Doing the Right Thing: A Geriatrician's Perspective on Medical Care for the Person with Advanced Dementia

2012 ◽  
Vol 40 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Muriel R. Gillick
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Older People ◽  
Medical Care ◽  
Oldest Old ◽  
Advanced Dementia ◽  
People With Dementia ◽  
Reasonable Approach ◽  
The Right ◽  
Number Of Individuals

America is aging. But even more striking than the rise in the proportion of the population over age 65 is the unprecedented number of individuals who are living into their eighties and nineties. While many people remain robust well into advanced age, the dramatic increase in the number of the oldest old has brought with it an epidemic of Alzheimer’s disease and other dementias. Dementia is a highly prevalent condition — currently 5.4 million Americans have Alzheimer’s disease, a number which may rise to 16 million by 2050 if there is no breakthrough in the prevention or treatment of the disease — but it disproportionately affects those over age 85, striking between one-third and one-half of this cohort. Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades.

scholarly journals COGNIC - A Mobile Device Application Used for Cognitive Stimulation in Older People with Dementia

Abakós ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 26-42
Author(s):  
Antônio Augusto de Faria Guimarães Melo Pertence ◽  
Rosilane Ribeiro da Mota ◽  
Luciana de Oliveira Assis
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Older People ◽  
Progressive Increase ◽  
Cognitive Stimulation ◽  
Usability Tests ◽  
Frequent Form ◽  
People With Dementia ◽  
Moderate Dementia ◽  
And Control

Dementia is characterized by marked cognitive impairment and is a prevalent mental illness among older people. Alzheimer’s disease is the most frequent form of dementia, affecting memory and other cognitive functions. Although there is no cure for the disease, there are treatments that can relieve cognitive symptoms and control the behavior of affected individuals. In recent years, there has been a progressive increase in the use of applications designed for smartphones and tablets for the non-pharmacological treatment of dementia. This article describes the development of an application for mobile devices with the Android® platform operating system based on guidelines established in the literature to be used by health professionals who provide care for older people with a diagnosis of mild to moderate dementia due to Alzheimer’s disease. The application was evaluated employing usability tests and questionnaires, the results of which indicated that the application met the proposed objectives, validating the guidelines established in the literature for the development of applications for this population.

scholarly journals Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia

2003 ◽  
Vol 183 (3) ◽  
pp. 248-254 ◽  
Author(s):  
Aimee Spector ◽  
Lene Thorgrimsen ◽  
Bob Woods ◽  
Lindsay Royan ◽  
Steve Davies ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Older People ◽  
Intervention Group ◽  
Cognitive Stimulation ◽  
Control Group ◽  
Cognitive Stimulation Therapy ◽  
People With Dementia

BackgroundA recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials.AimsTo test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life.MethodA single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures.ResultsOne hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale – Cognition (ADAS–Cog) (P=0.014) and Quality of Life – Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS–Cog the number needed to treat was 6 for the intervention group.ConclusionThe results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.

Pakistan

2019 ◽  
pp. 61-78 ◽  
Author(s):  
Muhammad Nasar Sayeed Khan ◽  
Muhammad Iqbal Afridi ◽  
Afzel Javed
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Life Expectancy ◽  
Memory Loss ◽  
Developed Countries ◽  
World Health ◽  
Average Life Expectancy ◽  
People With Dementia ◽  
Health Organization ◽  
Number Of Individuals

Pakistan is one of the largest and most populated nations of South Asia and ranked sixth among the most crowded countries in the world, with a population exceeding 196 million. Because of a lack of research and the cultural setting, it is exceptionally hard to obtain an exact number of individuals suffering from dementia. However, the extrapolated prevalence of people with dementia in Pakistan is around 200,000. Compared to developed countries, only 4.2% of the Pakistani population are aged above 65 years, possibly due to an average life expectancy of 66 years for both genders . Although no specific data on elderly people with dementia in Pakistan are available, it is estimated that 8–10% of the general population aged above 65 years suffer from chronic memory loss. According to the latest 2014 World Health Organization data, Alzheimer’s disease/dementia-related deaths in Pakistan reached a total of 1776 or 0.16% of total deaths. Pakistan currently has the largest generation of young people ever recorded in its history, who will be at risk for dementia and Alzheimer’s disease by 2050, at which time, life expectancy would be expected to continue rising. Thus, the economic burden of treating patients with Alzheimer’s disease and other types of dementia will increase considerably.

scholarly journals Validation of the Italian Version of the Caregiver Abuse Screen among Family Caregivers of Older People with Alzheimer’s Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-15 ◽  
Author(s):  
Maria Gabriella Melchiorre ◽  
Mirko Di Rosa ◽  
Francesco Barbabella ◽  
Norma Barbini ◽  
Fabrizia Lattanzio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Older People ◽  
Family Caregivers ◽  
Elder Abuse ◽  
Principal Component ◽  
Validity And Reliability ◽  
Italian Version ◽  
People With Dementia

Introduction. Elder abuse is often a hidden phenomenon and, in many cases, screening practices are difficult to implement among older people with dementia. The Caregiver Abuse Screen (CASE) is a useful tool which is administered to family caregivers for detecting their potential abusive behavior.Objectives. To validate the Italian version of the CASE tool in the context of family caregiving of older people with Alzheimer’s disease (AD) and to identify risk factors for elder abuse in Italy.Methods. The CASE test was administered to 438 caregivers, recruited in the Up-Tech study. Validity and reliability were evaluated using Spearman’s correlation coefficients, principal-component analysis, and Cronbach’s alphas. The association between the CASE and other variables potentially associated with elder abuse was also analyzed.Results. The factor analysis suggested the presence of a single factor, with a strong internal consistency (Cronbach’s alpha = 0.86). CASE score was strongly correlated with well-known risk factors of abuse. At multivariate level, main factors associated with CASE total score were caregiver burden and AD-related behavioral disturbances.Conclusions. The Italian version of the CASE is a reliable and consistent screening tool for tackling the risk of being or becoming perpetrators of abuse by family caregivers of people with AD.

scholarly journals Disconnection of the right superior parietal lobule from the precuneus is associated with memory impairment in oldest-old Alzheimer's disease patients

Heliyon ◽  
2020 ◽  
Vol 6 (7) ◽  
pp. e04516
Author(s):  
Pukovisa Prawiroharjo ◽  
Ken-ichiro Yamashita ◽  
Koji Yamashita ◽  
Osamu Togao ◽  
Akio Hiwatashi ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Memory Impairment ◽  
Oldest Old ◽  
Superior Parietal Lobule ◽  
Parietal Lobule ◽  
The Right ◽  
With Memory

Delayed help seeking behavior in dementia care: preliminary findings from the Clinical Pathway for Alzheimer's Disease in China (CPAD) study

2015 ◽  
Vol 28 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Mei Zhao ◽  
Xiaozhen Lv ◽  
Maimaitirexiati Tuerxun ◽  
Jincai He ◽  
Benyan Luo ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Family History ◽  
Clinical Pathway ◽  
Help Seeking ◽  
Univariate Analysis ◽  
Positive Family History ◽  
Dementia Care ◽  
Factors Associated ◽  
People With Dementia

ABSTRACTBackground:The prevalence and factors associated with delays in help seeking for people with dementia in China are unknown.Methods:Within 1,010 consecutively registered participants in the Clinical Pathway for Alzheimer's Disease in China (CPAD) study (NCT01779310), 576 persons with dementia (PWDs) and their informants reported the estimated time from symptom onset to first medical visit seeking diagnosis. Univariate analysis of general linear model was used to examine the potential factors associated with the delayed diagnosis seeking.Results:The median duration from the first noticeable symptom to the first visit seeking diagnosis or treatment was 1.77 years. Individuals with a positive family history of dementia had longer duration (p= 0.05). Compared with other types of dementia, people with vascular dementia (VaD) were referred for diagnosis earliest, and the sequence for such delays was: VaD < Alzheimer's disease (AD) < frontotemporal dementia (FTD) (p< 0.001). Subtypes of dementia (p< 0.001), family history (p= 0.01), and education level (p= 0.03) were associated with the increased delay in help seeking.Conclusions:In China, seeking diagnosis for PWDs is delayed for approximately 2 years, even in well-established memory clinics. Clinical features, family history, and less education may impede help seeking in dementia care.

scholarly journals Diet, nutrients and metabolism: cogs in the wheel driving Alzheimer's disease pathology?

2015 ◽  
Vol 113 (10) ◽  
pp. 1499-1517 ◽  
Author(s):  
Rhona Creegan ◽  
Wendy Hunt ◽  
Alexandra McManus ◽  
Stephanie R. Rainey-Smith
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Clinical Symptoms ◽  
Aged Care ◽  
Ageing Population ◽  
People With Dementia ◽  
Stage Disease ◽  
Custodial Care ◽  
Global Statistics ◽  
End Stage

Alzheimer's disease (AD), the most common form of dementia, is a chronic, progressive neurodegenerative disease that manifests clinically as a slow global decline in cognitive function, including deterioration of memory, reasoning, abstraction, language and emotional stability, culminating in a patient with end-stage disease, totally dependent on custodial care. With a global ageing population, it is predicted that there will be a marked increase in the number of people diagnosed with AD in the coming decades, making this a significant challenge to socio-economic policy and aged care. Global estimates put a direct cost for treating and caring for people with dementia at $US604 billion, an estimate that is expected to increase markedly. According to recent global statistics, there are 35·6 million dementia sufferers, the number of which is predicted to double every 20 years, unless strategies are implemented to reduce this burden. Currently, there is no cure for AD; while current therapies may temporarily ameliorate symptoms, death usually occurs approximately 8 years after diagnosis. A greater understanding of AD pathophysiology is paramount, and attention is now being directed to the discovery of biomarkers that may not only facilitate pre-symptomatic diagnosis, but also provide an insight into aberrant biochemical pathways that may reveal potential therapeutic targets, including nutritional ones. AD pathogenesis develops over many years before clinical symptoms appear, providing the opportunity to develop therapy that could slow or stop disease progression well before any clinical manifestation develops.

Longitudinal study of medication use in caregivers of people with Alzheimer’s disease – Kuopio ALSOVA study

Dementia ◽  
2018 ◽  
Vol 19 (5) ◽  
pp. 1573-1585
Author(s):  
Tarja Välimäki ◽  
Julia FM Gilmartin-Thomas ◽  
J Simon Bell ◽  
Tuomas Selander ◽  
Anne M Koivisto
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Family Caregivers ◽  
Social Insurance ◽  
Medication Use ◽  
Self Report ◽  
Rank Test ◽  
Kappa Statistics ◽  
Prescription Register ◽  
People With Dementia

Background The longitudinal pattern of medication use among family caregivers of people with dementia is not well understood, despite the potential for medication over- or under-use. Objectives To investigate caregiver medication use over a five-year follow-up using data obtained via self-report and from a national prescription register, and compare agreement between medication data obtained from the two sources. Methods Medication data for 222 family caregivers of people with Alzheimer’s disease were obtained via self-report and from the Finnish Social Insurance Institution. Generalised estimating equations, Kappa statistics and related samples Wilcoxon signed rank test were used to analyse medication use over time. Results The mean number of medications used by caregivers increased from 3.4 to 4.1 (self-reported current regular medications) and 2.4 to 2.8 (reimbursed prescription medications during the past 90 days) over five years (p < 0.001). Significantly, more medications were identified via self-report (mean 3.6, SD = 3.3) than the national prescription register (mean 2.6, SD = 2.4, Z= –12.300, p < 0.001). Agreement between the two data sources was good for cardiovascular medications and anti-hypertensives (Kappa = 0.883–0.967, p < 0.001) and medications for acid-related disorders (Kappa = 0.508–0.092, p < 0.001). Agreement was moderate for analgesics (Kappa = 0.281–0.477, p < 0.001) and psychotropics (Kappa = 0.281–0.562, p < 0.002). The proportion of caregivers using five or more medications increased from 27.5% to 44.6% (self-report), and 16.7% to 27.7% (register) (p < 0.001). Conclusion Caregivers use an increasing number of medications in the first five years of caring for persons with dementia, and self-report using a higher number of medications than data from the national prescription register suggest.

scholarly journals Cross-cultural adaptation of the German version of the Quality of Life in Alzheimer's Disease scale - Nursing Home version (QoL-AD NH)

2016 ◽  
Vol 28 (8) ◽  
pp. 1399-1400 ◽  
Author(s):  
Martin Nikolaus Dichter ◽  
Eva-Maria Wolschon ◽  
Gabriele Meyer ◽  
Sascha Köpke
Keyword(s):  
Quality Of Life ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Community Dwelling ◽  
Positive Effects ◽  
People With Dementia ◽  
The Us ◽  
Dementia Research ◽  
Almost All

Dementia is a chronic and currently incurable syndrome. Therefore, quality of life (QoL) is a major goal when caring for people with dementia (Gibson et al., 2010) and a major outcome in dementia research (Moniz-Cook et al., 2008). The measurement of QoL, especially proxy-rating, is challenging because of the proxy-perspective (Pickard and Knight, 2005), reliability (Dichter et al., 2016), validity (O'Rourke et al., 2015), and responsiveness (Perales et al., 2013). Probably due to these challenges, it has not been possible to show positive effects for QoL in almost all non-pharmacological interventions for people with dementia (Cooper et al., 2012). One recommended (Moniz-Cook et al., 2008) and frequently used instrument is the Quality of Life in Alzheimer's Disease scale (QoL-AD), which was originally developed in the US for community-dwelling people with dementia. The QoL-AD consists of 13 items based on a 4-point Likert scale ranging from “1”=poor to “4”=excellent (Logsdon et al., 1999). The original instrument has been adapted for people living in nursing homes (NH) by Edelmann et al. (2005).

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