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Kokorelias KM, Nadesar N, Bak K, Boger J, Nygård L, Mäki-Petäjä-Leinonen A, Nedlund AC, Astell A. The impact on employment and education of caregiving for a family member with young onset dementia: A scoping review. DEMENTIA 2024; 23:850-881. [PMID: 38623057 DOI: 10.1177/14713012241247339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Young-onset dementia (YOD) affects individuals under 65 years of age, often leading to loss of employment and independence. Families provide increasing levels of care to family members with YOD, resulting in changes to their daily lives, including their occupational pursuits. This review examines evidence of the occupational implications for family members who provide care to a family with YOD to identify: (i) the influence and impact caregiving tasks and responsibilities have on employment, volunteering, and education, and (ii) caregiver, and caregiving situation factors associated with changes in employment, volunteering, and education. A scoping review was performed using eight electronic databases. Included articles were narratively synthesized using a thematic analysis. Sixteen studies met the inclusion criteria and were included for review. The over-arching (main) theme of 'decision-making' was identified, with family members required to make choices about their own occupational goals and roles to be able to provide care to family living with YOD. The outcomes of these decisions are dynamic and changeable across the caregiving trajectory. Three caregiving factors influence decision-making: (1) Implications of Combining Caregiving and Occupations, (2) Altered Identity (3) Strategies to Support Caregivers of Individuals Living with YOD. A fourth theme was also identified 'Guidance for Researchers To Support Caregivers'. There is a scarce body of literature examining the influence caregiving has on occupational outcomes for the YOD caregiver population. Much of this work is descriptive and lacks focus on the implications, particularly long-term impacts. This review provides a foundational guide for future research and practices to support YOD family caregivers to obtain and sustain occupations.
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Affiliation(s)
- Kristina M Kokorelias
- Sinai Health System, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Nirusa Nadesar
- University Health Network, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Katherine Bak
- University Health Network, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- UBC-Okanagan, Kelowna, BC, Canada
| | - Louise Nygård
- Division of occupational therapy, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Arlene Astell
- University Health Network, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- University of Reading, Reading, UK
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Jiang X, Jiang H. Mentalising imagery therapy for family dementia caregivers: protocol for a scoping review. BMJ Open 2024; 14:e076727. [PMID: 38754883 PMCID: PMC11097803 DOI: 10.1136/bmjopen-2023-076727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Dementia is a growing public health concern, and providing long-term care for individuals affected by this condition is challenging for their family caregivers. While researchers have explored various intervention options to provide psychological support for dementia caregivers, mentalising imagery therapy (MIT) has gained significant recognition as an effective programme. Despite its significance and effectiveness, there is a lack of comprehensive scoping reviews of MIT in dementia caregiving. Thus, conducting such a review can provide valuable insights into the status and outcomes of MIT, identify gaps in existing research and provide recommendations for a more effective clinical practice. METHODS AND ANALYSIS This study proposes a scoping review conducted according to the Joanna Briggs Institute, Arksey and O'Malley's methodological framework, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension. PubMed, Web of Science, Embase, Scopus, CINAHL and PsycINFO databases will be searched while grey literature will be retrieved via Google Scholar. Covidence will be used to manage the literature selection process and remove duplicate publications. Two researchers will independently screen the literature according to the inclusion criteria, with any discrepancies resolved through discussions with a third researcher. Data will be presented in a structured tabular format, with a narrative synthesis providing an overview of the findings on the identified research gaps and the effectiveness of MIT in the field of dementia caregiving. ETHICS AND DISSEMINATION In a scoping review, no ethical approval is necessary. The results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER The scoping review protocol has been registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/FHRG8).
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Affiliation(s)
- Xue Jiang
- Department of Nursing, Puding County People's Hospital, Anshun, China
| | - Hu Jiang
- Department of Nursing, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
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Mitchell A, Kelso W, Paynter C, Hayes L, Velakoulis D, Loi SM. Peer Support for Caregivers of People Living with Posterior Cortical Atrophy in Melbourne, Australia: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:513. [PMID: 38673424 PMCID: PMC11050742 DOI: 10.3390/ijerph21040513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
Posterior Cortical Atrophy (PCA) is a rare form of young-onset dementia that causes early visuospatial and visuoperceptual deficits. The symptom profile of Posterior Cortical Atrophy leads to very specific care needs for those affected, who often rely on informal caregivers (including friends and family). Rare dementia support groups can be useful for both patients and their caregivers to assist with knowledge sharing, psychoeducation, and the provision of psychosocial support. Despite this, few such support groups exist. The purpose of this study was to examine a PCA support group for caregivers of individuals living with PCA. We held a structured psychoeducation support group comprised of four sessions with the aim being to provide education, strategies for the management of the disease, and peer support. Caregivers' mental health and quality of life were assessed. The results of our study showed that support group participation was a positive experience and assisted with increasing the knowledge of caregivers and fostering social connections. We suggest that peer support groups may be beneficial for both people living with PCA and their caregivers. We recommend that future quantitative and qualitative research is conducted to further assess health-promotion benefits to people living with PCA and their caregivers, and to assess their development and implementation in different contexts.
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Affiliation(s)
- Alexander Mitchell
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Wendy Kelso
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Camille Paynter
- Melbourne School of Health Sciences, University of Melbourne, Parkville 3052, Australia;
| | - Leanne Hayes
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
| | - Dennis Velakoulis
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
- Department of Psychiatry, University of Melbourne, Parkville 3052, Australia
| | - Samantha M. Loi
- Neuropsychiatry Centre, Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Australia; (A.M.); (W.K.); (L.H.); (D.V.)
- Department of Psychiatry, University of Melbourne, Parkville 3052, Australia
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Yuan S, Dan L, Zhang Y, Wu J, Zhao J, Kivipelto M, Chen J, Ludvigsson JF, Li X, Larsson SC. Digestive System Diseases, Genetic Risk, and Incident Dementia: A Prospective Cohort Study. Am J Prev Med 2024; 66:516-525. [PMID: 37918457 DOI: 10.1016/j.amepre.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Although digestive system disease affects gut microbiota and their metabolites associated with dementia risk, the association between digestive system diseases and incident dementia has not yet been established. METHODS This cohort analysis included 458,181 participants free of baseline dementia in the UK Biobank (2006-2021). The associations of 14 digestive system diseases with dementia incidence were examined in 2022 using Cox proportional hazards regression models. Analyses were performed to differentiate the associations for early-onset (age <65 years) and late-onset (age ≥65 years) dementia. Interaction and stratification analyses were performed for polygenic risk score and APOE. RESULTS During a median follow-up of 12.4 years, 6,415 incident dementia cases were diagnosed. Eleven digestive system diseases showed significant associations with an increased risk of dementia after controlling for covariates and multiple testing. Compared with hazard ratios for individuals without digestive system diseases, the hazard ratios of dementia increased from 1.15 (95% confidence interval=1.09, 1.23) for patients with intestinal diverticular disease to 2.31 (95% confidence interval=1.98, 2.70) for patients with cirrhosis. The associations were different between certain digestive system diseases and dementia by onset age. The associations appeared to be stronger for cirrhosis (Q=0.001), irritable bowel syndrome (Q<0.001), gastritis and duodenitis (Q=0.002), gastroesophageal reflux disease (Q<0.001), ulcerative colitis (Q=0.047), gallbladder disease (Q=0.012), and peptic ulcer (Q=0.030) with early-onset dementia. There were no interactions for polygenic risk score or APOE (p>0.05). CONCLUSIONS These findings suggest an increased need for dementia prevention among patients with digestive system diseases.
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Affiliation(s)
- Shuai Yuan
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lintao Dan
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Wu
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jianhui Zhao
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland; Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Jie Chen
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Xue Li
- Department of Big Data in Health Science, School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Brown AD, Kelso W, Eratne D, Loi SM, Farrand S, Summerell P, Neath J, Walterfang M, Velakoulis D, Stolwyk RJ. Investigating Equivalence of In-Person and Telehealth-Based Neuropsychological Assessment Performance for Individuals Being Investigated for Younger Onset Dementia. Arch Clin Neuropsychol 2024:acad108. [PMID: 38251841 DOI: 10.1093/arclin/acad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/24/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Given the rapid shift to in-home teleneuropsychology models, more research is needed to investigate the equivalence of non-facilitator models of teleneuropsychology delivery for people with younger onset dementia (YOD). This study aimed to determine whether equivalent performances were observed on neuropsychological measures administered in-person and via teleneuropsychology in a sample of people being investigated for YOD. METHOD Using a randomized counterbalanced cross-over design, 43 participants (Mage = 60.26, SDage = 7.19) with a possible or probable YOD diagnosis completed 14 neuropsychological tests in-person and via teleneuropsychology, with a 2-week interval. Repeated measures t-tests, intraclass correlation coefficients (ICC), and Bland Altman analyses were used to investigate equivalence across the administration conditions. RESULTS No statistical differences were found between in-person and teleneuropsychology conditions, except for the Hospital Anxiety and Depression Scale Anxiety subtest. Small to negligible effect sizes were observed (ranging from .01 to .20). ICC estimates ranged from .71 to .97 across the neuropsychological measures. Bland Altman analyses revealed that the Wechsler Adult Intelligence Scale-Fourth Edition Block Design subtest had slightly better overall performance in the in-person condition and participants reported higher levels of anxiety symptoms during the teleneuropsychology condition; however, average anxiety symptoms remained within the clinically normal range. Participants reported a high level of acceptability for teleneuropsychology assessments. CONCLUSIONS These results suggest that performances are comparable between in-person and teleneuropsychology assessment modalities. Our findings support teleneuropsychology as a feasible alternative to in-person neuropsychological services for people under investigation of YOD, who face significant barriers in accessing timely diagnoses and treatment options.
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Affiliation(s)
- Aimee D Brown
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Wendy Kelso
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | | | - Joanna Neath
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia
| | | | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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Cui X, Wang J, Wu B, Zhao Q, Tang X, Wang J. Interventions for Persons with Young-Onset Dementia and Their Families: A Scoping Review. J Alzheimers Dis 2024; 97:1519-1531. [PMID: 38277297 DOI: 10.3233/jad-231006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Background Dementia occurring before age 65 is known as young-onset dementia (YOD), with Alzheimer's disease being the most common type. YOD poses unique challenges for persons and families, impacting their working-age years and family responsibilities. Person-centered interventions and services are essential to improve their quality of life and social engagement. Objective This study aims to synthesize non-pharmacological interventions for persons with YOD and their families to inform future targeted interventions. Methods We conducted a systematic literature search across four databases: PubMed, PsycINFO, Scopus, and CINAHL. The included articles were carefully screened, categorized, and synthesized by following Arksey and O'Malley's five stages framework. Results We included 20 studies reported in 24 papers, with 11 studies (14 papers) on persons with YOD and nine studies (10 papers) on families. Quantitative intervention results vary, but qualitative interviews show positive feedback. Stakeholders provided positive evaluations, stating these interventions provided a sense of normalcy, facilitated communication among families, enhanced the independence of persons with YOD, and improved the families' caregiving self-efficacy, thereby reducing care burden and psychological distress. The heterogeneity among the studies posed integration challenges. Conclusions Interventions for YOD can improve the quality of life for both persons with YOD and their families. More extensive intervention studies are urgently needed, especially in developing countries, with a focus on family-centered and life course perspectives. In future intervention research design, a more extensive incorporation of stakeholder involvement is essential for successful implementation. Moreover, the integration of new technologies shows promise as a potential avenue for intervention advancement.
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Affiliation(s)
- Xiaoyan Cui
- Fudan University School of Nursing, Shanghai, China
| | - Junqiao Wang
- Fudan University School of Nursing, Shanghai, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, NY, USA
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xueting Tang
- Fudan University School of Nursing, Shanghai, China
| | - Jing Wang
- University of New Hampshire, NH, USA
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Li R, Li R, Xie J, Chen J, Liu S, Pan A, Liu G. Associations of socioeconomic status and healthy lifestyle with incident early-onset and late-onset dementia: a prospective cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e693-e702. [PMID: 38042162 DOI: 10.1016/s2666-7568(23)00211-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Modifiable risk factor estimates are sparse for early-onset dementia incidence. This study aimed to estimate and compare the risk factor profiles of early-onset dementia and late-onset dementia, and to explore the complex relationships between socioeconomic status, lifestyles, and early-onset dementia risk. METHODS In this prospective cohort study, we used data from the UK Biobank for analysis of early-onset dementia and late-onset dementia. For early-onset dementia analyses, data were collected on those aged younger than 60 years without prevalent dementia at baseline. For late-onset dementia analyses, data were collected on those aged 65 years or older at the end of follow-up. Participants with missing information on socioeconomic factors were excluded. Two models were used to test associations between early-onset dementia incidence and socioeconomic status. The first model tested associations between socioeconomic status and early-onset and late-onset dementia incidence, adjusting for covariates. Participant socioeconomic status was defined using education level, income, and employment status via latent class analysis. The second model additionally included a healthy lifestyle score, which was constructed using data on smoking, alcohol consumption, physical activity, and the Healthy Diet Index. Incident early-onset dementia was defined as a dementia case diagnosed before 65 years of age. Multivariable-adjusted Cox proportional hazard regression models were used to estimate the hazard ratio (HR) for risk of dementia. We used multivariable-adjusted Cox proportional-hazard regression models to estimate the HR for risk of both early-onset dementia and late-onset dementia. FINDINGS Between 2007 and 2010, 257 345 individuals were included in the analysis of early-onset dementia, and 294 133 older individuals were included in the analysis of late-onset dementia. During a mean follow-up of 11·9-12·5 years, 502 early-onset dementia cases and 5768 late-onset dementia cases were documented. Risk factor profiles were typically dissimilar between early-onset dementia and late-onset dementia. For instance, the age and sex adjusted HR for low socioeconomic status (vs high) was 4·40 (95% CI 3·43-5·65) for early-onset dementia and 1·90 (1·74-2·07) for late-onset dementia, yielding a ratio of HRs of 2·32 (1·78-3·02). After adjusting for various risk factors, participants with low socioeconomic status (vs high) had increased risk for early-onset dementia (3·38, 2·61-4·37), and overall lifestyle mediated 3·2% (1·8-5·7) of the association. Individuals with both low socioeconomic status and unhealthy lifestyles had a higher risk of early-onset dementia (5·40, 3·66-7·97). No significant interaction was observed between lifestyle and socioeconomic status. The association between socioeconomic status and early-onset dementia seemed to be more pronounced in individuals with type 2 diabetes (HR 11·21, 95% CI 2·70-46·57). INTERPRETATION Early-onset dementia and late-onset dementia might have different risk factor profiles; although risk factors were similar, the magnitude of associations between risk factors and dementia incidence was greater for early-onset dementia. Only a small proportion of the socioeconomic inequity in dementia risk was mediated by healthy lifestyles, which indicates that measures other than healthy lifestyle promotion to improve social determinants of health are warranted. FUNDING The National Key Research and Development Program of China, the National Natural Science Foundation of China, the Hubei Province Science Fund for Distinguished Young Scholars, and the Fundamental Research Funds for the Central Universities.
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Affiliation(s)
- Rui Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruyi Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinchi Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junxiang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sen Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Wong D, Pike K, Stolwyk R, Allott K, Ponsford J, McKay A, Longley W, Bosboom P, Hodge A, Kinsella G, Mowszowski L. Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper. Neuropsychol Rev 2023:10.1007/s11065-023-09624-0. [PMID: 38032472 DOI: 10.1007/s11065-023-09624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.
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Affiliation(s)
- Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kerryn Pike
- School of Psychology and Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Melbourne, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Kelly Allott
- , Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- MERRC, Rehabilitation and Mental Health Division, Epworth HealthCare, Richmond, Australia
| | - Wendy Longley
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, Australia
- The Uniting War Memorial Hospital, Waverley, Sydney, Australia
| | - Pascalle Bosboom
- MindLink Psychology, West Perth, Australia
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | | | - Glynda Kinsella
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Loren Mowszowski
- Faculty of Science, School of Psychology & Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Sandu IA, Ștefăniu R, Alexa-Stratulat T, Ilie AC, Albișteanu SM, Turcu AM, Sandu CA, Alexa AI, Pîslaru AI, Grigoraș G, Ștefănescu C, Alexa ID. Preventing Dementia-A Cross-Sectional Study of Outpatients in a Tertiary Internal Medicine Department. J Pers Med 2023; 13:1630. [PMID: 38138857 PMCID: PMC10744972 DOI: 10.3390/jpm13121630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
Dementia is a significant health problem worldwide, being the seventh leading cause of death (2,382,000 deaths worldwide in 2016). Recent data suggest there are several modifiable risk factors that, if addressed, can decrease dementia risk. Several national dementia screening programs exist; however, limited-income countries do not have the means to implement such measures. We performed a prospective cross-sectional study in an outpatient department to identify individuals at risk for dementia. Patients with no known cognitive dysfunction seeking a medical consult were screened for dementia risk by means of the cardiovascular risk factors, ageing, and dementia (CAIDE) and modified CAIDE tests. Additionally, we collected demographic and clinical data and assessed each participant for depression, mental state, and ability to perform daily activities. Of the 169 patients enrolled, 63.3% were identified as being in the intermediate-risk or high-risk group, scoring more than seven points on the mCAIDE test. Over 40% of the elderly individuals in the study were assessed as "somewhat depressed" or "depressed" on the geriatric depression scale. Almost 10% of the study population was diagnosed de novo with cognitive dysfunction. In conclusion, using a simple questionnaire such as the mCAIDE in a predefined high-risk population is easy and does not represent a major financial burden. At-risk individuals can subsequently benefit from personalized interventions that are more likely to be successful. Limited-resource countries can implement such screening tools in outpatient clinics.
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Affiliation(s)
- Ioana-Alexandra Sandu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
| | - Ramona Ștefăniu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Teodora Alexa-Stratulat
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
| | - Adina-Carmen Ilie
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Sabinne-Marie Albișteanu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Ana-Maria Turcu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Călina-Anda Sandu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Ophtalmology Department, “St. Spiridon” Hospital, 700111 Iasi, Romania
| | - Anisia-Iuliana Alexa
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Ophtalmology Department, “St. Spiridon” Hospital, 700111 Iasi, Romania
| | - Anca-Iuliana Pîslaru
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
| | - Gabriela Grigoraș
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
| | - Cristinel Ștefănescu
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Acute Psychiatry Department, “Socola” Institute of Psychiatry, 700282 Iasi, Romania
| | - Ioana-Dana Alexa
- Department of Medical Specialties II, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (I.-A.S.); (T.A.-S.); (A.-C.I.); (S.-M.A.); (A.-M.T.); (C.-A.S.); (A.-I.A.); (A.-I.P.); (G.G.); (C.Ș.); (I.-D.A.)
- Geriatrics and Internal Medicine Department, “C. I. Parhon” Hospital, 700503 Iasi, Romania
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10
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Yin T, Liu Y, He B, Gong B, Chu J, Gao C, Liang W, Hao M, Sun W, Zhuang J, Gao J, Yin Y. Cell primitive-based biomimetic nanomaterials for Alzheimer's disease targeting and therapy. Mater Today Bio 2023; 22:100789. [PMID: 37706205 PMCID: PMC10495673 DOI: 10.1016/j.mtbio.2023.100789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder, which is not just confined to the older population. Although developments have been made in AD treatment, various limitations remain to be addressed. These are partly contributed by biological hurdles, such as the blood-brain barrier and peripheral side effects, as well as by lack of carriers that can efficiently deliver the therapeutics to the brain while preserving their therapeutic efficacy. The increasing AD prevalence and the unavailability of effective treatments have encouraged researchers to develop improved, convenient, and affordable therapies. Functional materials based on primitive cells and nanotechnology are emerging as attractive therapeutics in AD treatment. Cell primitives possess distinct biological functions, including long-term circulation, lesion site targeting, and immune suppression. This review summarizes the challenges in the delivery of AD drugs and recent advances in cell primitive-based materials for AD treatment. Various cell primitives, such as cells, extracellular vesicles, and cell membranes, are presented together with their distinctive biological functions and construction strategies. Moreover, future research directions are discussed on the basis of foreseeable challenges and perspectives.
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Affiliation(s)
- Tong Yin
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
| | - Yan Liu
- Department of Clinical Pharmacy, Xinhua Hospital, Clinical pharmacy innovation institute, Shanghai Jiao Tong University of Medicine, Shanghai, 200000, China
| | - Bin He
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
| | - Baofeng Gong
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
| | - Jianjian Chu
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
| | - Chao Gao
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
| | - Wendanqi Liang
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
- School of Health Science and Engineering, University of Shanghaifor Science and Technology, Shanghai, 200093, China
| | - Mengqi Hao
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
- School of Health Science and Engineering, University of Shanghaifor Science and Technology, Shanghai, 200093, China
| | - Wenjing Sun
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
| | - Jianhua Zhuang
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
| | - Jie Gao
- Changhai Clinical Research Unit, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - You Yin
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai, 200003, China
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11
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Loi SM, Cations M, Velakoulis D. Young-onset dementia diagnosis, management and care. Med J Aust 2023. [PMID: 37270204 DOI: 10.5694/mja2.51995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Samantha M Loi
- University of Melbourne, Melbourne, VIC
- Royal Melbourne Hospital, Melbourne, VIC
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12
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Bahlo M. Young-onset dementia diagnosis, management and care. Med J Aust 2023. [PMID: 37270187 DOI: 10.5694/mja2.51996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Melanie Bahlo
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC
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13
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Brown CW, Chen HY, Panegyres PK. Electroencephalography in young onset dementia. BMC Neurol 2023; 23:202. [PMID: 37221470 DOI: 10.1186/s12883-023-03248-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Young onset dementia (YOD) is a major diagnostic and management problem. METHODS We set out to explore if electroencephalography (EEG) might be useful in the diagnosis of young onset Alzheimer's disease (YOAD) and young onset frontotemporal dementia (YOFTD). The ARTEMIS project is a 25-year prospective study of YOD based in Perth, Western Australia. 231 participants were included: YOAD: n = 103, YOFTD: n = 28, controls: n = 100. EEGs were performed prospectively, with 30-minute recording time for each subject, without knowledge of diagnosis or other diagnostic data. RESULTS 80.9% of patients with YOD had abnormal EEGs (P < 0.00001). Slow wave changes were more frequent in YOAD that YOFTD (P < 0.00001), but no difference in the frequency of epileptiform activity (P = 0.32), with 38.8% of YOAD and 28.6% of YOFTD patients having epileptiform activity. Slow wave changes were more generalized in YOAD (P = 0.001). Slow wave changes and epileptiform activity were not sensitive to the diagnosis of YOD, but highly specific (97-99%). The absence of slow wave changes and epileptiform activity had a 100% negative predictive value and likelihood radio 0.14 and 0.62 respectively, meaning that those without slow wave changes or epileptiform activity had low probability of having YOD. No relationship was established between EEG findings and the patient's presenting problem. Eleven patients with YOAD developed seizures during the study, and only one with YOFTD. CONCLUSIONS The EEG is highly specific for the diagnosis of YOD with the absence of slow wave changes and epileptiform phenomena making the diagnosis unlikely, with 100% negative predictive value and with low probability for the dementia diagnosis.
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Affiliation(s)
- Casey W Brown
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, 6009, Australia
| | - Huei-Yang Chen
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, West Perth, WA, 6005, Australia
| | - Peter K Panegyres
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, 6009, Australia.
- Neurodegenerative Disorders Research Pty Ltd, 4 Lawrence Avenue, West Perth, West Perth, WA, 6005, Australia.
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