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Alzheimer's Disease: diagnosis and new treatments
- Author:
- THOMPSON June
- Journal article citation:
- Community Practitioner, 72(2), February 1999, pp.28-29.
- Publisher:
- Community Practitioners' and Health Visitors' Association
The chance of contracting dementia roughly doubles every five years beyond the age of 65. Yet despite its high prevalence, a cure for the most common form of dementia, Alzheimer's Disease, remains elusive. Considers the characteristics of Alzheimer's Disease and the new drug treatments which offer some hope to sufferers.
Cholinesterase inhibitors and Alzheimer’s disease: patient, carer and professional factors influencing the use of drugs for Alzheimer’s disease in the United Kingdom
- Authors:
- HUTCHINGS Deborah, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 9(3), August 2010, pp.427-443.
- Publisher:
- Sage
Cholinesterase inhibitors are a major breakthrough in the treatment of Alzheimer’s disease. Between 2001 and 2006 guidance in the United Kingdom recommended that people with mild to moderate Alzheimer’s disease were eligible for treatment with donepezil, rivastigmine and galanatamine on the National Health Service (NHS). However, previous research has shown a considerable variation in uptake of and access to treatment. This study investigated which factors influence decisions to initiate, continue and discontinue treatment with the drugs. The views and experiences of 12 older people referred for memory problems or receiving treatment, 11 family carers and 16 health and social care professionals were obtained using a combination of semi-structured interviews and focus groups. Findings revealed four factors outside UK guidance and prescribing budgets influenced decisions to utilise the drug treatments – perceptions of treatment availability and effectiveness, resource capacity, carer perceived benefits, and professional ethics. In conclusion, the authors suggest that unequal access to treatment and ethical concerns remain key issues in the distribution of these medications.
A memory like clockwork: accounts of living through dementia
- Author:
- GILLIES B.A.
- Journal article citation:
- Aging and Mental Health, 4(4), November 2000, pp.366-374.
- Publisher:
- Taylor and Francis
The opportunities open to individuals with dementia to describe their experience and there by influence their treatment and care have hitherto been limited by a perception of assumed inability and incompetence, rendering such contributions as invalid or at best unreliable. Recently, more attention has been focused on the value of finding an appropriate means of harnessing such experiences and examining what can be learned from listening to subjective accounts. This paper presents findings from a qualitative study of the experiences of 20 individuals diagnosed with dementia. In the absence of a shared diagnosis, however, these individuals contextualised their experiences in the normality of old age. Their accounts offer insight into the impact and frustrations of living with a failing memory and the challenges of the aging process, the meaning they attached to what was happening to them, and how they attempted to cope with the assaults on their self-esteem brought about by a growing sense of failure, incompetence and letting down those closest to them.
Orientation by seasons
- Author:
- BENDER Michael
- Journal article citation:
- Nursing Times, 26.4.95, 1995, pp.64-65.
- Publisher:
- Nursing Times
Describes how the author devised a way for staff to relate to people with advanced dementia through 'unison' groups.
Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial)
- Authors:
- KNAPP Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1205-1216.
- Publisher:
- Wiley
Objective: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. The authors examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. Methods: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial. A total of 295 community-dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine. Results: Continuing donepezil for 52 weeks was more cost-effective than discontinuation, considering cognition, activities of daily living and health-related quality of life. Starting memantine was more cost-effective than donepezil discontinuation. Donepezil–memantine combined is not more cost-effective than donepezil alone. Conclusions: Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. (Edited publisher abstract)
Computer-based cognitive interventions for people living with dementia: a systematic literature review and meta-analysis
- Authors:
- GARCIA-CASAL J. Antonio, et al
- Journal article citation:
- Aging and Mental Health, 21(5), 2017, pp.454-467.
- Publisher:
- Taylor and Francis
Objectives: To estimate the efficacy of computer-based cognitive interventions for improving cognition in people with dementia (PWD). Method: Online literature databases were searched for relevant studies. Interventions were categorised as follows: cognitive recreation, cognitive rehabilitation, cognitive stimulation or cognitive training. A systematic review, quality assessment and meta-analyses were conducted. Results: Twelve studies were identified. Their methodological quality was acceptable according to Downs & Black criteria, the weakest methodological area being the external validity. The meta-analyses indicated cognitive interventions lead to beneficial effects on cognition in PWD (SMD −0.69; 95% CI = −1.02 to −0.37; P < 0.0001; I2 = 29%), depression (SMD 0.47; 95% CI = 0.16 to 0.78; p = 0.003; I2 = 0%) and anxiety (SMD 0.55; 95% CI = 0.07 to 1.04; P < 0.03; I2 = 42%). They benefited significantly more from the computer-based cognitive interventions than from the non-computer-based interventions in cognition (SMD 0.48; 95% CI = 0.09 to 0.87; P = 0.02; I2 = 2%). Conclusion: Computer-based cognitive interventions have moderate effects in cognition, and anxiety and small effects in depression in PWD. No significant effects were found on activities of daily living. They led to superior results compared to non-computer-based interventions in cognition. Further research is needed on cognitive recreation and cognitive stimulation. There is also a need for longer-term follow-up to examine the potential retention of treatment effects, and for the design of specific outcome measures. (Publisher abstract)
Associations between physical function, dual-task performance and cognition in patients with mild Alzheimer's disease
- Authors:
- AUE SOBOL Nanna, et al
- Journal article citation:
- Aging and Mental Health, 20(11), 2016, pp.1139-1146.
- Publisher:
- Taylor and Francis
Objective: Alzheimer's disease (AD) causes a gradual decline in cognition, limitations of dual-tasking and physical function leading to total dependence. Hence, information about the interaction between physical function, dual-task performance and cognition may lead to new treatment strategies with the purpose of preserving function and quality of life. The objective of this study was to investigate the associations between physical function, dual-task performance and cognition in community-dwelling patients with mild AD. Methods: Baseline results from 185 participants (50–90 years old) in the single blinded multicenter RCT ‘ADEX’ (Alzheimer's disease: the effect of physical exercise) were used. Assessments included tests of physical function: 400-m walk test, 10-m walk test, Timed Up and Go test and 30-s chair stand test; dual-task performance, i.e., 10-m walk while counting backwards from 50 or naming the months backwards; and cognition, i.e., Mini Mental State Examination, Symbol Digit Modalities Test, the Stroop Color and Word Test, and Lexical verbal fluency test. Results: Results in the 30-s chair stand test correlated significantly with all tests of cognition (r = .208–.242) while the other physical function tests only randomly correlated with tests of cognition. Results in the dual-task counting backwards correlated significantly with results in all tests of cognition (r = .259–.388), which accounted for 7%–15% of the variation indicating that a faster time to complete dual-task performance was associated with better cognitive performance. Conclusion: The evidence of the associations between physical function, dual-task performance and cognition is important when creating new rehabilitation interventions to patients with mild AD. (Publisher abstract)
A pilot randomized controlled trial of mindfulness-based stress reduction for caregivers of family members with dementia
- Authors:
- BROWN Kirk Warren, COOGLE Constance L., WEGELIN Jacob
- Journal article citation:
- Aging and Mental Health, 20(11), 2016, pp.1157-1166.
- Publisher:
- Taylor and Francis
Objectives: The majority of care for those with Alzheimer's disease and other age-related dementias is provided in the home by family members. To date, there is no consistently effective intervention for reducing the significant stress burden of many family caregivers. The present pilot randomised controlled trial tested the efficacy of an adapted, eight-week mindfulness-based stress reduction (MBSR) programme, relative to a near structurally equivalent, standard social support (SS) control condition for reducing caregiver stress and enhancing the care giver–recipient relationship. Method: Thirty-eight family caregivers were randomised to MBSR or SS, with measures of diurnal salivary cortisol, and perceived stress, mental health, experiential avoidance, caregiver burden, and relationship quality collected pre- and post-intervention and at three-month follow-up. Results: MBSR participants reported significantly lower levels of perceived stress and mood disturbance at post-intervention relative to SS participants. At three-month follow-up, participants in both treatment conditions reported improvements on several psychosocial outcomes. At follow-up, there were no condition differences on these outcomes, nor did MBSR and SS participants differ in diurnal cortisol response change over the course of the study. Conclusion: Both MBSR and SS showed stress reduction effects, and MBSR showed no sustained neuroendocrine and psychosocial advantages over SS. The lack of treatment condition differences could be attributable to active ingredients in both interventions, and to population-specific and design factors. (Edited publisher abstract)
Does targeted cognitive training reduce educational disparities in cognitive function among cognitively normal older adults?
- Authors:
- CLARK Daniel O., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(7), 2016, pp.809-817.
- Publisher:
- Wiley
Objective: The aim of this study was to investigate educational differences in treatment responses to memory, reasoning, and speed of processing cognitive training relative to no-contact control. Methods: Secondary analyses of the Advanced Cognitive Training for Independent and Vital Elderly trial were conducted. Two thousand eight hundred older adults were randomized to memory, reasoning, or speed of processing training or no-contact control. A repeated-measures mixed-effects model was used to investigate immediate post-training and 1-year outcomes with sensitivity analyses out to 10 years. Outcomes were as follows: (1) memory composite of Hopkins Verbal Learning Test, Rey Auditory Verbal Learning Test, and Rivermead Behavioral Memory Test; (2) reasoning composite of letter series, letter sets, and word series; and (3) speed of processing measured using three trials of useful field of view and the digit symbol substitution test. Results: The effects of reasoning and memory training did not differ by educational attainment. The effect of speed of processing training did. Those with fewer than 12 years of education experienced a 50% greater effect on the useful field of view test compared with those with 16 or more years of education. The training advantage for those with fewer than 12 years of education was maintained to 3 years post-training. Conclusion: Older adults with less than a secondary education are at elevated risk of dementia, including Alzheimer's disease. The analyses here indicate that speed of processing training is effective in older adults with low educational attainment. (Publisher abstract)
Dementia and cognitive decline: a review of the evidence
- Authors:
- RAY Sujata, DAVIDSON Susan
- Publisher:
- Age UK
- Publication year:
- 2014
- Pagination:
- 38
- Place of publication:
- London
A summary of what is generally accepted and can be trusted on cognitive decline and dementia. This paper clarifies key terms and concepts, filtering out unreliable evidence. It provides an update on the best and most recent brain research and includes information on how the brain changes over time, how it can age healthily and how it is affected by disease. The report focuses on the types of dementia, test and diagnosis of dementia, prevalence, causes, risk and protective factors, and interventions for cognitive decline and dementia. It suggests that five modifiable lifestyle factors are linked with a lower risk of dementia. These are: physical exercise; a Mediterranean diet; not smoking; drinking alcohol in moderation; and preventing and treating diabetes, high blood pressure and obesity. (Edited publisher abstract)