Dementia

Introduction: Research suggests that physical and cognitive exercise can have a positive effective on those with dementia, but less is known about such interventions in those at risk for dementia. Understanding the feasibility of administering clinical assessments remotely using Zoom for Healthcare^TM in the context of a dementia prevention trial for at risk older adults is not well understood.

Methods: SYNERGIC@Home/SYNERGIE~Chez soi (NCT04997681) is a home-based, remotely delivered clinical trial targeting older adults at risk for dementia. Participants underwent a screening/baseline assessment and were randomized to one of four physical and cognitive exercise intervention arms for 16 weeks (3 times per week). They were reassessed immediately post-intervention and 6-months later. The standardized assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life were done at all three points. A research coordinator completed the assessments on a one-on-one basis via Zoom for Healthcare^TM. The quality of life questionnaire was mailed to the participant.

Results: Forty-eight of 60 participants (80%) (mean age 68.7 ± 5.7 years, 81.3% female) completed the study. Most participants (75.0%) were cognitively intact with at least 2 dementia risk factors. No participants withdrew from the trial because of difficulty with the remote delivery of the assessments. There were no statistically significant changes in any of the assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, or quality of life throughout the study.

Conclusion: This study demonstrates it is possible to administer standardized clinical assessments of cognition, physical activity, mobility, mental health, nutrition, sleep, and quality of life remotely in the context of a clinical trial. The study was not powered to detect meaningful differences in these assessments. Nevertheless, this confirms the feasibility of remotely administering clinical assessments to older adults at risk for dementia

Background

Dementia is a prevalent condition in an ageing population. Persons with dementia and their caregivers are often uncertain about what to expect after an initial diagnosis. Previous studies conducted on the experiences of informal caregivers show a clear demand to address these: providing adequate information, psychosocial support and access to services.

Introduction

The diagnosis of dementia is usually made by specialists in the tertiary hospital. However, resources in acute tertiary hospitals are expensive and valuable. To better allocate resources and improve the manpower situation, we have collaborated with our community partner to provide post diagnosis support (PDS) to patients newly diagnosed with dementia.

Methods

A PDS team consisting of an allied health professional and a caregiver peer is established by our community partner. They conduct home visits to provide psychoeducation to help persons with dementia and their caregivers understand more about dementia, develop personalised care plans, and coordinate support services to provide psychoemotional support.

Close communication is maintained between the PDS team and the acute hospital referral team. Multidisciplinary team meetings involving the geriatricians, nurses, case managers and community partners are also held quarterly to provide regular updates about the progress of the patients and facilitate learning.

Results

A total of 95 persons who were newly diagnosed with dementia in the previous 1.5 years were referred. 53 patients were eventually enrolled under the PDS programme, and received psychoeducation and personalised care plans. 72% were given caregiver support and 66% were linked up to community services. The average duration between date of referral to date of first home visit is 13 days.

Conclusions

In an ageing population where there is high healthcare utilisation, it is efficient to utilise existing services instead of duplicating them. By collaborating with community partners, we are empowering them to play a better role in supporting persons with dementia.

Introduction:

With population aging comes challenges like dementia, prompting the urgent identification of risk factors and its associations with other psychiatric disorders. This review aims to explore the connection between depression and the onset of mild cognitive impairment (MCI) or dementia through recent literature analysis.

Methods:

Systematic review and meta-analysis, following PRISMA recommendations, with studies from 2013 onwards. The search strategy “Depression” AND “Dementia” AND “Aged” was employed in the Cochrane, Embase, LILACS, PubMed, Scopus, and Scielo databases. Cohort studies in Portuguese, English, or Spanish were included, while reviews or clinical trials were excluded.The meta-analysis was conducted using RevMan software, employing unadjusted OR effect measures for exposure in the Forest Plot graph. Study heterogeneity was calculated using the I² statistic, with a cutoff point of >75% indicating high heterogeneity.

Results:

The search strategy identified 3,394 articles, screened by title and abstract. Of these, 187 were fully read, and 26 were included in the review. The most used tool for assessing depressive symptoms was the Geriatric Depression Scale (38.4%), while the Mini-Mental State Examination was the most frequently used tool for assessing symptoms of MCI and dementia (26.9%). The quantitative analysis included 14 studies evaluating dementia and 8 studies evaluating MCI. The likelihood of older adults with depression developing dementia was 1.75 times higher than in the non-depressed population (OR = 1.75; 95% CI 1.46 - 2.11). Additionally, a twofold increase in the likelihood of developing MCI was found in depressed older adults (OR = 2.03; 95% CI 1.44 - 2.88). All analyses revealed high heterogeneity.

Conclusion:

Depression was found to be associated with higher likelihood of developing MCI or dementia in older adults. Understanding this complex relationship with new studies and reviews is crucial for developing targeted interventions and improving the prognosis for individuals affected by both conditions.

Introduction

In 2021, the Welsh Government launched the “All Wales Dementia Care Pathway of Standards”, which the Cardiff and Vale University Health Board (CVUHB) Memory Assessment Service (MAS) works under (1. Welsh Government, 2021). This service evaluation aims to evaluate the CVUHB MAS diagnostic pathway against these standards.

Method

This retrospective review analysed 299 referrals to the CVUHB MAS from August 2020-2023. Data was collected via referral and clinic letters, focusing on demographics, referral sources, diagnostic timelines and clinical outcomes.

Results

Patients had a mean age of 78.2 years (n=299), with 86.0% (n=257/299) referred by General Practitioners. The average Charlson Comorbidity Index (CCI) was 4.93 (n=299) and the median Clinical Frailty Scale (CFS) score was 4 (n=299). Patients were on an average of 6.5 (n=299) medications at referral, with an anticholinergic burden (ACB) score of 1.12 (n=293) and 15.0% (n=44/293) had a high ACB (≥3). The average time from referral to diagnosis was 19.3 weeks, primarily due to pending neuroimaging. Ethnic minorities experienced longer symptom onset to diagnosis, 2.56 (n=16) vs 1.94 (n=263) years average. 59.2% (n=177/299) of patients received a diagnosis of dementia and 36.5% (n=109/299) of cognitive impairment. Medication was initiated in 30.8% (n=92/299). 84.1% (n=244/290) required one clinical appointment to receive a diagnosis.

Conclusions

Results showed the average CCI score was 4.93, indicating significant health burdens. The need for targeted medication reviews in Memory Clinic was highlighted in 15.0% of patients with an ACB ≥3. Addressing ethnic disparities is crucial to the overall reduction of diagnosis times. The CVUHB MAS achieved a high diagnostic rate at first clinical contact (84.1%). 30.4% (n=91/299) received a diagnosis of mild cognitive impairment, a critical cohort for early intervention to manage disease progression. Streamlining the pre-diagnostic pathway, especially performing neuroimaging at referral, is essential to meet the 12-week diagnosis target (1).

The introduction of an additional meal in nursing homes may be associated with a positive impact on the BMI of residents with dementia.

Abstract

Background

Since 2010, many nursing homes in Norway have introduced an extra meal daily, with a hot lunch, and pushing dinner to later in the day. This initiative aims to reduce the long time interval between breakfast and supper.

Aim

This study examines how an extra meal affects the residents' body mass index (BMI) at nursing homes in Norway. Research questions include how an extra meal affects BMI among residents in the dementia unit.

Methods

We used a cross-sectional design to analyze data from residents over 65 years old in dementia care units. Both parametric and non-parametric statistical tests were used to evaluate changes in BMI.

Results

Our study identified a modest increase in BMI among residents in the dementia care unit after introducing an additional meal. The results imply that incorporating an extra meal to meet residents' needs could support the maintenance of a healthy BMI.

Discussion

Our study reveals that the introduction of an extra meal resulted in a slight increase in BMI among the residents with dementia, which does not correspond with previous studies indicating malnutrition among these residents. The dementia disease reduces functional abilities, and challenges related to mealtime behavior, restlessness, and depression can lead to weight loss. The fact that our results show a slight increase in BMI at the dementia units may be related to these residents often being troubled with restlessness and not finding the peace to consume a full meal. By introducing an extra meal, the total food intake increases since residents still eat a little at each meal, and focusing more on accommodating each resident might have influenced the increase in BMI values.

Conclusion

The study indicates that the introduction of an extra meal has a positive effect on the BMI value of residents with dementia in nursing homes.

Introduction

Physical and cognitive decline at an older age is preceded by changes that accumulate over time until they become clinically evident difficulties. These changes, frequently overlooked by patients and health professionals, may respond better than fully established conditions to strategies designed to prevent disabilities and dependence in later life. The objective of this study was twofold: to provide further support for the need to screen for early functional changes in older adults and to look for an early association between decline in mobility and cognition.

Methods

A cross-sectional cohort study was conducted on 95 active functionally independent community-dwelling older adults in Havana, Cuba. We measured their gait speed at the usual pace and their cognitive status using the MMSE. A value of 0.8 m/s was used as the cut-off point to decide whether they presented a decline in gait speed. A quantitative analysis of their EEG at rest was also performed to look for an associated subclinical decline in brain function.

Results

Results show that 70% of the sample had a gait speed deterioration (i.e., lower than 0.8 m/s), of which 80% also had an abnormal EEG frequency composition for their age. While there was no statistically significant difference in the MMSE score between participants with a gait speed above and below the selected cut-off, individuals with MMSE scores below 25 also had a gait speed < 0.8 m/s and an abnormal EEG frequency composition.

Conclusions

Our results provide further evidence of early decline in older adults – even if still independent and active - and point to the need for clinical pathways that incorporate screening and early intervention targeted at early deterioration to prolong the years of functional life in older age.

• Collaboration between a nursing home and an ambulatory geriatric-psychiatric team to patients with Behavioral and Psychological Symptoms of Dementia (BPSD)

Introduction

Healthcare professionals in nursing homes collaborate with specialized healthcare services to manage and support patients with BPSD. Geriatric- psychiatric ambulatory teams from the specialist health service provide professional assistance to healthcare professionals and family members for patients with geriatric psychiatric disorders and BPSD. This outreach- service is not very developed and could be further expanded. The study aimed to elucidate the collaboration between municipal health services and ambulatory geriatric-psychiatric teams within the specialist healthcare service.

Method

In this qualitative study we conducted individual interviews with six healthcare professionals representing four different nursing homes. The analysis is inspired by systematic text condensation. The research project has been submitted to the Norwegian Centre for Research Data.

Results

The informants expressed the importance of enhanced interaction with the specialist healthcare service in general and to patients with BPSD in spesific. When the informants receiving support from the team, the interaction is deemed more valuable and constructive. They find a shared meeting point with opportunity for sharing knowledge and engaging in dialogue.

Conclusion

The study indicates that health professionals see the importance of improved collaboration with specialized health services for patients with BPDS. When ambulatory teams engage actively, they experience collaboration characterized by closeness and shared understanding. The ambulatory-geriatric psychiatric team may become more well-known and the method of requesting professional help from the team can be made more transparent and clearer. It is also important that healthcare personnel proactively request professional assistance for patients with BPSD. With the increasing prevalence of patients with dementia, there is a need for further research to address the challenges in this area. Ambulatory geriatric-psychiatry teams are a service that should be explored further.

Background: ‘IN REACH’ was established, having identified a significant need to improve nutrition for cognitively and physically frail hospital inpatients, admitted to the Complex Medical Units (CMU) at the John Radcliffe Hospital. The IN REACH team includes the CMU multi-disciplinary team (MDT), representatives from patient and volunteer groups, caterers and medical illustrators.

Introduction: IN REACH identified that food and drink is often unreachable by inpatients. The project’s aim is to ensure food and drink is always within patient reach, improving nutritional intake, avoiding dehydration, reducing weight loss, reducing family anxiety, promoting independence and improving health outcomes.

Method: MDT members, patients and their families were engaged in the design. Baseline observational data included whether both food and drink were in reach and whether the patient had cognitive impairment. Interventions to be evaluated by Plan-Do-Study-Act (PDSA) methodology include: raising awareness at daily MDT meetings; focussed education by presenting observational data to catering team; involvement of volunteers; the introduction of IN REACH champions; and prompting by signage, both physical and digital. Improved inpatient nutrition will be correlated with data on length of stay and health outcomes. Improved rates of return to baseline function and independence are anticipated, by keeping food and drink, in reach.

Results: Baseline data showed out of 319 inpatients, only 33% had both food and drink within reach. 67% had cognitive impairment and only 27% were able to reach food and drink. Following 4 initial PDSA cycles 58% of patients had food and drink within reach.

Conclusions: Most CMU patients have food and drink left out of reach. Patients with cognitive impairment are particularly at risk. Changing ward culture is challenging. Further and repeated interventions are necessary.

 Introduction: The COVID-19 pandemic has raised concerns about its long-term effects, leading to conditions such as "Long COVID." Neurological manifestations, including "Brain Fog" with impaired cognitive function, have been reported, but their relationship with age and memory decline remains unclear. Method: This study aimed to investigate the effects of COVID-19 infection on memory function and explore the relationship between age and memory scores. The research utilized data from the 'COVID-19 Online Rapid Objective Neuro-memory Assessment' (CORONA) study, employing an online survey with a memory task. Ethical approval was obtained, and participants aged 18 and older were recruited globally, with 5,308 participants included in the analysis. Memory scores were obtained through a task featuring four categories. Statistical analysis, including T-tests and linear regression, was employed to evaluate the data. Results: Participants testing positive for COVID-19 (n = 678) exhibited lower mean total memory scores than those testing negative (n = 4,630), with a statistically significant difference (P < 0.05). Hospitalized COVID-19 patients (n = 37) had significantly lower memory scores compared to non-hospitalized patients (n = 641), suggesting a greater impact of hospitalization on memory function. Age was associated with declining memory scores, with an overall trend of decreasing scores as age increased. Three age groups exhibited significant differences in memory scores between COVID-19 positive and negative participants. Conclusion This study provides evidence that COVID-19 infection may be associated with worsened memory outcomes and cognitive function. Hospitalization due to COVID-19 appears to have a more substantial impact on memory than the infection alone. A steeper decline in memory scores with age was observed among COVID-19-positive participants, suggesting potential age-related vulnerability to memory decline associated with COVID-19. However, discrepancies in results may be attributed to sample size limitations, emphasizing the need for larger cohorts in future research.

Introduction:

Symptom heterogenicity in dementia subtypes can pose diagnostic challenges, leading to potential misdiagnoses and significant implications on patient management. The NICE Guidelines for Dementia 2018 [NG97] recommend FDG-PET where diagnostic uncertainty remains after initial assessment. From 2021, a national and collaborative initiative supported using FDG-PET brain imaging for dementia in Wales to facilitate more accurate and timely diagnoses with higher degrees of confidence. This project aimed to evaluate the temporal aspects and diagnostic accuracy of FDG-PET utilization in Cardiff and Vale University Health Board.

Methods:

A retrospective review of 25 patients’ medical records who underwent FDG-PET between 2019 – 2023 was completed. Demographics, diagnostic journey details, and durations between steps were recorded. A comparison of diagnoses made at Memory Clinic (MC) and post-FDG-PET was performed. Results: The average age of patients referred for FDG-PET was 63.3 years (sd=7.69); 60% were under the age of 65 (n=15). The mean time taken from GP referral to MC review was 108.7 days (sd= 44.9). The mean duration from MC review to FDG-PET was 201.7 days (influenced by one outlier with complex presentations). The median time from MC review to FDG-PET was 71 days. The most common final diagnosis was Alzheimer’s disease, both typical and atypical subtypes. 16% (n= 4) of final diagnoses differed from initial clinical suspicion but imaging was supportive in guiding onward management. Patient outcomes depended on final diagnoses.

Conclusion:

Overall, FDG-PET supported the team in establishing a diagnosis with greater confidence, where 84% of FDG-PET outcomes were consistent with the initial working diagnosis. The recorded durations between initial review in MC and FDG-PET imaging varied considerably between individuals, however, the impression was that access to FDG-PET in Wales has supported earlier confirmation of diagnosis compared with prior practice and plays a particular role in earlier diagnosis of younger individuals.