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BMJ Open Jan 2018To evaluate the association between the quality of relationship between a person with dementia and their family carer and outcomes for the person with dementia. (Review)
Review
OBJECTIVES
To evaluate the association between the quality of relationship between a person with dementia and their family carer and outcomes for the person with dementia.
DESIGN
Systematic review.
ELIGIBILITY CRITERIA
Cohort studies of people with clinically diagnosed dementia and their main carers. Exposures of interest were any elements of relationship quality, for example, attachment style, expressed emotion and coping style. Our primary outcome was institutionalisation, and secondary outcomes were hospitalisation, death, quality of life and behavioural and psychiatric symptoms of dementia ('challenging behaviour').
DATA SOURCES
MEDLINE, Embase, Web of Science, PsycInfo, the Cochrane Library and Opengrey were searched from inception to May 2017.
STUDY APPRAISAL AND SYNTHESIS METHODS
The Newcastle-Ottawa Scale was used to assess risk of bias. A narrative synthesis of results was performed due to differences between studies.
RESULTS
Twenty studies were included. None of the studies controlled for all prespecified confounding factors (age, gender, socioeconomic status and severity of dementia). Reporting of results was inadequate with many studies simply reporting whether associations were 'statistically significant' without providing effect size estimates or CIs. There was a suggestion of an association between relationship factors and global challenging behaviour. All studies evaluating global challenging behaviour provided statistical evidence of an association (most P values below 0.02). There was no consistent evidence for an association for any other outcome assessed.
CONCLUSIONS
There is currently no strong or consistent evidence on the effects of relationship factors on institutionalisation, hospitalisation, death or quality of life for people with dementia. There was a suggestion of an association between relationship factors and challenging behaviour, although the evidence for this was weak. To improve our ability to support those with dementia and their families, further robust studies are needed.
PROSPERO REGISTRATION NUMBER
CRD42015020518.
Topics: Adaptation, Psychological; Caregivers; Dementia; Family Relations; Hospitalization; Humans; Quality of Life; Risk Factors
PubMed: 29358414
DOI: 10.1136/bmjopen-2016-015538 -
Advances in Nutrition (Bethesda, Md.) Mar 2015Nutrition is an important modifiable risk factor that plays a role in the strategy to prevent or delay the onset of dementia. Research on nutritional effects has until... (Review)
Review
Nutrition is an important modifiable risk factor that plays a role in the strategy to prevent or delay the onset of dementia. Research on nutritional effects has until now mainly focused on the role of individual nutrients and bioactive components. However, the evidence for combined effects, such as multinutrient approaches, or a healthy dietary pattern, such as the Mediterranean diet, is growing. These approaches incorporate the complexity of the diet and possible interaction and synergy between nutrients. Over the past few years, dietary patterns have increasingly been investigated to better understand the link between diet, cognitive decline, and dementia. In this systematic review we provide an overview of the literature on human studies up to May 2014 that examined the role of dietary patterns (derived both a priori as well as a posteriori) in relation to cognitive decline or dementia. The results suggest that better adherence to a Mediterranean diet is associated with less cognitive decline, dementia, or Alzheimer disease, as shown by 4 of 6 cross-sectional studies, 6 of 12 longitudinal studies, 1 trial, and 3 meta-analyses. Other healthy dietary patterns, derived both a priori (e.g., Healthy Diet Indicator, Healthy Eating Index, and Program National Nutrition Santé guideline score) and a posteriori (e.g., factor analysis, cluster analysis, and reduced rank regression), were shown to be associated with reduced cognitive decline and/or a reduced risk of dementia as shown by all 6 cross-sectional studies and 6 of 8 longitudinal studies. More conclusive evidence is needed to reach more targeted and detailed guidelines to prevent or postpone cognitive decline.
Topics: Alzheimer Disease; Cognition; Cognition Disorders; Dementia; Diet; Diet, Mediterranean; Feeding Behavior; Humans
PubMed: 25770254
DOI: 10.3945/an.114.007617 -
BMC Geriatrics Jun 2015Population screening might provide a mechanism to enable early detection of dementia. Yet the potential benefits, harms or acceptability of such a large-scale... (Review)
Review
BACKGROUND
Population screening might provide a mechanism to enable early detection of dementia. Yet the potential benefits, harms or acceptability of such a large-scale intervention are not well understood. This research aims to examine the attitudes and preferences of the general public, health care professionals, people with dementia and their carers towards population screening for dementia.
METHODS
A systematic review of the international literature was undertaken. A search of fifteen bibliographic databases was conducted (up to 12 July 2012; no language restriction) using terms related to dementia, screening, specific screening tools, case finding, and attitudes and preferences; genetic screening and biomarkers were excluded. All study designs were included except opinion-based papers. Included papers were doubly quality assessed and thematically analysed using NVivo.
RESULTS
29,910 papers were identified of which 29 met the inclusion criteria. We identified seventeen themes relating to the 3 phases of the screening process (pre-, in- and post-screen) - none emerged as more of a facilitator than a barrier to the acceptance of dementia screening. Seven themes emerged in relation to the patient, carer and general population: existing health state; lifestyle and life view; awareness of dementia; role of clinician; communication; benefit; and role of the family. Ten themes emerged in relation to the clinician and healthcare professional: patient's existing health and comorbidities; awareness of dementia; confidence; duration of patient contact; suitability of screening tool; cost; disclosure; time; treatment and prognosis; and stigma.
CONCLUSIONS
As for all screening programmes, screening for dementia raises complex issues around preference and choice for clinicians and the public, and it is unclear what specific factors promote or reduce screening acceptance the most. Overall, the level of evidence is low, few large scale studies have been undertaken and none were conducted in representative samples, all affecting the generalizability of identified themes across healthcare contexts. Nevertheless, our findings suggest that population screening for dementia may not be acceptable to either the general public or health care professionals, and highlight where focused efforts are needed to gain insights into dementia specific issues.
Topics: Attitude of Health Personnel; Dementia; Humans; Mass Screening; Patient Preference
PubMed: 26076729
DOI: 10.1186/s12877-015-0064-6 -
BMC Geriatrics Apr 2023High-risk alcohol use is an established modifiable risk factor for dementia. However, prior reviews have not addressed sex differences in alcohol-related dementia risk....
BACKGROUND
High-risk alcohol use is an established modifiable risk factor for dementia. However, prior reviews have not addressed sex differences in alcohol-related dementia risk. In this systematic review, we take a sex-specific perspective towards the alcohol-dementia link, taking into account the age of dementia onset.
METHODS
We searched electronic databases for original cohort or case-control studies investigating the association between alcohol use and dementia. Two restrictions were considered: First, studies had to report results stratified by sex. Second, given the fact that the age at dementia onset seems to affect the alcohol-dementia link, studies were required to distinguish between early-onset and late-onset dementia (cut-off: 65 years). Additionally, the contribution of alcohol to dementia incidence was quantified for a set of 33 European countries for the year 2019.
RESULTS
We reviewed 3,157 reports, of which 7 publications were finally included and summarised narratively. A lower dementia risk when drinking alcohol infrequent or at moderate levels was found in men (three studies) and women (four studies). High-risk use and alcohol use disorders increased the risk of mild cognitive impairment and dementia, particularly early-onset dementia. Estimating the alcohol-attributable share of incident dementia cases revealed that 3.2% and 7.8% of incident dementia cases were estimated to be attributable to high-risk alcohol use (at least 24 g of pure alcohol per day) in 45-to-64-year-old women and men, respectively.
CONCLUSIONS
Research to date has paid little attention to the sex-specific link of alcohol and dementia. In the absence of sex-specific research, the established recommendations on high-risk alcohol use should be employed to communicate the alcohol-attributable dementia risk.
Topics: Female; Humans; Male; Aged; Alcoholism; Dementia; Alcohol Drinking; Europe; Cognitive Dysfunction
PubMed: 37098501
DOI: 10.1186/s12877-023-03972-5 -
Clinical and Experimental Nephrology Jan 2022To identify the association between albuminuria and dementia or cognitive impairment. (Meta-Analysis)
Meta-Analysis
BACKGROUND
To identify the association between albuminuria and dementia or cognitive impairment.
METHODS
The literature search was performed to identify relevant scientific studies through August 2019, including PubMed/Medline and EMBASE. For inclusion, the studies had to fulfil the following criteria: population-based cohort, case-control or cross-sectional studies; quantifying an association of albuminuria with cognitive impairment or dementia; and reported odds ratio (OR), and the corresponding 95% confidential interval (95% CI). Random effects model was used to yield pooled estimates.
RESULTS
A total of 16 studies (11 cohort studies and five cross-sectional studies) were included in the meta-analyses. Based on the fully adjusted estimates, albuminuria was associated with a significant higher risk of cognitive impairment or dementia. Furthermore, the same trend existed for cognitive impairment and dementia, respectively. In addition, both of Alzheimer's diseases (AD) and vascular dementia (VaD) were significantly associated with albuminuria.
CONCLUSION
Albuminuria was significantly associated with cognitive impairment and dementia. Corresponding to an earlier subclinical time-point in kidney disease progress, albuminuria may be a potential factor predicting the future occurrence of dementia.
Topics: Albuminuria; Alzheimer Disease; Cognitive Dysfunction; Cross-Sectional Studies; Dementia; Humans
PubMed: 34468878
DOI: 10.1007/s10157-021-02127-3 -
BMC Medicine Nov 2023Sex difference exists in the prevalence of dementia and cognitive decline. The impacts of sex-specific reproductive risk factors across the lifespan on the risk of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sex difference exists in the prevalence of dementia and cognitive decline. The impacts of sex-specific reproductive risk factors across the lifespan on the risk of dementia or cognitive decline are still unclear. Herein, we conducted this systemic review and meta-analysis to finely depict the longitudinal associations between sex-specific reproductive factors and dementia or cognitive decline.
METHODS
PubMed, EMBASE, and Cochrane Library were searched up to January 2023. Studies focused on the associations of female- and male-specific reproductive factors with dementia or cognitive decline were included. Multivariable-adjusted effects were pooled via the random effect models. Evidence credibility was scored by the GRADE system. The study protocol was pre-registered in PROSPERO and the registration number is CRD42021278732.
RESULTS
A total of 94 studies were identified for evidence synthesis, comprising 9,839,964 females and 3,436,520 males. Among the identified studies, 63 of them were included in the meta-analysis. According to the results, seven female-specific reproductive factors including late menarche (risk increase by 15%), nulliparous (11%), grand parity (32%), bilateral oophorectomy (8%), short reproductive period (14%), early menopause (22%), increased estradiol level (46%), and two male-specific reproductive factors, androgen deprivation therapy (18%), and serum sex hormone-binding globulin (22%) were associated with an elevated risk of dementia or cognitive decline.
CONCLUSIONS
These findings potentially reflect sex hormone-driven discrepancy in the occurrence of dementia and could help build sex-based precise strategies for preventing dementia.
Topics: Pregnancy; Female; Male; Humans; Dementia; Longevity; Androgen Antagonists; Prostatic Neoplasms; Cognitive Dysfunction; Risk Factors; Parity
PubMed: 37996855
DOI: 10.1186/s12916-023-03159-0 -
BMC Geriatrics Sep 2023To systematically review the association between traumatic life events (TLE) and dementia risk. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To systematically review the association between traumatic life events (TLE) and dementia risk.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
APA, PsychINFO, Embase and MEDLINE from their inception to 29.05.21 and updated on 20.04.22.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Original research articles published in peer reviewed journals examining the association between TLE and all cause dementia in individuals aged 60 and over. Two researchers independently assessed the risk of bias using the Newcastle-Ottawa Scale. We conducted a generic inverse variance random effects meta-analysis to provide an overall estimate of TLE impact on dementia risk.
MAIN OUTCOME MEASURES
Risk, odds and hazards ratios relating to dementia risk.
RESULTS
Initially, 3,487 studies were retrieved in the search and seven studies were included in the meta-analysis with data being used from 276,570 participants. TLE were associated with increased dementia risk. Trauma in general had a pooled HR of 1.21, (95% CI 1.03, 1.43, P = 0.0001). War/ Holocaust trauma and childhood trauma were also associated with increased dementia risk (HR = 1.28 (95% CI 1.01-1.63, P = 0.02) and HR = 1.76 (95% CI 1.17-2.64, P = 0.007) respectively).
CONCLUSIONS
We have found an association between TLE and dementia risk. Future research exploring the dimensions of TLE and individual level factors are needed to better understand the relationship between TLE and dementia.
TRIAL REGISTRATION
PROSPERO CRD42021253090.
Topics: Humans; Middle Aged; Aged; Analysis of Variance; Dementia
PubMed: 37740188
DOI: 10.1186/s12877-023-04287-1 -
Neurologia 2024Risk factors for dementia include genetic factors, aging, environmental factors, certain diseases, and unhealthy lifestyle; most types of dementia share a common chronic... (Review)
Review
INTRODUCTION
Risk factors for dementia include genetic factors, aging, environmental factors, certain diseases, and unhealthy lifestyle; most types of dementia share a common chronic systemic inflammatory phenotype. Psoriasis is also considered to be a chronic systemic inflammatory disease. It has been suggested that psoriasis may also contribute to the risk of dementia. The aim of this study was to systematically review the literature on the association between psoriasis and dementia.
DEVELOPMENT
Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Web of Science databases to identify articles published in peer-reviewed journals and studying the association between psoriasis and dementia. Studies meeting the inclusion criteria were reviewed. We used the Newcastle-Ottawa Scale to assess the quality of each study. After applying the inclusion and exclusion criteria, we included 8 studies for review, 3 of which were found to present a higher risk of bias. Six of the 8 studies supported the hypothesis that prior diagnosis of psoriasis increases the risk of dementia; one study including only a few cases reported that psoriasis decreased the risk of dementia, and one study including relatively young patients found no significant association between psoriasis and the risk of dementia.
CONCLUSION
Most studies included in this review supported the hypothesis that psoriasis constitutes a risk factor for dementia. However, well-designed stratified cohort studies assessing both psoriasis severity and treatment status are still required to determine the real effect of psoriasis on the risk of dementia and its subtypes.
Topics: Humans; Chronic Disease; Psoriasis; Risk Factors; Dementia
PubMed: 38161072
DOI: 10.1016/j.nrleng.2023.12.005 -
Journal of the American Heart... Jul 2022Background Recent studies have identified an increased risk of dementia in patients with atrial fibrillation (AF). However, both AF and dementia usually manifest late in... (Meta-Analysis)
Meta-Analysis Review
Background Recent studies have identified an increased risk of dementia in patients with atrial fibrillation (AF). However, both AF and dementia usually manifest late in life. Few studies have investigated this association in adults with early-onset dementia. The aim of this study was to investigate the relationship between AF and early-onset dementia. Methods and Results We searched the PubMed/MEDLINE, Embase, and Scopus databases through April 15, 2022, for studies reporting on the association between AF and dementia in adults aged <70 years, without language restrictions. Two reviewers independently performed the study selection, assessed the risk of bias, and extracted the study data. We performed a meta-analysis of early-onset dementia risk according to occurrence of AF using a random-effects model. We retrieved and screened 1006 potentially eligible studies. We examined the full text of 33 studies and selected the 6 studies that met our inclusion criteria. The pooled analysis of their results showed an increased risk of developing dementia in individuals with AF, with a summary relative risk of 1.50 (95% CI, 1.00-2.26) in patients aged <70 years, and 1.06 (95% CI, 0.55-2.06) in those aged <65 years. Conclusions In this systematic review and meta-analysis, AF was a risk factor for dementia in adults aged <70 years, with an indication of a slight and statistically imprecise excess risk already at ages <65 years. Further research is needed to assess which characteristics of the arrhythmia and which mechanisms play a role in this relationship.
Topics: Adult; Atrial Fibrillation; Databases, Factual; Dementia; Humans; Risk Factors
PubMed: 35861843
DOI: 10.1161/JAHA.122.025653 -
BMC Geriatrics Jul 2017The need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review... (Review)
Review
BACKGROUND
The need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review was to give an overview of the state of the evidence on implementation and dissemination of dementia care, and create a systematic evidence map.
METHODS
We sought studies that addressed dissemination and implementation strategies or described barriers and facilitators to implementation across dementia stages and care settings. Twelve databases were searched from inception to October 2015 followed by forward citation and grey literature searches. Quantitative studies with a comparative research design and qualitative studies with recognised methods of data collection were included. Titles, abstracts and full texts were screened independently by two reviewers with discrepancies resolved by a third where necessary. Data extraction was performed by one reviewer and checked by a second. Strategies were mapped according to the ERIC compilation.
RESULTS
Eighty-eight studies were included (30 quantitative, 34 qualitative and 24 mixed-methods studies). Approximately 60% of studies reported implementation strategies to improve practice: training and education of professionals (94%), promotion of stakeholder interrelationships (69%) and evaluative strategies (46%) were common; financial strategies were rare (15%). Nearly 70% of studies reported barriers or facilitators of care practices primarily within residential care settings. Organisational factors, including time constraints and increased workload, were recurrent barriers, whereas leadership and managerial support were often reported to promote implementation. Less is known about implementation activities in primary care and hospital settings, or the views and experiences of people with dementia and their family caregivers.
CONCLUSION
This scoping review and mapping of the evidence reveals a paucity of robust evidence to inform the successful dissemination and implementation of evidence-based dementia care. Further exploration of the most appropriate methods to evaluate and report initiatives to bring about change and of the effectiveness of implementation strategies is necessary if we are to make changes in practice that improve dementia care.
Topics: Caregivers; Databases, Factual; Dementia; Evidence-Based Medicine; Humans; Qualitative Research
PubMed: 28709402
DOI: 10.1186/s12877-017-0528-y