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Dementia (London, England) Apr 2024There is a need in South Africa to understand the status of available care and support to strengthen responses to dementia. This study provides a situational analysis of...
There is a need in South Africa to understand the status of available care and support to strengthen responses to dementia. This study provides a situational analysis of the current provisions of health, care and support for older persons, people living with dementia and their families in South Africa. It is a first step towards describing the landscape of needs and services available, and provides an evidence base to inform priority-setting for strengthening responses to dementia in South Africa. This situational analysis was conducted in three phases: (1) a desk review guided by a comprehensive topic guide which includes the WHO's Global Dementia Observatory indicators; (2) multi-sectoral stakeholder interviews to verify the secondary sources used in the desk review, and to identify gaps and opportunities in policy and service provisions; and (3) a SWOT-analysis examining the strengths, weaknesses, opportunities and threats in current care and support provisions in South Africa. Our findings highlight the gaps and opportunities with current service provision and show how structural factors create barriers to diagnosis, support, and care. There is an urgent need for intersectoral policy responses to support and strengthen current health, social care, and long-term support systems so that people living with dementia and their families can live and age well. This paper forms part of a larger study on strengthening responses to dementia (The STRIDE project).
Topics: Humans; South Africa; Dementia; Aged; Health Policy
PubMed: 37337309
DOI: 10.1177/14713012231183358 -
Frontiers in Public Health 2023A shift in research interest from separate care problem to care problem clusters among caregivers of people living with dementia may contribute to a better understanding...
BACKGROUND
A shift in research interest from separate care problem to care problem clusters among caregivers of people living with dementia may contribute to a better understanding of dementia care. However, the care problems network among caregivers of people living with dementia are still unknown. This study aimed to identify care problem clusters and core care problems, and explore demographic variables associated with these care problem clusters among caregivers of people living with dementia.
METHODS
Participants were recruited through memory clinics and WeChat groups. The principal component analysis was applied to identify care problem clusters. The network analysis was conducted to describe the relationships among care problems and clusters. Multiple linear models were used to explore the associated factors for the occurrence of the overall care problems and top three central care problem clusters.
RESULTS
A total of 1,012 carer-patient pairs were included in the analysis. Nine care problem clusters were identified. In the entire care problem network, "deterioration in activities of daily living" was the most core care problem cluster across the three centrality indices, followed by "verbal and nonverbal aggression" and "loss of activities of daily living." Variables including marital status, years of dementia diagnosis, number of dementia medication type, and caregiver's educational attainment were associated with the prevalence of these three care problem clusters.
CONCLUSION
Our study suggests that there is a need to evaluate care problem clusters for the improvement of care problem management among people living with dementia. It is particularly important to include assessment and treatment of core care problem as an essential component of the dementia care.
Topics: Humans; Aged; Caregivers; Activities of Daily Living; Educational Status; Linear Models; Dementia
PubMed: 37637827
DOI: 10.3389/fpubh.2023.1195637 -
Age and Ageing May 2024Hippocampal neurogenesis (HN) occurs throughout the life course and is important for memory and mood. Declining with age, HN plays a pivotal role in cognitive decline...
Association of dietary and nutritional factors with cognitive decline, dementia, and depressive symptomatology in older individuals according to a neurogenesis-centred biological susceptibility to brain ageing.
Hippocampal neurogenesis (HN) occurs throughout the life course and is important for memory and mood. Declining with age, HN plays a pivotal role in cognitive decline (CD), dementia, and late-life depression, such that altered HN could represent a neurobiological susceptibility to these conditions. Pertinently, dietary patterns (e.g., Mediterranean diet) and/or individual nutrients (e.g., vitamin D, omega 3) can modify HN, but also modify risk for CD, dementia, and depression. Therefore, the interaction between diet/nutrition and HN may alter risk trajectories for these ageing-related brain conditions. Using a subsample (n = 371) of the Three-City cohort-where older adults provided information on diet and blood biobanking at baseline and were assessed for CD, dementia, and depressive symptomatology across 12 years-we tested for interactions between food consumption, nutrient intake, and nutritional biomarker concentrations and neurogenesis-centred susceptibility status (defined by baseline readouts of hippocampal progenitor cell integrity, cell death, and differentiation) on CD, Alzheimer's disease (AD), vascular and other dementias (VoD), and depressive symptomatology, using multivariable-adjusted logistic regression models. Increased plasma lycopene concentrations (OR [95% CI] = 1.07 [1.01, 1.14]), higher red meat (OR [95% CI] = 1.10 [1.03, 1.19]), and lower poultry consumption (OR [95% CI] = 0.93 [0.87, 0.99]) were associated with an increased risk for AD in individuals with a neurogenesis-centred susceptibility. Increased vitamin D consumption (OR [95% CI] = 1.05 [1.01, 1.11]) and plasma γ-tocopherol concentrations (OR [95% CI] = 1.08 [1.01, 1.18]) were associated with increased risk for VoD and depressive symptomatology, respectively, but only in susceptible individuals. This research highlights an important role for diet/nutrition in modifying dementia and depression risk in individuals with a neurogenesis-centred susceptibility.
Topics: Humans; Neurogenesis; Aged; Male; Female; Depression; Cognitive Dysfunction; Dementia; Nutritional Status; Risk Factors; Hippocampus; Aging; Aged, 80 and over; Cognition; Age Factors; Diet; Cognitive Aging; Biomarkers
PubMed: 38745492
DOI: 10.1093/ageing/afae042 -
Alzheimer's Research & Therapy Jan 2024Disease-modifying treatments for Alzheimer's disease highlight the need for early detection of cognitive decline. However, at present, most primary care providers do not... (Review)
Review
BACKGROUND
Disease-modifying treatments for Alzheimer's disease highlight the need for early detection of cognitive decline. However, at present, most primary care providers do not perform routine cognitive testing, in part due to a lack of access to practical cognitive assessments, as well as time and resources to administer and interpret the tests. Brief and sensitive digital cognitive assessments, such as the Digital Clock and Recall (DCR™), have the potential to address this need. Here, we examine the advantages of DCR over the Mini-Mental State Examination (MMSE) in detecting mild cognitive impairment (MCI) and mild dementia.
METHODS
We studied 706 participants from the multisite Bio-Hermes study (age mean ± SD = 71.5 ± 6.7; 58.9% female; years of education mean ± SD = 15.4 ± 2.7; primary language English), classified as cognitively unimpaired (CU; n = 360), mild cognitive impairment (MCI; n = 234), or probable mild Alzheimer's dementia (pAD; n = 111) based on a review of medical history with selected cognitive and imaging tests. We evaluated cognitive classifications (MCI and early dementia) based on the DCR and the MMSE against cohorts based on the results of the Rey Auditory Verbal Learning Test (RAVLT), the Trail Making Test-Part B (TMT-B), and the Functional Activities Questionnaire (FAQ). We also compared the influence of demographic variables such as race (White vs. Non-White), ethnicity (Hispanic vs. Non-Hispanic), and level of education (≥ 15 years vs. < 15 years) on the DCR and MMSE scores.
RESULTS
The DCR was superior on average to the MMSE in classifying mild cognitive impairment and early dementia, AUC = 0.70 for the DCR vs. 0.63 for the MMSE. DCR administration was also significantly faster (completed in less than 3 min regardless of cognitive status and age). Among 104 individuals who were labeled as "cognitively unimpaired" by the MMSE (score ≥ 28) but actually had verbal memory impairment as confirmed by the RAVLT, the DCR identified 84 (80.7%) as impaired. Moreover, the DCR score was significantly less biased by ethnicity than the MMSE, with no significant difference in the DCR score between Hispanic and non-Hispanic individuals.
CONCLUSIONS
DCR outperforms the MMSE in detecting and classifying cognitive impairment-in a fraction of the time-while being not influenced by a patient's ethnicity. The results support the utility of DCR as a sensitive and efficient cognitive assessment in primary care settings.
TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT04733989.
Topics: Humans; Female; Male; Dementia; Cognitive Dysfunction; Alzheimer Disease; Mental Status and Dementia Tests; Neuropsychological Tests
PubMed: 38167251
DOI: 10.1186/s13195-023-01367-7 -
Lancet (London, England) Nov 2023Dementia's growing impact, especially in ageing societies such as the UK, emphasises the importance of modifiable risk factors as primary prevention targets. Despite...
BACKGROUND
Dementia's growing impact, especially in ageing societies such as the UK, emphasises the importance of modifiable risk factors as primary prevention targets. Despite this, the temporal progression and the population attributable fraction (PAF) of dementia attributable to these factors remain unclear. This investigation aims to examine the temporal trajectories of the modifiable risk factors for dementia in England from 2004 to 2019.
METHODS
We used data from the English Longitudinal Study of Ageing collected between June, 2004, and July, 2019, covering 76 904 participants. We calculated the PAFs for 12 modifiable risk factors, as recommended by the Lancet Commission on dementia prevention, intervention, and care, and the individual weighted PAFs (IW-PAFs) for each risk factor. We analysed temporal trends to understand the changes in the overall PAF and IW-PAF over the study period.
FINDINGS
The overall PAF for dementia showed a decrease from 46·31% in 2004-05 to 43·95% in 2018-19, but this trend was not significant (p=0·226). Hypertension, with an average IW-PAF of 8·67%, has been the primary modifiable determinant of dementia, trailed by obesity (6·42%), social isolation (5·84%), hearing loss (5·02%), depression (4·89%), low education (4·80%), physical inactivity (3·40%), diabetes (2·61%), smoking (2·08%), excessive alcohol consumption (1·22%), air pollution (0·44%), and traumatic brain injury (0·28%). During 2004-19, only IW-PAFs of low education (p=0·001), social isolation (p=0·034), and smoking (p=0·007) showed significant decreasing trends, whereas IW-PAFs of other factors had either stagnated with insignificant changes or, worryingly, climbed upwards.
INTERPRETATION
This investigation provides valuable insights into the temporal trends of modifiable risk factors for dementia in England. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them. Notable, PAF was based on a theoretical scenario in which dementia risk can be wholly eliminated by removing risk factors, which should be explained with caution in practice.
FUNDING
UK Foreign, Commonwealth and Development Office; National Institute for Health and Care Research (NIHR).
Topics: Humans; Longitudinal Studies; Risk Factors; Obesity; Aging; Dementia
PubMed: 37997075
DOI: 10.1016/S0140-6736(23)02078-0 -
Neurobiology of Disease Aug 2023Neurological conditions such as Alzheimer's disease (AD) and related dementias (ADRD) present with many challenges due to the heterogeneity of the related disease(s),... (Review)
Review
Neurological conditions such as Alzheimer's disease (AD) and related dementias (ADRD) present with many challenges due to the heterogeneity of the related disease(s), making it difficult to develop effective treatments. Additionally, the progression of ADRD-related pathologies presents differently between men and women. With two-thirds of the population affected with ADRD being women, ADRD has presented itself with a bias toward the female population. However, studies of ADRD generally do not incorporate sex-based differences in investigating the development and progression of the disease, which is detrimental to understanding and treating dementia. Additionally, recent implications for the adaptive immune system in the development of ADRD bring in new factors to be considered as part of the disease, including sex-based differences in immune response(s) during ADRD development. Here, we review the sex-based differences of pathological hallmarks of ADRD presentation and progression, sex-based differences in the adaptive immune system and how it changes with ADRD, and the importance of precision medicine in the development of a more targeted and personalized treatment for this devastating and prevalent neurodegenerative condition.
Topics: Male; Female; Humans; Alzheimer Disease; Dementia; Immune System
PubMed: 37330146
DOI: 10.1016/j.nbd.2023.106202 -
Journal of Neurology Jan 2024Poor cardiometabolic health is associated with dementia. Considering previous meta-analyses have confirmed associations between ultra-processed foods (UPFs) and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Poor cardiometabolic health is associated with dementia. Considering previous meta-analyses have confirmed associations between ultra-processed foods (UPFs) and cardiometabolic disease, we were interested in the contribution of UPF consumption to the risk of developing dementia.
METHODS
We performed a systematic review and meta-analysis of all records registered on Ovid Medline and Web of Science from inception until December 2022 [PROSPERO (CRD42023388363)]. Studies that assessed UPF consumption in adults, determined according to NOVA, and that reported dementia (Alzheimer's disease, vascular dementia and mild cognitive impairment) determined by clearly stated diagnostic criteria (including formal assessment of dementia or use of diagnostic codes) were included. The association between UPF consumption and dementia was assessed using random-effects meta-analysis, controlling for confounding variables. Study quality was assessed using the Newcastle Ottawa Scale and evidence credibility evaluated using the NutriGrade system.
RESULTS
Seven thousand ten records were screened, and 122 records underwent full text review. From these, 10 observational (8 longitudinal) studies, analysing 867,316 individuals, were included. Included studies adjusted for age, socioeconomic status and co-morbidity, alongside other confounders. High (vs. low) intake of UPF was associated with increased risk of dementia (pooled relative risk 1.44 (95% confidence interval 1.09-1.90) (p = 0.02)) (I = 97.0%), although moderate (vs. low) intake of UPF was not (1.12 (0.96-1.31) (0.13)) (85.0%). Funnel plots demonstrate low risk of publication bias.
CONCLUSION
High UPF consumption is associated with dementia. Public health measures to reduce overconsumption of UPFs are imperative to reduce the burden of dementia.
Topics: Adult; Humans; Diet; Food, Processed; Public Health; Dementia; Observational Studies as Topic
PubMed: 37831127
DOI: 10.1007/s00415-023-12033-1 -
Journal of Alzheimer's Disease : JAD 2024Dementia prevalence is increasing in low- and middle-income countries such as the Philippines. (Review)
Review
BACKGROUND
Dementia prevalence is increasing in low- and middle-income countries such as the Philippines.
OBJECTIVE
This study aimed to give an overview of dementia care in the Philippines and to identify gaps in terms of local epidemiology, research, financial coverage, diagnostics, pharmacotherapy, manpower, and caregiver support.
METHODS
This scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines extension for scoping reviews. Six international and two local databases, and government and non-government websites were searched. Data published in the English or Filipino language on dementia epidemiology, research, diagnostics, management, manpower, and training were extracted from the earliest indexed record until June 2022.
RESULTS
The prevalence of dementia in the Philippines is high and research output on all aspects of dementia is low. Cost is a major barrier as health care coverage is limited, with reliance mainly on out-of-pocket payments, leading to challenges in the proper diagnosis and treatment of dementia. There is a low specialist-to-population ratio, with shortages beyond manpower and training.
CONCLUSIONS
Gaps in dementia care include limited published local data, high healthcare costs, inadequate health financing, and limited manpower.
Topics: Humans; Philippines; Health Services; Health Care Costs; Prevalence; Dementia
PubMed: 38306035
DOI: 10.3233/JAD-230845 -
Environment International Jan 2024While epidemiologic evidence links higher levels of exposure to fine particulate matter (PM) to decreased cognitive function, fewer studies have investigated links with...
BACKGROUND
While epidemiologic evidence links higher levels of exposure to fine particulate matter (PM) to decreased cognitive function, fewer studies have investigated links with traffic-related air pollution (TRAP), and none have examined ultrafine particles (UFP, ≤100 nm) and late-life dementia incidence.
OBJECTIVE
To evaluate associations between TRAP exposures (UFP, black carbon [BC], and nitrogen dioxide [NO]) and late-life dementia incidence.
METHODS
We ascertained dementia incidence in the Seattle-based Adult Changes in Thought (ACT) prospective cohort study (beginning in 1994) and assessed ten-year average TRAP exposures for each participant based on prediction models derived from an extensive mobile monitoring campaign. We applied Cox proportional hazards models to investigate TRAP exposure and dementia incidence using age as the time axis and further adjusting for sex, self-reported race, calendar year, education, socioeconomic status, PM, and APOE genotype. We ran sensitivity analyses where we did not adjust for PM and other sensitivity and secondary analyses where we adjusted for multiple pollutants, applied alternative exposure models (including total and size-specific UFP), modified the adjustment covariates, used calendar year as the time axis, assessed different exposure periods, dementia subtypes, and others.
RESULTS
We identified 1,041 incident all-cause dementia cases in 4,283 participants over 37,102 person-years of follow-up. We did not find evidence of a greater hazard of late-life dementia incidence with elevated levels of long-term TRAP exposures. The estimated hazard ratio of all-cause dementia was 0.98 (95 % CI: 0.92-1.05) for every 2000 pt/cm increment in UFP, 0.95 (0.89-1.01) for every 100 ng/m increment in BC, and 0.96 (0.91-1.02) for every 2 ppb increment in NO. These findings were consistent across sensitivity and secondary analyses.
DISCUSSION
We did not find evidence of a greater hazard of late-life dementia risk with elevated long-term TRAP exposures in this population-based prospective cohort study.
Topics: Adult; Humans; Air Pollutants; Air Pollution; Environmental Exposure; Prospective Studies; Nitrogen Dioxide; Incidence; Particulate Matter; Dementia
PubMed: 38185046
DOI: 10.1016/j.envint.2024.108418 -
Alzheimer's & Dementia : the Journal of... Oct 2023With the rapid expansion of the aging population, the burden of Alzheimer's disease related dementias (ADRD) is anticipated to increase in racialized and minoritized...
INTRODUCTION
With the rapid expansion of the aging population, the burden of Alzheimer's disease related dementias (ADRD) is anticipated to increase in racialized and minoritized groups who are at disproportionately higher risk. To date, research emphasis has been on further characterizing the existence of racial disparities in ADRD through comparisons to groups racialized as White that are assumed to be normative. Much of the literature on this comparison insinuates that racialized and minoritized groups experience poorer outcomes due to genetics, culture, and/or health behaviors.
METHODS
This perspective shines a light on a category of ADRD research that employs ahistorical methodological approaches to describe racial disparities in ADRD that puts us on a merry-go-round of research with no benefits to society.
METHODS
This commentary provides historical context for the use of race in ADRD research and justification for the study of structural racism. The commentary concludes with recommendations to guide future research.
Topics: Humans; Alzheimer Disease; Dementia; Health Status Disparities; Racial Groups; Racism
PubMed: 37394968
DOI: 10.1002/alz.13359