Frontiers in dementia最新文献

Introduction: The impact of Hormone Replacement Therapy (HRT) on cognitive function in postmenopausal women remains a topic of considerable debate. Although estrogen's neuroprotective effects suggest potential cognitive benefits, empirical findings are mixed.

Methods: This study uses data from the Cognitive Function and Ageing Study Wales (CFAS Wales) cohort to explore the relationships between HRT use, age at menopause, APOE4 carrier status, lifestyle factors, comorbidities, and cognitive outcomes in older adult women. Two regression models were employed: one analyzing cognitive performance at follow-up and another examining changes in cognitive scores over time.

Results: Results indicate that while age, education, HRT use, age at menopause, alcohol consumption, and diet were associated with cognitive function at a single later time point, only age remained a significant predictor when modeling cognition over time.

Discussion: These findings suggest that while HRT, menopausal age and lifestyle factors may support cognitive stability, they do not necessarily predict cognitive decline in post-menopausal older women. A major limitation of the current work is the lack of detail regarding HRT use, such as formulation, timing and duration; caveats that future studies should address. The study underscores the need for longer follow-up periods, consideration of other female-specific risk factors, and more comprehensive lifestyle and health assessments to clarify the complex interplay between HRT use, reproductive history, lifestyle, comorbidities and cognitive aging in women.

Purpose: Rare forms of dementia bring unique difficulties related to age of onset, impact on family commitments, employment and finances, and also bring distinctive needs for support and care. The aim of the present study was to explore and better understand what the concept of support means for people living with different rare dementia (PLwRD) and their care-partners who attend ongoing support groups.

Methods: Representing seven types of rare dementia, source material was collected from 177 PLwRD and care-partners attending in-person support groups, with the goal of developing research-informed group poems, co-constructed by a facilitating poet. Data were analyzed through a three-step process involving linguistic analysis followed by structured-tabular thematic analysis, relational analysis, and concluded with an online survey about participation in the study.

Results: Linguistic analysis found that co-constructed poems remained faithful to the original source material offered by participants. These results provided confidence to subsequently conduct a thematic analysis of eight completed poems, identifying 15 initial themes. A further relational analysis between themes drew on six relational forms and identified an overarching theme "A Community, Not an Intervention" that describes the process of support for this population. Survey results revealed a varied but generally positive response to writing whilst reactions to the completed poems reflected strong emotional connections that resonated with personal experience.

Conclusion: This is the first study that we are aware of to explore the use of co-constructed research poetry to better understand how in-person support groups provide support for people impacted by different rare dementias. The poems portray the complex, dynamic and relational aspects of how support groups provide a necessary form of connection for this population. An overarching theme characterized the support groups as a community rather than an intervention. Findings are discussed within the theoretical context of positive social identity, social health and biosocial groups. The results also demonstrate that solicited words from participants can be faithfully portrayed in poems co-created by an experienced poet. This novel finding expands methodological options for the use of research poetry in healthcare and also offers support group members further creative choices for engagement, connection and communication.

Objective: To provide the first estimates of dementia incidence rates among elderly in Lebanon.

Methods: The cohort established in 2013 consisted of 470 elderly from Beirut and Mount Lebanon, who consented to be followed-up. In 2017, we reached 341 participants/informants, achieving a response rate of 72.6%. The validated Arabic version of the 10/66 Dementia Research Group diagnostic tool was administered through face-to-face interviews. Direct age standardization was applied to the data using the Western European population distribution. Age-, sex- and location-specific incidence rates were estimated.

Results: After 3.5 years of follow up, 19 new cases of dementia were identified among 229 surviving participants. The crude incidence rate was 16.8 per 1,000 p-y, and the age standardized rate was 20.5 per 1,000 p-y. The incidence rate increased with age, going from 6.5 for those aged 65-74 years to 54.0 for those aged 85-89 years. Incidence rate was higher among females than males (20.7 vs.12.0), and higher in Mount Lebanon, as compared to the capital city Beirut (19.5 vs.14.9).

Conclusion: Dementia incidence rate was close to European and North American countries' estimates. The use of validated tools increased the internal validity of our results. A large cohort study is warranted to confirm these results.

Objectives: This paper aims to provide a comprehensive review of National Dementia Plans (NDPs) from selected European and North American countries, focusing on the distinct prevention strategies outlined and the approaches employed for reducing dementia risk.

Method: The sample consisted of 16 NDPs from Austria, Canada, Finland, France, Germany, Greece, Ireland, Italy, Liechtenstein, Luxembourg, Malta, the Netherlands, Spain, Switzerland, the UK, and the USA. These NDPs were retrieved from the Alzheimer's Disease International (ADI) database, with regular updates checked on official governmental websites. A qualitative analysis was conducted to identify common themes related to the vision, goals, and corresponding actions and measures within these strategies.

Results: Our analysis revealed that dementia prevention is a strategic goal for most of the countries studied. Common actions identified include the identification of risk factors, advancing research, promoting healthy aging, increasing public awareness, and encouraging lifestyle interventions.

Conclusion: We discuss the limitations and challenges of these actions, and more broadly, of the NDPs in relation to the recent literature on the most effective approaches to preventing dementia. We suggest adopting a more "horizontal" approach to dementia prevention, which current NDPs overlook in favor of "vertical" paradigms.

Background: The role of primary healthcare is pivotal in the management of the surge of dementia prevalence particularly in low-resource areas. In this study, two telehealth-based memory clinics in primary healthcare operating within the frames of the INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) are presented.

Methods: The first clinic, which is led by a general practitioner, operates at a primary healthcare center in a semi-mountainous area and closely collaborates with the geriatric psychiatry outpatient clinic of the Patras University General Hospital via a telehealth medicine platform. The second clinic is embedded at the General Hospital Center for Interconnected Psychiatric Support on the island of Syros, is led by registered nurses, and is interconnected with the geriatric psychiatry unit at the Eginition University Hospital in Athens.

Results: Both memory clinics are in their infancy. At the general practitioner-led memory clinic, 13 beneficiaries were assessed and treated during the first 6 months of its operation. Cognitive decline and depressive and/or anxiety symptoms were detected in 10 and eight individuals, respectively. In 9 of the 27 beneficiaries of the registered nurse-led memory clinic, either mild cognitive impairment or dementia was diagnosed, while affective and/or anxiety symptoms were detected in almost all of them. Of note, only 14 beneficiaries of both clinics had received a diagnosis of a mental or neurocognitive disorder prior to their assessment at the memory clinics.

Conclusion: Developing memory clinics in primary healthcare may be a pragmatic strategy to improve access of older adults living in low-resource areas to cognitive healthcare services.

Background: Hypertension is a potentially modifiable risk factor for cognitive decline. Understanding the variables of hypertension related to cognitive functions will help in mitigating the risk.

Objective: The study aims to assess the characteristics of hypertension and its effect on cognitive functions in the older adults.

Methods: The study involved 95 hypertensive participants aged 60 years and above from cardiology and medicine outpatient services of a tertiary care hospital from August to October 2022. The characteristics of hypertension and cognitive functions were assessed using semi-structured proforma and Adenbrooke's Cognitive Examination (ACE-III) Hindi version respectively. Further, individual cognitive functions were compared with duration of the hypertension and hypertensive status of the participants. The chi-square test and independent t-tests were used and p value < 0.05 was considered to be significant.

Result: The mean age of the study population was 68.2 years, the cognitive functions was comparable in terms of age, sex, locality, co-morbidity, and treatment characteristic. Although a significant difference in cognitive functions was present in relation to duration and status of hypertension. Among the individual cognitive domains, a significant difference was observed in attention and fluency domains of cognitive function based on HTN status (p > 0.05) but differential effect on cognitive domains was not seen with the duration of HTN. However, there was overall decline in cognitive domains with both hypertension status and the duration of hypertension.

Conclusion: The study highlights association of status of hypertension and its characteristics with cognitive decline.

Background: Concerns about falling (e.g., low balance confidence) increase fall risk in older populations with balance impairments. Exercise can improve physical limitations associated with falls (e.g., poor balance), which are more prevalent in people with Mild Cognitive Impairment (MCI) and dementia. This scoping review aimed to understand exercise interventions targeting concerns about falling in people with MCI and dementia.

Methods: Using Arksey and O'Malley's five-stage scoping review framework, 968 search combinations were run across six electronic databases from inception to September 15, 2023. Articles were available in English full text, featured original peer-reviewed research with an intervention study design, targeted people with MCI or dementia with the exercise intervention, and included concerns about falling as an outcome measure.

Results: Of the 2,111 articles screened, 27 met the inclusion criteria. Only one article looked at concerns about falling as a primary outcome; in the remaining studies, concerns about falling were a secondary outcome. Multi-modal interventions (i.e., containing more than one type of exercise) were most common, with balance and strength as the most frequently employed exercise types. Secondary results are presented on (i) intervention details, (ii) outcomes and measures for concerns about falling, (iii) participant accommodations, and (iv) components of effective interventions for concerns about falling.

Conclusions: There is a lack of focus on concerns about falling experienced by people with MCI and dementia. Although concerns about falling were not the primary outcome of most papers, the results highlight the potential of exercise interventions to help address concerns about falling and other fall risk factors (e.g., balance, cognition) in people with MCI and dementia.

Long-term care settings are at the center of strongly debated approaches to policies that shape the delivery of care and operational practices. There is advocacy for transformational change within these settings to support a person-centered approach to care delivery, but it is difficult and multifaceted involving everything from changing the level of staffing and care models to developing appropriate metrics to assess an individual's quality of life. The physical environment is a key component for accomplishing the organizational and operational goals related to person-centered care, but providers and their design teams need the appropriate tools to guide evidence-based decision-making. The Environmental Audit Scoring Evaluation (EASE) is a tool that helps lend structure to the process of developing the environment for our senior population-especially those living with dementia. This perspective article will discuss how EASE aims to align the design process to more fully support the myriad environmental elements that have a demonstrable impact on the individual, and the associated quality of life they experience. The article will also explore how EASE differs from previous planning strategies that did not prioritize residents' psychological wellbeing in conforming to current person-centered philosophies.

Introduction: The vast majority of studies on aging, cognition, and dementia focus on non-Hispanic white subjects. This paper adds to the extant literature by providing insight into the African American aging experience. Here we describe the study design and baseline characteristics of the African American Dementia and Aging Project (AADAPt) study, which is exploring aging and cognition in African American older adults in Oregon.

Methods: African American older adults (n = 177) participated in AADAPt, a longitudinal study that collected data on cognitive, physical, and social functioning in annual visits since 2000.

Results: AADAPt participants had risk factors for developing dementia in future, such as hypertension and hyperlipidemia, but also reported protective factors such as high social engagement.

Discussion: The AADAPt project offers new insights into aging in older African Americans that includes data on cognition, social engagement, and physical health, which are crucial for understanding the experience of under-represented groups and making future studies more inclusive.

Introduction: One emerging technology in long-term care (LTC) is virtual reality (VR), an innovative tool that uses head-mounted devices to provide the viewer with an immersive experience. It has been shown that VR has a positive impact on the well-being of residents living with dementia, and staff are essential in the implementation and sustainable use of technology. Currently, there is a lack of inclusion and focus on direct staff perspectives on VR implementation in LTC. This paper aims to report staff perspectives on VR adoption in a 2-year study on a virtual reality program at three Canadian LTC homes.

Methods: Our interdisciplinary team (clinicians, people living with dementia and family partners, trainees, and researchers) explored the facilitators and barriers to implementing VR in LTC, guided by the Consolidated Framework for Implementation Research (CFIR) and intersectionality supplemented CFIR. Twenty-one participants were recruited, including recreation staff, care aides, nurses, screeners, and leadership team members. The team collected data through staff interviews, focus groups, and ethnographic observation field notes. Reflexive thematic analysis was performed to identify themes reporting the facilitators and barriers for VR implementation in LTC from staff perspectives.

Results: The data analysis resulted in three facilitators and four barriers. Facilitators are (1) perceived VR benefits, (2) integrate VR into workflow and routines, and (3) partner with skillful VR champions. Barriers include (1) staff concerns about VR use, (2) financial burden and competing priorities, (3) lack of infrastructure and physical spaces, and (4) staff workload and limited leadership support.

Discussion: This study contributes to the field with staff perspectives on facilitators and barriers to VR implementation. It underscores the rarely discussed aspects of VR implementation, such as funding prioritization and implementation timing. We offer practical strategies to inform future practices and research. Future studies should further explore long-term VR implementation, the involvement of family members as VR facilitators, and the use of VR in LTC.