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Clinics in Geriatric Medicine Nov 2023Emergency department (ED) care for persons living with dementia (PLWD) involves the identification of dementia or cognitive impairment, ED care which is sensitive to the... (Review)
Review
Emergency department (ED) care for persons living with dementia (PLWD) involves the identification of dementia or cognitive impairment, ED care which is sensitive to the specific needs of PLWD, effective communication with PLWD, their care partners, and outpatient clinicians who the patient and care-partner know and trust, and care-transitions from the emergency department to other health care settings. The recommendations in this article made based on wide-ranging heterogeneous studies of various interventions which have been studied primarily in single-site studies. Future research should work to incorporate promising findings from interventions such as hospital at home, or ED to home Care Transitions Intervention.
Topics: Humans; Patient Transfer; Emergency Service, Hospital; Home Care Services; Emergency Medical Services; Dementia
PubMed: 37798067
DOI: 10.1016/j.cger.2023.06.004 -
Journal of the American Geriatrics... Oct 2023
Topics: Humans; Nursing Homes; Long-Term Care; Dementia
PubMed: 37676467
DOI: 10.1111/jgs.18583 -
Neurological Sciences : Official... Jan 2024The relationship between varicella zoster virus (VZV) infection and the risk of dementia has not been previously studied specifically. Therefore, this study sought to... (Meta-Analysis)
Meta-Analysis
PURPOSE
The relationship between varicella zoster virus (VZV) infection and the risk of dementia has not been previously studied specifically. Therefore, this study sought to determine the relationship between studying VZV infection and dementia occurring in the general population by conducting an extensive meta-analysis of published cases.
METHOD
A systematic literature search was conducted in seven online databases by October 31, 2022. Heterogeneity was tested by the I index. Pooled HR and 95% CI were used to estimate the effect of VZV infection on dementia. Sensitivity analyses and publication bias were also performed.
RESULT
Nine studies involving 3,326,673 subjects were included. VZV infection was associated with an increased risk of dementia (HR = 1.11, 95% CI: 1.02-1.21). The risk of dementia was reduced in those who received antiviral therapy compared to those who did not (HR = 0.84, 95% CI: 0.71-0.99). In addition, VZV infection was found to be associated with an increased risk of developing dementia in the pooled results of the moderate quality study (HR = 1.81,95% CI: 1.27-2.59), and this association persisted when subgroup analyses were performed based on region (Asia: HR = 1.18,95% CI: 1.04-1.33).
CONCLUSIONS
Our results suggest that VZV infection might increase the risk of developing dementia, but there is no clear mechanism about the true relationship, and since there is no effective treatment for dementia, and our results suggest that some populations can benefit from antiviral therapy, it is at least arguable that patients who develop VZV infection should be treated with appropriate antiviral medications.
Topics: Humans; Antiviral Agents; Dementia; Herpes Zoster; Herpesvirus 3, Human
PubMed: 37639023
DOI: 10.1007/s10072-023-07038-7 -
Australasian Journal on Ageing Sep 2023This study evaluated the impact of a 5-week educational and supportive program for people newly diagnosed with dementia and their caregivers.
OBJECTIVES
This study evaluated the impact of a 5-week educational and supportive program for people newly diagnosed with dementia and their caregivers.
METHODS
The study involved a pretest-posttest survey followed by interviews. Wilcoxon signed-rank test was conducted to determine postprogram changes. Kruskal-Wallis tests measured variation in responses between the people with dementia and their caregivers. Interviews were analysed using the NVivo software identifying themes against the program objectives of improving knowledge on dementia, coping strategies, communication and support services for people with dementia and their caregivers.
RESULTS
Fifty-three dyads (n = 106) completed the survey. There were significant improvements in participants' level of understanding of dementia (z = -8.04, p < 0.001), knowledge of local services (z = -8.11, p < 0.001) and coping with life with dementia (z = -6.93, p < 0.001). These findings were consistent with interview data from 16 dyads.
CONCLUSIONS
The increasing number of people with dementia and their caregivers living in the community present health challenges. Programs that assist this group to function well in the community are important. Evaluation of this program indicated improved outcomes in relation to adjusting to life with dementia, enhancing knowledge, fostering communication and reducing feelings of isolation. Areas of improvement included lengthening the program with ongoing contact sessions with program facilitators and other participants. Given the positive effects of the program on this vulnerable group of people, it maybe useful for health-care agencies involved in dementia care to conduct this type of program as a matter of routine treatment and care for people newly diagnosed with dementia.
Topics: Humans; Caregivers; Dementia; Adaptation, Psychological
PubMed: 36734521
DOI: 10.1111/ajag.13172 -
Journal of Alzheimer's Disease : JAD 2024This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related... (Review)
Review
This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.
Topics: Humans; Dementia; Deinstitutionalization; Quality of Life; Caregivers; Personal Autonomy
PubMed: 38759003
DOI: 10.3233/JAD-231180 -
Neurology(R) Neuroimmunology &... Sep 2023Autoimmune encephalitis (AIE) may present with prominent cognitive disturbances without overt inflammatory changes in MRI and CSF. Identification of these...
BACKGROUND & OBJECTIVES
Autoimmune encephalitis (AIE) may present with prominent cognitive disturbances without overt inflammatory changes in MRI and CSF. Identification of these neurodegenerative dementia diagnosis mimics is important because patients generally respond to immunotherapy. The objective of this study was to determine the frequency of neuronal antibodies in patients with presumed neurodegenerative dementia and describe the clinical characteristics of the patients with neuronal antibodies.
METHODS
In this retrospective cohort study, 920 patients were included with neurodegenerative dementia diagnosis from established cohorts at 2 large Dutch academic memory clinics. In total, 1,398 samples were tested (both CSF and serum in 478 patients) using immunohistochemistry (IHC), cell-based assays (CBA), and live hippocampal cell cultures (LN). To ascertain specificity and prevent false positive results, samples had to test positive by at least 2 different research techniques. Clinical data were retrieved from patient files.
RESULTS
Neuronal antibodies were detected in 7 patients (0.8%), including anti-IgLON5 (n = 3), anti-LGI1 (n = 2), anti-DPPX, and anti-NMDAR. Clinical symptoms atypical for neurodegenerative diseases were identified in all 7 and included subacute deterioration (n = 3), myoclonus (n = 2), a history of autoimmune disease (n = 2), a fluctuating disease course (n = 1), and epileptic seizures (n = 1). In this cohort, no patients with antibodies fulfilled the criteria for rapidly progressive dementia (RPD), yet a subacute deterioration was reported in 3 patients later in the disease course. Brain MRI of none of the patients demonstrated abnormalities suggestive for AIE. CSF pleocytosis was found in 1 patient, considered as an atypical sign for neurodegenerative diseases. Compared with patients without neuronal antibodies (4 per antibody-positive patient), atypical clinical signs for neurodegenerative diseases were seen more frequently among the patients with antibodies (100% vs 21%, = 0.0003), especially a subacute deterioration or fluctuating course (57% vs 7%, = 0.009).
DISCUSSION
A small, but clinically relevant proportion of patients suspected to have neurodegenerative dementias have neuronal antibodies indicative of AIE and might benefit from immunotherapy. In patients with atypical signs for neurodegenerative diseases, clinicians should consider neuronal antibody testing. Physicians should keep in mind the clinical phenotype and confirmation of positive test results to avoid false positive results and administration of potential harmful therapy for the wrong indication.
Topics: Humans; Alzheimer Disease; Autoantibodies; Autoimmune Diseases of the Nervous System; Dementia; Disease Progression; Frontotemporal Dementia; Retrospective Studies; Netherlands; Neurons; Reproducibility of Results; Male; Female; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over
PubMed: 37311646
DOI: 10.1212/NXI.0000000000200137 -
American Journal of Preventive Medicine Sep 2023
Topics: Humans; Aged; Sleep Wake Disorders; Dementia; Sleep
PubMed: 37597951
DOI: 10.1016/j.amepre.2023.04.007 -
Age and Ageing Oct 2023Over 55 million people live with dementia worldwide. With 40% of modifiable risk factors estimated to contribute to dementia, the potential for prevention is high, and... (Review)
Review
Over 55 million people live with dementia worldwide. With 40% of modifiable risk factors estimated to contribute to dementia, the potential for prevention is high, and preventive measures, at an early stage of cognitive decline, are likely to positively influence future dementia trends. Countries need reliable health data and adequate measurement tools to quantify, monitor and track early changes in cognitive capacity in the general population. Many cognitive tests exist; however, there is no consensus to date about which instruments should be employed, and important variations in measurement have been observed. In this narrative review, we present a number of cognitive tests that have been used in nationally representative population-based longitudinal studies of ageing. Longitudinal panel studies of ageing represent critical platforms towards capturing the process of cognitive ageing and understanding associated risk and protective factors. We highlight optimal measures for use at a population level and for cross-country comparisons, taking into consideration instrument reliability, validity, duration, ease of administration, costs, literacy and numeracy requirements, adaptability to sensory and fine motor impairments and portability to different cultural and linguistic milieux. Drawing upon the strengths and limitations of each of these tests, and the experience gained and lessons learnt from conducting a nationally representative study of ageing, we indicate a comprehensive battery of tests for the assessment of cognitive capacity, designed to facilitate its standardised operationalisation worldwide.
Topics: Humans; Reproducibility of Results; Cognition; Aging; Longitudinal Studies; Dementia
PubMed: 37902512
DOI: 10.1093/ageing/afad122 -
Journal of Extracellular Vesicles Dec 2023Dementia is a leading cause of death worldwide, with increasing prevalence as global life expectancy increases. The most common neurodegenerative disorders are...
Proteomic comparison between non-purified cerebrospinal fluid and cerebrospinal fluid-derived extracellular vesicles from patients with Alzheimer's, Parkinson's and Lewy body dementia.
Dementia is a leading cause of death worldwide, with increasing prevalence as global life expectancy increases. The most common neurodegenerative disorders are Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). With this study, we took an in-depth look at the proteome of the (non-purified) cerebrospinal fluid (CSF) and the CSF-derived extracellular vesicles (EVs) of AD, PD, PD-MCI (Parkinson's disease with mild cognitive impairment), PDD and DLB patients analysed by label-free mass spectrometry. This has led to the discovery of differentially expressed proteins that may be helpful for differential diagnosis. We observed a greater number of differentially expressed proteins in CSF-derived EV samples (N = 276) compared to non-purified CSF (N = 169), with minimal overlap between both datasets. This finding suggests that CSF-derived EV samples may be more suitable for the discovery phase of a biomarker study, due to the removal of more abundant proteins, resulting in a narrower dynamic range. As disease-specific markers, we selected a total of 39 biomarker candidates identified in non-purified CSF, and 37 biomarker candidates across the different diseases under investigation in the CSF-derived EV data. After further exploration and validation of these proteins, they can be used to further differentiate between the included dementias and may offer new avenues for research into more disease-specific pharmacological therapeutics.
Topics: Humans; Alzheimer Disease; Lewy Body Disease; Parkinson Disease; Dementia; Proteomics; Extracellular Vesicles; Biomarkers
PubMed: 38082559
DOI: 10.1002/jev2.12383 -
BMC Geriatrics Sep 2023An important goal in dementia care is how people with dementia can be supported in living well. To this end, we need a conceptualization of "living well" that is... (Review)
Review
BACKGROUND
An important goal in dementia care is how people with dementia can be supported in living well. To this end, we need a conceptualization of "living well" that is suitable for older people with dementia and then develop this conceptualization from the perspectives of both older people and caregivers. This study analyzed the concept of "living well" among older people with dementia.
METHODS
Following Schwartz-Barcott and Kim's hybrid model, this study comprised theoretical, fieldwork, and final analytic phases. In the theoretical phase, we reviewed the extant literature. In the fieldwork phase, we conducted in-depth interviews with 12 participants (five older people with dementia, two family members, and five nurses), followed by qualitative content analysis. In the final analytic phase, we defined the concept of "living well" by comprehensively analyzing the data from the theoretical phase and results from the fieldwork phase.
RESULTS
We derived physical, mental, and social relationship dimensions of the conceptualization of "living well" for older people with dementia. The physical dimensions were "ability for daily living" and "symptom management." The mental dimensions were "psychological health," "psychological stability," "maintaining identity and growth," and "human dignity." Finally, the social relationship dimensions were "maintaining social relations and community connectivity" and "government support."
CONCLUSIONS
Our analysis of the concept of "living well" can be used for developing tools and interventions to improve the ability of older people with dementia to live well.
Topics: Humans; Aged; Dementia; Caregivers; Interpersonal Relations; Family; Mental Health
PubMed: 37773102
DOI: 10.1186/s12877-023-04304-3