre, St Leonards, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Melbourne Neuropsychiatry Centre, The University of Melbourne and The Royal Melbourne Hospital, Parkville, VIC, Australia
| |
Collapse
|
27
|
Chirico I, Ottoboni G, Linarello S, Ferriani E, Marrocco E, Chattat R. Family experience of young-onset dementia: the perspectives of spouses and children. Aging Ment Health 2022; 26:2243-2251. [PMID: 34842004 DOI: 10.1080/13607863.2021.2008871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Although young-onset dementia (YOD) affects the whole family system, this population is still under-represented in literature, and no progress in care provision has been made. Hence, additional evidence is necessary to understand how family and social relationships are affected by YOD and care challenges, as to provide recommendations for clinical practice and service improvement from a family perspective. METHOD Family carers were recruited via one memory clinic and the local Alzheimer's Associations in Italy. Semi-structured interviews explored their experiences with YOD, the impact of the condition on their lives, family and social relationships, and the support and care they received. Transcripts were coded by three researchers and analysed using inductive thematic analysis. RESULTS Thirty-eight interviews were conducted with 26 spouses and 12 adult children. Three themes emerged: 1) Problems around diagnosis, 2) Lack of post-diagnostic support, and 3) Living with YOD as a family. Overall, problems occurred across the dementia pathway. Without appropriate support, it was difficult for families to adjust to living with YOD and to the associated changes in family roles and relationships. CONCLUSIONS Since optimal care depends on good family relationships, better support for families in the adaptation to condition would likely benefit patient care while ensuring social inclusion and health equity for vulnerable groups.
Collapse
Affiliation(s)
- Ilaria Chirico
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Simona Linarello
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy
| | - Elisa Ferriani
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy.,Department of Oncology, Local Health Care Unit, Bologna, Italy
| | - Enrica Marrocco
- Center for Cognitive Disorders and Dementia, Local Health Care Unit, Bologna, Italy.,Department of Oncology, Local Health Care Unit, Bologna, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| |
Collapse
|
28
|
O'Connor CMC, Fisher A, Cheung SC, Caga J, Piguet O. Supporting behaviour change in younger-onset dementia: mapping the needs of family carers in the community. Aging Ment Health 2022; 26:2252-2261. [PMID: 34424808 DOI: 10.1080/13607863.2021.1966744] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Almost 10% of people with dementia experience a younger-onset of disease (before 65 years). Changes in behaviour are common, as are delays in diagnosis and limited access to appropriate support and services. This study aimed to explore the specific behaviour support needs of families living with younger-onset dementia. METHODS Seventy-one families of people with younger-onset dementia were surveyed to understand the experience of family carers regarding difficult-to-manage behaviour changes, confidence in identifying and implementing behaviour support strategies, use of specific behaviour support strategies, and use of formal and informal support services regarding behaviour changes. RESULTS Survey responses were received from family members of people living with behavioural variant frontotemporal dementia (n = 28), semantic dementia (n = 17), and Alzheimer's disease (n = 23). Over 90% of family carers reported difficult-to-manage behaviours which fell into four main domains: (1) aggression, (2) compulsive behaviour, (3) disinhibition and inappropriate social behaviour, and (4) apathy. A range of preventative and responsive strategies, with an emphasis on de-escalation strategies were identified and carers reported variable confidence in managing behaviour changes or in accessing formal support strategies. CONCLUSIONS Difficult-to-manage behaviour changes in community-dwelling people with younger-onset dementia are common. The existing agency of families should be recognised and built upon with better access to specific behaviour support services to increase competence and confidence in providing behaviour support and ultimately improve quality of life for them and their family member with dementia.
Collapse
Affiliation(s)
- Claire M C O'Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia.,School of Population Health, The University of New South Wales, Sydney, Australia
| | - Alinka Fisher
- College of Nursing and Health Sciences Adelaide, Flinders University, Adelaide, Australia
| | - Sau Chi Cheung
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Jashelle Caga
- Sydney Medical School and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, Australia
| |
Collapse
|
29
|
Muacevic A, Adler JR. Young-Onset Dementia and Neurodegenerative Disorders of the Young With an Emphasis on Clinical Manifestations. Cureus 2022; 14:e30025. [PMID: 36381805 PMCID: PMC9637441 DOI: 10.7759/cureus.30025] [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: 08/04/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Young-onset dementia (YOD) refers to a neurological ailment primarily affecting people below 65 years of age in roughly about 8% of cases found through various researches. The high rate of prevalence of secondary dementias among older patients proves that younger people show a better prognosis of the conditions causing dementia than older people. However, effective interventions have to be usually provided early in the course of cognitive decline to help facilitate cognitive improvement. The risk of development of prodromal dementia is high if there is a development of psychoses in middle-aged or older people. When there is a development of psychoses in middle to late life, the likelihood of this indicates prodromal dementia is high. The clinical presentation is quite variable and often subtle in frontotemporal dementia (FTD) but may be dominated by personality change, behavioral disturbances, motivation, or the loss of empathy. There is great heterogeneity in the probable causes of dementia in young age as compared to dementia in old age, and some observed differences also exist in the course and characteristics of the disease. These causes may range from the most probable cause such as Alzheimer's disease (AD) to causes with low probability, such as metabolic disorders and prion diseases. The symptoms of young-onset dementia include a gradual development of personality and behavioral changes over a period of years. However, in the initial stages of young-onset dementia, this change can be attributed to various issues, such as depression, marital problems, and menopause. Other neurodegenerative diseases such as Huntington's disease show presentations such as changes in personality, chorea, and depression that can be observed in patients in their early adulthood. A few other neurodegenerative disorders are myoclonic epilepsy with ragged red fibers (MERRF) and mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) with presentations such as characterized muscle weakness, poor growth, problems with vision and hearing, and the involvement of the multi-organ system, including the central nervous system to name a few. There is also the prevalence of juvenile parkinsonism in the community, which represents a group of clinicopathological entities present before the age of 21. Young-onset Parkinson's disease (PD) (YOPD) appears to have the same pathological presentation as late-onset Parkinson's disease (LOPD). Recent researches have proved that "gene therapy" can be useful in the treatment and in preventing the progression of symptoms in cases of neurodegenerative diseases.
Collapse
|
30
|
Ryan B, To E, Ma'u E, Chan AHY, Rivera-Rodriguez C, Curtis MA, Cullum S, Cheung G. Prevalence of young-onset dementia: nationwide analysis of routinely collected data. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329126. [PMID: 35995550 DOI: 10.1136/jnnp-2022-329126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/23/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Young-onset dementia prevalence is understudied internationally. Previous studies have been limited by low case numbers, reliance on single sources of routinely collected health data for case identification and inclusion of a limited age range. Our objective was to determine the 1-year period prevalence of diagnosed dementia in people aged 0-64 in the entire New Zealand population using routinely collected health data. METHODS A population-based descriptive study was carried out in New Zealand (population 4.8 million) using routinely collected deidentified health data from 2016 to 2020. Dementia cases in seven linked health datasets in the New Zealand Integrated Data Infrastructure were identified using diagnostic codes and/or use of antidementia medication. Prevalence for each of the four study years was calculated by age, sex and ethnicity. RESULTS From a total population of 4 027 332-4 169 754 individuals aged 0-64, we identified 3396-3474 cases of 'all-cause' dementia in each of the study years (prevalence crude range: 83-84/100 000 people aged 0-64; 139-141/100 000 people aged 30-64 years; 204-207/100 000 people aged 45-64 years). Age-standardised prevalence was higher in males than females. Age-standardised and sex-standardised prevalence was higher in Māori and Pacific People than European and Asian. DISCUSSION By using a large study population and multiple national health datasets, we have minimised selection bias and estimated the national prevalence of diagnosed young-onset dementia with precision. Young-onset dementia prevalence for the total New Zealand population was similar to reported global prevalence, validating previous estimates. Prevalence differed by ethnicity, which has important implications for service planning.
Collapse
Affiliation(s)
- Brigid Ryan
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
| | - Edith To
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Etuini Ma'u
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | - Maurice A Curtis
- Department of Anatomy and Medical Imaging, The University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
31
|
Van Rickstal R, Vleminck AD, Engelborghs S, Versijpt J, Van den Block L. A qualitative study with people with young-onset dementia and their family caregivers on advance care planning: A holistic, flexible, and relational approach is recommended. Palliat Med 2022; 36:964-975. [PMID: 35470742 PMCID: PMC9174579 DOI: 10.1177/02692163221090385] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Broad consensus exists on the relevance of advance care planning in dementia. Although people with young-onset dementia and their family are hypothesized to have distinct needs and preferences in this area, they are hardly ever included in studies. AIM We aim to explore the experiences with and views on advance care planning of people with young-onset dementia and their family caregivers. DESIGN A qualitative study was conducted, analyzing semi-structured interviews through the method of constant comparative analysis. SETTING/PARTICIPANTS We included 10 people with young-onset dementia and 10 of their family caregivers in Flanders. RESULTS Participants lacked awareness about the concept of advance care planning, especially as a communication process. They had not or barely engaged in planning future care yet pointed out possible benefits of doing so. Initially, people with young-onset dementia and their caregivers directly associated advance care planning with planning for the actual end of life. When discussing advance care planning as a communication process, they paid ample attention to non-medical aspects and did not distinguish between medical, mental, and social health. Rather, respondents thought in the overarching framework of what is important to them now and in the future. CONCLUSIONS Engagement in advance care planning might be hindered if it is too medicalized and exclusively patient-centered. To accommodate advance care planning to people with young-onset dementia's and their caregivers' needs, it should be presented and implemented as a holistic, flexible, and relational communication process. Policy and practice recommendations are provided on how to do so.
Collapse
Affiliation(s)
- Romy Van Rickstal
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-Life Care Research Group, Brussels, Belgium.,Fonds voor Wetenschappelijk Onderzoek-Vlaanderen, Brussels, Belgium
| | - Aline De Vleminck
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-Life Care Research Group, Brussels, Belgium.,Fonds voor Wetenschappelijk Onderzoek-Vlaanderen, Brussels, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Jan Versijpt
- Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-Life Care Research Group, Brussels, Belgium.,Fonds voor Wetenschappelijk Onderzoek-Vlaanderen, Brussels, Belgium.,Francqui Research Professor (2020-2023), Brussels, Belgium
| |
Collapse
|
32
|
Loi SM, Flynn L, Cadwallader C, Stretton-Smith P, Bryant C, Baker FA. Music and Psychology & Social Connections Program: Protocol for a Novel Intervention for Dyads Affected by Younger-Onset Dementia. Brain Sci 2022; 12:brainsci12040503. [PMID: 35448034 PMCID: PMC9031190 DOI: 10.3390/brainsci12040503] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Psychosocial interventions targeting the specific needs of people affected by younger-onset dementia are lacking. Younger-onset dementia refers to dementia where symptom onset occurs at less than 65 years old. Because of its occurrence in middle age, the impact on spouses is particularly marked and dyadic-based interventions are recommended. Music And Psychology & Social Connections (MAPS) is a novel online intervention, informed by the theory of adaptive coping by Bannon et al. (2021) for dyads affected by younger-onset dementia. MAPS combines therapeutic songwriting, cognitive behaviour therapy, and a private social networking group that focuses on the dyads. This will be a randomised controlled trial with a waitlist control. The primary aims are to assess whether MAPS improves depressive, anxiety, and stress symptoms in caregivers, with secondary aims to assess whether MAPS improves depressive symptoms in people with younger-onset dementia. The trial also aims to assess dyadic social connectedness; caregiver coping skills; and neuropsychiatric symptoms in people with younger-onset dementia. We will recruit 60 dyads to participate in a group-based weekly online program for 8 weeks facilitated by a credentialed music therapist and psychologist. Sessions 1 and 8 will include both caregivers and people with younger-onset dementia and Sessions 2–7 will involve separate group sessions for caregivers and those with dementia. There will be focus groups for qualitative feedback. Due to its online administration, MAPS has the potential to reach many dyads affected by younger-onset dementia.
Collapse
Affiliation(s)
- Samantha M. Loi
- Department of Psychiatry, The University of Melbourne, Parkville, VIC 3052, Australia
- Neuropsychiatry, John Cade Level 2, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Correspondence: ; Tel.: +613-9342-8750
| | - Libby Flynn
- Department of Fine Arts and Music, The University of Melbourne, Parkville, VIC 3052, Australia; (L.F.); (C.C.); (P.S.-S.); (F.A.B.)
| | - Claire Cadwallader
- Department of Fine Arts and Music, The University of Melbourne, Parkville, VIC 3052, Australia; (L.F.); (C.C.); (P.S.-S.); (F.A.B.)
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Phoebe Stretton-Smith
- Department of Fine Arts and Music, The University of Melbourne, Parkville, VIC 3052, Australia; (L.F.); (C.C.); (P.S.-S.); (F.A.B.)
| | - Christina Bryant
- Department of Psychology, The University of Melbourne, Parkville, VIC 3052, Australia;
| | - Felicity A. Baker
- Department of Fine Arts and Music, The University of Melbourne, Parkville, VIC 3052, Australia; (L.F.); (C.C.); (P.S.-S.); (F.A.B.)
- Music Education and Music Therapy Department, Norwegian Academy of Music, 0369 Oslo, Norway
| |
Collapse
|
33
|
Effects of Phone-Based Psychological Intervention on Caregivers of Patients with Early-Onset Alzheimer’s Disease: A Six-Months Study during the COVID-19 Emergency in Italy. Brain Sci 2022; 12:brainsci12030310. [PMID: 35326267 PMCID: PMC8945970 DOI: 10.3390/brainsci12030310] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Caregivers of patients with early-onset Alzheimer’s disease (EOAD) experience higher level of burden, stress, and depression, due to premature role changes and social isolation. Moreover, the SARS-CoV-2 pandemic compelled restrictions regarding social interactions and mobility in Italy from March 2020, prompting telemedicine approaches for supporting patients and their families confined at home. We reported our experience regarding the effects of psychological phone-intervention (phone-I) on EOAD caregivers during pandemic. Twenty caregivers of EOAD patients were randomly assigned to treatment (TG) or control (CG) group. TG weekly underwent a phone-I for one month. All participants were assessed for caregiver burden and needs, anxiety and depression levels, and subjective impact of traumatic events at baseline (T0), at the fifth week (T1) and after 6 months (T2) from phone-I. We observed higher vulnerability to post-traumatic stress in TG compared to CG in all timepoints (p ≤ 0.05). Decreased stress effects and caregiver burden were revealed in TG at T1 compared to T0 (p ≤ 0.05), although showing an increase of these measures at T2 in the treated caregivers. Our findings suggest that although TG showed a peculiar vulnerability to post-traumatic stress, they showed increased wellbeing immediately after phone-I. However, this benefit disappeared six months later, along with the second infection wave, probably due to “exhaustion stage” achievement in “General Adaptation Syndrome”. This trend may suggest a beneficial but not solving role of a prompt phone-I on burden of caregivers of EOAD patients during the SARS-CoV-2 emergency.
Collapse
|
34
|
Tsoukra P, Velakoulis D, Wibawa P, Malpas CB, Walterfang M, Evans A, Farrand S, Kelso W, Eratne D, Loi SM. The Diagnostic Challenge of Young-Onset Dementia Syndromes and Primary Psychiatric Diseases: Results From a Retrospective 20-Year Cross-Sectional Study. J Neuropsychiatry Clin Neurosci 2022; 34:44-52. [PMID: 34538074 DOI: 10.1176/appi.neuropsych.20100266] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Distinguishing a dementia syndrome from a primary psychiatric disease in younger patients can be challenging and may lead to diagnostic change over time. The investigators aimed to examine diagnostic stability in a cohort of patients with younger-onset neurocognitive disorders. METHODS A retrospective review of records was conducted for patients who were admitted to an inpatient neuropsychiatry service unit between 2000 and 2019, who were followed up for at least 12 months, and who received a diagnosis of young-onset dementia at any time point. Initial diagnosis included Alzheimer's disease-type dementia (N=30), frontotemporal dementia (FTD) syndromes (N=44), vascular dementia (N=7), mild cognitive impairment (N=10), primary psychiatric diseases (N=6), and other conditions, such as Lewy body dementia (N=30). RESULTS Among 127 patients, 49 (39%) had a change in their initial diagnoses during the follow-up period. Behavioral variant FTD (bvFTD) was the least stable diagnosis, followed by dementia not otherwise specified and mild cognitive impairment. Compared with patients with a stable diagnosis, those who changed exhibited a higher cognitive score at baseline, a longer follow-up period, greater delay to final diagnosis, and no family history of dementia. Patients whose diagnosis changed from a neurodegenerative to a psychiatric diagnosis were more likely to have a long psychiatric history, while those whose diagnosis changed from a psychiatric to a neurodegenerative one had a recent manifestation of psychiatric symptoms. CONCLUSIONS Misdiagnosis of younger patients with neurocognitive disorders is not uncommon, especially in cases of bvFTD. Late-onset psychiatric symptoms may be the harbinger to a neurodegenerative disease. Close follow-up and monitoring of these patients are necessary.
Collapse
Affiliation(s)
- Paraskevi Tsoukra
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Dennis Velakoulis
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Pierre Wibawa
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Charles B Malpas
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Mark Walterfang
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Andrew Evans
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Sarah Farrand
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Wendy Kelso
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Dhamidhu Eratne
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| | - Samantha M Loi
- Department of Neurology, Evaggelismos Hospital, Athens, Greece (Tsoukra); Neuropsychiatry Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Melbourne Neuropsychiatry Centre, University of Melbourne and Royal Melbourne Hospital, Parkville, Australia (Velakoulis, Wibawa, Walterfang, Evans, Farrand, Kelso, Eratne, Loi); Department of Medicine, Clinical Outcomes Research Unit, Royal Melbourne Hospital, Parkville, Australia (Malpas); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (Malpas); and Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia (Malpas)
| |
Collapse
|
35
|
van de Veen D, Bakker C, Peetoom K, Pijnenburg Y, Papma J, de Vugt M, Koopmans R. Provisional consensus on the nomenclature and operational definition of dementia at a young age, a Delphi study. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5691. [PMID: 35156239 PMCID: PMC9305901 DOI: 10.1002/gps.5691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Dementia at a young age differs from late onset dementia in pathology and care needs. This requires further research to improve the understanding of this group, support and service provision. Aim of current study is to reach consensus on the terminology and operational definition (i.e., age-related criteria and possible causes) of dementia at a young age, to aid further research. METHODS A classical Delphi technique was used to transform opinions into group consensus by using an online survey. In three rounds statements regarding (1) terminology, (2) age-related criteria, and (3) aetiologies that can be considered as causes of dementia at a young age were sent to international experts in the field to give their opinions and additional comments on the statements. RESULTS Forty-four experts responded and full consensus was reached on 22 out of 35 statements. Young-onset dementia emerged as the term of preference. Provisional consensus was found for the use of age 65 at symptom onset as preferred cut-off age. Consensus was reached on the inclusion of 15 out of 22 aetiologies and categories of aetiologies as potential cause for dementia at a young age. CONCLUSIONS A clear term and operational definition have been reached. Although beneficial for conducting future research to gain more insight in pathology and care needs of young people living with dementia, still consensus about some details is lacking. To reach consensus about these details and implications for use in research and clinical practice, the organisation of an in person consensus meeting is advised.
Collapse
Affiliation(s)
- Dennis van de Veen
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
- Stichting Zorggroep Florence, Mariahoeve, Center for Specialized Care in Young‐Onset DementiaThe HagueThe Netherlands
| | - Christian Bakker
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
- Groenhuysen, Center for Specialized Geriatric CareRoosendaalThe Netherlands
| | - Kirsten Peetoom
- Alzheimer Center Limburg, Maastricht UniversityMaastrichtThe Netherlands
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical CenterAmsterdamThe Netherlands
| | - Janne Papma
- Department of Neurology and Alzheimer CenterErasmus University Medical CenterRotterdamThe Netherlands
| | | | - Marjolein de Vugt
- Alzheimer Center Limburg, Maastricht UniversityMaastrichtThe Netherlands
| | - Raymond Koopmans
- Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
- Joachim en Anna, Center for Specialized Geriatric CareNijmegenThe Netherlands
| |
Collapse
|
36
|
Walia N, Eratne D, Loi SM, Li QX, Varghese S, Malpas CB, Walterfang M, Evans AH, Parker S, Collins SJ, Masters CL, Velakoulis D. Cerebrospinal fluid neurofilament light predicts the rate of executive function decline in younger-onset dementia. J Neurol Sci 2022; 432:120088. [PMID: 34922179 DOI: 10.1016/j.jns.2021.120088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Determining disease severity and predicting prognosis in younger onset-dementia (YOD) remains challenging. Whether CSF biomarkers neurofilament light (NfL), tau and amyloidβ 42 (Aβ42) can help provide such information has been underexplored. METHODS Patients with YOD and CSF analysis were identified. We compared baseline NfL, tau and Aβ42 concentrations with contemporaneous Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) scores to assess their association with severity of cognitive impairment. Cognitive decline, as measured by longitudinal NUCOG assessment, was correlated against baseline biomarker levels to assess their utility in predicting the rate of cognitive decline. RESULTS 78 patients with YOD (mean age = 56 years, SD = 8) and CSF analysis were identified. Dementia types included Alzheimer's disease, behavioural variant frontotemporal dementia, dementia not-otherwise-specified and other. Tau was associated with contemporaneous memory dysfunction (r = -0.556, 95% CI:[-0.702,-0.393], p < .001). 21 patients had longitudinal cognitive assessment up to 82 months from CSF sampling. NfL was associated with the rate of executive function decline (r = 0.755, 95% CI:[0.259,0.937], p < .001). Aβ42 was associated with the rate of memory decline (r = -0.582, 95% CI:[-0.855,-0.274], p = .007) and rate of total NUCOG decline (r = -0.515, 95% CI: [-0.809, -0.227], p = .017). CONCLUSION CSF tau is related to contemporaneous memory impairment in YOD. NfL and Aβ42 levels are associated with the rate of executive function and memory decline, respectively, and may have a role in prognostication in YOD.
Collapse
Affiliation(s)
- N Walia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - D Eratne
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - S M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Q-X Li
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - S Varghese
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - C B Malpas
- Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - M Walterfang
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - A H Evans
- Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - S Parker
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - S J Collins
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - C L Masters
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - D Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| |
Collapse
|
37
|
Couzner L, Day S, Draper B, Withall A, Laver KE, Eccleston C, Elliott KE, McInerney F, Cations M. What do health professionals need to know about young onset dementia? An international Delphi consensus study. BMC Health Serv Res 2022; 22:14. [PMID: 34974838 PMCID: PMC8722147 DOI: 10.1186/s12913-021-07411-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background People with young onset dementia (YOD) have unique needs and experiences, requiring care and support that is timely, appropriate and accessible. This relies on health professionals possessing sufficient knowledge about YOD. This study aims to establish a consensus among YOD experts about the information that is essential for health professionals to know about YOD. Methods An international Delphi study was conducted using an online survey platform with a panel of experts (n = 19) on YOD. In round 1 the panel individually responded to open-ended questions about key facts that are essential for health professionals to understand about YOD. In rounds 2 and 3, the panel individually rated the collated responses in terms of their importance in addition to selected items from the Dementia Knowledge Assessment Scale. The consensus level reached for each statement was calculated using the median, interquartile range and percentage of panel members who rated the statement at the highest level of importance. Results The panel of experts were mostly current or retired clinicians (57%, n = 16). Their roles included neurologist, psychiatrist and neuropsychiatrist, psychologist, neuropsychologist and geropsychologist, physician, social worker and nurse practitioner. The remaining respondents had backgrounds in academia, advocacy, or other areas such as law, administration, homecare or were unemployed. The panel reached a high to very high consensus on 42 (72%) statements that they considered to be important for health professionals to know when providing care and services to people with YOD and their support persons. Importantly the panel agreed that health professionals should be aware that people with YOD require age-appropriate care programs and accommodation options that take a whole-family approach. In terms of identifying YOD, the panel agreed that it was important for health professionals to know that YOD is aetiologically diverse, distinct from a mental illness, and has a combination of genetic and non-genetic contributing factors. The panel highlighted the importance of health professionals understanding the need for specialised, multidisciplinary services both in terms of diagnosing YOD and in providing ongoing support. The panel also agreed that health professionals be aware of the importance of psychosocial support and non-pharmacological interventions to manage neuropsychiatric symptoms. Conclusions The expert panel identified information that they deem essential for health professionals to know about YOD. There was agreement across all thematic categories, indicating the importance of broad professional knowledge related to YOD identification, diagnosis, treatment, and ongoing care. The findings of this study are not only applicable to the delivery of support and care services for people with YOD and their support persons, but also to inform the design of educational resources for health professionals who are not experts in YOD.
Collapse
Affiliation(s)
- Leah Couzner
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | | | | | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia. .,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| |
Collapse
|
38
|
Stamou V, La Fontaine J, O'Malley M, Jones B, Parkes J, Carter J, Oyebode JR. Helpful post-diagnostic services for young onset dementia: Findings and recommendations from the Angela project. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:142-153. [PMID: 33951252 DOI: 10.1111/hsc.13383] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
There is a significant lack of evidence regarding optimum models for service provision in young onset dementia (YOD). Our study aim was to gather detailed information about services experienced as helpful by those with YOD and family carers. The objective was to identify the core features of these services to inform service design, delivery and improvements. A qualitative approach based on appreciative inquiry was used, posing open-ended questions about services experienced as helpful, as part of a national UK survey of people with YOD and carers. We used inductive thematic analysis to analyse the free-text responses. The resulting template was used as a basis for analysis of in-depth follow-up interviews, conducted to acquire greater in-depth understanding. Two hundred and thirty-three survey respondents provided 856 examples of helpful support. Twenty-four follow-up interviews were conducted (two with dyads, so 26 participants in total: 8 with people with YOD, 14 with carers, 2 with dyads). Twelve themes capturing the features of helpful services were clustered into three super-ordinate themes. 'Person-centredness' reflects micro levels of person-professional interaction (positive attitude, flexibility, collaborative, user-friendly materials, and in-person). 'Functional consistency' captures the meso level, demonstrating that services were helpful when organised consistently with needs (age-appropriate, holistic, responsive, and accessible). 'Organisational coherence', at the macro level, emphasises the need for service integration, specialist services and service continuity. Key conclusions are that the needs for flexibility and a collaborative stance may be particularly important for those under 65 years with dementia, who have full lives and are used to being in control; to be age-appropriate, helpful services need to provide activities and opportunities suitable for active middle-aged people; and to be holistic, services need to provide for needs associated with rare dementias and be family-centred. Specialist services need to be commissioned and arrangements need to be stable over time to enable continuity.
Collapse
Affiliation(s)
- Vasileios Stamou
- Faculty of Health Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Jenny La Fontaine
- Faculty of Health Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Mary O'Malley
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Bridget Jones
- Department of Economics, Surrey Health Economics Centre, University of Surrey, Guildford, UK
| | - Jacqueline Parkes
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Janet Carter
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Jan R Oyebode
- Faculty of Health Studies, Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| |
Collapse
|
39
|
Day S, Roberts S, Launder NH, Goh AMY, Draper B, Bahar-Fuchs A, Loi SM, Laver K, Withall A, Cations M. Age of Symptom Onset and Longitudinal Course of Sporadic Alzheimer's Disease, Frontotemporal Dementia, and Vascular Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 85:1819-1833. [PMID: 34958038 DOI: 10.3233/jad-215360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding how the age of dementia symptom onset affects the longitudinal course of dementia can assist with prognosis and care planning. OBJECTIVE To synthesize evidence regarding the relationship of age of symptom onset with the longitudinal course of sporadic Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). METHODS We searched Medline, CINAHL, Embase, PsycINFO, PubMed, and Scopus for longitudinal studies that examined the impact of sporadic AD, VaD, or FTD symptom onset age on measures of cognition, function, or behavioral symptoms. Studies that examined age at diagnosis only were excluded. Quantitative meta-analysis was conducted where studies reported sufficient data for pooling. RESULTS Thirty studies met all inclusion criteria (people with AD (n = 26), FTD (n = 4)) though no studies examined VaD. Earlier onset of AD was associated with more rapid annual cognitive decline (estimate = -0.07; 95% CI -0.14 to 0.00; p = 0.045). Most studies that stratified their sample reported that younger AD onset (usually < 65 years) was associated with more rapid cognitive decline. Other evidence was inconclusive. CONCLUSION Younger people with AD appear to have a poorer prognosis in terms of faster cognitive decline than older people with AD. More research is required to determine the impact of symptom onset age in VaD and FTD, and on functional decline in all dementias.
Collapse
Affiliation(s)
- Sally Day
- College of Education, Psychology and Social Work, Flinders University, Adelaide SA, Australia
| | - Stefanie Roberts
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,National Ageing Research Institute, Melbourne VIC, Australia
| | - Nathalie H Launder
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia
| | - Anita M Y Goh
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,National Ageing Research Institute, Melbourne VIC, Australia
| | - Brian Draper
- School of Psychiatry, UNSW Sydney, New South Wales, Australia
| | - Alex Bahar-Fuchs
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia
| | - Samantha M Loi
- Department of Psychiatry, The University of Melbourne, Melbourne VIC, Australia.,Neuropsychiatry, Royal Melbourne Hospital, Parkville VIC, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Adrienne Withall
- School of Population Health, UNSW Sydney, New South Wales, Australia.,Ageing Futures Institute, UNSW Sydney, New South Wales, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide SA, Australia
| |
Collapse
|
40
|
Zheng Y, Tang N, Omar R, Hu Z, Duong T, Wang J, Wu W, Haick H. Smart Materials Enabled with Artificial Intelligence for Healthcare Wearables. ADVANCED FUNCTIONAL MATERIALS 2021; 31. [DOI: 10.1002/adfm.202105482] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Indexed: 08/30/2023]
Abstract
AbstractContemporary medicine suffers from many shortcomings in terms of successful disease diagnosis and treatment, both of which rely on detection capacity and timing. The lack of effective, reliable, and affordable detection and real‐time monitoring limits the affordability of timely diagnosis and treatment. A new frontier that overcomes these challenges relies on smart health monitoring systems that combine wearable sensors and an analytical modulus. This review presents the latest advances in smart materials for the development of multifunctional wearable sensors while providing a bird's eye‐view of their characteristics, functions, and applications. The review also presents the state‐of‐the‐art on wearables fitted with artificial intelligence (AI) and support systems for clinical decision in early detection and accurate diagnosis of disorders. The ongoing challenges and future prospects for providing personal healthcare with AI‐assisted support systems relating to clinical decisions are presented and discussed.
Collapse
Affiliation(s)
- Youbin Zheng
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute Technion‐Israel Institute of Technology Haifa 3200003 Israel
| | - Ning Tang
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute Technion‐Israel Institute of Technology Haifa 3200003 Israel
| | - Rawan Omar
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute Technion‐Israel Institute of Technology Haifa 3200003 Israel
| | - Zhipeng Hu
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute Technion‐Israel Institute of Technology Haifa 3200003 Israel
- School of Chemistry Xi'an Jiaotong University Xi'an 710126 P. R. China
| | - Tuan Duong
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute Technion‐Israel Institute of Technology Haifa 3200003 Israel
| | - Jing Wang
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute Technion‐Israel Institute of Technology Haifa 3200003 Israel
| | - Weiwei Wu
- School of Advanced Materials and Nanotechnology Interdisciplinary Research Center of Smart Sensors Xidian University Xi'an 710126 P. R. China
| | - Hossam Haick
- Department of Chemical Engineering and Russell Berrie Nanotechnology Institute Technion‐Israel Institute of Technology Haifa 3200003 Israel
- School of Advanced Materials and Nanotechnology Interdisciplinary Research Center of Smart Sensors Xidian University Xi'an 710126 P. R. China
| |
Collapse
|
41
|
Roman de Mettelinge T, Calders P, Cambier D. The Effects of Aerobic Exercise in Patients with Early-Onset Dementia: A Scoping Review. Dement Geriatr Cogn Disord 2021; 50:9-16. [PMID: 33957623 DOI: 10.1159/000516231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early-onset dementia (EOD) defines all dementia related conditions with an onset before the age of 65 years. EOD places a large and distressing psychological, emotional and financial burden on the individuals themselves and their caregivers. For various reasons, diagnostic and treatment strategies for EOD are very challenging. There is a general agreement that not only the human body but also the mind benefits from physical activity and/or exercise. Especially aerobic exercise has shown to have favorable effects on cognitive functions in healthy older adults, as well as in patients with MCI and dementia. However, there are major differences in age, physical fitness level and clinical presentation between EOD and late-onset dementia. Therefore, one cannot just assume that the same type and intensity of exercise will lead to similar effects in the former population. By conducting this scoping review, the authors aimed to identify the evidence on the effectiveness of aerobic exercise on physical and mental health outcomes in individuals with EOD, display gaps in this context, and formulate related directions for future research. SUMMARY There are a number of reasons to assume that aerobic exercise might be extremely valuable within individuals with EOD. However, this scoping review led to the surprising and striking finding that not a single study so far has investigated the effects of physical exercise on cognition, physical performance and feelings of well-being and quality of life in EOD. Although nowadays the disease is increasingly recognized, coping and (non-pharmacological) treatment strategies for EOD are virtually non-existent. Key Messages: Exercise intervention studies in EOD are lacking. With this scoping review the authors hope to inspire researchers in the field for related directions for future research. The potential beneficial effects of aerobic exercise in individuals with EOD should be explored and assessed extensively. Secondarily, decent guidelines for non-pharmacological treatment and coping strategies should be developed, with the aim of supporting people with EOD and their caregivers.
Collapse
Affiliation(s)
- Tine Roman de Mettelinge
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dirk Cambier
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
42
|
van de Veen D, Bakker C, Peetoom K, Pijnenburg Y, Papma JM, de Vugt M, Koopmans R. An Integrative Literature Review on the Nomenclature and Definition of Dementia at a Young Age. J Alzheimers Dis 2021; 83:1891-1916. [PMID: 34487041 PMCID: PMC8609678 DOI: 10.3233/jad-210458] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: There has been growing interest in young people living with dementia. Future research requires consensus on the terminology and operational definition of this group. Objective: The purpose of this integrative review was to explore and include all operational definitions used to define dementia at a young age. Methods: On August 14, 2020, the PubMed, Embase, Cinahl, and PsycInfo databases were searched for empirical and theoretical literature using Google. Various terms to describe and define ‘dementia’ and ‘at a young age’ were used to collect literature concerning terminology; age-related aspects, including cut-off ages and criteria; and etiologies of dementia at a young age. Results: The search yielded 6,891 empirical and 4,660 theoretical publications, resulting in the inclusion of 89 publications, including 36 publications containing an explicit discussion and 53 publications as confirmation. ‘Young-onset dementia’ was the most commonly used term of seven identified terms, in the last two decades. The age of 65 years at symptom onset was used most frequently when considering a total of six upper age limits and four criteria to define a cut-off age. Eight lower age limits and an option for subdivision based on age were included. We identified 251 different etiologies and 27 categories of etiologies. Conclusion: Despite relative consensus on the term young-onset dementia and an age at symptom onset being used as a cut-off criterion, much is still unclear concerning possible etiologies of dementia at a young age. In the current study, controversies were detected for discussion in an international consensus study.
Collapse
Affiliation(s)
- Dennis van de Veen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Florence, Mariahoeve, Center for Specialized Care in Young-Onset Dementia, The Hague, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, the Netherlands
| | - Kirsten Peetoom
- Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Yolande Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Marjolein de Vugt
- Department of Neurology and Alzheimer Center, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboudumc Alzheimer Center, Nijmegen, the Netherlands.,Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| |
Collapse
|
43
|
Carcaillon-Bentata L, Quintin C, Boussac-Zarebska M, Elbaz A. Prevalence and incidence of young onset dementia and associations with comorbidities: A study of data from the French national health data system. PLoS Med 2021; 18:e1003801. [PMID: 34555025 PMCID: PMC8496799 DOI: 10.1371/journal.pmed.1003801] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 10/07/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dementia onset in those aged <65 years (young onset dementia, YOD) has dramatic individual and societal consequences. In the context of population aging, data on YOD are of major importance to anticipate needs for planning and allocation of health and social resources. Few studies have provided precise frequency estimates of YOD. The aim of this study is to provide YOD prevalence and incidence estimates in France and to study the contribution of comorbidities to YOD incidence. METHODS AND FINDINGS Using data from the French national health data system (Système National des Données de Santé, SNDS) for 76% of the French population aged 40 to 64 years in 2016 (n = 16,665,795), we identified all persons with dementia based on at least 1 of 3 criteria: anti-Alzheimer drugs claims, hospitalization with the International Classification of Diseases-10th Revision (ICD-10) dementia codes (F00 to F03, G30, G31.0, G31.1, or F05.1), or registration for free healthcare for dementia. We estimated prevalence rate (PR) and incidence rate (IR) and estimated the association of comorbidities with incident YOD. Sex differences were investigated. We identified 18,466 (PRstandardized = 109.7/100,000) and 4,074 incident (IRstandardized = 24.4/100,000 person-years) persons with prevalent and incident YOD, respectively. PR and IR sharply increased with age. Age-adjusted PR and IR were 33% (95% confidence interval (CI) = 29 to 37) and 39% (95% CI = 31 to 48) higher in men than women (p < 0.001 both for PR and IR). Cardio- and cerebrovascular, neurological, psychiatric diseases, and traumatic brain injury prevalence were associated with incident YOD (age- and sex-adjusted p-values <0.001 for all comorbidities examined, except p = 0.109 for antihypertensive drug therapy). Adjustment for all comorbidities explained more than 55% of the sex difference in YOD incidence. The lack of information regarding dementia subtypes is the main limitation of this study. CONCLUSIONS We estimated that there were approximately 24,000 and approximately 5,300 persons with prevalent and incident YOD, respectively, in France in 2016. The higher YOD frequency in men may be partly explained by higher prevalence of cardiovascular and neurovascular diseases, substance abuse disorders, and traumatic brain injury and warrants further investigation.
Collapse
Affiliation(s)
| | | | | | - Alexis Elbaz
- Santé publique France, Saint-Maurice, France
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Inserm, Villejuif, France
| |
Collapse
|
44
|
Grundberg Å, Sandberg J, Craftman ÅG. Childrens' and young adults' perspectives of having a parent with dementia diagnosis: A scoping review. DEMENTIA 2021; 20:2933-2956. [PMID: 34096358 DOI: 10.1177/14713012211023653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dementia is a key health issue worldwide. In Sweden, as in other European countries, most persons with dementia live in domestic settings and are often cared for by their family members. This scoping review aims to describe the perspectives of children and young adults with a parent diagnosed with dementia. Young family members may be alone and without support despite their high level of care burden. DESIGN AND METHODS Three electronic databases (PubMed, Web of Science and PsycINFO) were used to search for English-language articles focusing on children and young adults between the ages of 6 and 34 who have a parent diagnosed with dementia. A thematic synthesis of the included articles was performed. FINDINGS Sixteen original published qualitative studies were identified. These studies were categorised based on information about the authors, year of publication, study location, participants, aim of the study, data collection, analysis and main findings. Five main analytical themes were identified: (1) children and young adults identify changes in their parents' behaviour and personality, (2) children and young adults experience changed roles and relationships within the family, (3) children and young adults need to cope with an uncertain future, (4) children and young adults relate changes in their parent to their own mixed emotions and (5) children and young adults need help and seek it out but experience inadequate support. CONCLUSIONS The children and young adults in the included studies seem to provide significant levels of care and support to their affected parent, which may affect their own health, social relations, community participation, employment, education, finances and sense of security. This means that it is important for health care systems and social services to identify barriers to these young family members' access to relevant care and support for themselves.
Collapse
Affiliation(s)
- Åke Grundberg
- Department of Learning, Informatics, Management and Ethics, LIME, 27106Karolinska Institutet, Solna, Sweden
| | - Jonas Sandberg
- Department of Caring Science, Sophiahemmet University, Stockholm, Sweden
| | - Åsa G Craftman
- Department of Caring Science, Sophiahemmet University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, NVS, 27106Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
45
|
Ottoboni G, Stamou V, Chirico I, De Riso L, Allione L, Johannessen A, Chattat R. Needs-appropriate services for people with young onset dementia: The perspectives of healthcare professionals. DEMENTIA 2021; 20:2725-2745. [PMID: 33896232 DOI: 10.1177/14713012211009340] [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: 11/15/2022]
Abstract
Young onset dementia has become a growing challenge in national healthcare systems. Concerns about the situation have already been expressed; however, they mostly report the views of services end-users. Aimed at finding out useful further improvement, interviews documenting the working experiences of professionals addressing healthcare services to people with young onset dementia (YOD) were analysed qualitatively. The interviews resulted in four themes and twelve categories. The themes regarded services' complexity and responsiveness, the levels of education and knowledge on YOD, the impact that serving people with YOD reflects on staff working experience and quality of life, and a series of proposals aimed at improving services by giving people with YOD and families the provision of care they deserve. Although some of the themes recapped the ones reported in the previous literature, the mixture of internally and externally driven instances represented in the themes depict the complexity of care delivery in the services. Findings are discussed in the light of a pragmatical framework capable of suggesting what changes services should implement to be timely responsive.
Collapse
Affiliation(s)
- Giovanni Ottoboni
- Department of Psychology; "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, 9296University of Bologna, Bologna, Italy
| | - Vasileios Stamou
- Department of Psychology, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Ilaria Chirico
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Laura De Riso
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Luisa Allione
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Aud Johannessen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway USN, Norway/ Vestfold Hospital Trust, National Advisory Unit on Ageing and HealthNational Advisory Unit on Ageing and Health, Norway
| | - Rabih Chattat
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| |
Collapse
|
46
|
Gerritsen AAJ, Bakker C, Bruls E, Verhey FRJ, Pijnenburg YAL, Millenaar JK, de Vugt ME, Koopmans RTCM. Psychotropic drug use in community-dwelling people with young-onset dementia: two-year course and determinants. Aging Ment Health 2021; 25:179-186. [PMID: 31746238 DOI: 10.1080/13607863.2019.1691145] [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: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to describe the course of psychotropic drug use in people with young-onset dementia and to explore possible associations with age, sex, dementia severity, dementia subtype and neuropsychiatric symptoms. METHODS Psychotropic drug use was studied in 198 community-dwelling persons participating in the Needs in Young-onset Dementia study. Data about psychotropic drug use were retrieved at baseline, as well as at 6, 12, 18 and 24 months and was classified into five groups (antiepileptics, antipsychotics, anxiolytics, hypnotics/sedatives and antidepressants) and quantified as 'present' or 'absent'. Generalized Estimating Equation modeling and chi-square tests were used to study associations between the determinants and psychotropic drug use. RESULTS There was a statistically significant increase in the prevalence of psychotropic drug use from 52.3% to 62.6% during the course of the study. Almost three-quarters (72.4%) of the participants were treated with any psychotropic drug during the study, and more than one-third (37.4%) received psychotropic drugs continuously. Antipsychotics were used continuously in more than 10% of the participants and antidepressants in more than 25%. Increasing age was positively associated (p = .018) with psychotropic drug use at baseline, while apathy symptoms were negatively associated (p = .018). CONCLUSIONS Despite the recommendations of various guidelines, the prolonged use of psychotropic drugs in community-dwelling people with young-onset dementia is high. Therefore, more attention is needed to timely evaluate psychotropic drug use and the introduction of self-management programs for caregivers should be encouraged to support caregivers in dealing with the neuropsychiatric symptoms caused by the dementia.
Collapse
Affiliation(s)
- Adrie A J Gerritsen
- De Wever, Center for Elderly Care, Tilburg, The Netherlands.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc, Alzheimer Center, Nijmegen, The Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc, Alzheimer Center, Nijmegen, The Netherlands.,Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, The Netherlands
| | - Esther Bruls
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yolande A L Pijnenburg
- Department of Neurology and Alzheimer Center, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Joany K Millenaar
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein E de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboudumc, Alzheimer Center, Nijmegen, The Netherlands.,Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| |
Collapse
|
47
|
Laver KE, Crotty M, Low LF, Clemson L, Whitehead C, McLoughlin J, Swaffer K, Cations M. Rehabilitation for people with dementia: a multi-method study examining knowledge and attitudes. BMC Geriatr 2020; 20:531. [PMID: 33297973 PMCID: PMC7727118 DOI: 10.1186/s12877-020-01940-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/30/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND People with dementia are not routinely offered rehabilitation services despite experiencing disability associated with the condition and accumulating evidence for therapies such as exercise, occupational therapy, and cognitive or physical rehabilitation. It is important to understand the needs and preferences of people with dementia regarding rehabilitation services. The aim of this study was to explore thoughts and beliefs about rehabilitation amongst people with dementia and their families. METHODS Interviews with people with dementia and family members regarding their experience of care following diagnosis and their attitudes and beliefs about rehabilitation for dementia. Surveys with older people with cognitive impairment and/or a diagnosis of dementia to determine preferences for services and understanding of rehabilitation programs. RESULTS Interviews with 13 participants (n = 6 people living with dementia with mean age 60 and n = 7 care partners) revealed gaps in care post diagnosis. People reported having to seek out services and frequently sought out services which were rehabilitative in nature. Survey data (n = 91 participants, average age 82) showed that most people had heard of rehabilitation (92%) or had experience of rehabilitation (49%) at some point. There was a wide range of services identified as being beneficial. Rehabilitative interventions including case management, exercise and memory strategies were considered desirable. CONCLUSIONS People with dementia report having a wide variety of needs. There are gaps following diagnosis where people with dementia report having to seek out their own services. Some interview participants (who tended to be younger) clearly articulated the need for tailored interventions which maximised independence and quality of life. Survey participants, who were on average older, reported that they would participate in individually applicable rehabilitative therapies if they were available.
Collapse
Affiliation(s)
- Kate E Laver
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Lee-Fay Low
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Whitehead
- Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kate Swaffer
- Dementia Alliance International, Adelaide, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
48
|
Busted LM, Nielsen DS, Birkelund R. " Sometimes it feels like thinking in syrup" - the experience of losing sense of self in those with young onset dementia. Int J Qual Stud Health Well-being 2020; 15:1734277. [PMID: 32111147 PMCID: PMC7067159 DOI: 10.1080/17482631.2020.1734277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: To explore and describe the experience of people having young-onset dementia.Methods: This was a qualitative study that used semi-structured interviews to collect data from nine persons with young-onset dementia (aged 47-65; five men and four women). Data were collected in the spring of 2018. All interviews were conducted at the participants' choice and in their own homes by one interviewer. The collected data were analysed using the six-stage process of reflexive thematic analysis model.Results: The analysis revealed three themes: Dementia causing loss of control over oneself; becoming a burden to the family while sense of self disappears; and fearing a humiliating future.Conclusions: The experience of having and living with young onset dementia affected the persons' thoughts and memory and was experienced through the persons' loss of personality and sense of self. Thoughts about the future were associated with fear, and the risk of changing their personalities to something different from the one which they had experienced as humiliating throughout most of their lives.
Collapse
Affiliation(s)
- Laila Mohrsen Busted
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center, UCL University College, Odense, Denmark
| | - Dorthe S Nielsen
- Health Sciences Research Center, UCL University College, Odense, Denmark.,Migrant Health Clinic, Odense University Hospital, Center for Global Health, University of Southern Denmark, Odense, Denmark
| | - Regner Birkelund
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,IRS, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| |
Collapse
|
49
|
Abstract
Hintergrund Aufgrund des demographischen Wandels sind Demenzen ein häufiger und dramatisch zunehmender Grund für ärztliche Vorstellungen. In etwa 8 % der Fälle treten sie bereits vor dem 65. Lebensjahr auf. Gerade bei jüngeren Patienten sind die psychosozialen und ökonomischen Folgen oft gravierend. Die Behandler stehen vor großen diagnostischen Herausforderungen. Eine rasche Diagnose ist für das Patientenmanagement von zentraler Bedeutung. Ziel der Arbeit/Fragestellung Dieser Übersichtsartikel stellt die Besonderheiten der Demenzen bei jüngeren Menschen sowie die wichtigsten zugrunde liegenden Krankheitsbilder vor und vermittelt ein strukturiertes klinisch-diagnostisches Vorgehen. Methoden Narrativer Review. Die Literatursuche wurde in PubMed durchgeführt. Ergebnisse Das differenzialdiagnostische Spektrum von Demenzen bei jüngeren Menschen vor dem 65. Lebensjahr ist sehr breit. Die häufigsten Ursachen stellen die Alzheimer-Krankheit mit typischen oder atypischen klinischen Präsentationen sowie die frontotemporale Lobärdegeneration dar. Je jünger das Erkrankungsalter, desto höher ist der Anteil an behandelbaren und potenziell reversiblen Ursachen eines demenziellen Syndroms. Diskussion Die Diagnostik primär neurodegenerativer Erkrankungen hat sich zunehmend verbessert, insbesondere unter Berücksichtigung einer stetig steigenden Zahl an klinischen, molekularen und bildgebenden Biomarkern. Dennoch muss die Diagnostik der Demenzen mit frühem Erkrankungsbeginn hypothesengeleitet erfolgen, d. h. nach einer präzisen klinisch-syndromalen Zuordnung der Symptome. So können unnötige und belastende Untersuchungen vermieden werden.
Collapse
|
50
|
Van Rickstal R, De Vleminck A, Morrison SR, Koopmans RT, van der Steen JT, Engelborghs S, Neugroschl J, Aldridge MD, Sano M, Van den Block L. Comparing Advance Care Planning in Young-Onset Dementia in the USA vs Belgium: Challenges Partly Related to Societal Context. J Am Med Dir Assoc 2020; 21:851-857. [DOI: 10.1016/j.jamda.2020.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 10/24/2022]
|