Ageism is widespread, including in institutions providing health and social care, and in workplaces, the media and elsewhere, according to the World Health Organization. Such ageism can convey a ...narrative that incontinence is a normal or inevitable part of ageing – and that nothing can be done to change the outcome either for those affected or across healthcare services.
Purpose of Review
Diet, physical activity, and sleep are three major modifiable lifestyle factors. This selective review examines the evidence for strong and reliable associations between these three ...lifestyle factors and risk of dementia and cognitive decline, in an effort to assist clinicians with providing more informed answers to the common questions they face from patients.
Recent Findings
Certain aspects of nutrition can decrease risk for dementia. Physical activity has also been associated with delayed or slower age-related cognitive decline. In addition, emerging evidence links sleep dysfunction and dementia, with amyloid deposition being a possible mediator.
Summary
Data from further clinical trials are needed before more definitive conclusions can be drawn regarding the efficacy of these lifestyle interventions for lowering the risk of incident dementia and cognitive decline. Nevertheless, it is reasonable to make recommendations to our patients to adopt certain dietary changes and to engage in regular physical activity to improve cardiovascular risk factors for dementia. It is also reasonable to include questions on sleep during cognitive evaluations of the elderly, given the common co-occurrence of sleep dysfunction and cognitive impairment in the elderly population.
Cognitive impairment associated with aging has emerged as one of the major public health challenges of our time. Although Alzheimer's disease is the leading cause of clinically diagnosed dementia in ...Western countries, cognitive impairment of vascular etiology is the second most common cause and may be the predominant one in East Asia. Furthermore, alterations of the large and small cerebral vasculature, including those affecting the microcirculation of the subcortical white matter, are key contributors to the clinical expression of cognitive dysfunction caused by other pathologies, including Alzheimer's disease. This scientific expert panel provides a critical appraisal of the epidemiology, pathobiology, neuropathology, and neuroimaging of vascular cognitive impairment and dementia, and of current diagnostic and therapeutic approaches. Unresolved issues are also examined to shed light on new basic and clinical research avenues that may lead to mitigating one of the most devastating human conditions.
Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are ...currently unknown.
To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD.
National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored.
People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08-8.22;
= 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15-7.55;
= 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92-0.98,
< 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04-2.90,
= 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96-0.99,
= 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51-0.90,
= 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10-3.73,
= 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09-1.16,
< 0.001) were associated with worse therapy outcomes in PLWD.
Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
In this multicenter study on subjective cognitive decline (SCD) in community-based and memory clinic settings, we assessed the (1) incidence of Alzheimer's disease (AD) and non-AD dementia and (2) ...determinants of progression to dementia.
Eleven cohorts provided 2978 participants with SCD and 1391 controls. We estimated dementia incidence and identified risk factors using Cox proportional hazards models.
In SCD, incidence of dementia was 17.7 (95% Poisson confidence interval 15.2-20.3)/1000 person-years (AD: 11.5 9.6-13.7, non-AD: 6.1 4.7-7.7), compared with 14.2 (11.3-17.6) in controls (AD: 10.1 7.7-13.0, non-AD: 4.1 2.6-6.0). The risk of dementia was strongly increased in SCD in a memory clinic setting but less so in a community-based setting. In addition, higher age (hazard ratio 1.1 95% confidence interval 1.1-1.1), lower Mini–Mental State Examination (0.7 0.66-0.8), and apolipoprotein E ε4 (1.8 1.3-2.5) increased the risk of dementia.
SCD can precede both AD and non-AD dementia. Despite their younger age, individuals with SCD in a memory clinic setting have a higher risk of dementia than those in community-based cohorts.
•A large collaborative study indicates subjective cognitive decline (SCD) is a prodrome of Alzheimer's disease and non-Alzheimer's disease dementia.•Incidence of dementia for SCD is 17.7 (95% confidence interval 15.2-20.3)/1000 person-years.•Risk factors for progression from SCD to dementia are age, lower MMSE, and APOE.•SCD in a memory clinic setting increased the risk of dementia.
IMAGING IN DEMENTIA Bevan-Jones, W Richard; Aigbirhio, Franklin; Passamonti, Luca ...
Journal of neurology, neurosurgery and psychiatry,
12/2016, Letnik:
87, Številka:
12
Journal Article
Recenzirano
A 49 year old lady presented with behavioural variant Frontotemporal Dementia in the absence of parkinsonism, supported by neuropsychological testing and frontotemporal atrophy on Magnetic Resonance ...imaging. Her father had developed behavioural variant Frontotemporal Dementia at 49, with post mortem Tau neuropathology resembling corticobasal degeneration (tau-positive neuronal and glial inclusions, ballooned abnormal achromatic neurons, neuronal loss). His mother had developed dementia in her late 40's. Genetic testing conformed a mutation in the gene MAPT, encoding the microtubule associated protein tau (10+16C>T). Positron Emission Tomography imaging using the novel Tau radioligand 18FAV-1451 showed increased binding in subcortical grey matter (striatum and thalamus), and cortex.PET radioligands are potentially important biomarkers to detect and monitor tau in many neurodegenerative diseases. In this case, the genetic mutation in the proband and confirmed pathology in her father support the case for 18FAV-1451 as a biomarker of tau neuropathology. Further work will evaluate the potential for 18FAV-1451 to monitor presymptomatic mutation carriers; to differentiate tauopathies from other neurodegenerative disorders; and to monitor disease progression and therapy.
Music is a universal stimulus that generates powerful emotion and reward. Responses to music depend on internalised ‘rules’ that generate strong psychological expectancies and have been little ...studied in disease. We assessed expectations generated while listening to music and associated affective responses in cohorts of patients with Alzheimer's disease (AD) and frontotemporal lobar degeneration (behavioural variant frontotemporal dementia (bvFTD), semantic dementia (SD) and progressive nonfluent aphasia (PNFA) in relation to healthy older individuals. We created a set of short novel melodies in which cadence was manipulated such that the melodies sounded either ‘finished’ or ‘unfinished’. Participants were asked to label each melody explicitly and to rate how pleasing they found the ending. Relative to the healthy control group, AD and bvFTD showed a significant deficit of labelling of melodies as finished or unfinished. All participants, apart from the SD group, found unfinished melodies significantly more unpleasant than finished melodies.In VBM, grey matter correlates of melody classification accuracy and pleasantness rating were identified in a distributed network including anterior temporal, medial and lateral orbitofrontal cortices. Music is a promising tool with which to probe the differential effects of dementia diseases on reward and rule–based processes.
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