Objectives: To identify factors that may increase intentions to seek help for an early dementia diagnosis. Early dementia diagnosis in Ireland is low, reducing the opportunity for intervention, which can delay progression, reduce psychological distress and increase social supports.
Method: Using the theory of planned behaviour (TPB), and a mixed methods approach, three focus groups were conducted (N = 22) to illicit attitudes and beliefs about help seeking for an early dementia diagnosis. The findings informed the development of the Help Seeking Intentions for Early Dementia Diagnosis (HSIEDD) questionnaire which was piloted and then administered to a sample of community dwelling adults from Dublin and Kildare (N = 95).
Results: Content analysis revealed participants held knowledge of the symptoms of dementia but not about available interventions. Facilitators of help seeking were family, friends and peers alongside well informed health professionals. Barriers to seeking help were a lack of knowledge, fear, loss, stigma and inaccessible services. The quantitative findings suggest the TPB constructs account for almost 28% of the variance in intentions to seek help for an early diagnosis
(Publisher abstract)
Objectives: To identify factors that may increase intentions to seek help for an early dementia diagnosis. Early dementia diagnosis in Ireland is low, reducing the opportunity for intervention, which can delay progression, reduce psychological distress and increase social supports.
Method: Using the theory of planned behaviour (TPB), and a mixed methods approach, three focus groups were conducted (N = 22) to illicit attitudes and beliefs about help seeking for an early dementia diagnosis. The findings informed the development of the Help Seeking Intentions for Early Dementia Diagnosis (HSIEDD) questionnaire which was piloted and then administered to a sample of community dwelling adults from Dublin and Kildare (N = 95).
Results: Content analysis revealed participants held knowledge of the symptoms of dementia but not about available interventions. Facilitators of help seeking were family, friends and peers alongside well informed health professionals. Barriers to seeking help were a lack of knowledge, fear, loss, stigma and inaccessible services. The quantitative findings suggest the TPB constructs account for almost 28% of the variance in intentions to seek help for an early diagnosis of dementia, after controlling for sociodemographic variables and knowledge of dementia. In the final step of the regression analysis, the main predictors of help seeking were knowledge of dementia and subjective norm, accounting for 6% and 8% of the variance, respectively.
Conclusion: Future interventions should aim to increase awareness of the support available to those experiencing early memory problems, and should highlight the supportive role that family, friends, peers and health professionals could provide.
(Publisher abstract)
Subject terms:
dementia, diagnosis, early intervention, attitudes;
... and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria.
Conclusions: The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.
(Edited publisher abstract)
Objectives: Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates.
Methods/setting/participants: A systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation.
Results: 23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7%. The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria.
Conclusions: The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community.
(Edited publisher abstract)
International Journal of Geriatric Psychiatry, 32(9), 2017, pp.933-939.
Publisher:
Wiley
... the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT.
Methods: Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a “yes” (abnormal) versus “suspected” versus “no” (normal) classification.
(Edited publisher abstract)
Objectives: The clock drawing test (CDT) is a commonly used brief cognitive measure. The authors evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. They further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT.
Methods: Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a “yes” (abnormal) versus “suspected” versus “no” (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. The authors also used a 17-point CDT rating system.
Results: When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI.
Conclusions: A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system.
(Edited publisher abstract)
People with learning disabilities can be at particular risk of developing dementia, but special challenges can arise in trying to support them. This article describes 'The Dementia Project' from learning disability charity MacIntyre and updates on its progress to date. The project is creating a range of learning and multi-media resources to help improve practice and care for people with learning disabilities living with dementia. The resources will be available when the project finishes in 2019.
(Edited publisher abstract)
People with learning disabilities can be at particular risk of developing dementia, but special challenges can arise in trying to support them. This article describes 'The Dementia Project' from learning disability charity MacIntyre and updates on its progress to date. The project is creating a range of learning and multi-media resources to help improve practice and care for people with learning disabilities living with dementia. The resources will be available when the project finishes in 2019.
(Edited publisher abstract)
Subject terms:
learning disabilities, dementia, person-centred care, diagnosis, training;
The second edition of a guide providing advice for people with dementia, and their carers, to help them come to terms with their diagnosis, and to plan ahead and enable them to live well with the condition. It includes sections focusing on the emotional impact of a diagnosis; drug treatments that are available; signposting to services available through the NHS; social services, charities
(Edited publisher abstract)
The second edition of a guide providing advice for people with dementia, and their carers, to help them come to terms with their diagnosis, and to plan ahead and enable them to live well with the condition. It includes sections focusing on the emotional impact of a diagnosis; drug treatments that are available; signposting to services available through the NHS; social services, charities and private organisations; and support for carers. The guide has been endorsed by the Royal College of Psychiatrists (RCP), the Royal College of General Practitioners (RCGP) and the Association of Directors of Adult Social Services (ADASS).
(Edited publisher abstract)
Subject terms:
carers, dementia, diagnosis, health professionals, social care provision, quality of life, therapy and treatment;
An overview of a feasibility study to spread and adopt the Dementia Assessment Referral to GP (DeAR-GP) tool for both older adults housing providers and community health teams. DeAR-GP was originally developed to support care workers in care homes to identify people who are showing signs of dementia and refer them to their GP or another healthcare professional for review. This feasibility study carried out pre-pilot focus group to gain insight into staff understanding and experience of dementia and what adaptations would be required to make DeAR-GP suitable for these settings. Pilots then took place at eight sites across four London boroughs. The results of the pilot found that the DeAR-GP could be adapted for community health teams and older adults housing settings. Staff across both settings found the tool accessible and easy to use. DeAR-GP helped communication between front line staff and GPs. Levels of dementia training for front line staff varied across the housing providers and the pilot recommended that housing providers implement Dementia Friends Training provided by the Alzheimer’s Society when implementing DeAR-GP. The tools and implementation guide are available in the appendices.
(Edited publisher abstract)
An overview of a feasibility study to spread and adopt the Dementia Assessment Referral to GP (DeAR-GP) tool for both older adults housing providers and community health teams. DeAR-GP was originally developed to support care workers in care homes to identify people who are showing signs of dementia and refer them to their GP or another healthcare professional for review. This feasibility study carried out pre-pilot focus group to gain insight into staff understanding and experience of dementia and what adaptations would be required to make DeAR-GP suitable for these settings. Pilots then took place at eight sites across four London boroughs. The results of the pilot found that the DeAR-GP could be adapted for community health teams and older adults housing settings. Staff across both settings found the tool accessible and easy to use. DeAR-GP helped communication between front line staff and GPs. Levels of dementia training for front line staff varied across the housing providers and the pilot recommended that housing providers implement Dementia Friends Training provided by the Alzheimer’s Society when implementing DeAR-GP. The tools and implementation guide are available in the appendices.
(Edited publisher abstract)
Subject terms:
referral, dementia, housing, community mental health teams, assessment, diagnosis, general practitioners;
International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1280-1304.
Publisher:
Wiley
Objective: The Lewy body dementias (LBD, dementia with Lewy bodies and Parkinson's disease dementia) are the second most common cause of neurodegenerative dementia but remain under-recognised, with long delays from initial assessment to diagnosis. Whilst validated instruments have been developed for key symptoms, there is no brief instrument for overall diagnostic assessment suitable for routine to address an important need, the under-diagnosis of LBD, by developing toolkits for improving the recognition and diagnosis of the LBD, which were acceptable to clinicians working in routine dementia and Parkinson's disease services.
(Edited publisher abstract)
Objective: The Lewy body dementias (LBD, dementia with Lewy bodies and Parkinson's disease dementia) are the second most common cause of neurodegenerative dementia but remain under-recognised, with long delays from initial assessment to diagnosis. Whilst validated instruments have been developed for key symptoms, there is no brief instrument for overall diagnostic assessment suitable for routine practice. Here the authors report the development of such assessment toolkits.
Methods: The authors developed the LBD assessment toolkits in three stages. First, they conducted a systematic search for brief validated assessments for key symptoms and combined these into draft instruments. Second, feedback was obtained on acceptability and feasibility through two rounds of interviews with their patient and public involvement group. This led to modification of the toolkits. Finally, the authors piloted the toolkits in a feasibility study in routine dementia and Parkinson's disease services to produce final instruments suitable for routine clinical practice.
Results: Eleven clinicians, working in both dementia/memory assessment and Parkinson's disease/movement disorder services, consented to pilot the assessment toolkits and provide feedback on their feasibility. Clinicians worked in routine health service (not academic) settings and piloted the draft toolkits by integrating them into their regular clinical assessments. Feedback obtained informally, by written comments and through qualitative interviews led to modifications and production of final acceptable versions.
Conclusions: The authors were able to address an important need, the under-diagnosis of LBD, by developing toolkits for improving the recognition and diagnosis of the LBD, which were acceptable to clinicians working in routine dementia and Parkinson's disease services.
(Edited publisher abstract)
Subject terms:
assessment, diagnosis, dementia, Parkinsons disease, instruments, health care, memory;
Child sexual abuse (CSA) is a worldwide problem with serious consequences. No recognisable symptom pattern for suspected CSA has yet been identified in very young children. The authors aim to investigate psychosocial symptoms in a sample of children with confirmed or strongly suspected CSA and the interpretations given to such symptoms by independent clinical experts. Secondly the authors examined whether experts were able to identify confirmed victims of severe CSA. A qualitative study including inductive content analysis of medical files and focus group discussions with independent experts on the interpretation of psychosocial symptoms was conducted. Included were 125 children (76 boys, 60.8%, and 49 girls, 39.2%; median age 3.3 years; age range 0–11) who were involved in the Amsterdam sexual abuse case (ASAC) and had been examined for strongly suspected CSA. The authors identified four themes among the psychosocial symptoms: problems concerning emotions, behaviour, toilet training, and development, whether or not associated with the day care centre or the perpetrator. Clinical experts identified signs of posttraumatic stress disorder (PTSD), regression in continence skills (not otherwise explained), and problems triggered by exposure to the perpetrator or the abuse location as concerning symptoms for CSA. Less concerning symptoms were designated as worrisome if they were numerous and there was no clear explanation for these symptoms. A clear symptom pattern was lacking and about half of the confirmed severe victims of CSA did not display any psychosocial problems. Therefore, it is difficult for experts to identify confirmed CSA victims. Thus, the assessment of suspected CSA should be over time and multidisciplinary.
(Edited publisher abstract)
Child sexual abuse (CSA) is a worldwide problem with serious consequences. No recognisable symptom pattern for suspected CSA has yet been identified in very young children. The authors aim to investigate psychosocial symptoms in a sample of children with confirmed or strongly suspected CSA and the interpretations given to such symptoms by independent clinical experts. Secondly the authors examined whether experts were able to identify confirmed victims of severe CSA. A qualitative study including inductive content analysis of medical files and focus group discussions with independent experts on the interpretation of psychosocial symptoms was conducted. Included were 125 children (76 boys, 60.8%, and 49 girls, 39.2%; median age 3.3 years; age range 0–11) who were involved in the Amsterdam sexual abuse case (ASAC) and had been examined for strongly suspected CSA. The authors identified four themes among the psychosocial symptoms: problems concerning emotions, behaviour, toilet training, and development, whether or not associated with the day care centre or the perpetrator. Clinical experts identified signs of posttraumatic stress disorder (PTSD), regression in continence skills (not otherwise explained), and problems triggered by exposure to the perpetrator or the abuse location as concerning symptoms for CSA. Less concerning symptoms were designated as worrisome if they were numerous and there was no clear explanation for these symptoms. A clear symptom pattern was lacking and about half of the confirmed severe victims of CSA did not display any psychosocial problems. Therefore, it is difficult for experts to identify confirmed CSA victims. Thus, the assessment of suspected CSA should be over time and multidisciplinary.
(Edited publisher abstract)
Subject terms:
child sexual abuse, diagnosis, children, psychosocial approach, professionals, assessment;
Journal of Elder Abuse and Neglect, 29(4), 2017, pp.270-287.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual’s residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack
(Publisher abstract)
Elder neglect is the one of the most pervasive forms of mistreatment, and often the only place outside of the individual’s residence to identify and assist neglected individuals is in a medical setting. However, elder neglect cases treated in hospitals do not present with a single diagnosis or clinical sign, but rather involve a complex constellation of clinical signs. Currently, there is a lack of comprehensive guidelines on which clinical signs to use in screening tools for neglect among patients treated in hospitals. Using the DELPHI method, a group of experts developed and tested a scale to be used as a pre-screener that conceptually could be integrated into electronic health record systems so that it could identify potential neglect cases in an automated manner. By applying the scale as a pre-screener for neglect, the tool would reduce the pool of at-risk patients who would benefit from in-depth screening for elder neglect by 95%.
(Publisher abstract)
Subject terms:
neglect, elder abuse, older people, screening, diagnosis, hospitals, health care;
Journal of Mental Health, 26(5), 2017, pp.395-404.
Publisher:
Taylor and Francis
Place of publication:
London
Background: There is limited research investigating how information about a mental health diagnosis is discussed and received.
Aims: To measure community-based service users’ satisfaction and preferences toward receiving news of a serious mental health diagnosis and to assess the acceptability of a diagnostic communication protocol (SPIKES: Setting; Perception; Invitation; Knowledge; Empathy; of diagnosis from additional health professionals rather than only a sole practitioner. The SPIKES protocol was rated as highly acceptable, with Empathy being rated as the most important feature.
Conclusions: This research indicates there were specific areas of communication practices which can be improved within mental health service provision, as a gap existed between participants’ desire for support
(Edited publisher abstract)
Background: There is limited research investigating how information about a mental health diagnosis is discussed and received.
Aims: To measure community-based service users’ satisfaction and preferences toward receiving news of a serious mental health diagnosis and to assess the acceptability of a diagnostic communication protocol (SPIKES: Setting; Perception; Invitation; Knowledge; Empathy; Summarizing).
Method: A survey was conducted with 101 participants.
Results: Participants rated the methods clinicians use to facilitate diagnostic discussions are highly important; however, they were not wholly satisfied with their experience. Higher satisfaction was reported if participants were provided with information in a face-to-face meeting, and if they received supplementary support at the time of diagnosis from additional health professionals rather than only a sole practitioner. The SPIKES protocol was rated as highly acceptable, with Empathy being rated as the most important feature.
Conclusions: This research indicates there were specific areas of communication practices which can be improved within mental health service provision, as a gap existed between participants’ desire for support and their experience. Strategies outlined in the SPIKES protocol, and others such as addressing stigma concerns, may prove useful in development of clinician training and service improvement.
(Edited publisher abstract)
Subject terms:
severe mental health problems, user views, stigma, diagnosis, communication, service users, mental health services;