Lack of exercise might invite dementia

Parking yourself in front of the TV may make you as likely to develop dementia as people genetically predisposed to the condition, a Canadian study suggests.

In a study of more than 1,600 adults aged 65 and older, those who led a sedentary life seemed to have the same risk of developing dementia as those who carried the apolipoprotein E (APOE) gene mutation, which increases the chances of developing dementia.

Conversely, people who exercised appeared to have lower odds of developing dementia than those who didn't, the five-year study found.

"Being inactive may completely negate the protective effects of a healthy set of genes," said lead researcher Jennifer Heisz, an assistant professor in the department of kinesiology at McMaster University in Hamilton, Ontario.

However, the study didn't prove that lack of exercise caused dementia risk to increase. It only found an association between the two.

The APOE mutation is the strongest genetic risk factor for vascular dementia, Lewy body dementia, Parkinson's disease and, especially, Alzheimer's disease, the researchers said.

People with a single APOE "allele" may have a three to four times increased risk of dementia than non-carriers, the study authors said.

How exercise may reduce the risk for dementia isn't known, Heisz said.

These study results, however, suggest that your physical activity level can influence your dementia risk as much as your genetics, Heisz said. "You can't change your genes, but you can change your lifestyle," she added.

The kind of exercise that's best isn't known, although the people who were physically active in the study reported walking three times a week, Heisz said.

"Which means you don't have to train like an Olympian to get the brain health benefits of being physically active," she said.

The report was published Jan. 10 in the Journal of Alzheimer's Disease.

Dr. Sam Gandy directs the Center for Cognitive Health at Mount Sinai Hospital in New York City. He said the study findings aren't "really a surprise, but it is good to see it proven."

Other scientists showed some years ago that people with the APOE mutation could virtually erase the risk of developing amyloid plaques in the brain if they became regular runners, Gandy said. Amyloid plaques are one of the hallmark signs of Alzheimer's.

"That was an amazing report that, I believe, has been underpublicized," Gandy said.

However, this new study suggests that if you are blessed with genes that lower your risk for Alzheimer's, you could lose that benefit if you don't exercise, he said.

"I cannot understand why the fear of dementia is not sufficient to induce everyone to adopt a regular exercise program," Gandy said.

"I tell all my patients that if they leave with one, and only one, piece of advice, that the one thing that they can do to reduce their risk of dementia or slow the progression of dementia is to exercise," he said.

About 47.5 million people around the world are living with dementia, the researchers said, and that number is expected to surge to 115 million by 2050. With no known cure, there's an urgent need to explore, identify and change lifestyle factors that can reduce dementia risk, the study authors said.

SOURCE: Steven Reinberg, wflx.com

Women And Dementia: The Overlooked Majority

There’s no escaping from the fact that dementia has become an urgent global health crisis that is only set to worsen. Global diagnosis rates are low, people are receiving sub-standard or no care and stigma in many communities remains rife. But while there is growing recognition of the scale of the problem, there is a key issue that continues to be significantly overlooked.

Women are disproportionately affected by dementia. The World Health Organisation lists dementia as one of the top ten causes of death for women and it is the top cause of death for females in the UK. Research shows that women not only face a greater prevalence of the condition, but also fulfil the majority of care support and face the greatest stigma.

Internationally, women account for two in three providers of dementia care support. Cultural norms, particularly in lower and middle income countries, often determine that a mother, daughter or daughter-in-law should assume the role of family carer. These unpaid care responsibilities mean many women are forced to sacrifice their job opportunities, either reducing their hours or ceasing work altogether. They are subsequently left vulnerable to financial hardship.

out of school to help with caring duties and to save money to support the family

These gendered roles can become even more complex, with women in some communities unable to detach from their responsibility as homemaker and family carer. One woman in India told us that she moved away from her family to receive dementia and cancer care, as she wanted to preserve her self-respect by not relying on her relatives.

A cruel paradox means that while often relied on as care partners, women are also significantly more likely to develop dementia themselves. Around the world, a greater proportion of women than men live with dementia. Once they have overcome the initial barriers to getting a diagnosis, women can also face discrimination in care. A recent UK study identified that women living with dementia are more likely than men to be prescribed psychotropic medication that can negatively affect their physical health.

Too often around the world, in every country, families do not understand what is wrong with their loved ones when they develop dementia. In this situation, a simple first step is dementia awareness. Community health workers and volunteers must first be taught that dementia is a medical condition, and then take further steps to utilise the tools that exist to support diagnosis and care.

Worryingly, in some countries, there’s not even a word for dementia, with many people affected accused of witchcraft and at risk of daily threats of violence. A lack of recognition or understanding of the condition permeates from within the community right up to a policy level. There is a universal stigma surrounding the condition and extreme forms of discrimination can lead to the abuse of women. Older women are particularly vulnerable to what has been called a “triple jeopardy”, discriminated against because of their sex, age and medical condition. Some people are bound by a cultural stigma that forbids them seeking external help. The ramifications of these misunderstandings are dangerous and can sometimes lead to abuse.

Kiki Laniyonu Edwards a leading dementia advocate in Nigeria features in a new film released for World Alzheimer’s Day ‘And Then I Looked Up Dementia - Women Speak Out.’ As in many parts of the world, the stigma and misunderstanding of dementia that exists in Nigeria is extensive and can be dangerous. People with dementia are commonly labelled as witches, and sometimes abandoned by their families for fear they too will be accused of witchcraft because of courtesy stigma. When they are not abandoned, people with dementia are often locked away without proper care and support to manage their symptoms. Kiki herself has been accused of witchcraft due to her care support and association with people living with the condition.

Next year, dementia will become a $1trillion disease that’s a cost greater than the GDP of all but the 15 richest economies in the world. There’s no longer time to shirk our global responsibility to address this issue. The Global Alzheimer’s and Dementia Action Alliance (GADAA) is urging global leaders to recognise dementia as a medical condition that needs urgent action, and unite in ensuring better diagnosis, care, research and awareness through the development of national dementia plans in every country in the world. But so far only 12 countries have taken into consideration the needs of women in their commitments and only 29 countries have a national dementia plan. Around the world people remain trapped in a perennial struggle to access the diagnosis, care and support that they desperately need - and for women the challenge is even greater.

International civil society also has a role to play in addressing the stigma and in delivering change for people living with dementia. We need as many voices as possible to spread the word that dementia is not a normal part of ageing, and not a curse, but one of the most prevalent and under-supported medical conditions the world over.

This World Alzheimer’s Day - and beyond it - unite with us in recognising dementia as a global women’s health, social care and rights issue that can no longer be ignored.

SOURCE: Amy White

As the need for greater resources grows, so too does the incidence of dementia diagnoses.

Law requiring dementia training for healthcare professionals is unprecedented, Alzheimer's Association says

Healthcare professionals who treat adults in Massachusetts will be required to undergo training related to Alzheimer's disease under a new law signed Thursday by Gov. Charlie Baker.

The Mass Alzheimer's and Dementia Act addresses what the Alzheimer's Association calls “the most under-recognized threat to public health in the 21st century,” costing the country $277 billion annually in Medicare, Medicaid, caregiving and other expenses.

“No other state in the country has something like this,” Daniel C. Zotos, director of public policy and advocacy for the Massachusetts/New Hampshire chapter of the Alzheimer's Association, said of the law to the Boston Globe.

LeadingAge Massachusetts and the Massachusetts Senior Care Association, the state affiliate of the American Health Care Association / National Center for Assisted Living, were two members of a coalition advocating for passage of H. 4116, according to the Alzheimer's Association.

The act requires physicians, physician assistants and registered and practical nurses who treat adults to undergo one-time training in diagnosing Alzheimer's disease and treating and caring for people with dementia before they can obtain or renew their licenses.

The law also mandates that doctors who have diagnosed Alzheimer's in someone inform a family member or legal representative about the diagnosis and provide the family member or representative with information about care-planning services.

Protective services caseworkers in designated local agencies also will undergo training to help them recognize the signs and symptoms of cognitive impairments and understand how such impairments may affect screening, investigation and service-planning.

Additionally under the law, all hospitals in the state must develop and implement plans for recognizing and managing dementia or delirium by Oct. 1, 2021.

The signed legislation also requires the state Executive Office of Health and Human Services to assess all state programs that address Alzheimer's disease and create and maintain an integrated state plan to overcome the disease.

A new 17-member advisory council will include state officials as well as Alzheimer's healthcare providers, caregivers, patient advocates and researchers. The council will meet quarterly in public and will produce an annual report suggesting updates to the state plan and evaluating state-funded efforts related to institutional and home- and community-based programs, research and clinical care for the disease.

Baker, a Republican, also is advocating for national Alzheimer's legislation.

He and Gov. Steve Bullock of Montana, a Democrat, last month wrote an opinion piece in Newsweek in support of the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act. The act, which was written by Sens. Susan Collins (R-ME) and Catherine Cortez Masto (D-NV), chairman and member, respectively, of the Senate Special Committee on Committee and introduced in November, would establish Centers of Excellence in Public Health Practice to promote Alzheimer's disease management, caregiving interventions and public education.

“Alzheimer's impacts us all in some way — as a taxpayer, loved one, caregiver, or by developing the disease ourselves,” they wrote. “Regardless of socioeconomic standing, geographic location or political beliefs, we should all be concerned about the public health threat posed by Alzheimer's.”

SOURCE: McKnights Senior Living, Lois A Bowers

Deaths from resident-to-resident incidents in dementia offers insights to inform policy

Analyzing the incidents between residents in dementia in long-term care homes may hold the key to reducing future fatalities among this vulnerable population, according to new research from the University of Minnesota School of Nursing. Gathered from media accounts and death review records, the exploratory study by Eilon Caspi, PhD, is the first to examine the circumstances surrounding the death of elders as a result of resident-to-resident incidents in dementia in the United States and Canada.

Despite growing concerns about the projected growth in the number of people with dementia and the expected rise in resident-to-resident incidents, the phenomenon is not currently being tracked by the two largest federally mandated clinical and oversight systems in nursing homes in the U.S.

"The fact that we are not capturing and tracking this phenomenon represents a major missed opportunity for learning and prevention of these incidents," says Caspi, the study's author and a research associate at the School of Nursing. "We need to develop a data-driven national action plan to reduce these incidents and ensure that frail and vulnerable residents will remain safe in the last years of their lives. Delivery of evidence-based staff training programs to improve understanding, prevention, and de-escalation of these episodes is urgently needed."

Among Caspi's findings:

- Nearly half (44 percent) of all fatalities were the results of physical contact classified as push-fall. "Many of the injuries consisted of hip fractures or head or brain injuries and on average it was slightly more than two weeks from the incident to their passing, which speaks volumes to the frailty and vulnerability of this population."

- While men and women equally died as a result of these incidents, three-quarters of exhibitors were men. "The most common exhibitor-target dyad was man to man (approximately 50 percent) followed by man to woman (24 percent) and woman to woman (21 percent). Woman to man accounted for only 4 percent of the dyads. While more research is needed to examine the role of gender in injurious and fatal episodes, the preliminary findings may have implications for more targeted interventions."

- More than half (59 percent) of all incidents took place inside bedrooms and 43 percent involved roommates. "The bedroom is the last frontier of privacy for people in dementia. Policies, procedures, and practices related to roommate assignment and monitoring need to be thoughtful and revisited regularly and we need to explore all avenues for reducing to the minimum possible the use of shared bedrooms or at a minimum increasing roommates' sense of privacy and security. In addition, stronger measures to prevent residents' unwanted entries into other residents' bedrooms (including the use of assistive technology) could reduce these incidents."

- Evenings (44 percent) were the most common time for incidents to occur, with 38 percent of all incidents occurring on weekends. 62 percent were reportedly not witnessed by staff. "While incidents occur at virtually all times, evenings and weekends appear to be especially vulnerable time periods. Taking proactive, anticipatory, preventative measures and increasing staffing levels, the active presence of managers, and meaningful engagement during the evenings and weekends could reduce the incidence."

Caspi points out that his findings are not meant to suggest that residents with dementia are inherently "aggressive," "abusive," "violent," or "dangerous." He cautions that adopting this view could run the risk of stigmatizing an already stigmatized population.

Labeling a person with dementia using these terms assumes that these behavioral expressions are intentionally initiated to harm another person when the majority of individuals in mid-to-late stages of dementia do not initiate these expressions without a distressing situational trigger. Caspi says they often engage in these episodes when their human needs and situational frustrations are not met in a timely manner by dedicated but understaffed, undertrained, and undersupervised direct care staff members.

SOURCE: Science News, University of Minnesota

Some interesting facts to come out of this study such as the proportion of incidents taking place at weekends and evenings and more often than not in residents' bedrooms. Does this suggest the residents have less supervision and direct care at these times?  Very sad to read the number of deaths that correlate directly with an incident in the weeks leading up to it.

Doncaster care home residents told to leave over safety fears

Twenty-seven residents were told to leave their care home and find a new one within less than 24 hours due to concerns about safety failings.

Doncaster Council said it stepped in to move people out of Warneford House, which specialises in dementia care.

The council and Clinical Commissioning Groups had been monitoring standards and quality of care at the privately-owned home due to family concerns.

No-one from the home has been available for comment.

Residents were told on the afternoon of 3 August they "needed to be moved for their safety" and were allocated a social worker to help them choose alternative accommodation.

'Unprecedented situation'

The council said the decision was made with the knowledge of the home owners and residents had until the end of the day to move.

Karen Johnson, Doncaster Council's assistant director of adult social care and safeguarding, said: "This was an unprecedented situation and whilst we appreciate it has been a difficult time, the safety of our residents is of upmost concern."

The Care Quality Commission said it had been made aware of concerns at the home and had planned to carry out an inspection the week beginning the 6 August but then the council moved residents.

A spokesperson said: "CQC is currently reviewing evidence supplied by its partner agencies in order to determine whether any regulatory action is required in the interests of those using services."

The GMB union, that represents some of the workers in the home, has demanded a public inquiry into the "scandalous situation".

It has written to Ed Miliband, MP for North Doncaster, calling for an urgent meeting over the closure.

Since 2017, Warneford House has been owned by a company called UK Medi-Care Associates Ltd, based in Dartford, Kent. UK Medi-Care Associates Ltd has also been contacted for a comment.

The home has been in operation since at least 2011.

SOURCE: BBC News

Agitation in dementia: Are drugs the best treatment?

A common symptom among people with dementia is agitation, which can affect their and their carers' well-being. Dementia experts conducted a new study and found the most effective means of addressing agitation.

In a paper that is now published in the journal International Psychogeriatrics, experts from several research institutions — including the University of Michigan in Ann Arbor, and Johns Hopkins University in Baltimore, MD — express their consensus on the best approaches to manage dementia-related behavioral and psychological symptoms.

More specifically, they speak of how to address states of agitation and psychosis in people with Alzheimer's disease.

This paper — which is based on evidence presented by dementia experts across the globe — ranks the best methods of addressing agitation in Alzheimer's, and nondrug-based approaches come first.

"This research advocates a significant shift from current practice, recommending that nonpharmacological treatments are a first-line approach for agitation in dementia."

Study co-author Dr. Helen Kales, University of Michigan

Person-centered care to be prioritized

In the new study, the first four treatments that the researchers advise healthcare professionals and other caregivers to prioritize are all nonpharmacological, focusing on behavioral approaches instead.

The specialists advise, first and foremost, the assessment and management of underlying causes for agitation and other behavioral and psychological symptoms.

Alzheimer's: Scientists find the cause of evening agitation

Why do some people with dementia become agitated in the evening?

They also encourage providing appropriate education to caregivers and adapting the environment that people with Alzheimer's inhabit to suit their needs as closely as possible.

According to the experts' evidence, a person-centered approach to care and providing an activity program that fits the individuals' needs are, more often than not, preferable to administering drugs when it comes to addressing agitation.

As for the pharmacological treatments, the highest-ranking drug for behavioral symptoms was the antidepressant citalopram, and even this only ranked sixth on the experts' list. Medication for pain management also ranked higher than other drugs.

Of the antipsychotic drugs currently prescribed, the specialists consensually recommended only risperidone, which came in seventh on the list of treatments and approaches.

"Aside from risperidone at number [seven] in the list, none of the other atypical antipsychotic drugs were recommended," notes Dr. Kales.

"This is a very welcome change," she emphasizes, "given the known harms associated with these treatments."

When it comes specifically to managing psychosis — including hallucinations and delusions — in people with a form of dementia, the specialists strongly advise that healthcare professionals first thoroughly assess patients for underlying causes and aim to manage these.

Once more, the panel of experts only consensually approved the antipsychotic drug risperidone, and it came second on their list of appropriate treatments for symptoms of psychosis.

Risperidone, the researchers add, is the only antipsychotic whose effectiveness in the context of dementia is backed up by scientific evidence.

In general, however, the specialists strongly advocate for the use of a therapeutic approach known as "Describe, Investigate, Create, and Evaluate" (DICE).

This approach requires identifying a person's triggers for agitation and other behavioral symptoms to prevent or address them more systematically.

One preferred strategy in the DICE approach is using music to manage mood, which has been shown to work in many cases of dementia, and which allows healthcare professionals to avoid prescribing drugs that may have harmful side effects.

"Symptoms such as psychosis and agitation can be particularly distressing and challenging for people with dementia, their carers, and their families," notes study co-author Prof. Clive Ballard, from the University of Exeter Medical School in the United Kingdom.

"Many commonly prescribed medications can cause harm, in some cases significantly increasing risk of stroke or death," he explains.

However, he adds that "[we] now know that nondrug approaches are the best starting points and can prove effective," and [the current] research provides more specific and targeted guidance to support clinicians to give the best possible treatment options."

SOURCE: Medical News Today, Maria Cohut

Its certainly interesting to read these studies where other approaches have resulted in excellent benefits to both patients and in the wider sense care givers. Antipsychotic drugs have long been associated with increased risks to health, most notably stroke. Strategies for dealing with agitation in dementia that do not involve such drugs can only be beneficial and the more research into this, the better.

Doctors failing to diagnose one in three dementia cases: GPs take average of three years to pick up illness

GPs take an average of three years to diagnose the disease in patients 

Doctors are failing to detect dementia in hundreds of thousands of patients, a major study has found.

It suggests a third of those affected by the illness do not realise it because they have not been given a formal diagnosis.

The Cambridge-led research, the first of its kind, found even those who were eventually diagnosed had to live with the disease for an average of three years before it was finally detected by GPs.

Those who were eventually diagnosed had to live with the disease for an average of three years before it was finally detected by GPs.

The Cambridge-led research, the first of its kind, found even those who were eventually diagnosed had to live with the disease for an average of three years before it was finally detected by GPs

Many suffer from dementia for more than six years before it is picked up – while others die without finding out.

The research will raise serious questions over the Government’s dementia strategy. Ministers have pledged to make the UK a world leader in tackling the condition.

A major study earlier this month said dementia was one of the reasons that life expectancy had stalled for the first time in 100 years.

The Alzheimer’s Society says early diagnosis is vital. But researchers behind today’s study believe some GPs think telling patients and families will only cause anxiety, as there is no cure for dementia.

Another reason is that many sufferers live alone, meaning no one notices if they become more forgetful, confused or start behaving differently.

Others are worried about the stigma of dementia and fear losing friends, their independence and their driving licence.

A major study earlier this month said dementia was one of the reasons that life expectancy had stalled for the first time in 100 years

The research by Cambridge, East Anglia and Newcastle universities, which is still ongoing, hopes to provide one of the most accurate pictures of dementia diagnosis rates to date. 

It involves 7,796 over-65s in England who were interviewed between 2011 and 2013 for two to three hours. Results were then analysed to see which patients had dementia.

Controversially, the researchers did not tell patients if they tested positively. Instead, they waited to see how much time elapsed before the disease was diagnosed by family doctors.

Earlier this year the researchers contacted the GPs of 458 patients they had identified as having dementia. 

The nine risk factors 

Nine risk factors including obesity, smoking and high blood pressure have been blamed for dementia in one in three cases.

A report last week was the first time scientists have been able to show how much of the disease is preventable. They warned the public should not see dementia as ‘an inevitable part of ageing’ but take responsibility for reducing their own risk.

In the journal The Lancet, senior experts recommended a major crackdown on high blood pressure which could help prevent one in 50 dementia cases. Ensuring universal education to age 15 would cut the number of dementia cases by 8 per cent, the report added.

In middle age, treating hearing loss would have the biggest impact, cutting cases by 9 per cent. Stopping smoking in over-65s would stop 5 per cent of cases and treating depression would prevent 4 per cent.

Even a 1 per cent reduction in dementia cases would mean that 8,500 fewer Britons suffer from the disease. 

They found more than a third – some 37 per cent – had yet to be given a formal diagnosis by the GP. 

There was not even any mention of symptoms in their notes. Of the patients who had been diagnosed, there was an average delay of three years between researchers identifying the illness and GPs picking it up. 

The researchers calculated a fifth of dementia patients wait six years or more for a diagnosis. Another fifth die before being told they have the disease.

These early results were presented at the world’s largest Alzheimer’s conference in Docklands, east London, last week.

The full research will be presented at the end of the year.

Dr George Savva, lead author from East Anglia University, said: ‘Many of these people have been living with dementia for six years without diagnosis.

‘Doctors thought there’s no point in diagnosing because there’s nothing we can do.

‘We don’t have a lot of evidence as to whether diagnosis helps and the broad consensus is that many people don’t really want to know. But there are drugs that can certainly help some people for some time, although not everybody and not much.’ 

Dr James Pickett, of the Alzheimer’s Society, which is funding the study, said: ‘We know people who get a diagnosis can get access to drugs, help and support, they can plan for their future and they can avoid reaching a crisis point.’

East Anglia researcher Clare Aldus said diagnosis ‘helps them understand what is going wrong – a diagnosis can bring some relief’.

Separate figures last week suggested approximately one million Britons are living with dementia. This number is expected to double by 2051 due to the ageing population and obesity, which raises the risk.

Ministers have pledged to improve dementia care since Labour issued a National Dementia Strategy in 2009 and former prime minister David Cameron launched the Dementia Challenge in 2012.

GPs were urged to improve diagnosis rates and hospital doctors had training to better detect the illness. In 2014, the NHS paid GPs an extra £55 for every new dementia case they recorded. The scheme was scrapped the next year.

A Department of Health spokesman said it is investing £50million to make hospitals dementia-friendly and £150million to develop a national Dementia Research Institute.

An NHS England spokesman said the number of people with a formal diagnosis has ‘dramatically increased … with approximately 150,000 more people able to access early support’.

SOURCE: MailOnline, Rosie Taylor and Sophie Borland

It seems the Alzheimers Society spokesperson has the right idea, that early diagnosis offers access to drugs and future planning that may avoid sufferers reaching crisis point.