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Al-Awad FA, Al-Zahrani MA, Bawazeer AO, Al-Qahtani FS, Al-Jabari SA, Jayaseeli NJ, Alabdulkader AM, Al-Harkan KS, Al-Shammari MO, Mohammedin AS, Rohaiem SN, Al-Muslim NI, Al-Shurem MA, Albakr DM. Physicians' attitudes and confidence toward dementia care: A cross-sectional study at primary healthcare facilities in the Eastern Province, Saudi Arabia. J Family Community Med 2024; 31:160-167. [PMID: 38800787 PMCID: PMC11114870 DOI: 10.4103/jfcm.jfcm_230_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Primary care physicians play an essential role in the health of older adults as they are frequently the first point of contact. Their positive attitude and knowledge influence the quality of care provided to patients with dementia and their caregivers. This study examined the attitudes of primary care physicians towards dementia care and their confidence in their own dementia-care skills. MATERIALS AND METHODS This cross-sectional study was conducted among 316 primary care physicians working in Eastern Province of Saudi Arabia. Data were collected using a structured questionnaire that included questions related to demographic characteristics, Dementia Care Attitude Scale (DCAS) to assess attitudes towards dementia, and Confidence in Dementia Care Skills (CDCS) Scale to measure confidence. Data were analyzed using SPSS version 29; mean and standard deviation (SD) were computed for continuous and categorical variables were described using frequencies and percentages. Mann Whitney U test and Kruskal Wallis test were used to compare attitude and confidence scores by categorical variables. RESULTS The mean DCAS score was 36.4 ± 5.41 out of 50. On a scale ranging from 15 to 75, the mean CDCS was 51.89 ± 10.20. A statistically significant (P < 0.05) relation was found between confidence and professional rank, knowing close relatives with dementia, and number of dementia and elderly patients treated. Overall, 78.9% of physicians lacked confidence to prescribe memory medications; 32% felt that dementia management was generally more frustrating than rewarding. CONCLUSION Primary care physicians had a positive attitude toward caring for patients with dementia. However, they lacked confidence in their dementia care skills in several areas. The confidence in their diagnostic skills was higher than their management skills. Most challenging skills were recognizing and managing behavioral symptoms of dementia. Need to develop educational and training interventions that target healthcare providers to help improving dementia care in primary care settings.
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Affiliation(s)
- Feras A. Al-Awad
- Department of Psychiatry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Abdullah O. Bawazeer
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal S. Al-Qahtani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Nithya J. Jayaseeli
- Research Support Unit, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Assim M. Alabdulkader
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid S. Al-Harkan
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak O. Al-Shammari
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed S. Mohammedin
- Department of Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shaimaa N. Rohaiem
- Department of Geriatrics and Gerontology, Ain Shams University, Cairo, Egypt
| | - Nora I. Al-Muslim
- Department of Neurology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed A. Al-Shurem
- Department of Neurology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dalal M. Albakr
- Department of Psychiatry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Crombie A, Lingam S, Pascoe A, Disler P, Asaid A, Disler R. Rural general practitioner confidence in diagnosing and managing dementia: A two-stage, mixed methods study of dementia-specific training. Aust J Rural Health 2024; 32:263-274. [PMID: 38268187 DOI: 10.1111/ajr.13082] [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: 05/24/2022] [Revised: 10/16/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Dementias a prevalent chronic healthcare condition affecting 46 million people worldwide and projected to grow in the coming years. Australians living in rural and regional areas often lack access to specialist dementia care, despite greater prevalence relative to metropolitan areas. OBJECTIVE This study aimed to explore general practitioners (GP) understanding, confidence and attitudes towards dementia management in the rural context, and design and pilot a dementia-specific training program. DESIGN A two-stage, mixed methods design, using qualitative and quantitative methods. Sixteen regional GPs from across Victoria participated in scoping semi-structured interviews. Fourteen separate GPs in the St Anthony Family Medical Practice group in the regional Loddon-Mallee area of Victoria completed the pilot training intervention. Pre- and post-training surveys (n = 10), as well as post-training interviews (n = 10), assessed attitude and knowledge changes. FINDINGS Analysis of semi-structured scoping interviews indicated three themes regarding experience of dementia management, including: (1) attitudes to and experiences of dementia; (2) supporting people living with dementia; and (3) knowledge, education and training of dementia. The pilot dementia-specific training was found to improve attitudes (agreement across 24 best-practice indicators improved from 30% to 79%), knowledge (median increase of 2.5/10) and confidence in managing dementia and disclosing dementia diagnoses (median increase 3/10 and 2.75/10, respectively). DISCUSSION General practitioners in this study lacked initial confidence in detecting and managing dementia in a rural primary care setting. A targeted training program showed improvements in these areas. CONCLUSION Accessible, locally delivered, dementia education has the potential to improve confidence in early detection and management of people with dementia and thereby may address gaps in access to care for people living with dementia in rural settings.
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Affiliation(s)
- Angela Crombie
- School of Rural Health, Monash University, Clayton, Victoria, Australia
- Research and Innovation, Bendigo Health, Bendigo, Victoria, Australia
| | - Shivanjali Lingam
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
| | - Amy Pascoe
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
| | - Peter Disler
- School of Rural Health, Monash University, Clayton, Victoria, Australia
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
- St Anthony Memory Service (SAMS), Strathfieldsaye, Bendigo, Victoria, Australia
| | - Adel Asaid
- St Anthony Memory Service (SAMS), Strathfieldsaye, Bendigo, Victoria, Australia
| | - Rebecca Disler
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
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Moniz-Cook E, Mountain G. The memory clinic and psychosocial intervention: Translating past promise into current practices. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1052244. [PMID: 37214129 PMCID: PMC10192709 DOI: 10.3389/fresc.2023.1052244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/16/2023] [Indexed: 05/24/2023]
Abstract
Disproportionate negative effects since the pandemic have amplified the already limited post-diagnostic support for older people with dementia. This paper summarizes an exploratory randomized controlled study of a proactive family-based intervention compared with "usual" post-diagnostic dementia care. Memory clinic practitioners collaborated with the family doctor (GP) to coordinate this. At 12-month follow-up, positive effects on mood, behavior, carer coping and maintenance of care at home were found. Current approaches to deliver post-diagnostic support in primary care may require rethinking since (i) GP workloads have increased with low numbers of GPs per head of population in parts of England; and (ii) unlike many other long-term conditions, ongoing stigma, fear and uncertainty associated with dementia adds to the huge complexity of timely care provision. There is a case for return to a "one-stop facility", with a single pathway of continuing multidisciplinary coordinated care for older people with dementia and families. Future longitudinal research could compare structured post-diagnostic psychosocial intervention coordinated by skilled practitioners in a single locality memory service "hub", against other approaches such support organized mostly within primary care. Dementia-specific instruments for outcome measurement are available for use in routine practice, and should be included in such comparative studies.
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Affiliation(s)
- Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Gail Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
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Perruchoud E, von Gunten A, Ferreira T, Queirós AM, Verloo H. Home-Dwelling Older Adults' Day-to-Day Community Interactions: A Qualitative Study. Geriatrics (Basel) 2022; 7:geriatrics7040082. [PMID: 36005258 PMCID: PMC9408690 DOI: 10.3390/geriatrics7040082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Many home-dwelling older adults present abnormal behaviours related to dementia or to non-dementia cognitive impairment (e.g., agitation, anxiety, apathy, etc.). Because many older adults live at home alone or are able to hide any signs of abnormal behaviours from others, the non-healthcare workers who interact with older adults on a daily basis are key actors in detecting those behaviours and orienting older adults towards appropriate support services. To the best of our knowledge, no studies to date have explored the daily interactions experienced between older adults and the various non-healthcare workers whom they regularly encounter in the community. This work aimed to identify the non-healthcare workers who are regularly in direct contact with older adults during their day-to-day activities and then develop specific training for these workers on the subject of abnormal behaviours among the elderly. Methods: This qualitative and ethnographic study asked 21 home-dwelling older adults aged 65 years old or more to answer open-ended questions. Sixteen had no self-reported cognitive impairments, and five had a probable or diagnosed slight cognitive impairment or mild-to-moderate dementia. A thematic analysis of the data was carried out. Results: The non-healthcare workers who spent the most time with older adults with and without reported cognitive impairments were those working in cafés or tea rooms and leisure or activity centres. Conclusions: In view of the significant amounts of contact between home-dwelling older adults and non-healthcare workers, it seems necessary and sensible to increase non-healthcare workers’ knowledge about abnormal behaviours, especially by offering them training. The proactive detection and identification of older adults’ abnormal behaviours by non-healthcare workers will ensure earlier care and reduce avoidable hospitalisations, institutionalisations and costs linked to geriatric healthcare.
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Affiliation(s)
- Elodie Perruchoud
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
- Correspondence:
| | - Armin von Gunten
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
| | - Tiago Ferreira
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
| | - Alcina Matos Queirós
- Department of Health and Social Welfare, CH-1008 Lausanne, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Henk Verloo
- Department of Nursing Sciences, School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts Western Switzerland, Chemin de l’Agasse 5, CH-1950 Sion, Switzerland
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Route de Cery 60, CH-1008 Lausanne, Switzerland
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Agüera-Ortiz L, Martín-Carrasco M, Arriola-Manchola E, Martínez-Lage P, Pérez-Martínez DA, Ojea T, Soler-López B, García-Ribas G. Does Your Loved One With Cognitive Symptoms Need to See a Doctor? Check It Online. Front Comput Neurosci 2022; 16:840200. [PMID: 35910452 PMCID: PMC9330199 DOI: 10.3389/fncom.2022.840200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
Widespread access to emerging information and communication technologies (ICT) allows its use for the screening of diseases in the general population. At the initiative of the Spanish Confederation of Associations of Families of People with Alzheimer’s disease and other dementias (CEAFA), a website (http://www.problemasmemoria.com) has been created that provides information about Alzheimer’s disease and includes questionnaires to be completed by family or friends concerned about memory problems of a relative. A cross-sectional, randomized, multicenter study was performed to evaluate feasibility, validity, and user satisfaction with an electronic method of completion vs. the current method of paper-based questionnaires for clinically dementia screening completed by the informants: the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Alzheimer’s disease-8 screening test (AD8). A total of 111 pairs were recruited by seven memory clinics. Informants completed IQCODE and AD8 questionnaires both in their paper and electronic versions. The correlation between paper and electronic versions was significantly positive for IQCODE (r = 0.98; p < 0.001) and AD8 (r = 0.96; p < 0.001). The execution time did not differ significantly, and participants considered their use equally easy. This study shows that an electronic version of the IQCODE and AD8 questionnaires is suitable for its online use via the internet and achieves the same results as the traditional paper versions.
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Affiliation(s)
- Luis Agüera-Ortiz
- Psychiatry Department, Instituto de Investigación Hospital 12 de Octubre (i + 12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Manuel Martín-Carrasco
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Clínica Padre Menni, Pamplona, Spain
| | | | - Pablo Martínez-Lage
- Area of Neurology, Fundación CITA-Alzheimer Fundazioa, Donostia-San Sebastián, Spain
| | - David Andrés Pérez-Martínez
- Servicio de Neurología, Instituto de Investigación i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Tomás Ojea
- Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Begoña Soler-López
- E-C-BIO, S.L. Departamento Médico, Madrid, Spain
- *Correspondence: Begoña Soler-López, , orcid.org/0000-0001-5853-2307
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Lee L, Hillier LM, Weston WW. "Booster Days": An educational initiative to develop a community of practice of primary care collaborative memory clinics. GERONTOLOGY & GERIATRICS EDUCATION 2020; 41:4-19. [PMID: 28873041 DOI: 10.1080/02701960.2017.1373350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study explores the value of a Booster Day education initiative for clinicians working in interprofessional Primary Care Collaborative Memory Clinics (PCCMC) to share updates in dementia care, challenging cases, key lessons learned, and best practices, as a mechanism to foster learning and support the PCCMC Community of Practice (CoP). Between 2010 and 2016, 17 annual Booster Days were delivered to health professionals who completed the PCCMC training program. All participants were invited to complete an evaluation survey in which they identified the ways in which the sessions have been helpful; 89% (1361/1530) completed surveys. The Booster Days were valued as opportunities for networking to learn from other clinicians, fostering a sense of community, learning new information, learning to support practice improvements, and team building. An annual Booster Day that incorporates active participant engagement, information sharing, and networking may effectively support CoPs, learning, team building, and practice change within interprofessional teams.
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Affiliation(s)
- Linda Lee
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Schlegel-UW Research Institute for Aging Waterloo, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Loretta M Hillier
- Geriatric Education and Research in Aging Sciences Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - W Wayne Weston
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Giezendanner S, Monsch AU, Kressig RW, Mueller Y, Streit S, Essig S, Zeller A, Bally K. General practitioners' attitudes towards early diagnosis of dementia: a cross-sectional survey. BMC FAMILY PRACTICE 2019; 20:65. [PMID: 31109304 PMCID: PMC6528190 DOI: 10.1186/s12875-019-0956-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/30/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Dementia is often underdiagnosed in general practice, which may be based on general practitioners' (GPs') knowledge and emotional factors as well as external problems. This study aimed to describe GPs' attitudes toward early diagnosis of dementia. METHODS Cross-sectional postal survey in Switzerland in 2017. Members of the Swiss Association of General Practitioners (N = 4460) were asked to participate in the survey. The questionnaire assessed attitudes, enablers and barriers to early dementia diagnosis and post-diagnostic intervention strategies. Exploratory factor analysis and linear regression were used. RESULTS The survey response rate was 21%. 85% of GPs agreed with enablers of early dementia recognition (e.g. "Plan for the future, organize support and care", "Minimize the strain and insecurity of patients and their informal family caregivers"). On the other hand, 15% of respondents perceived barriers towards early dementia recognition (e.g. "Time constraints in carrying out the necessary procedures to diagnose dementia"). GPs who were more likely to agree with barriers would less often counsel family members (β = - 0.05, 95% CI = - 0.09 - -0.02) or test fitness to drive (β = - 0.05, 95% CI = - 0.09 - -0.02), and more often choose a watchful waiting strategy (β = 0.05, 95% CI = 0.02-0.09). CONCLUSIONS The attitude of the majority of GPs is not characterized by diagnostic and therapeutic nihilism. However, negative attitudes were associated with sub-optimal management after the diagnosis. Thus, health systems are required to critically examine the use of available resources allowing GPs to look after patients and their relatives in a holistic way.
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Affiliation(s)
| | - Andreas U. Monsch
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Reto W. Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Yolanda Mueller
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care Lucerne, Lucerne, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Basel, Switzerland
| | - Klaus Bally
- Centre for Primary Health Care, University of Basel, Basel, Basel, Switzerland
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Woods B, Arosio F, Diaz A, Gove D, Holmerová I, Kinnaird L, Mátlová M, Okkonen E, Possenti M, Roberts J, Salmi A, van den Buuse S, Werkman W, Georges J. Timely diagnosis of dementia? Family carers' experiences in 5 European countries. Int J Geriatr Psychiatry 2019; 34:114-121. [PMID: 30246266 PMCID: PMC6586062 DOI: 10.1002/gps.4997] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/08/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Timely diagnosis of dementia is recommended in national strategies. To what extent is it occurring across Europe, what factors are associated with it, and what is the impact on carers emotions of quality of diagnostic disclosure? METHODS/DESIGN Survey of family carers recruited through 5 Alzheimer's associations (Czech Republic, Finland, Italy, the Netherlands, and Scotland). One thousand four hundred and nine carers participated, 84% completing online. Fifty-two percent were adult children, and 37% were spouses, with median age 57. Most (83%) were female. RESULTS Nearly half (47%) of carers reported that an earlier diagnosis would have been preferable. Delaying factors included reluctance of the person with dementia, lack of awareness of dementia, the response of professionals, and delays within health systems. Recent diagnoses were no more likely to be considered timely, although professional responses appeared to be improving. Delayed diagnoses were more often reported by adult child carers and where the diagnosis was made in the later stages of dementia, or another condition had been previously diagnosed. In all countries except Italy, the diagnosis was shared with the person with dementia in the majority of cases. Timely diagnoses and higher quality diagnostic disclosure are associated with better adjustment and less negative emotional impact on carers in the short and medium term. CONCLUSIONS Although the study sample were well educated and likely to be in touch with an Alzheimer organisation, many continued to experience the diagnosis of dementia as coming too late, and further work on public awareness, as well as on professional responses, is needed.
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Affiliation(s)
- Bob Woods
- Dementia Services Development Centre WalesBangor UniversityBangorUK
| | | | - Ana Diaz
- Alzheimer EuropeLuxembourgLuxembourg
| | | | | | | | | | - Eila Okkonen
- Muistiliitto—Alzheimer Society of FinlandHelsinkiFinland
| | | | - Jennifer Roberts
- Dementia Services Development Centre WalesBangor UniversityBangorUK
| | - Anna Salmi
- Muistiliitto—Alzheimer Society of FinlandHelsinkiFinland
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Tumiran MA, Abdul Rahman NN, Mohd Saat R, Ismail AZ, Ruzali WAW, Bashar NKN, Hasan Adli DS. Senile Dementia from Neuroscientific and Islamic Perspectives. JOURNAL OF RELIGION AND HEALTH 2018; 57:1-11. [PMID: 26160145 DOI: 10.1007/s10943-015-0079-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Diseases involving the nervous system drastically change lives of victims and commonly increase dependency on others. This paper focuses on senile dementia from both the neuroscientific and Islamic perspectives, with special emphasis on the integration of ideas between the two different disciplines. This would enable effective implementation of strategies to address issues involving this disease across different cultures, especially among the world-wide Muslim communities. In addition, certain incongruence ideas on similar issues can be understood better. The former perspective is molded according to conventional modern science, while the latter on the analysis of various texts including the holy Qur'an, sunnah [sayings and actions of the Islamic prophet, Muhammad (pbuh)] and writings of Islamic scholars. Emphasis is particularly given on causes, symptoms, treatments and prevention of dementia.
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Affiliation(s)
- Mohd Amzari Tumiran
- Department of Al-Quran and Al-Hadith, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Noor Naemah Abdul Rahman
- Department of Fiqh and Usul, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rohaida Mohd Saat
- Department of Mathematics and Science Education, Faculty of Education, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ahmad Zuhdi Ismail
- Department of Aqidah and Islamic Thought, Academy of Islamic Studies, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wan Adriyani Wan Ruzali
- Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nurul Kabir Nurul Bashar
- Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Lins AJCC, Muniz MTC, Garcia ANM, Gomes AV, Cabral RM, Bastos-Filho CJA. Using artificial neural networks to select the parameters for the prognostic of mild cognitive impairment and dementia in elderly individuals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 152:93-104. [PMID: 29054264 DOI: 10.1016/j.cmpb.2017.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 07/29/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES A huge number of solutions based on computational systems have been recently developed for the classification of cognitive abnormalities in older people, so that individuals at high risk of developing neurodegenerative diseases, such as Cognitive Impairment and Alzheimer?s disease, can be identified before the manifestation of the diseases. Several factors are related to these pathologies, making the diagnostic process a hard problem to solve. This paper proposes a computational model based on the artificial neural network to classify data patterns of older adults. METHODS The proposal takes into account the several parameters as diagnostic factors as gender, age, the level of education, study time, and scores from cognitive tests (Mini-Mental State Examination, Semantic Verbal Fluency Test, Clinical Dementia Rating and Ascertaining Dementia). This non-linear regression model is designed to classify healthy and pathological aging with machine learning techniques such as neural networks, random forest, SVM, and stochastic gradient boosting. We deployed a simple linear regression model for the sake of comparison. The primary objective is to use a regression model to analyze the data set aiming to check which parameters are necessary to achieve high accuracy in the diagnosis of neurodegenerative disorders. RESULTS The analysis demonstrated that the usage of cognitive tests produces median values for the accuracy greater than 90%. The ROC analysis shows that the best sensitivity performance is above 98% and specificity of 96% when the configurations have only cognitive tests. CONCLUSIONS The presented approach is a valuable tool for identifying patients with dementia or MCI and for supporting the clinician in the diagnostic process, by providing an outstanding support decision tool in the diagnostics of neurodegenerative diseases.
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Affiliation(s)
- A J C C Lins
- Federal Rural University of Pernambuco, Brazil; Catholic University of Pernambuco, Brazil.
| | - M T C Muniz
- Federal Rural University of Pernambuco, Brazil; University of Pernambuco, Brazil
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Chong SA, Abdin E, Vaingankar J, Ng LL, Subramaniam M. Diagnosis of dementia by medical practitioners: a national study among older adults in Singapore. Aging Ment Health 2016; 20:1271-1276. [PMID: 26260233 DOI: 10.1080/13607863.2015.1074160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Dementia is inevitably associated with an ageing population which has tremendous public health, social and economic implications. Yet the extant evidence suggests that the diagnosis of dementia in general is neither timely nor accurate. The aim of this present study was to establish the prevalence of dementia as diagnosed by medical practitioners in Singapore and its associated factors. METHOD The analysis is based on a national epidemiological study of older adults in Singapore which had established the prevalence of dementia using the 10/66 protocol. It was a community based survey, and face-to-face interviews were conducted with 2565 respondents (a response rate of 66%) and 2421 informants. RESULTS In all, 3% of the respondents were diagnosed by a medical practitioner to have dementia of which 11.5% were diagnosed by general practitioners. Only 30.3% were prescribed medications specifically for dementia. Those with comorbid depression were more likely to be diagnosed to have dementia. CONCLUSION The apparent low rate of diagnosis by medical practitioners is in line with studies done in the West. There is a need to elucidate the reasons underlying this under-diagnosis in order to better address this gap.
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Affiliation(s)
- Siow Ann Chong
- a Research Division, Institute of Mental Health , Singapore
| | | | | | - Li Ling Ng
- b Department of Psychological Medicine , Changi General Hospital , Singapore
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12
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Shen J, Anderson MC, Arehart KH, Souza PE. Using Cognitive Screening Tests in Audiology. Am J Audiol 2016; 25:319-331. [PMID: 27788277 DOI: 10.1044/2016_aja-16-0032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/03/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The population of the United States is aging. Those older adults are living longer than ever and have an increased desire for social participation. As a result, audiologists are likely to see an increased demand for service by older clients whose communication difficulty is caused by a combination of hearing loss and cognitive impairment. For these individuals, early detection of mild cognitive impairment is critical for providing timely medical intervention and social support. METHOD This tutorial provides information about cognition of older adults, mild cognitive impairment, and cognitive screening tests, with the purpose of assisting audiologists in identifying and appropriately referring potential cases of cognitive impairment. RESULTS Topics addressed also include how to administer cognitive screening tests on individuals with hearing loss, how to use test results in audiology practice, and the potential of using cognitive screening tests for evaluating the benefit of clinical interventions. CONCLUSIONS As health care professionals who serve the aging population, audiologists are likely to encounter cases of undiagnosed cognitive impairment. In order to provide timely referral for medical assistance as well as an optimized individual outcome of audiologic interventions, audiologists should be trained to recognize an abnormality in older clients' cognitive status.
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Affiliation(s)
- Jing Shen
- Northwestern University, Evanston, IL
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Hesson AM, Pichler H. Interpreting "I don't know" use by persons living with dementia in Mini-Mental State Examinations. PATIENT EDUCATION AND COUNSELING 2016; 99:1534-1541. [PMID: 27522941 DOI: 10.1016/j.pec.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 06/19/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We investigate dementia patients' use of "I don't know" (IDK) in Mini-Mental State Exams (MMSEs) using objective linguistic indicators to differentiate IDK signalling lack of knowledge (LOK) from IDK used to hedge responses, affect exam progression etc. We hypothesize that increased proportional use of LOK-IDK correlates with worsening dementia severity. METHODS 189 IDK tokens were extracted from 72 MMSE interactions and coded for linguistic/social characteristics. A data-driven, discourse position/relation-based functional taxonomy for IDK in MMSE was developed and the resulting functional distribution was subjected to multiple logistic regression. RESULTS Use of LOK-IDK (vs. non-LOK-IDK) is significantly correlated (p=0.01) with clinicians' subjective ratings of patients' dementia as 'severe' vs. 'mild'/'moderate', indicating that objective sociolinguistic criteria approximate physician judgments. 92% of 'severe' patients' IDKs signalled LOK, compared to only 68% of 'mild' patients', suggesting that uncritical interpretation of IDK as signalling LOK would result in 8-32% of IDK responses being mis-scored. CONCLUSION LOK and non-LOK uses distinguished on the basis of reliable, objective usage patterns are differentially distributed among dementia severity groups. PRACTICE IMPLICATIONS LOK-IDK serves as a supplemental indicator of dementia severity. Correct interpretation may improve diagnostic accuracy and allow clinicians to respond supportively during cognitive assessment.
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Affiliation(s)
- Ashley M Hesson
- Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, L3211 Women's, SPC 5276, Ann Arbor, MI 48109-5276, USA.
| | - Heike Pichler
- School of English Literature, Language & Linguistics, Percy Building, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.
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Nieto A, Galtier I, Hernández E, Velasco P, Barroso J. Addenbrooke's Cognitive Examination-Revised: Effects of Education and Age. Normative Data for the Spanish Speaking Population. Arch Clin Neuropsychol 2016; 31:811-818. [PMID: 27474027 DOI: 10.1093/arclin/acw057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Addenbrooke's Cognitive Examination-Revised is a brief test battery for the detection and classification of mild cognitive impairment and dementia. The aims were to investigate the influence of age and education on the Spanish version of the ACE-R and to propose normative data for the Spanish speaking population. METHOD Three hundred thirty-four normal healthy volunteers were included in the study. They were classified in three age groups (48-64, 65-75, and 75-89 years of age) and four educational level groups (≤3; 4-8; 9-12, and ≥13 years of education). They were assessed with the version of ACE-R validated in Argentina with some modifications in order to adapt it to the Spanish population. RESULTS Significant differences were obtained between all age groups in Total ACE-R, Memory, Fluency, and Language indexes. Differences were observed among the 48-64 and 76-89 age groups in the Attention-Orientation and Visuospatial indexes. Regarding education, significant difference between ≤3 years of education and the remaining groups were obtained in Total ACE-R and in all the indexes. Additionally, the group of 4-8 years of education performed significantly worse than the 9-12 and ≥13 groups in Total, Memory, Fluency, and Language indexes. Adjusted scores by education were obtained and percentiles for each age group were calculated. CONCLUSIONS The results show that both age and education have an important effect on ACE-R performance. Consequently, age and education should be taken into account when interpreting results in ACE-R to improve diagnostic accuracy.
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Iliffe S, Wilcock J, Haworth D. Delivering psychosocial interventions for people with dementia in primary care. DEMENTIA 2016. [DOI: 10.1177/1471301206067107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Psychosocial interventions are emerging as potentially important therapies for primary care, partly to fill a therapy ‘vacuum’ and partly because the evidence base for their effectiveness is growing. They can be labour-intensive and their effectiveness depends on the skills of those working with people with dementia. This creates an immediate problem, since the workforce necessary to extend psychosocial interventions beyond innovative schemes does not exist. The existing workforce in health and social care in the UK is already too small to implement all of the changes required by the National Service Framework for Older People and National Service Framework for Mental Health. This has clear implications for the labour-intensive work of dementia care. If the job categories cannot expand as fast as is needed, the tasks of dementia care will have to be redistributed, suggesting that skills will have to be shared and transferred between different disciplines. The question for service commissioners and providers is: how can smarter working be achieved? This article attempts to answer this question with a qualitative study in general practice settings and with specialist informants. A triangulation approach to data collection was used, involving nominal groups, individual interviews and participant observation. We identified five skills that appear key in primary care: pattern recognition; deductive synthesis to reduce uncertainty; dialogue and disclosure; disability perspectives; and case management with shared care. The paucity of understanding of psychosocial interventions across disciplines who offer dementia care in the community is, we suggest, a major problem for those attempting to deploy such interventions in primary care settings. The pervasive tendency to frame the tasks of dementia care in terms of a medical management model brings responses that can undermine the view that people with dementia may in fact have a tractable disability. We use our findings to suggest solutions to this problem.
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Abstract
There are strong opinions about the advantages and disadvantages of a disclosure of dementia to the individual affected, but little is known about how they and their families understand and respond to this information. This article reports and examines the impact of receiving a diagnosis of dementia, by comparing descriptions of its impact at two weeks, with descriptions explored at 12 weeks. Interviews were undertaken on two occasions with 18 couples, one of whom had received a diagnosis of dementia, the other being a family member. The interviews revealed a gradual process of realization of what the diagnosis meant, resulting in important subtle changes in understandings of dementia and personal relationships. Disclosure of dementia occurs at one point in time, but its impact should be seen as a process. Suggestions are made on how the process of diagnosis and its sharing may enhance family partnerships and social relationships through support of both individuals with dementia and families.
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Abstract
This article describes a qualitative study of the understandings of dementia held by a sample of 48 older people and 48 family members, who were interviewed separately, prior to assessment at a UK memory clinic. Most of the older people awaiting assessment described their lives as having purpose, meaning and pleasure for themselves and others. However, these individuals, who later received a diagnosis of a dementia, and their family members, perceived dementia as a loss of mind, associated it with loss of bodily functions (continence and mobility) and considered that it would negatively affect personal relationships and pleasure. For many, the consequences of dementia were predicted to be family upset, inactivity and an inevitable relocation to a care home. Most of the individuals and their family members showed a mutual concern for the future well-being of each other. The findings are reported with reference to an Illness Representation model, which captures a participant's appraisal or perception of a ‘health threat', in other words, the possibility of a dementia diagnosis. Service developments are proposed that acknowledge the personal strengths and concerns of memory clinic attendees and their families during this liminal time of waiting for assessment and possible confirmation of dementia. Advice on the maintenance of pleasure and relationships, as well as information that addresses the fears identified, are important avenues for timely psychosocial support, since these have potential to shape positive attitudes and lifestyle following a dementia diagnosis.
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Bond KS, Jorm AF, Kitchener BA, Kelly CM, Chalmers KJ. Development of guidelines for family and non-professional helpers on assisting an older person who is developing cognitive impairment or has dementia: a Delphi expert consensus study. BMC Geriatr 2016; 16:129. [PMID: 27387756 PMCID: PMC4936264 DOI: 10.1186/s12877-016-0305-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/21/2016] [Indexed: 01/08/2023] Open
Abstract
Background Assisting a person with dementia can lead to significant carer burden and possible negative outcomes for the person. Using the Delphi method, this study developed expert consensus guidelines for how family and non-professional carers should assist a person who is developing cognitive impairment, or has dementia or delirium. Methods A systematic search of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions needed for assisting a person who is developing cognitive impairment, or has dementia or delirium. These items were rated over three rounds by two international expert panels comprising professionals specialising in research or treatment of dementia, and dementia carer advocates. Results A total of 65 participants (43 in the professional panel and 22 in the carer advocate panel) completed all three survey rounds. Of the 656 survey items that were rated, a total of 389 items were endorsed by at least 80 % of each panel. The endorsed items formed the basis of a guidelines document that explains what family and non-professional carers need to know and do when assisting a person who is developing cognitive impairment, or has dementia or delirium. Conclusions The two groups of experts were able to reach substantial consensus on how to assist a person who is developing cognitive impairment, or has dementia or delirium. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0305-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K S Bond
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, VIC, 3052, Australia.
| | - A F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Parkville, VIC, 3010, Australia
| | - B A Kitchener
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, VIC, 3052, Australia.,School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - C M Kelly
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, VIC, 3052, Australia.,School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - K J Chalmers
- Mental Health First Aid Australia, Level 6, 369 Royal Parade, Parkville, VIC, 3052, Australia
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Cognitive training for patients with dementia living in a sicilian nursing home: a novel web-based approach. Neurol Sci 2016; 37:1685-91. [DOI: 10.1007/s10072-016-2659-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
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Abstract
The term “dementia” describes various neurodegenerative disorders that effect cognition, including Alzheimer disease, vascular dementia, and others. This article reviews the diagnosis and management of common types of dementia and comorbidities. Dementias are differentiated clinically by history, symptom presentation, and exclusion of other causes through laboratory and imaging studies. Cholinesterase inhibitors are useful but may not be effective for all types of dementia and provide only modest benefits. Certain medical comorbidities may increase the risk of dementia, although genetics are also important in its etiology. Psychiatric comorbidities in dementia include delirium, which is treated primarily by addressing underlying medical disorders, but antipsychotics can be useful for symptom management and patient comfort. Nonpharmacologic interventions are first-line treatments for other psychiatric comorbidities, although drug therapy may be useful in some cases. The management of patients with dementia presents many challenges and will continue to do so unless agents with pronounced disease-modifying capabilities are developed.
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Affiliation(s)
- Keith A. Swanson
- The University of Oklahoma College of Pharmacy, Department of Pharmacy: Clinical and Administrative Sciences, Oklahoma City, Oklahoma
| | - Ryan M. Carnahan
- The University of Oklahoma College of Pharmacy, Department of Pharmacy: Clinical and Administrative Sciences, Tulsa, Oklahoma,
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Time to Treatment Initiation in People With Alzheimer Disease: A Meta-Analysis of Randomized Controlled Trials. J Am Med Dir Assoc 2016; 17:24-30. [DOI: 10.1016/j.jamda.2015.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/03/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022]
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Takechi H, Mori T, Hashimoto T, Nakamura S. Present status and road map to achieve inclusive and holistic care for dementia in a Japanese community: analysis using the Delphi method. Dement Geriatr Cogn Disord 2015; 38:186-99. [PMID: 24732454 DOI: 10.1159/000358821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dementia is a priority issue in the public health realm. However, few reports address problems of dementia in the real world or provide comprehensive road maps to solve these problems. METHODS Nine groups of questions covering 4 topics were discussed using the Delphi method, relating to (1) current achievements and challenges regarding inclusive and holistic care in the community, (2) patients who are at a high risk of being excluded from care, (3) suggestions for a road map for the establishment of better and more inclusive medical and social care, and (4) unmet needs of patients with dementia. RESULTS In total, 477 opinions were obtained. Family issues, psychological/behavioral symptoms, and complications secondary to physical disorders are main factors for being excluded from care. To create a road map for care we have to address the topics of reaffirming care principles, multidisciplinary coalitions, and education for stakeholders. CONCLUSION Further effective collaboration to promote dementia care is required.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatric Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Gutmanis I, Snyder M, Harvey D, Hillier LM, LeClair JK. Health Care Redesign for Responsive Behaviours—The Behavioural Supports Ontario Experience: Lessons Learned and Keys to Success. ACTA ACUST UNITED AC 2015. [DOI: 10.7870/cjcmh-2015-001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Our health care system is ill prepared for the growing number of older adults and their families/caregivers who live with responsive behaviours associated with cognitive impairment. Considering the burden of illness, quality of life issues, and escalating costs, system-wide redesign is warranted. The Behavioural Supports Ontario (BSO) project is a province-wide, regionally implemented, evidence-informed change strategy that utilizes quality improvement principles and knowledge translation best practices as critical enablers. This paper describes the project and key lessons learned in the implementation of this initiative that can be applied to other jurisdictions wishing to enable large-scale system redesign and sustainable system change.
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Affiliation(s)
| | - Matt Snyder
- North Simcoe Muskoka Local Health Integration Network
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25
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Abstract
RÉSUMÉLa mise en oeuvre en l’Ontario de 15 cliniques interprofessionnelles des troubles de la mémoire à base de soins primaires représente un modèle unique de gestion de cas en équipe, visant à accroître la capacité de traitement de la démence au niveau des soins primaires. Chaque clinique a suivi les patients; dans un sous-ensemble des cliniques, des graphiques ont été vérifiés par les gériatres, les membres de la clinique ont été interrogés, et les patients, les soignants et les médecins traitants ont rempli des questionnaires de satisfaction. Dans toutes les cliniques, 582 patients ont été évalués, et 8,9 pour cent ont été adressés à un spécialiste. Les patients et les soignants étaient très satisfaits des soins reçus, de même que les médecins traitants de la famille, qui ont déclaré une augmentation de la capacité à gérer la démence. La vérification des dossiers des gériatres a révélé un niveau élevé d'accord avec le diagnostic et la gestion. Cette étude a démontré l'acceptabilité, la faisabilité et l'efficacité préliminaire du modèle de clinique des troubles de la mémoire de soins primaires. Dirigée par les médecins de famille spécialement formés, il a fourni un accès en temps opportun à la haute qualité des soins de la démence collaboratives, affectant recours aux services de santé par une utilisation plus efficace des maigres ressources spécialisées en gériatrie.
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Caruana-Pulpan O, Scerri C. Practices in diagnosis, disclosure and pharmacotherapeutic management of dementia by general practitioners--a national survey. Aging Ment Health 2014; 18:179-86. [PMID: 23869797 DOI: 10.1080/13607863.2013.819833] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To explore the practice patterns of general practitioners (GPs) for the diagnosis, disclosure and pharmacological management of individuals with dementia. We also investigated whether the number of years working in general practice is a determinant factor associated with the responses obtained. METHOD A national survey was sent to all registered GPs in the Maltese islands. The return rate was 54.2% with the majority of respondents having 15 years or more working experience in general practice. Chi-square analysis of variance was used to determine any relationship effects. RESULTS Although the majority of GPs indicated lack of competence in diagnosing dementia, only a small percentage showed a preference towards specialist referral. Lack of training was mostly envisaged by physicians with the least number of years in general practice. Significant differences in pharmacotherapeutic prescribing were noted depending on the stage of disease progression and the number of years working as a GP. Disease disclosure was not routinely carried out even though GPs were aware of the fact that disclosure may help individuals with dementia and their caregivers or relatives with future planning. CONCLUSION The findings show notable shortcomings in various aspects of dementia management by GPs. This highlights the need of providing continued educational support and training opportunities to enhance not only GPs' clinical competence, but also their role as key players in providing quality support to individuals with dementia in the primary care setting.
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Affiliation(s)
- Oana Caruana-Pulpan
- a Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery , University of Malta , Msida , Malta
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Utility of the mini-cog for detection of cognitive impairment in primary care: data from two spanish studies. Int J Alzheimers Dis 2013; 2013:285462. [PMID: 24069544 PMCID: PMC3771448 DOI: 10.1155/2013/285462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/16/2013] [Accepted: 07/19/2013] [Indexed: 11/27/2022] Open
Abstract
Objectives. To study the utility of the Mini-Cog test for detection of patients with cognitive impairment (CI) in primary care (PC). Methods. We pooled data from two phase III studies conducted in Spain. Patients with complaints or suspicion of CI were consecutively recruited by PC physicians. The cognitive diagnosis was performed by an expert neurologist, after formal neuropsychological evaluation. The Mini-Cog score was calculated post hoc, and its diagnostic utility was evaluated and compared with the utility of the Mini-Mental State (MMS), the Clock Drawing Test (CDT), and the sum of the MMS and the CDT (MMS + CDT) using the area under the receiver operating characteristic curve (AUC). The best cut points were obtained on the basis of diagnostic accuracy (DA) and kappa index. Results. A total sample of 307 subjects (176 CI) was analyzed. The Mini-Cog displayed an AUC (±SE) of 0.78 ± 0.02, which was significantly inferior to the AUC of the CDT (0.84 ± 0.02), the MMS (0.84 ± 0.02), and the MMS + CDT (0.86 ± 0.02). The best cut point of the Mini-Cog was 1/2 (sensitivity 0.60, specificity 0.90, DA 0.73, and kappa index 0.48 ± 0.05). Conclusions. The utility of the Mini-Cog for detection of CI in PC was very modest, clearly inferior to the MMS or the CDT. These results do not permit recommendation of the Mini-Cog in PC.
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Moore V, Cahill S. Diagnosis and disclosure of dementia--a comparative qualitative study of Irish and Swedish General Practitioners. Aging Ment Health 2013; 17:77-84. [PMID: 22690732 DOI: 10.1080/13607863.2012.692763] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To explore the attitudes of Irish and Swedish General Practitioners (GPs) to the diagnosis and disclosure of dementia to patients; to investigate GP under-graduate/post-graduate training in dementia; to examine the post-diagnostic support services available to GPs in both countries and to investigate the extent to which dementia is perceived as stigmatising. METHODS A cross-national exploratory qualitative design was used. In-depth interviews were conducted with five Irish and four Swedish GPs. Interviews were transcribed, translated, thematically coded and categorised. RESULTS Both Irish and Swedish GPs unequivocally considered the early diagnosis of dementia important but neither group was proactive in making a diagnosis. Both groups relied heavily on family members or patients to bring to their attention memory loss and cognitive impairment problems. Most GPs reported a reluctance to diagnose and several acknowledged going to considerable lengths to avoid using the word 'dementia'. The Swedish GPs had more exposure to dementia-specific training, saw the value in training and were generally very satisfied with post-diagnostic dementia services available to patients, while Irish GPs were less likely to have undergone training, were more equivocal about its value and were very dissatisfied with the community services available. CONCLUSION Despite the presence of very adequate post-diagnostic support services for people recently diagnosed with dementia, the majority of Swedish GPs like their Irish counterparts displayed therapeutic nihilism and were reluctant to speak overtly to their patients about their dementia. Dementia continues to be a stigmatising illness for both Irish and Swedish GPs.
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Affiliation(s)
- Vanessa Moore
- Living with Dementia Research Program, School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland.
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McAiney CA, Hillier LM, Stolee P, Harvey D, Michael J. ‘Throwing a lifeline’: the role of First Link™ in enhancing support for individuals with dementia and their caregivers. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.66] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Aim: The purpose of this study was to determine the extent to which First Link™, an initiative that aims to link individuals with dementia and their caregivers with support services, was able to connect caregivers of individuals with dementia to the services of the Alzheimer Society earlier in the disease process than individuals who self-refer to the Alzheimer Society, and to identify caregiver-, health professional- and health system-related impacts associated with this initiative. Participants & methods: This study evaluated First Link as implemented in two provinces in Canada and involved a mixed method, prospective cohort design; data sources included the Alzheimer Society referral database, surveys of caregivers (n = 135) and health professionals (n = 82), and interviews with key stakeholders (n = 40) and individuals with dementia and their caregivers (n = 33). Results: First Link was able to connect clients to the Alzheimer Society sooner after diagnosis compared with clients who self-referred. As a result of involvement with First Link, health professionals and caregivers had a greater capacity for managing dementia and awareness of the available community services and resources, all of which were reported to support individuals with dementia to remain at home for as long as possible and reduce failure-to-cope-related use of health system resources. Conclusion: This initiative has been well-received and is a significant approach to increasing caregiver and health professional capacity for dementia care.
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Affiliation(s)
- Carrie A McAiney
- Department of Psychiatry & Behavioural Neurosciences, McMaster University; and Geriatric Psychiatry Service, St Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Loretta M Hillier
- Specialized Geriatric Services, St Joseph’s Healthcare London; and Aging, Rehabilitation & Geriatric Care Research Centre, Lawson Health Research Institute, 801 Commissioners Road East, London, ON, N6C 5J1, Canada
| | - Paul Stolee
- School of Public Health & Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - David Harvey
- Alzheimer Society of Ontario, 20 Eglinton Avenue West, Suite 1600, Toronto, ON, M4R 1K8, Canada
| | - Joanne Michael
- Alzheimer Society of Saskatchewan, 301-2550-12th Avenue, Regina, SK, S4P 3X1, Canada
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Dementia skills and competencies for primary care liaison: a model for improving identification and timely diagnosis. Prim Health Care Res Dev 2012; 14:240-9. [PMID: 23127509 DOI: 10.1017/s1463423612000266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The need to improve the response of primary care in terms of identification of people with undiagnosed dementia has long been recognised. The role of Primary Care Liaison was identified as a possible solution. An in-depth consultation was undertaken to identify professional competencies required in executing such a role. METHODS Comprehensive literature and policy reviews were conducted to establish draft competencies or different options/combinations of competencies and competency levels. Consultations with a wide range of professional stakeholders (n = 23) and over 70 users and carers were conducted through focus groups, electronic document circulation and telephone interviews. An Equality Impact Assessment was conducted concurrent to the consultation. RESULTS The literature demonstrated a clear need both to improve the rate of diagnosis for people with dementia and to improve the way in which the diagnosis is made. The stakeholder consultation repeatedly affirmed that without a diagnosis the person with dementia and their caregivers did not get access to the appropriate services, and validated the need for a role that would be able to improve a system that would deliver an early and 'timely' diagnosis. Competencies, based on the literature and policy documents, were developed and debated through the consultation processes. CONCLUSIONS Three main areas of competency were identified: counselling; screening; and health education and promotion. The competencies identified require a skilled experienced professional approach. A useful team model would be that the role is placed within a 'GP cluster' as accessibility to GP records and collaborative working with GPs is essential within the role. Personal continuing professional development has a high profile in maintaining these competencies.
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Timely diagnosis and disclosure of Alzheimer disease gives patients opportunities to make choices. South Med J 2012; 104:779-80. [PMID: 22089353 DOI: 10.1097/smj.0b013e3182389599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Frank C, Feldman S, Schulz M. Resources for people with dementia: the Alzheimer Society and beyond. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2011; 57:1387-e464. [PMID: 22170190 PMCID: PMC3237510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To summarize services provided by the Alzheimer Society and discuss other supports and resources available for the management of people with dementia. SOURCES OF INFORMATION Ovid MEDLINE was searched using the terms dementia, Alzheimer disease, community health services utilization, and caregiver stress. MAIN MESSAGE Early diagnosis of dementia has been shown to be of benefit to patients and caregivers. Referral to the Alzheimer Society can help with nonpharmacologic management of dementia at the time of diagnosis and at any time during the course of the illness. Services include education about dementia, caregiver support, coordination of community services, and a variety of written resources for patients and caregivers. When available, the First Link program can assist with referral by minimizing the need for patients or caregivers to contact their local society branches. Other resources, including respite care and technological approaches to managing wandering, are discussed. CONCLUSION The Alzheimer Society is an important part of dementia management, and family physicians should always consider referral at the time of diagnosis, regardless of the severity of the condition. First Link, when it is available, can facilitate referral. Resources such as respite care and day programs should be considered when available.
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Chrisp TAC, Thomas BD, Goddard WA, Owens A. Dementia timeline: Journeys, delays and decisions on the pathway to an early diagnosis. DEMENTIA 2011. [DOI: 10.1177/1471301211409375] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Here we present the timeline for those who reach a memory assessment service based on research conducted with 31 people living with dementia and 49 carers in one area of the UK. The study develops the findings of earlier timeline work by illuminating other stages on the journey as events and decision points. Two key stages of delay are exposed. Firstly, the period from first thinking something may be amiss to the point of first talking to someone about it. Secondly, the period from first talking to someone, to first contact with a healthcare professional (HCP). A third period emerged where delays may occur once contact with the healthcare system is made. The mean journey time from thinking that something may be amiss to beginning the formal process of diagnosis was around three years. On average there is a gap of about a year between thinking something may be amiss and first talking to a friend or family member about the problem. Further, it typically takes just under two and a half years for a person to move from thinking something may be amiss to first contact with a healthcare professional. The mean time from first contact with a healthcare professional to arrival at a memory assessment service was around 35 weeks; however, for 90% of people it was eight weeks or less. Implications for policies that aim to bring forward diagnosis are that the largest potential for achieving earlier diagnosis will be from encouraging people to contact healthcare professionals earlier.
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Lee L, Kasperski MJ, Weston WW. Building capacity for dementia care: training program to develop primary care memory clinics. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2011; 57:e249-e252. [PMID: 21753083 PMCID: PMC3135463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PROBLEM BEING ADDRESSED Currently, dementia care provided by family physicians is suboptimal and access to specialist resources is limited. With the aging population, there is a need for system-wide, programmatic interventions to improve the diagnosis and management of patients with memory difficulties. The development of primary care memory clinics addresses this need. OBJECTIVE The Memory Clinic Training Program aims to develop highly functioning interprofessional memory clinics that assist family physicians in providing improved care for patients with dementia and other forms of cognitive impairment. PROGRAM DESCRIPTION The interprofessional training program consists of a 2-day case-based workshop, 1 day of observership and clinical training at the Centre for Family Medicine Memory Clinic, and 2 days of on-site mentorship at each newly formed memory clinic. CONCLUSION The Memory Clinic Training Program is an accredited, comprehensive program designed to assist family practice groups with developing primary care memory clinics. These clinics aim to transform the current limited practice capability of individual family physicians into a systematic, comprehensive, interprofessional health care service that improves capacity and quality of primary care for patients with cognitive impairment and dementia.
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Affiliation(s)
- Linda Lee
- The Centre for Family Medicine, 10 B Victoria St S, Kitchener, ON N2G 1C5.
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Innes A, Abela S, Scerri C. The organisation of dementia care by families in Malta: The experiences of family caregivers. DEMENTIA 2011. [DOI: 10.1177/1471301211398988] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper discusses the experiences of dementia family caregivers in Malta. The study design was essentially exploratory as this is the first funded social research on dementia in the island of Malta. In-depth semi-structured interviews were conducted in October 2008 with 17 caregivers. Identification of caregivers was through their relatives’ attendance at a hospital based outpatient memory clinic. Interviews were recorded, transcribed and when required, phrases were translated from Maltese to English. A thematic analysis was guided by the questions; What are the experiences of family caregiving in Malta? And what impact does caregiving have for individual/family life? Three key findings are discussed, namely: the organization of family care in Malta; the use of formal services; and the dislocation of dementia caregiving experiences from wider community life. This paper raises questions about support mechanisms currently available in Malta while presenting cross-national learning opportunities to apply established knowledge to the Maltese context.
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Affiliation(s)
| | - Stephen Abela
- Department for the Elderly and Community Care, Malta,
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Coll de Tuero G, Garre-Olmo J, Lòpez-Pousa S, Vilalta J, Limon E, Caja C. [Perception, attitudes and needs of Primary Care professionals as regards the patient with dementia]. Aten Primaria 2011; 43:585-94. [PMID: 21392856 DOI: 10.1016/j.aprim.2010.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 11/10/2010] [Accepted: 11/12/2010] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To find out the perception, attitudes and needs expressed by primary care professionals in the Girona (Spain) health area as regards the diagnosis and monitoring of patients with cognitive disorders. DESIGN Cross sectional study conducted in 26 primary healthcare areas (ABS) in Girona. SETTING Primary healthcare areas (ABS) in Girona. PARTICIPANTS Physicians and primary nursing care (PNC). MAIN MEASURAMENTS: Self-administered questionnaire by the professionals in the centres. In the context of regular meetings of the teams. RESULTS A total 218 practitioners from 19 ABS (73% of total) responded to the questionnaire (108 physicians and 110 primary nursing care-PNC-). Almost all (98.6%) of participants thought they needed training in dementia, but 49.1% of physicians and 74.5% of PNC mentioned never having any specific training or not in the last 5 years. A total of 88.7% of doctors do not make a diagnosis of dementia on a regular basis, and only in 25.5% of cases do they make one in the mild stages of dementia. The main barriers reported by physicians in the diagnosis of dementia were the lack of confidence in diagnosis (32.6%) and lack of consultation time (31.4%). The great majority (87%) of physicians mentioned difficulties in monitoring and control of these patients. CONCLUSIONS This study provides useful information for those involved in the care of dementia. It identifies priority training issues, and barriers and difficulties in the diagnosis, treatment and monitoring of these patients in the field of primary care.
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Ferretti M, Seematter-Bagnoud L, Martin E, Büla CJ. New Diagnoses of Dementia Among Older Patients Admitted to Postacute Care. J Am Med Dir Assoc 2010; 11:371-6. [DOI: 10.1016/j.jamda.2009.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 10/12/2009] [Accepted: 10/12/2009] [Indexed: 10/19/2022]
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Recruitment methods in Alzheimer's disease research: general practice versus population based screening by mail. BMC Med Res Methodol 2010; 10:35. [PMID: 20429946 PMCID: PMC2880123 DOI: 10.1186/1471-2288-10-35] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 04/29/2010] [Indexed: 11/18/2022] Open
Abstract
Background In Alzheimer's disease (AD) research patients are usually recruited from clinical practice, memory clinics or nursing homes. Lack of standardised inclusion and diagnostic criteria is a major concern in current AD studies. The aim of the study was to explore whether patient characteristics differ between study samples recruited from general practice and from a population based screening by mail within the same geographic areas in rural Northern Norway. Methods An interventional study in nine municipalities with 70000 inhabitants was designed. Patients were recruited from general practice or by population based screening of cognitive function by mail. We sent a questionnaire to 11807 individuals ≥ 65 years of age of whom 3767 responded. Among these, 438 individuals whose answers raised a suspicion of cognitive impairment were invited to an extended cognitive and clinical examination. Descriptive statistics, chi-square, independent sample t-test and analyses of covariance adjusted for possible confounders were used. Results The final study samples included 100 patients recruited by screening and 87 from general practice. Screening through mail recruited younger and more self-reliant male patients with a higher MMSE sum score, whereas older women with more severe cognitive impairment were recruited from general practice. Adjustment for age did not alter the statistically significant differences of cognitive function, self-reliance and gender distribution between patients recruited by screening and from general practice. Conclusions Different recruitment procedures of individuals with cognitive impairment provided study samples with different demographic characteristics. Initial cognitive screening by mail, preceding extended cognitive testing and clinical examination may be a suitable recruitment strategy in studies of early stage AD. Clinical Registration ClinicalTrial.gov Identifier: NCT00443014
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Doherty D, Benbow SM, Craig J, Smith C. Patients’ and carers’ journeys through older people’s mental health services. DEMENTIA 2009. [DOI: 10.1177/1471301209350286] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mapping the patient journey is a way of investigating the experiences of people using older people’s mental health services, particularly those with a dementia. It is a useful concept for patients and their families and enables them to tell their stories in a way which carries the potential for improving and developing the service. Similarly it is a useful concept for health and social care professionals in giving them the opportunity to understand, and reflect on, how their services work in practice for users and carers and how they might be improved. The collaboration between patients, carers and professionals may itself bring about broader benefits and changes in culture for the individuals and services involved. The West Midlands Older People’s Mental Health Collaborative has encouraged the use of mapping by Collaborative teams in order to identify areas for improvement work.
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Affiliation(s)
- Donna Doherty
- Staffordshire University and West Midlands Older People's
Mental Health Collaborative, UK,
| | - Susan Mary Benbow
- Staffordshire University and West Midlands Older People's
Mental Health Collaborative, UK, ,
| | - Julie Craig
- Wolverhampton City Council Adults & Community, UK
| | - Carol Smith
- Wolverhampton City Council Adults & Community, UK,
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Pimlott NJG, Persaud M, Drummond N, Cohen CA, Silvius JL, Seigel K, Hollingworth GR, Dalziel WB. Family physicians and dementia in Canada: Part 2. Understanding the challenges of dementia care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2009; 55:508-9.e97. [PMID: 19439708 PMCID: PMC2682312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore the challenges Canadian family physicians face in providing dementia care. DESIGN Qualitative study using focus groups. SETTING Academic family practice clinics in Calgary, Alta, Ottawa, Ont, and Toronto, Ont. PARTICIPANTS Eighteen family physicians. METHODS We conducted 4 qualitative focus groups of 4 to 6 family physicians whose practices we had audited in a previous study. Focus group transcripts were analyzed using the principles of thematic analysis. MAIN FINDINGS Five major themes related to the provision of dementia care by family physicians emerged: 1) diagnostic uncertainty; 2) the complexity of dementia; 3) time as a paradox in the provision of dementia care; 4) the importance of patients' families; 5) and familiarity with patients. Participants expressed uncertainty about diagnosing dementia and a strong need for expert verification of diagnoses owing to the complexity of dementia. Time, patients' family members, and familiarity with patients were seen as both barriers and enablers in the provision of dementia care. CONCLUSION Family physicians face many challenges in providing dementia care. The results of this study and the views of family physicians should be considered in the development and dissemination of future dementia guidelines, as well as by specialist colleagues, policy makers, and those involved in developing continuing physician education about dementia.
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Wilcock J, Iliffe S, Turner S, Bryans M, O'Carroll R, Keady J, Levin E, Downs M. Concordance with clinical practice guidelines for dementia in general practice. Aging Ment Health 2009; 13:155-61. [PMID: 19347682 DOI: 10.1080/13607860802636206] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dementia is said to be under-recognized and sub-optimally managed in primary care, but there is little information about actual processes of diagnosis and clinical care. AIM To determine general practitioners' concordance with clinical guidelines on the diagnosis and management of patients with dementia. DESIGN Unblinded, cluster randomized pre-test-post-test controlled trial involving 35 practices in the UK. METHODS Patients with a diagnosis of probable or confirmed dementia were identified in practices, and permission sought from the older person and/or their carer to study the medical records of these patients. Medical records were reviewed using a data extraction tool designed for the study and based on published guidelines, and unweighted scores for diagnostic concordance and management concordance were calculated. RESULTS We reviewed 450 records of patients aged 75 and over with a diagnosis of dementia and found that: only 4% of cases were identified first in secondary care; two-thirds of those identified in primary care were referred immediately; about one-third identified had informant history and blood tests documented at the Index consultation and one-fifth underwent cognitive function testing. DISCUSSION The records analysed in this study came from a period before the Quality Outcomes Framework and show that the documentation in primary care of the diagnostic process in dementia syndromes is good, although there were significant gaps, particularly around depression case-finding. Information about management processes were less evident in the records.
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Affiliation(s)
- Jane Wilcock
- Research Department of Primary Care & Population Health, RFUCLMS, London, UK
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Morgan DG, Crossley M, Kirk A, D’Arcy C, Stewart N, Biem J, Forbes D, Harder S, Basran J, Dal Bello-Haas V, McBain L. Improving access to dementia care: development and evaluation of a rural and remote memory clinic. Aging Ment Health 2009; 13:17-30. [PMID: 19197686 PMCID: PMC3966903 DOI: 10.1080/13607860802154432] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The availability, accessibility and acceptability of services are critical factors in rural health service delivery. In Canada, the aging population and the consequent increase in prevalence of dementia challenge the ability of many rural communities to provide specialized dementia care. This paper describes the development, operation and evaluation of an interdisciplinary memory clinic designed to improve access to diagnosis and management of early stage dementia for older persons living in rural and remote areas in the Canadian province of Saskatchewan. We describe the clinic structure, processes and clinical assessment, as well as the evaluation research design and instruments. Finally, we report the demographic characteristics and geographic distribution of individuals referred during the first three years.
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Affiliation(s)
- Debra G. Morgan
- a University of Saskatchewan, Canadian Centre for Health and Safety in Agriculture , Saskatoon, Saskatchewan, Canada
| | - Margaret Crossley
- b University of Saskatchewan, Department of Psychology , Saskatoon, Saskatchewan, Canada
| | - Andrew Kirk
- c University of Saskatchewan, Division of Neurology , Saskatoon, Saskatchewan, Canada
| | - Carl D’Arcy
- d University of Saskatchewan, Applied Research/Psychiatry , Saskatoon, Saskatchewan, Canada
| | - Norma Stewart
- e University of Saskatchewan, College of Nursing , Saskatoon, Saskatchewan, Canada
| | - Jay Biem
- f Lakeshore General Hospital, Department of Medicine , Montreal, Quebec, Canada
| | - Dorothy Forbes
- g University of Western Ontario, School of Nursing , London, Ontario, Canada
| | - Sheri Harder
- h Loma Linda University Medical Centre, Radiology , Loma Linda, California, USA
| | - Jenny Basran
- i University of Saskatchewan, Geriatric Medicine , Saskatoon, Saskatchewan, Canada
| | - Vanina Dal Bello-Haas
- j University of Saskatchewan, School of Physical Therapy , Saskatoon, Saskatchewan, Canada
| | - Lesley McBain
- k First Nations University of Canada, Indigenous Studies Department, Prince Albert , Saskatchewan, Canada
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Jolley D, Moniz-Cook E. Memory clinics in context. Indian J Psychiatry 2009; 51 Suppl 1:S70-6. [PMID: 21416022 PMCID: PMC3038532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The growing number of older people in all parts of the world raises the question of how best to respond to their health needs, including those associated with memory impairment. Specialist Memory Clinics have a role to play, complementing community services which reach out to older people with mental health problems and encompassing younger people who become forgetful. Dementia is the most common syndrome seen, but there are other important treatable conditions which present with subjective or objective dysmnesia. Memory Clinics provide a high quality, devoted focus for early intervention, treatment, support and research.
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Affiliation(s)
- David Jolley
- Honorary Reader Manchester University, PSSRU Dover Building, Dover Street, M13 9PL, Hull HU3 2 SG
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General practitioners' experiences and understandings of diagnosing dementia: Factors impacting on early diagnosis. Soc Sci Med 2008; 67:1776-83. [DOI: 10.1016/j.socscimed.2008.09.020] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Indexed: 11/24/2022]
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De Lepeleire J, Wind AW, Iliffe S, Moniz-Cook ED, Wilcock J, Gonzalez VM, Derksen E, Gianelli MV, Vernooij-Dassen M. The primary care diagnosis of dementia in Europe: an analysis using multidisciplinary, multinational expert groups. Aging Ment Health 2008; 12:568-76. [PMID: 18855172 DOI: 10.1080/13607860802343043] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore the extent of variation in the detection of dementia in primary care across Europe, and the potential for the development of European guidelines. METHOD A mixture of focus group and adapted nominal group methods involving 23 experts of different disciplines and from eight European countries. RESULTS The diagnosis of dementia should be 'timely' rather than 'early'. Timeliness has an impact on the patient, on the caregiver, on healthcare professionals, and on society. Ethical and moral issues may interfere with the aim of timely diagnosis. Guidelines may be important for facilitating a timely diagnosis of dementia, but were infrequently used and not even available in three of the eight countries. Referral pathways often depended on health care system characteristics, differing throughout the eight European countries, whilst diagnostic strategies differed due to varied cultural influences. There was consensus that national variations can be reduced and timely diagnosis enhanced by combining simple tests using a systematic stepwise case-finding strategy, in conjunction with a strong infrastructure of multidisciplinary collaboration. CONCLUSIONS This study identified three key themes that should be considered in harmonizing European approaches to the diagnosis of dementia in primary care: (1) a focus on timely diagnosis, (2) the need for the development and implementation of guidelines, and (3) the identification of appropriate referral pathways and diagnostic strategies including multi-professional collaboration. The content of guidelines may be determined by the perspectives of the guideline developers.
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Affiliation(s)
- J De Lepeleire
- Academisch Centrum Huisartsgeneeskunde, Katholieke Universiteit Leuven, Belgium.
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Perry M, Drasković I, van Achterberg T, Borm GF, van Eijken MIJ, Lucassen P, Vernooij-Dassen MJFJ, Olde Rikkert MGM. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial. BMC Health Serv Res 2008; 8:71. [PMID: 18384675 PMCID: PMC2391160 DOI: 10.1186/1472-6963-8-71] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 04/02/2008] [Indexed: 11/10/2022] Open
Abstract
Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP) aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses. Methods The DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and the possible causal relations between the rate of success of the intervention components and the outcomes. Discussion We developed multifaceted dementia training programme. Novelties in this programme are the training in fixed collaborative duos and the inclusion of an individual coaching program. The intervention is designed according to international guidelines and educational standards. Exploratory analysis will reveal its successful elements. Selection bias and contamination may be threats to the reliability of future results of this trial. Nevertheless, the results of this trial may provide useful information for policy makers and developers of continuing medical education. Trial registration ClinicalTrials.gov ID NCT00459784
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Affiliation(s)
- M Perry
- Department of Geriatric Medicine of Radboud University; Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Hodson R, Keady J. Mild cognitive impairment: a review and nursing implications. ACTA ACUST UNITED AC 2008; 17:368-73. [DOI: 10.12968/bjon.2008.17.6.28902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - John Keady
- University of Manchester School of Nursing, Midwifery and Social Work, Bolton, Salford and Trafford Mental Health NHS Trust, Manchester
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Iliffe S, Manthorpe J, Drennan V, Goodman C, Warner J. The EVIDEM programme: a test for primary care research in London? LONDON JOURNAL OF PRIMARY CARE 2008; 1:69-73. [PMID: 25949561 DOI: 10.1080/17571472.2008.11493211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
KEY MESSAGES The emphasis in NHS Research and Development is shifting towards the 'D' component, and primary care is better placed than traditional academia to use the opportunities that this shift will create.Multidisciplinary working and collaboration between institutions that are competitive are possible, and may even be easier to achieve through primary care because of its collaborative traditions.The fragmentary nature of London's health and social services, and the diversity of the population, are a challenge to all research and development work.The bureaucracy of research governance, and the risk aversion that it contains, are a problem for research and development. WHY THIS MATTERS TO ME This paper matters to me for two reasons, one to do with applied research and the other to do with ageing and neurodegenerative diseases.
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Affiliation(s)
- Steve Iliffe
- Professor of Primary Care for Older People, Research Department of Primary Care and Population Health, University College London, UK
| | - Jill Manthorpe
- Professor of Social Work, Social Care Workforce Research Unit, King's College London, UK
| | - Vari Drennan
- Professor of Health Policy and Service Delivery, St George's, University of London and Kingston University, UK
| | - Claire Goodman
- Professor of Health Services Research, University of Hertfordshire, UK
| | - James Warner
- Old Age Psychiatrist and Honorary Senior Lecturer, Imperial College London, UK
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Argimón Pallàs JM, Riu Subirana S, Lizán Tudela L, Badia Llach X, Martínez Lage JM. [Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care: ISSEA Study]. Aten Primaria 2007; 39:171-7. [PMID: 17428419 PMCID: PMC7664581 DOI: 10.1016/s0212-6567(07)70871-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Accepted: 05/24/2006] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the initial treatment of patients >60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. DESIGN Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. SETTING A total of 105 primary care centres. PARTICIPANTS The study included 921 patients who attended a clinic. MAIN MEASUREMENTS In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. RESULTS The majority of subjects were female (66.9%) and the mean age was 74.3+/-6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), aetiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. CONCLUSIONS The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective.
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Affiliation(s)
| | | | - Luis Lizán Tudela
- Health Economics and Outcomes Research. IMS Health. Barcelona. España
- Unidad Docente de Medicina de Familia. Castellón. España
| | - Xavier Badia Llach
- Health Economics and Outcomes Research. IMS Health. Barcelona. España
- Departamento de Epidemiología Clínica y Salud Pública. Hospital de la Santa Creu i Sant Pau. Barcelona. España
| | - José Manuel Martínez Lage
- Unidad de Trastornos de Memoria. Departamento de Neurología y Neurocirugía. Clínica Universitaria de la Universidad de Navarra. Pamplona. Navarra. España
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Burns A, O'Brien J, Auriacombe S, Ballard C, Broich K, Bullock R, Feldman H, Ford G, Knapp M, McCaddon A, Iliffe S, Jacova C, Jones R, Lennon S, McKeith I, Orgogozo JM, Purandare N, Richardson M, Ritchie C, Thomas A, Warner J, Wilcock G, Wilkinson D. Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology. J Psychopharmacol 2006; 20:732-55. [PMID: 17060346 DOI: 10.1177/0269881106068299] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review the evidence on the drug treatment for dementia. The level of evidence (types) was rated using a standard system: Types 1a and 1b (evidence from meta-analysis of randomised controlled trials or at least one controlled trial respectively); types 2a and 2b (one well-designed study or one other type of quasi experimental study respectively); type 3 (non-experimental descriptive studies); and type 4 (expert opinion). There is type 1a evidence for cholinesterase inhibitors (donepezil, rivastigmine and galantamine) for mild to moderate Alzheimer's disease; memantine for moderate to severe Alzheimer's disease; and for the use of bright light therapy and aromatherapy. There is type 1a evidence of no effect of anti inflammatory drugs or statins. There is conflicting evidence regarding oestrogens, with type 2a evidence of a protective effect of oestrogens but 1b evidence of a harmful effect. Type 1a evidence for any effect of B12 and folate will be forthcoming when current trials report. There is type 1b evidence for gingko biloba in producing a modest benefit of cognitive function; cholinesterase inhibitors for the treatment of people with Lewy body disease (particularly neuropsychiatric symptoms); cholinesterase inhibitors and memantine in treatment cognitive impairment associated with vascular dementia; and the effect of metal collating agents (although these should not be prescribed until more data on safety and efficacy are available). There is type 1b evidence to show that neither cholinesterase inhibitors nor vitamin E reduce the risk of developing Alzheimer's disease in people with mild cognitive impairment; and there is no evidence that there is any intervention that can prevent the onset of dementia. There is type 1b evidence for the beneficial effects of adding memantine to cholinesterase inhibitors, and type 2b evidence of positive switching outcomes from one cholinesterase inhibitor to another. There is type 2a evidence for a positive effect of reminiscence therapy, and type 2a evidence that cognitive training does not work. There is type 3 evidence to support the use of psychological interventions in dementia. There is type 2 evidence that a clinical diagnosis of dementia can be made accurately and that brain imaging increases that accuracy. Although the consensus statement dealt largely with medication, the role of dementia care in secondary services (geriatric medicine and old age psychiatry) and primary care, along with health economics, was discussed. There is ample evidence that there are effective treatments for people with dementia, and Alzheimer's disease in particular. Patients, their carers, and clinicians deserve to be optimistic in a field which often attracts therapeutic nihilism.
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