Regular problem solving does not protect against mental decline

The well known ‘use it or lose it’ claim has been widely accepted by healthcare professionals, but researchers in the Christmas issue of The British Medical Journal find that regularly doing problem solving activities throughout your lifetime does not prevent mental decline in later life. However, the results suggest that regularly engaging in intellectual activities boosts mental ability throughout life and provides a “higher cognitive point” from which to decline.

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Abstract
Objectives:  To examine the association between intellectual engagement and cognitive ability in later life, and determine whether the maintenance of intellectual engagement will offset age related cognitive decline.

Design: Longitudinal, prospective, observational study.

Setting:  Non-clinical volunteers in late middle age (all born in 1936) living independently in northeast Scotland.

Participants:  Sample of 498 volunteers who had taken part in the Scottish Mental Health Survey of 1947, from one birth year (1936).

Main outcome measures:  Cognitive ability and trajectory of cognitive decline in later life. Typical intellectual engagement was measured by a questionnaire, and repeated cognitive measurements of information processing speed and verbal memory were obtained over a 15 year period (recording more than 1200 longitudinal data points for each cognitive test).

Results:  Intellectual engagement was significantly associated with level of cognitive performance in later life, with each point on a 24 point scale accounting for 0.97 standardised cognitive performance (IQ-like) score, for processing speed and 0.71 points for memory (both P<0.05). Engagement in problem solving activities had the largest association with life course cognitive gains, with each point accounting for 0.43 standardised cognitive performance score, for processing speed and 0.36 points for memory (both P<0.05). However, engagement did not influence the trajectory of age related decline in cognitive performance. Engagement in intellectual stimulating activities was associated with early life ability, with correlations between engagement and childhood ability and education being 0.35 and 0.22, respectively (both P<0.01).

Conclusion:  These results show that self reported engagement is not associated with the trajectory of cognitive decline in late life, but is associated with the acquisition of ability during the life course. Overall, findings suggest that high performing adults engage and those that engage more being protected from relative decline.

Full reference: Staff, R. et al. | Intellectual engagement and cognitive ability in later life (the “use it or lose it” conjecture): longitudinal, prospective study | BMJ | 10 December 2018

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Neck scan could identify early symptoms of dementia in 5 minutes

British Heart Foundation | November 2018 | Neck scan predicts cognitive decline decade in advance

A research team lead by University College London (UCL) Professor John Deanfield, followed over 3000 participants over a fifteen-year period (3,191) middle-aged volunteers, who were given ultrasound in 2002 to measure the intensity of the pulse travelling towards their brain. Over the next 15 years, researchers monitored the participants memory and problem-solving ability.

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According to the research a five minute scan of blood vessels in the neck during mid-life predicts cognitive decline a decade before symptoms appear, according to new research  co-funded by The British Heart Foundation. The findings were presented recently at the American Heart Association’s AHA Scientific Sessions conference in Chicago.

The study’s findings would need confirming in larger stuides, but the scan could potentially be used n future to help doctors identify patients who might be at high risk of developing dementia earlier than  previously possible. 

Those participants with the highest intensity pulse (top quarter) at the outset of the study were  approximately 50 per cent  more likely to exhibit accelerated cognitive decline during the next ten years when compared to the rest of the participant cohort. The researchers controlled factors which might also contribute to cognitive decline, like age, BMI, blood pressure and diabetes.

One of the researchers, Dr Scott Chiesa from UCL commented on their findings:

“These findings demonstrate the first direct link between the intensity of the pulse transmitted towards the brain with every heartbeat and future impairments in cognitive function.”

“It’s therefore an easily measurable and potentially treatable cause of cognitive decline in middle aged adults which can be spotted well in advance.” (Source: British Heart Foundation)

Full press release available from BHF 

In the media:

BBC News Dementia risk: Five-minute scan ‘can predict cognitive decline’

Evening Standard Dementia Screening: ‘Five minute neck scan could spot early signs’ say researchers 

 

 

New resource launched to improve dementia care

People living with dementia will benefit from improved care following the launch of a new resource for healthcare providers and carers | Health Education England

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Image source:hee.nhs.uk

Managing Success in Dementia is a resource commissioned by Health Education England (HEE) and developed by Skills for Care, Skills for Health and Leeds Beckett University to support leaders and managers working across health and social care to implement the training outcomes of the Dementia Training Standards Framework – in particular those responsible for implementing training at Tier 2 level.

Tier 2 training provides additional skills and knowledge for people who regularly work directly with people living with dementia.

Full document: Managing success in dementia care: A support resource for implementing Tier 2 of the Dementia Training Standards Framework in health and social care settings

How does stress affect the brain?

This research looks at the impact stress has on the brain in physiological and cognitive terms. The results published in the medical journal of the American Academy of Neurology suggest stress negatively affects memory and thinking skills | via EurekAlert

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A study published in the October 24, 2018 issue of Neurology has found that middle-aged people with high levels of a hormone called cortisol in their blood have impaired memory when compared to those with average levels of the hormone. People with high levels of the hormone also had lower brain volume than those with regular cortisol levels.

Cortisol, produced by the adrenal glands, helps the body respond to stress. It can also help reduce inflammation, control blood sugar and blood pressure, regulate metabolism and help with immune response. High cortisol levels can be caused by stress, medical conditions or medications.

In this study, researchers identified 2,231 people with an average age of 49 who were free of dementia. At the beginning of the study, each participant had a psychological exam and assessments for memory and thinking skills. Their memory and thinking skills were tested again an average of eight years later. Researchers also measured cortisol levels in the blood and then divided participants into low, middle and high groups. A total of 2,018 participants also had an MRI brain scan to measure brain volume.

After adjusting for age, sex, smoking, and body mass index, researchers found that people with high levels of cortisol had lower scores on tests of memory and thinking skills than those with normal levels of cortisol. High cortisol was also linked to lower total brain volume.

Full reference: Echouffo-Tcheugui , J. B. et al. | Circulating cortisol and cognitive and structural brain measures | Neurology | First published October 24, 2018

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Sundowning (changes in behaviour at dusk)

With the clocks going back at 2am this Sunday 28th October, Dementia UK shares some tips for preventing and managing sundowning

What is sundowning?

alarm-clock-2175342_1920Sundowning is a term used for the changes in behaviour that occur in the evening, around dusk. Some people who have been diagnosed with dementia experience a growing sense of agitation or anxiety at this time.

Sundowning symptoms might include a compelling sense that they are in the wrong place. The person with dementia might say they need to go home, even if they are home; or that they need to pick the children up, even if that is not the case. Other symptoms might include shouting or arguing, pacing, or becoming confused about who people are or what’s going on.

Tips for managing sundowning as it happens

  • Use distraction techniques: go into a different room, make a drink, have a snack, turn some music on, or go out for a walk
  • Ask the person what is the matter. Listen carefully to the response and if possible, see if you can deal with the source of their distress
  • Talk in a slow, soothing way
  • Hold the person’s hand or sit close to them and stroke their arm.

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Practical tips on preventing sundowning

  • Follow a routine during the day that contains activities the person enjoys
  • Going outside for a walk or visiting some shops is good exercise
  • Limit the person’s intake of caffeinated drinks. Consider stopping the person from drinking alcohol altogether. Caffeine-free tea, coffee and cola are available, as is alcohol-free beer and wine
  • Try and limit the person’s naps during the day to encourage them to sleep well at night instead
  • Close the curtains and turn the lights on before dusk begins, to ease the transition into nighttime
  • If possible, cover mirrors or glass doors. Reflections can be confusing for someone with dementia
  • Once you are in for the evening, speak in short sentences and give simple instructions to the person, to try and limit their confusion
  • Avoid large meals in the evening as this can disrupt sleep patterns
  • Introduce an evening routine with activities the person enjoys, such as: watching a favourite programme, listening to music, stroking a pet etc. However, try to keep television or radio stations set to something calming and relatively quiet—sudden loud noises or people shouting can be distressing for a person with dementia.

Full information leaflet: Sundowning (changes in behaviour at dusk). Understanding changes in behaviour in dementia | Dementia UK

Future Alzheimer’s treatment

Report suggests joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients | RAND Corporation

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  • The burden of Alzheimer’s disease in high-income countries is expected to approximately double between 2015 and 2050. Recent clinical trial results give hope that a disease-modifying therapy might become available in the near future. The therapy is expected to treat early-stage patients to prevent or delay the progression to dementia.
  • This preventive treatment paradigm implies the need to screen, diagnose, and treat a large population of patients with mild cognitive impairment. There would be many undiagnosed prevalent cases that would need to be addressed initially, and then the longer-term capacity to address incident cases would not need to be as high.
  • Researchers used a simulation model to assess the preparedness of the health care system infrastructure in six European countries — France, Germany, Italy, Spain, Sweden, and the United Kingdom — to evaluate, diagnose, and treat the expected number of patients.
  • Projected peak wait times range from five months for treatment in Germany to 19 months for evaluation in France. The first year without wait times would be 2030 in Germany and 2033 in France, and 2042 in the United Kingdom and 2044 in Spain. Specialist capacity is the rate-limiting factor in France, the United Kingdom, and Spain, and treatment delivery capacity is an issue in most of the countries.
  • If a disease-modifying therapy becomes available in 2020, we estimate the projected capacity constraints could result in over 1 million patients with mild cognitive impairment progressing to Alzheimer’s dementia while on wait lists between 2020 and 2050 in these six countries.

Recommendations

  • In addition to increasing specialist and infusion capacity in each individual country, joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients.
  • A combination of reimbursement, regulatory, and workforce planning policies, as well as innovation in diagnosis and treatment delivery, is needed to expand capacity and to ensure that available capacity is leveraged optimally to treat patients with early-stage Alzheimer’s disease.

Full report: Assessing the Preparedness of the Health Care System Infrastructure in Six European Countries for an Alzheimer’s Treatment | RAND Corporation

Nursing home builds real-life 1950s memory lane to help dementia patients

The Telegraph | October 2018 | Nursing home builds real-life 1950s memory lane to help dementia patients

Starting this week (3 October) residents at the Five Rise Nursing Home in Bingley can take a stroll down an artificial street designed to resemble how the West Yorkshire town looked in the 1950s.

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The new-build home which cost £6m, is an innovation from twin brothers Danny and Damien Holt.

Damien, a psychiatric nurse, said: “People with advanced dementia can have very complex needs and we know how vital it is to provide plenty of mental stimulation in a safe, modern environment.

“Many of our residents have lived around Bingley for years.

“They remember it as it was.

“The purpose of our memory lane is to provide an attractive and interesting destination for the people we care for, offering reminiscence therapy to improve the psychological well being and quality of life for our residents.”( Source: The Telegraph)

 

News story from The Telegraph