Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review

Background The increasing awareness and diagnosis of dementia in Africa necessitate documentation of caregiving practices to understand local patterns and improve the quality of care. Caregiving in African communities is rooted in informal-communal social organization. This scoping review analyses caregiver characteristics and experiences, and practices of caregiving for persons living with dementia in Africa. Methods A total of 152 references were retrieved, with 64 references obtained from PubMed, 85 from AJOL, and three from Scopus. Based on the relevance of titles, 83 references were further retained from PubMed (64), AJOL (16), and Scopus (3). A rapid review of abstracts was done in Distiller SR, and finally, six relevant articles were content-analyzed using Atlas ti 8.4 qualitative analysis software. Results All six included studies were published between 2003 and 2018. Four themes were identified: article characteristics, caregiver characteristics, caregiver in context, and caregiver potentialities (challenges and opportunities). Studies reported findings from research conducted in four African countries: three from Nigeria, and one each from South Africa, Egypt, and Tanzania. Caregivers of persons living with dementia typically had eight years or less of formal education, were unpaid, and spent a daily average of 13 hours in caregiving. Cultural thresholds and individual caregiver differences underlie the interpretation of stressors across cultures. Caregivers lack the right training and information as well as support systems to improve their role performance and reduce accumulated stress. Conclusion In African countries, informational and educational platforms are essential for improved individual dementia caregiving, vis-à-vis strengthened roles of governments, and religious/traditional leaders and organizations.

Treating Agitation in Patients with Dementia with a Therapy Dog in a Milieu Therapy Setting on a Geropsychiatric Ward

<b><i>Background:</i></b> Animal-assisted intervention has become a common therapeutic practice used for patients with dementia in home-dwelling and institutions. The most established procedure is a visiting service by specially trained dogs and their owners to improve social interactions and reduce symptoms of agitation. <b><i>Objectives:</i></b> The study aims to investigate the effects of a therapy dog on agitation of inpatients with dementia in a gerontopsychiatric ward. <b><i>Materials and Methods:</i></b> The severity of agitation was assessed by a rater blinded for the presence of the dog via the Overt Agitation Severity Scale (OASS). The scale was conducted on 1 day with the dog and his handler present (resident doctor on the ward) and on another day with only the handler present. Each patient was his/her own control. Heart rate variability (HRV) and serum level of brain-derived neurotrophic factor (BDNF) of the patients were measured on both days. 26 patients with the Mini-Mental Status Examination (MMSE) score &#x3c;21 and the diagnosis of dementia were included in the study. <b><i>Results:</i></b> A significant reduction of agitation in the OASS could be shown when the dog was present (<i>p</i> = 0.006). The data neither demonstrated a difference in the HRV for the parameters mean heart rate (<i>p</i> = 0.65), root mean square of successive differences (<i>p</i> = 0.63), and high frequencies (<i>p</i> = 0.27) nor in serum BDNF concentrations (<i>p</i> = 0.42). <b><i>Discussion:</i></b> Therapy dogs can be implemented as a therapeutic tool in a gerontopsychiatric ward to reduce symptoms of agitation in patients with dementia. The study was registered in the German Clinical Trials Register (DRKS00024093).

Identification Of Dementia In Recent Medicare Claims Data, Compared To Rigorous Clinical Assessments

BACKGROUND Medicare fee-for-service (FFS) claims data are increasingly leveraged for dementia research. Few studies address the validity of recent claims data to identify dementia, or carefully evaluate characteristics of those assigned the wrong diagnosis in claims. METHODS We used claims data from 2014-2018, linked to participants administered rigorous, annual dementia evaluations in five cohorts at the Rush Alzheimer’s Disease Center. We compared prevalent dementia diagnosed through the 2016 cohort evaluation versus claims identification of dementia, applying the Bynum-standard algorithm. RESULTS Of 1,054 participants with Medicare Parts A and B FFS in a 3-year window surrounding their 2016 index date, 136 had prevalent dementia diagnosed during cohort evaluations; the claims algorithm yielded 217. Sensitivity of claims diagnosis was 79%, specificity 88%, positive predictive value 50%, negative predictive value 97%, and overall accuracy 87%. White participants were disproportionately represented among detected dementia cases (true-positive) versus cases missed (false-negative) by claims (90% versus 75%, respectively, p=0.04). Dementia appeared more severe in detected than missed cases in claims (mean MMSE=15.4 versus 22.0, respectively, p&lt;0.001; 28% with no limitations in activities of daily living versus 45%, p=0.046). By contrast, those with “over-diagnosis” of dementia in claims (false-positive) had several worse health indicators than true negatives (eg, self-reported memory concerns=51% versus 29%, respectively, p&lt;0.001; mild cognitive impairment in cohort evaluation=72% versus 44%, p&lt;0.001; mean comorbidities=7 versus 4, p&lt;0.001). CONCLUSIONS Recent Medicare claims perform reasonably well in identifying dementia; however, there are consistent differences in cases of dementia identified through claims than in rigorous cohort evaluations.

Diagnosis and management in dementia – recommendations

The diagnosis of dementia and further management of patients are based on the latest recommendations developed by European and global organisations dealing with the diagnosis and standards of treatment of neurodegenerative diseases. Using useful and practical diagnostic methods, as well as the results of the latest additional tests and differential tools, a modern approach allows for a relatively quick diagnosis and implementation of recommended treatment. In addition to dementia in the course of Alzheimer’s disease, the paper presents recommendations for the diagnosis and treatment of other diseases including vascular dementia, dementia with Lewy bodies, dementia in Parkinson’s disease, frontotemporal dementia, and atypical parkinsonisms. Particular attention is given to the diagnosis of mild cognitive impairment due to Alzheimer’s disease and the possibilities of diagnosis and treatment of this phase, not only in a specialised medical practice. The article discusses the principles of procognitive pharmacological management in dementia and in the case of neuropsychiatric problems: psychotic, behavioural, and mood disorders. The importance of non-pharmacological management, primarily diet and cognitive stimulation, is also highlighted. Patient care requires close cooperation between the doctor and the caregiver, who is as important as the patient, and satisfying the caregiver’s needs is a guarantee of better care for the patient. Specifically, caregivers should be supported in handling their medical, legal, and psychological problems resulting from the burden of caring for the patient.

Automated Classification of Normal Control and Early-Stage Dementia Based on Activities of Daily Living (ADL) Data Acquired from Smart Home Environment

With the global trend toward an aging population, the increasing number of dementia patients and elderly living alone has emerged as a serious social issue in South Korea. The assessment of activities of daily living (ADL) is essential for diagnosing dementia. However, since the assessment is based on the ADL questionnaire, it relies on subjective judgment and lacks objectivity. Seven healthy seniors and six with early-stage dementia participated in the study to obtain ADL data. The derived ADL features were generated by smart home sensors. Statistical methods and machine learning techniques were employed to develop a model for auto-classifying the normal controls and early-stage dementia patients. The proposed approach verified the developed model as an objective ADL evaluation tool for the diagnosis of dementia. A random forest algorithm was used to compare a personalized model and a non-personalized model. The comparison result verified that the accuracy (91.20%) of the personalized model was higher than that (84.54%) of the non-personalized model. This indicates that the cognitive ability-based personalization showed encouraging performance in the classification of normal control and early-stage dementia and it is expected that the findings of this study will serve as important basic data for the objective diagnosis of dementia.

Impact of Molecular Imaging on the Diagnosis of Dementia Subtypes

Objective: To evaluate the impact of positron emission tomography with ¹⁸F-FDG, ¹¹C-PiB, and ¹⁸F-THK 5351 on the diagnosis of Alzheimer’s disease, primary tauopathies, and other dementia subtypes. Materials and Methods: The authors recruited 30 patients with varying degrees of cognitive impairment that included 14 males and 16 females, aged 50 to 77 years and with a mean age ±SD: 66.6±6.9 years). All patients underwent ¹⁸F-FDG, ¹¹C-PiB, and ¹⁸F-THK 5351 PET/CT scans. Quantitative and visual analyses of the PET images were performed and reported back to the neurologists responsible for the initial diagnoses. Outcome measures were changed between pre- and post-PET clinical diagnoses and treatment. Results: The primary diagnoses changed after the disclosure of ¹⁸F-FDG, ¹¹C-PiB, and ¹⁸F-THK 5351 PET scan results in 18 of 30 patients (60%) and was able to resolve 20 of 21 (95.2%) pre-PET diagnostic dilemmas. No new diagnostic dilemmas were created. All changes in clinical diagnoses were accompanied by changes in treatment plan. PET imaging results confirmed the initial diagnoses of six patients. Conclusion: Combined ¹¹C-PiB, ¹⁸F-THK 5351, and ¹⁸F-FDG-PET are of additional diagnostic value over standard diagnostic work-up, especially in diagnostic dilemmas or difficult-to-diagnose dementia patients. Keywords: ¹⁸F-FDG; ¹¹C-PiB; ¹⁸F-THK 5351; Positron emission tomography; Tauopathy

Underdiagnosis of Dementia among Indigenous Older Adults with Cognitive Impairment

Early and timely diagnosis of dementia has been recognized as key to improving health outcomes. However, underdiagnosis among the indigenous population has not been adequately investigated. This study examines the association between indigenous ethnic identity and receiving a diagnosis of dementia and identifies factors associated with receiving a diagnosis of dementia. Data were drawn from Ecuador’s Survey of Health, Welfare and Aging (SABE) – 2009, based on a probability sample of households in Ecuador with at least one person 60 years or older. This is a robust data set that allows for understanding ethnic dimensions and disparities, especially because of the successful recruitment of indigenous households. The final sample consisted of 1,437 people who had cognitive impairment. Whether participants had ever been told that he/she had dementia was compared between the groups of people who identified themselves either as indigenous or others. Binary logistic regression analysis was utilized. Indigenous participants had a lower probability than others of receiving a diagnosis of dementia after controlling for health and function related covariates. This association became statistically insignificant after including socioeconomic factors in the model. The final model revealed that people who had higher educational attainment were more likely to receive a diagnosis of dementia. Findings suggest that underdiagnosis among indigenous older adults can be explained by their lower socioeconomic status rather than by health and functional status. This finding implies the possibility of developing strategies to promote timely diagnosis by targeting populations who are especially susceptible to underdiagnosis of dementia.

Estimating Dementia from Self-Reports of Diagnoses Among Adults Aged 65 and Over: United States, 2019

Prior research shows that, overall, about 10% of the population aged 65 and over in the U.S. has dementia. Estimating the prevalence of dementia from nationally representative surveys can be accomplished by asking respondents about a diagnosis, by administering a cognitive assessment, or, if available, by examining linked medical claims data. In 2019 for the first time, the National Health Interview Survey (NHIS) added “dementia, including Alzheimer’s disease” to the questions asking about doctor-diagnosed health conditions. Although estimates derived from doctor-diagnosed questions usually underestimate the true prevalence of a condition, and estimating dementia from self-reports presents additional challenges, they are still useful for many surveillance and research objectives. Early diagnosis of dementia is encouraged to allow patients and their families to plan for future needs. The objective of this research is to describe the noninstitutionalized population aged 65 and over who have a dementia diagnosis, by selected socio-demographic, health, and healthcare utilization characteristics. Point estimates, standard errors, and 95% confidence intervals for percentages are calculated using NHIS adult sample weights and adjusted for the complex sample design of NHIS. Preliminary analyses show that, overall, 4% of the 65 and over noninstitutionalized population has a diagnosis of dementia. About 8% of respondents with less than a high school education reported a dementia diagnosis compared with 2% of those with more than a high school education. Those with a dementia diagnosis were more likely to report depression than those without a dementia diagnosis (44% vs. 14%).