Tag: dementia

In Dementia, De-cluttering is of Little Value

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A new study has shown that a clutter-free environment may not help people living with dementia carry out daily tasks.

Researchers studied whether people with dementia were better able to carry out tasks, such as making a cup of tea, at home amidst their normal clutter or in a clutter-free environment. Surprisingly, participants with moderate dementia performed better when surrounded by their usual clutter. But the different environments made no difference to people with mild and severe dementia, who were able to perform at the same level in both settings. The findings were published in Alzheimer Disease & Associated Disorders.

Prof Eneida Mioshi, from the University of East Anglia. said: “As dementia progresses, people gradually lose their ability to carry out daily tasks due to changes in their cognitive, perceptual and physical abilities. Participation in daily tasks could then be improved by adapting the person’s environment.

“To this end, we wanted to investigate the role of clutter in activity participation, given the potential to use de-cluttering to support people with dementia to continue to be independent.

“Environmental clutter has been defined as the presence of an excessive number of objects on a surface or the presence of items that are not required for a task. It is generally assumed that a person with dementia will be better-able to carry out daily tasks when their home space is tidy and clutter free. However there has been very little research to really test this hypothesis.

“We wanted to see whether clutter was negatively affecting people with dementia. So we studied how people at different stages of dementia coped with carrying out daily tasks at home, surrounded by their usual clutter, compared to in a clutter-free setting – a specially designed home research lab.”

Occupational therapist and PhD student Julieta Camino carried out the study with 65 participants. They were grouped into those with mild, moderate and severe dementia, and were asked to carry out daily tasks including making a cup of tea and making a simple meal, both at their own home and at UEA’s specially designed NEAT research bungalow, a fully furnished research facility that feels just like a domestic bungalow. 

The researchers evaluated performance of activities in both settings, and also measured the amount of clutter in the participants’ homes. Meanwhile the NEAT home setting was completely clutter free.

Source: University of East Anglia

Elderly with Mild Dementia Benefit from Smartphone Reminder Apps

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Results from a new study show that older adults with mild dementia can learn to use smartphone memory aids to help them remember to complete everyday tasks that are important to their quality of life.

The study, which was published in the Journal of the American Geriatrics Society, recruited 52 older adults with mild cognitive impairment or mild dementia, and were coached on how to use a digital voice recorder app or a reminder app.

After a four-week intervention, participants reported improvements in performing daily intentions. They also performed relatively well when the investigators assigned them with tasks, with performance levels favouring the reminder app in week 1, but by week 4 changing to favour the digital voice recorder app. Greater usage of the digital recorder or reminder apps was associated with better memory and greater improvements in activities of daily living.

The researchers note that smartphone aids are free and widely available, and they should be shared with patients and caregivers to help support quality of life and independent functioning.

“There is this pervasive notion that older adults dislike technology, but we found that participants enjoyed learning to use smartphone memory apps and were able to improve their daily prospective memory performance,” said lead author Michael K. Scullin, PhD, of Baylor University. “Technology companies have an opportunity to improve broad adoption of smartphone memory aids in older adults and persons with mild stages of Alzheimer’s disease by tailoring the interface and user experience of their reminder apps to this demographic and by incorporating age diversity into their marketing campaigns. With the help of smart technology companies, we can make great headway on improving functioning and quality of life for families impacted by Alzheimer’s disease and related dementias.”

Source: Wiley

No Dementia Risk with Hormone Replacement Therapy

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A large UK study found that use of menopausal hormone therapy (MHT, also known as hormone replacement therapy, HRT) is not associated with increased dementia risk.

The study, published in the BMJ, found within the subgroup of women with a specific diagnosis for Alzheimer’s disease, a slight increasing risk association was found with use of oestrogen-progestogen treatments, but only seen for long-term usage (5 years or more).

This study “brings clarity to previously inconsistent findings and should reassure women in need of menopausal hormonal therapy,” said the researchers.

MHT relieves menopausal symptoms such as hot flushes, sleep disturbance, mood swings, memory losses and depression. Treatment includes oral tablets with oestrogen only, or oestrogen and progestogen combined, as well as patches, gels and creams.

Early signs of dementia are similar to some menopausal symptoms. Research has shown a beneficial link between oestrogen and age-related brain decline. However, in the largest trial of MHT, the Women’s Health Initiative Memory Study, an increased dementia risk was found among users of oestrogen-progestogen treatments. A recent study picked up a possible link to Alzheimer’s disease among users of both oestrogen-only and oestrogen-progestogen treatments, though the study has some issues.

To address this uncertainty, researchers set out to investigate the risks of developing dementia for women using commonly available menopausal hormone therapy treatments.

They used two UK primary care databases to analyse MHT prescriptions for the 118 501 women aged 55 and older diagnosed with dementia between 1998 and 2020 (cases), and 497 416 matched women without dementia (controls).

After adjusting for confounding factors, no overall associations were found between use of hormone therapy and risk of dementia, regardless of hormone type, application, dose, or duration of treatment. Only a slightly decreased risk of dementia was found in one subgroup: those under 80 years who had been taking oestrogen-only therapy for 10 years or more.
Analysis of cases with a specific diagnosis of Alzheimer’s disease showed a slight increase in risk associated with oestrogen-progestogen therapy. This rose gradually with each year of exposure, reaching an average 11% increased risk for use of between 5 and 9 years and an average 19% for use of 10 years or more, equivalent to, respectively, five and seven extra cases per 10 000 woman years.

As this is an observational study it cannot establish cause, and some limitations include incomplete recording of menopausal symptoms, particularly for women registered after their menopause. However, its large size counts in its favour.
According to the researchers, this study provides the most detailed estimates of risk for individual treatments, and their results are in line with existing concerns in guidelines about long term exposures to combined hormone therapy treatments.

“The findings will be helpful to policy makers, doctors, and patients when making choices about hormone therapy,” they concluded.

The findings do not change the recommendation that menopausal hormone therapy should not be used to prevent dementia, US researchers commented in a linked opinion article. However, it is helpful for providers to put dementia findings in context for patients, they added.

“The primary indication for hormone therapy continues to be the treatment of vasomotor symptoms, and the current study should provide reassurance for women and their providers when treatment is prescribed for that reason,” they concluded.

Source: News-Medical.Net

Study Uncovers Assortment of New Biomarkers for Dementia

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An international study identified 15 novel biomarkers that are linked to late-onset dementias. These protein biomarkers predict cognitive decline and subsequent increased risk of dementia 20 years before the disease onset. 

The proteins identified by the study are involved with immune system dysfunction, blood-brain-barrier dysfunction, vascular pathologies, and central insulin resistance. Six of these proteins can be modified with currently available medications.  

“These findings provide novel avenues for further studies to examine whether drugs targeting these proteins could prevent or delay the development of dementia,” explained lead author Joni Lindbohm MD, PhD from the University College London and University of Helsinki.

The study findings have been published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Pathophysiological research on dementia aetiology has focused on amyloid beta and tau proteins, but thus far prevention and treatment trials targeting these biomarkers have been unsuccessful. This has spurred the search for other potential mechanisms that could predispose to dementia. Recent development of scalable platforms has made it possible to analyse a wide range of circulating proteins, which may reveal novel dementia-linked biological processes.

In this study, the researchers analysed proteins with a novel large-scale protein panel from stored blood samples of the British Whitehall II and US Atherosclerosis Risk in Communities (ARIC) study collected 20 years ago. Using a panel of 5000 proteins, the researchers identified proteins in plasma that predicted cognitive decline in 5-yearly screenings and subsequent onset of clinical dementia. The 15 proteins that were identified were predictive of dementia in both the British and US cohorts.

“This new study is the first step in our 5-year Wellcome Trust funded research programme. We will next examine whether the identified proteins have a causal association with dementia, and whether they are likely to be modifiable, and druggable”, said study author Professor Mika Kivimäki, Director of the Whitehall II study at University College London.

The research programme ultimately aims to identify novel drug targets for dementia prevention.

Source: EurekAlert!

Sustained Antipsychotic Benefits of Pimavanesirn Shown in Study

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Evidence of the sustained benefits of an investigational antipsychotic treatment for people with dementia-related psychosis has been published.

Up to half of the 45 million people worldwide who are living with Alzheimer’s disease will experience psychotic episodes, a figure that is even higher in some other forms of dementia. Psychosis is linked to a faster deterioration in dementia, and currently there is no safe and effective treatment for it. Widely-used antipsychotics have significant drawbacks in people with dementia, leading to sedation, falls and increased risk of deaths.

Pimavanserin works by blocking serotonin 5HT2A receptors, with no interaction with dopamine receptors. In the US, it is licensed to treat hallucinations and delusions in people with Parkinson’s disease psychosis.

To test this drug, a clinical trial was conducted in 392 people with psychosis associated with Alzheimer’s disease, Parkinson’s disease, Lewy body, frontotemporal, or vascular dementia. All participants were given pimavanserin for 12 weeks, with those reaching a certain level of symptom improvement were then assigned to pimavanserin or placebo for up to 26 weeks. Due to positive efficacy results however, the trial was concluded early. 

Of the 351 participants, 217 (61.8%) had a sustained initial treatment benefit, of whom 112 were assigned to placebo and 105 to pimavanserin. Relapse occurred in 28/99 (28.3%) of the placebo group, compared to 12/95 (12.6%) of the pimvanserin group, with pimvanserin more than halving the relapse rate and significantly improving the sustained benefit.

Professor Clive Ballard, Executive Dean of the University of Exeter Medical School, said: “Psychosis affects up to half of all people with dementia, and it’s a particularly distressing symptom – yet there’s currently no safe and effective treatment. Currently used antipsychotics are known to cause harms, and best practice guidelines recommend prescribing for no longer than 12 weeks for people with dementia as a result. We urgently need alternatives. It’s exciting that the relapse rate in the pimavanserin group was lower than the placebo group, indicating that the treatment benefits may be sustained over time. We now need longer and larger scale trials to explore this further.”

The trial found headache, urinary tract infection and constipation occurred more frequently in the pimavanserin group, but there was no increase in mortality or the other serious events, such as stroke, which are seen in other antipsychotics.

The full paper is published in the New England Journal of Medicine.

Source: EurekAlert!

Lifestyle Changes Shown to Reduce Risk of Dementia

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After almost two decades, a new drug for Alzheimer’s disease has been approved in the US. However, some experts say it doesn’t really work — only treating amyloid plaques which are thought to cause the disease — and worry that it may cost a lot.

The amount of attention around this news reflects the importance of preventing dementia, with its devastating toll on families and patients. But millions of adults could lower their chances of needing such a drug by taking preventative measures.

That’s why a national panel of experts including the University of Michigan’s Deborah Levine, MD, MPH, recently published a guide for primary care providers on this topic as an official Scientific Statement from the American Heart Association.

People dread Alzheimer’s disease, she said. Helping people understand that they can prevent or slow future dementia by taking specific steps now could motivate them to increase their healthy behaviours for a positive effect.

The first step is to recognise that dementia risk is higher among people with seven major modifiable risk factors.

These are: depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidaemia, poor diet, smoking, social isolation, excessive alcohol use, sleep disorders and hearing loss. Addressing each of these factors can, to varying extents, help reduce the risk of developing dementia, a fact backed by decades of research.

The second step is using medication, lifestyle change and other interventions to help patients reduce their dementia risk.

“Dementia is not inevitable,” said Dr Levine, a primary care provider at the University of Michigan Health, part of Michigan Medicine. “Evidence is growing that people can better maintain brain health and prevent dementia by following healthy behaviours and controlling vascular risk factors.”

These strategies can help preserve cognitive function and lower risk for heart attacks and strokes, said Dr Levine, who heads the Cognitive Health Services Research Program and sees patients at the Frankel Cardiovascular Center.

“We need to address the significant disparities that lead women, Black, Hispanic and less-educated Americans to have a much higher risk of dementia,” said Levine, a member of the U-M Institute for Healthcare Policy and Innovation.

She added that it’s never too late in life to start working on cognitive risk factor control.

“We have no treatments that will halt dementia – so it’s important to protect your brain health.”

Source: University of Michigan

Tooth Loss may Decrease the Capacity to Perform Everyday Tasks

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Older adults with more natural teeth are better able to perform everyday tasks such as cooking a meal, making a telephone call or going shopping, according to a new study. 

The study, conducted by researchers from UCL and the Tokyo Medical and Dental University, was published in the Journal of American Geriatrics Society, The researchers analysed data from 5631 adults from the English Longitudinal Study of Ageing (ELSA) with ages between 50 and 70 years old.

Previous research had established a link between tooth loss and various reductions in capacity, such as cognitive decline. However, such research could not tease out any kind of causal link: did the tooth loss cause the decline, or did the decline result in tooth loss?

In this study the research team wanted to investigate the causal effect of tooth loss on someone’s ability to carry out daily activities. After controlling for factors such as participants’ socioeconomic status and health status, they nevertheless found evidence of an independent link between tooth loss and the ability to carry out everyday tasks.

The participants in the study were asked how many natural teeth they had, with older adults usually having up to 32 natural teeth that are lost over time. Using data gathered in 2014-2015, the researchers measured how tooth loss affected people’s ability to carry out key instrumental activities of daily living (IADL). The activities included preparing a hot meal, shopping for groceries, making telephone calls, taking medications, doing work around the house or garden, or managing money.

Senior author Georgios Tsakos, professor at UCL Institute of Epidemiology and Health, explained: “We know from previous studies that tooth loss is associated with reduced functional capacity, but this study is the first to provide evidence about the causal effect of tooth loss on the instrumental activities of daily living (IADL) among older adults in England. And this effect is considerable.

“For example, older adults with 10 natural teeth are 30% more likely to have difficulties with key activities of daily living such as shopping for groceries or working around the house or garden compared to those with 20 natural teeth.

“Even after taking in factors such as participant’s education qualification, self-rated health and their parent’s education level for example, we still found a positive association between the number of natural teeth a person had and their functional ability.”

The researchers had a number of possible explanations for this relationship, noting that having more natural teeth is linked to delaying the onset of disability and death and that tooth loss can also hamper social interactions, which is also linked to poorer quality of life. Tooth loss could be linked to having a poorer diet with less nutrients, they suggested.

However the researchers cautioned that the results should be considered carefully due to the study’s complex design. Further studies are needed to investigate the causal relationship between tooth loss and functional ability.

First author, Dr Yusuke Matsuyama, at Tokyo Medical and Dental University, said: “Preventing tooth loss is important for maintaining functional capacity among older adults in England. Given the high prevalence of tooth loss, this effect is considerable and maintaining good oral health throughout the life course could be one strategy to prevent or delay loss of functional competence.

“The health gain from retaining natural teeth may not be limited to oral health outcomes but have wider relevance for promoting functional capacity and improving overall quality of life.”

Source: University College London

Journal information: Yusuke Matsuyama et al, Causal Effect of Tooth Loss on Functional Capacity in Older Adults in England: A Natural Experiment, Journal of the American Geriatrics Society (2021). DOI: 10.1111/jgs.17021

High Blood Pressure Dementia Risk Found for Women

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Differences in blood pressure’s influence on dementia risk in men and women may provide clues to help slow the rapid progress of the disease, according to new research.

In a study involving half a million people, researchers found that although the link between several mid-life cardiovascular risk factors and dementia was similar for both sexes, for blood pressure it was not. Low and high blood pressure were both shown to be associated with a greater risk of dementia in men, but for women the risk of dementia increased as blood pressure went up.

Lead author Jessica Gong said that while more research was needed to verify these findings, they may point to better ways of managing risk.

“Our results suggest a more tailored approach to treating high blood pressure could be more effective at preventing future cases of dementia,” she said.

Dementia is fast becoming a global epidemic, currently affecting an estimated 50 million people worldwide. This is projected to triple by 2050 – mainly driven by aging populations. Rates of dementia and associated deaths are both known to be higher in women than men.

In 2016 it overtook heart disease as the leading cause of death in Australian women and it is the second leading cause of death for all Australians.

With no treatment breakthroughs of any significance, the focus has therefore been on cutting the risk of developing the disease. Cardiovascular risk factors are increasingly recognised as contributors to different types of dementia.

To explore differences in major cardiovascular risk factors for dementia between the sexes, George Institute researchers accessed data from the UK Biobank, a large-scale biomedical database that recruited 502 489 dementia-free Britons 40-69 years old between 2006 and 2010.

They found that, to a similar degree in women and men, smoking , diabetes, high body fat levels, prior stroke history, and low socio-economic status were all linked to a greater risk of dementia.

But when it came to blood pressure, the relationship with dementia risk between the sexes was different. Although the reason for this wasn’t clear, the authors proposed some possible explanations.

“Biological differences between women and men may account for the sex differences we saw in the relationship between blood pressure and the risk of dementia,” said Ms Gong.

“But there may also be differences in medical treatment for hypertension. For example, women are less likely to take medication as prescribed by their healthcare provider than men and may be taking more medications and experiencing more side effects.”

While there are no effective treatments for dementia, trying to reduce the burden of the disease by encouraging healthier lifestyles is the priority, and the strongest evidence points to blood pressure management.

“Our study suggests that a more individualised approach to treating blood pressure in men compared to women may result in even greater protection against the development of dementia,” said study co-author Professor Mark Woodward.

“It also shows the importance of ensuring sufficient numbers of women and men are recruited into studies and that the data for women and men should be analysed separately,” he added.

Source: George Institute

Sleep Apnoea Treatment May Reduce Risk of Dementia

Older adults receiving positive airway pressure therapy for obstructive sleep apnoea (OSA) may have a lower risk of developing Alzheimer’s disease and other kinds of dementia, according to a new study.

In a nationally representative study, Researchers from Michigan Medicine’s Sleep Disorders Centers analysed Medicare claims of over 50 000 Medicare beneficiaries 65 and older with OSA. They sought to find out whether people using positive airway pressure therapy had less risk of receiving a new diagnosis of dementia or mild cognitive impairment over the next 3 years, compared to those not using positive airway pressure therapy.

“We found a significant association between positive airway pressure use and lower risk of Alzheimer’s and other types of dementia over three years, suggesting that positive airway pressure may be protective against dementia risk in people with OSA,” said lead author Galit Levi Dunietz, PhD, MPH, an assistant professor of neurology and sleep epidemiologist.

The findings stress the impact of sleep on cognitive function. “If a causal pathway exists between OSA treatment and dementia risk, as our findings suggest, diagnosis and effective treatment of OSA could play a key role in the cognitive health of older adults,” said principal investigator Tiffany J. Braley, MD, MS, associate professor of neurology.

Obstructive sleep apnoea is a condition where there are episodes of complete or partial collapse of the airway with an associated decrease in oxygen saturation or arousal from sleep. This disturbance results in fragmented, nonrestorative sleep, and is associated with a variety of other neurological and cardiovascular conditions. Many older adults are at high risk for OSA. Dementia is prevalent as well, with roughly 5.8 million Americans currently living with it, said Prof Braley.

Source: Medical Xpress

Journal information: G L Dunietz et al, Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults, Sleep (2021). DOI: 10.1093/sleep/zsab076