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Harding E, Rossi-Harries S, Gerritzen EV, Zimmerman N, Hoare Z, Proctor D, Brotherhood E, Crutch S, Suárez-González A. "I felt like I had been put on the shelf and forgotten about" - lasting lessons about the impact of COVID-19 on people affected by rarer dementias. BMC Geriatr 2023; 23:392. [PMID: 37370011 DOI: 10.1186/s12877-023-03992-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The public health measures imposed in many countries to contain the spread of COVID-19 resulted in significant suspensions in the provision of support and care for people with dementia. The negative effects of these measures have been extensively reported. However, little is known about the specific impact on people with young onset, non-memory-led and inherited dementias. This group may have experienced different challenges compared to those with late onset dementia given their non-memory phenotypes and younger age. We explored the impact of the first COVID-19 lockdown on people living with familial Alzheimer's disease, behavioural variant frontotemporal dementia, familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical atrophy and primary progressive aphasia and their carers in the UK and their self-reported strategies for coping. METHODS This was a mixed methods study. An online survey was administered to people with dementia and family carers recruited via Rare Dementia Support. Free-text responses were analysed using framework analysis to identify key issues and themes. RESULTS 184 carers and 24 people with dementia completed the survey. Overall, people with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%), well-being (57%) and changes to medication (26%) during lockdown. Carers reported a reduction in the support they received (55%) which impacted their own mental health negatively. Qualitative analysis of free-text responses shed light on how the disruption to routines, changes to roles and responsibilities, and widespread disconnection from friends, family and health and social care support varied according to phenotype. These impacts were exacerbated by a more general sense that precious time was being lost, given the progressive nature of dementia. Despite significant challenges, respondents demonstrated resilience and resourcefulness in reporting unexpected positives and strategies for adapting to confinement. CONCLUSIONS This study has highlighted the specific impacts of the COVID-19 restrictions on people with young onset, non-memory-led and inherited dementias, including behavioural variant frontotemporal dementia, primary progressive aphasia and posterior cortical atrophy, and their carers. The specific challenges faced according to diagnosis and the self-reported strategies speak to the importance of - and may inform the development of - tailored support for these underrepresented groups more generally.
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Affiliation(s)
- Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Sam Rossi-Harries
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Esther Vera Gerritzen
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nikki Zimmerman
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Zoe Hoare
- NWORTH Clinical Trials Unit, School of Health Sciences, Bangor University, Bangor, UK
| | - Danielle Proctor
- Department of Clinical, Educational, and Health Psychology, UCL Division of Psychology and Language Sciences, UCL, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Sebastian Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK
| | - Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, 8-11 Queen Square, London, WC1N 3BG, UK.
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Waddington C, Harding E, Brotherhood EV, Davies Abbott I, Barker S, Camic PM, Ezeofor V, Gardner H, Grillo A, Hardy C, Hoare Z, McKee-Jackson R, Moore K, O'Hara T, Roberts J, Rossi-Harries S, Suarez-Gonzalez A, Sullivan MP, Edwards RT, Van Der Byl Williams M, Walton J, Willoughby A, Windle G, Winrow E, Wood O, Zimmermann N, Crutch SJ, Stott J. The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation. JMIR Res Protoc 2022; 11:e35376. [PMID: 35857375 PMCID: PMC9350818 DOI: 10.2196/35376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/10/2023] Open
Abstract
Background People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic. Objective We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups. Methods We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed. Results The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions. Conclusions The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population. International Registered Report Identifier (IRRID) DERR1-10.2196/35376
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Affiliation(s)
- Claire Waddington
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Emma Harding
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Emilie V Brotherhood
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Ian Davies Abbott
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Suzanne Barker
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Paul M Camic
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Hannah Gardner
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Adetola Grillo
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Chris Hardy
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Zoe Hoare
- School of Health Sciences, Bangor University, Bangor, United Kingdom
| | - Roberta McKee-Jackson
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Kirsten Moore
- Division of Psychiatry, University College London, London, United Kingdom
| | - Trish O'Hara
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Jennifer Roberts
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Samuel Rossi-Harries
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Aida Suarez-Gonzalez
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | | | - Jill Walton
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Alicia Willoughby
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Gill Windle
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Eira Winrow
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Olivia Wood
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Nikki Zimmermann
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Sebastian J Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Joshua Stott
- Psychology and Language Sciences, University College London, London, United Kingdom
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Ruksenaite J, Volkmer A, Jiang J, Johnson JC, Marshall CR, Warren JD, Hardy CJ. Primary Progressive Aphasia: Toward a Pathophysiological Synthesis. Curr Neurol Neurosci Rep 2021; 21:7. [PMID: 33543347 PMCID: PMC7861583 DOI: 10.1007/s11910-021-01097-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The term primary progressive aphasia (PPA) refers to a diverse group of dementias that present with prominent and early problems with speech and language. They present considerable challenges to clinicians and researchers. RECENT FINDINGS Here, we review critical issues around diagnosis of the three major PPA variants (semantic variant PPA, nonfluent/agrammatic variant PPA, logopenic variant PPA), as well as considering 'fragmentary' syndromes. We next consider issues around assessing disease stage, before discussing physiological phenotyping of proteinopathies across the PPA spectrum. We also review evidence for core central auditory impairments in PPA, outline critical challenges associated with treatment, discuss pathophysiological features of each major PPA variant, and conclude with thoughts on key challenges that remain to be addressed. New findings elucidating the pathophysiology of PPA represent a major step forward in our understanding of these diseases, with implications for diagnosis, care, management, and therapies.
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Affiliation(s)
- Justina Ruksenaite
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Jeremy Cs Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Chris Jd Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.
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Manca R, De Marco M, Venneri A. The Impact of COVID-19 Infection and Enforced Prolonged Social Isolation on Neuropsychiatric Symptoms in Older Adults With and Without Dementia: A Review. Front Psychiatry 2020; 11:585540. [PMID: 33192732 PMCID: PMC7649825 DOI: 10.3389/fpsyt.2020.585540] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background: The sudden and drastic changes due to the Coronavirus Disease 19 (COVID-19) pandemic have impacted people's physical and mental health. Clinically-vulnerable older people are more susceptible to severe effects either directly by the COVID-19 infection or indirectly due to stringent social isolation measures. Social isolation and loneliness negatively impact mental health in older adults and may predispose to cognitive decline. People with cognitive impairments may also be at high risk of worsening cognitive and mental health due to the current pandemic. This review provides a summary of the recent literature on the consequences of COVID-19, due to either viral infection or social isolation, on neuropsychiatric symptoms in older adults with and without dementia. Methods: A search was conducted in PubMed and Web of Science to identify all relevant papers published up to the 7th July 2020. Two independent assessors screened and selected the papers suitable for inclusion. Additional suitable papers not detected by literature search were manually added. Results: Fifteen articles were included: 8 focussed on the psychiatric symptoms caused by the COVID-19 infection and 7 investigated the impact of social isolation on older adults' neuropsychiatric symptoms. Four studies included older adults without dementia and 11 included patients with cognitive impairment mainly due to Alzheimer's disease. All studies found that different neuropsychiatric symptoms emerged and/or worsened in older adults with and without dementia. These changes were observed as the consequence of both COVID-19 infection and of the enforced prolonged conditions of social isolation. Cases were reported of viral infection manifesting with delirium at onset in the absence of other symptoms. Delirium, agitation and apathy were the symptoms most commonly detected, especially in people with dementia. Conclusion: The available evidence suggests that the COVID-19 pandemic has a wide negative impact on the mental well-being of older adults with and without dementia. Viral infection and the consequent social isolation to limit its spreading have a range of neuropsychiatric consequences. Larger and more robustly designed studies are needed to clarify such effects and to assess the long-term implications for the mental health of older adults, and to test possible mitigating strategies.
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Affiliation(s)
- Riccardo Manca
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
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