Interventions to prevent cognitive decline & dementia

Evidence supporting three interventions that might slow cognitive decline and the onset of dementia is encouraging but insufficient to justify a public health campaign focused on their adoption | ScienceDaily

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Image source: NASEM

Cognitive training, blood pressure management for people with hypertension, and increased physical activity all show modest but inconclusive evidence that they can help prevent cognitive decline and dementia, but there is insufficient evidence to support a public health campaign encouraging their adoption, says a new report from the National Academies of Sciences, Engineering, and Medicine.  Additional research is needed to further understand and gain confidence in their effectiveness, said the committee that conducted the study and wrote the report.

“I’m Still Here”: Personhood and the Early-Onset Dementia Experience

The current study examined the lived experience from the point of view of four adults younger than 65 with dementia, particularly how they perceive their personhood | Journal of Gerontological Nursing

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Using interpretative phenomenological analysis as the research approach, findings revealed that the EOD experience can be incorporated into six themes: (a) A Personal Journey, (b) Navigating the System, (c) The Stigma of Dementia, (d) Connecting to the World, (e) A Story Worth Telling, and (f) I’m Still Here. Participants’ stories, as presented via these six thematic threads, reveal that individuals with EOD can have a strong sense of personhood. Findings are discussed and situated within the current EOD body of knowledge, and new knowledge is presented. Implications for practice and recommendations for future research are discussed.

Full reference: Sakamoto, M.L. et al. (2017) “I’m Still Here”: Personhood and the Early-Onset Dementia Experience. Journal of Gerontological Nursing. 43(5) pp. 12-17

The effect of moderate drinking on brain structure

A new study on BMJ.com, examines the effect of moderate drinking on brain structure. Heavy drinking is known to have a deleterious effect on our brains, and is linked to dementias. However, for sometime it’s been thought that moderate drinking is actually protective.

In this Podcast, Anya Topiwala, clinical lecturer in old age psychiatry at the University of Oxford, discusses the association between alcohol consumption and those structural elements.

Reference to the research: Topiwala, A et al. Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study. BMJ 2017; 357 (Published 06 June 2017)

What causes Alzheimer’s disease? What we know, don’t know and suspect

This article by by Yen Ying Lim, Research Fellow, Florey Institute of Neuroscience and Mental Health looks at what we currently know, what we don’t know, and what we suspect about Alzheimer’s disease | Via The Conversation

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Alzheimer’s disease is the most common form of dementia, which is an umbrella term used to describe general loss of memory, thinking skills and other day-to-day functions.

A hallmark of Alzheimer’s disease is gradual deterioration of memory. But it is a biological disease, which means that, besides seeing outwards symptoms such as memory loss, we can also measure the breakdown that occurs in the brain as a consequence of disease progression.

In this article, the author examines a range of issues associated with Alzheimer’s disease including:

  • Amyloid and tau
  • The role of genes
  • Diet, diabetes and obesity
  • Physical activity
  • Sleep
  • Mood
  • Cognitive reserve or resilience
  • Preventing Alzheimer’s disease

The future burden of disability in the UK

2.8 million people over 65 will need nursing and social care by 2025 – largely because of a significant rise in dementia-related disability, research finds.

Research published by the Lancet Public Health medical journal says cases of disability related to dementia will rise by 40% among people aged 65 to 84, with other forms of disability increasing by about 31%.

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The investigators used a detailed model to produce estimates of the prevalence of disability due to cardiovascular disease, dementia, and other causes in people aged 65 years or older in England and Wales to the year 2025.

They found a 25% increase from 2015 in the number of older people who will be living with disability, representing 560 000 additional elderly people in England and Wales who will need care for their disabling condition, and showed that the largest relative increases will be in dementia cases.  They also predicted that although life expectancy among people older than 65 years will increase by 1·7 years, 0·7 of these years will be lived with disability.

Having identified these challenges, the authors have recommended increased capacity in formal social care and improved support for informal social care arrangements, along with enhanced interventions against predictable risk factors for non-communicable diseases disability, such as smoking, diet, and physical activity.

Full reference: Guzman-Castillo, Maria et al. | Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling studyThe Lancet Public Health Published online 23rd May 2017

The association between an inflammatory diet, cognitive function and dementia

The Mediterranean and Dietary Approaches to Stop Hypertension diets have been associated with lower dementia risk. We evaluated dietary inflammatory potential in relation to mild cognitive impairment (MCI)/dementia risk | Alzheimer’s & Dementia

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Method: Baseline food frequency questionnaires from n = 7085 women (aged 65–79 years) were used to calculate Dietary Inflammatory Index (DII) scores that were categorized into four groups. Cognitive function was evaluated annually, and MCI and all-cause dementia cases were adjudicated centrally. Mixed effect models evaluated cognitive decline on over time; Cox models evaluated the risk of MCI or dementia across DII groups.

Results: Over an average of 9.7 years, there were 1081 incident cases of cognitive impairment. Higher DII scores were associated with greater cognitive decline and earlier onset of cognitive impairment. Adjusted hazard ratios (HRs) comparing lower (anti-inflammatory; group 1 referent) DII scores to the higher scores were group 2-HR: 1.01 (0.86–1.20); group 3-HR: 0.99 (0.82–1.18); and group 4-HR: 1.27 (1.06–1.52).

Conclusions: Diets with the highest pro-inflammatory potential were associated with higher risk of MCI or dementia.

Full reference: Hayden, K.M. et al. (2017) The association between an inflammatory diet and global cognitive function and incident dementia in older women: The Women’s Health Initiative Memory Study. Alzheimer’s & Dementia. Published online: May 19 2017

Deaths from dementia set to quadruple by 2040

The number of people who will die from dementia could almost quadruple over the next 20 years, suggests a study published in BMC Medicine | Story via OnMedica

hospital-bed-315869_1280Researchers analysed mortality statistics for England and Wales from 2006 to 2014 to estimate the prevalence of palliative care need in the population.

By using explicit assumptions about change in disease prevalence over time and official mortality forecasts, they modelled palliative care need up to 2040 as well as making projections for dementia, cancer and organ failure.

They calculated that by 2040, annual deaths in England and Wales could rise by at least 25.4% from 501,424 in 2014 to 628,659 in 2040.  If age and sex-specific percentages with palliative care needs remained the same as in 2014, the number of people requiring palliative care could grow by 25% from 375,398 to 469,305 people a year.

However, if the upward trend observed from 2006 to 2014 continued, they said, the increase could be as much as 47% more people needing palliative care by 2040 in England and Wales.

In addition, disease-specific projections showed that dementia (increasing from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) would be the main drivers of the growing need.

The authors concluded: ‘Our analysis indicates that palliative care need will grow far more over the next 25 years than previously expected’.

Full reference: Etkind, S. N et al. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Medicine 2017 15:102.