Modeling the dementia epidemic

Incidence and Risk Profile of Dementia in the Regions of Middle East and North Africa

BACKGROUND

The risk of dementia is reported as "epidemic" and "looming" over the Middle East and North Africa (MENA) region. For this, we performed a multi-language review and feasible analysis on the incidence of dementia to offer apt conclusions.

METHODS

Totally, 3 databases (Magiran, Scientific Information Database, and PubMed) and 1 non-database source (Google) were searched in French, English, and Persian by using specific keywords and their combinations. All searches were independent and had no restriction for the year or type of publication. We also calculated cumulative incidence of dementia for Egypt and Israel-Palestine from relevant prevalence estimates by using standard formula.

RESULTS

Little information on incidence was available, sparing Israel (2.4/100,000/year; pre-senile). Ten (48.0%) countries had none-to-little information (of any kind) on dementia, indicating considerable awareness deficit in this region. Cumulative incidence of dementia in Egypt and Israel-Palestine was 2.7% over 20 years (55 new cases) and 14.7% (130 new cases) over 6 years, respectively. In Lebanon, cumulative incidence was 7.5% over 20 years. Data looked across dementia-related factors (i.e., fertility rate, polygamy, violence, hypovitaminosis D, diabetes, hypertension, life expectancy, age structure) did not seem to support epidemic proportions of dementia for MENA.

CONCLUSIONS

MENA is youthful and dementia here is neither likely to be an epidemic nor looming over. The only possible exception might be Arab pocket in Israel. To us, previous attributions on dementia do not seem to be based on the realities of this region and, therefore, may prevent pragmatic addressal of dementia. Lastly, values-based collaborations are invited to jointly fill the awareness deficit in a unique low-cost manner.

Achieving consensus and controversy around applicability of palliative care to dementia

BACKGROUND

People with dementia may benefit from palliative care which specifically addresses the needs of patients and families affected by this life-limiting disease. On behalf of the European Association for Palliative Care (EAPC), we recently performed a Delphi study to define domains for palliative care in dementia and to provide recommendations for optimal care. An international panel of experts in palliative care, dementia care or both, achieved consensus on almost all domains and recommendations, but the domain concerning the applicability of palliative care to dementia required revision.

METHODS

To examine in detail, the opinions of the international panel of 64 experts around the applicability of palliative care, we explored feedback they provided in the Delphi process. To examine which experts found it less important or less applicable, ordinal regression analyses related characteristics of the panelists to ratings of overall importance of the applicability domain, and to agreement with the domain's four recommendations.

RESULTS

Some experts expressed concerns about bringing up end-of-life issues prematurely and about relabeling dementia care as palliative care. Multivariable analyses with the two outcomes of importance and agreement with applicability indicated that younger or less experienced experts and those whose expertise was predominantly in dementia care found palliative care in dementia less important and less applicable.

CONCLUSIONS

Benefits of palliative care in dementia are acknowledged by experts worldwide, but there is some controversy around its early introduction. Further studies should weigh concerns expressed around care receiving a "palliative" label versus the benefits of applying palliative care early.

The rehabilitation engineering research center for the advancement of cognitive technologies

Barring few exceptions, allied health professionals, engineers, manufacturers of assistive technologies (ATs), and consumer product manufacturers have developed few technologies for individuals with cognitive impairments (CIs). In 2004, the National Institute on Disability Rehabilitation Research (NIDRR) recognized the need to support research in this emergent field. They funded the first Rehabilitation Engineering Research Center for the Advancement of Cognitive Technologies (RERC-ACT). The RERC-ACT has since designed and evaluated existing and emerging technologies through rigorous research, improving upon existing AT devices, and creating new technologies for individuals with CIs. The RERC-ACT has contributed to the development and testing of AT products that assist persons with CIs to actively engage in tasks of daily living at home, school, work, and in the community. This article highlights the RERC-ACT's engineering development and research projects and discusses how current research may impact the quality of life for an aging population.

Preventing dementia: how lifestyle in midlife affects risk

PURPOSE OF REVIEW

Dementia is a worldwide health priority, with increasing public health burden and thus need for preventive strategies. Although many associations are proposed, there has been lack of sufficient evidence or demonstration of modifiability. This review will discuss the methodological challenges and the most established, controversial and novel modifiable midlife risk factors.

RECENT FINDINGS

There has been a shift towards a life-course approach, with large cohort longitudinal studies helping to untangle 'windows of opportunity' or reverse causation with vascular factors (hypertension and BMI), hormone replacement therapy and depression. Other vascular factors, such as hyperglycaemia, have now been approached as a continuum and BMI/alcohol as U-shaped associations. There is evidence regarding associations or mechanisms for personality, insomnia, cognitive stimulation and social activities, head injury, diet, and reproductive and oral health. Environmental considerations such as passive smoke, noise and hygiene exposure are also explored.

SUMMARY

Increasing evidence of associations from midlife will guide the shift to interventional studies from the midlife period. However, research challenges are such that the ideal studies may be impossible, although, for numerous factors, it has been argued that other known adverse health effects justify initiating or continuing health interventions in the absence of this evidence.

A commentary on studies presenting projections of the future prevalence of dementia

BACKGROUND

Population ageing over the first half of this century is likely to lead to dramatic increases in the prevalence of dementia. This will affect all regions of the world, but particularly developing regions. Dementia projections have been used extensively to support policy. It is therefore important these projections are as accurate as possible.

DISCUSSION

In this paper we provide a commentary on studies projecting the future prevalence of dementia for the world or for individual continents. We identify some important limitations of the methods used in published projections and provide recommendations to improve the accuracy of future projections, and allow for the checking of the accuracy of the predictions.

SUMMARY

Accurate projections of dementia incidence, at both the global and local level, are essential for healthcare planners.

Neuroprotection in vascular dementia: a future path

The burden of cognitive disorders is likely to increase over the coming years due to both increased longevity and altered risk factor patterns, arising from changes in lifestyle, healthcare and society. Vascular dementia with its underlying heterogeneous pathology, is a challenge for clinicians, and is frequently further aggravated by overlap with other neurodegenerative processes. Current Alzheimer's disease drugs have had limited clinical efficacy in treating vascular dementia and none have been approved by major regulatory authorities specifically for this disease. Moving forward, a valid choice may be a multimodal therapy, as has already been successfully proven in Alzheimer's disease. Actovegin, a hemodialysate derived from calf blood, has been shown to have effects on a variety of cellular processes and a recent experimental study has revealed its neuroprotective mechanisms of action. These data, coupled with positive results from clinical trials in mixed dementia populations, have served as a foundation for the design of a new trial investigating the efficacy and disease-modifying effects of Actovegin in post-stroke cognitive impairment.