Psychosocial interventions for people with dementia

New research finds good evidence to suggest that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills for people with dementia | Aging & Mental Health

Objectives: Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works.

Methods: A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted.

Results: Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews.

Conclusion: There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.

Full reference: McDermott, O et al. | Psychosocial interventions for people with dementia: a synthesis of systematic reviews |Aging & Mental Health | Published online 17 Jan 2018

View the full article here

 

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Marriage may lower the risk of developing dementia

Marriage may help stave off dementia, study finds | Journal of Neurology Neurosurgery & Psychiatry

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Researchers combining the results of 15 studies including data on more than 800,000 participants have found  that lifelong singletons and widowers appear to have a heightened risk of developing dementia.

Analysis of the data showed that lifelong singletons were 42% more likely to develop dementia than those who were married, and widowers were 20% more likely to develop the condition. Part of this risk might be explained by poorer physical health among lifelong single people, suggest the researchers.  Marriage may help both partners to have healthier lifestyles, including exercising more, eating a healthy diet, and smoking and drinking less, all of which have been associated with lower risk of dementia. Couples may also have more opportunities for social engagement than single people – a factor that has been linked to better health and lower dementia risk, the researchers suggest.

Full reference: Sommerlad A, et al. | Marriage and risk of dementia: systematic review and meta-analysis of observational studies |  Journal of Neurology Neurosurgery & Psychiatry | published online 28 November 2017

Risk factors & Alzheimers Disease: Sleep disturbance, depression and anxiety

Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants | Aging & Mental Health

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Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Shanna L. Burke et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety  | Aging & Mental Health | Published online: 27th Oct 2017

 

Improving the care of people living with dementia admitted to hospitals

This review seeks to identify primary research and use its findings to develop explanations of what characteristics of dementia-friendly initiatives in hospitals make them work, in what circumstances, and why | BMJ 

Abstract

Objectives To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.

Design A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.

Data sources PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.

Eligibility criteria Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.

Results Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context–mechanism–outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.

Conclusions This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.

Full reference: Handley M, Bunn F, Goodman C. | Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review | BMJ Open 2017; 7:e015257

See also: Dementia care in hospital: training, leadership and culture change needed | The Mental Elf

Sugary beverage intake and preclinical Alzheimer’s

Excess sugar consumption has been linked with Alzheimer’s disease (AD) pathology in animal models | Alzheimers & Dementia

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We examined the cross-sectional association of sugary beverage consumption with neuropsychological (N = 4276) and magnetic resonance imaging (N = 3846) markers of preclinical Alzheimer’s disease and vascular brain injury (VBI) in the community-based Framingham Heart Study. Intake of sugary beverages was estimated using a food frequency questionnaire.

Relative to consuming less than one sugary beverage per day, higher intake of sugary beverages was associated with lower total brain volume (1–2/day, β ± standard error [SE] = −0.55 ± 0.14 mean percent difference, P = .0002; >2/day, β ± SE = −0.68 ± 0.18, P < .0001), and poorer performance on tests of episodic memory (all P < .01). Daily fruit juice intake was associated with lower total brain volume, hippocampal volume, and poorer episodic memory (all P < .05). Sugary beverage intake was not associated with VBI in a consistent manner across outcomes.

Higher intake of sugary beverages was associated cross-sectionally with markers of preclinical AD.

Full reference: Pase, M.P. et a; (2017) Sugary beverage intake and preclinical Alzheimer’s disease in the community. Alzheimers & Dementia. Vol. 13 (Issue 9) pp. 955–964.

Effectiveness of dementia risk reduction messaging in NHS health checks | via @alzheimerssoc

NHS health check 40-64 dementia pilot research findings | Alzheimer’s Society

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The NHS Health Check programme is a statutory public health intervention commissioned by all local authorities in England. It aims to improve the health and wellbeing of adults aged 40-74 years through the promotion of earlier awareness, assessment, and management of the major risks factors and conditions driving premature death, disability and health inequalities in England.

The overall aim of the research was to evaluate the pilot and assess the feasibility of extending the NHS Health Check for 40-64 year olds to include a dementia risk reduction component. Specific objectives of the research included first, to understand the impact of the NHS Health Check on an individual’s knowledge and awareness of dementia risk reduction and the impact of the intervention on individuals’ intention to change behaviour.

The second objective was to identify (where sample sizes allowed) whether any differences in the delivery of the intervention between pilot sites had any effect on individual’s awareness and understanding of dementia risk reduction.

The third objective was to understand professional awareness and confidence in promoting dementia risk reduction messages and to identify further training requirements, resources and support.

The final objective was to assess any implications for services and commissioners and provide PHE with advice on any further longer-term evaluation that will be required.

Full report here

Dementia in older age: barriers to primary prevention and factors

Evidence review showing that changing some behaviours in midlife can reduce the chances of getting dementia in older age | PHE

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These documents help commissioners and researchers make decisions about prioritisation of primary prevention measures relevant to dementia.

This review, by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and Political Science (2016), shows that there is evidence that the risk of dementia is increased by:

  • physical inactivity
  • current smoking
  • diabetes
  • hypertension in mid-life
  • obesity in mid-life and depression

It also shows that mental activity can reduce the risk of dementia.

To promote primary prevention of dementia, it is important to understand both the barriers to primary prevention and factors which facilitate primary prevention.

Read the full overview here