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Damsgaard L, Janbek J, Laursen TM, Høgh P, Vestergaard K, Gottrup H, Jensen‐Dahm C, Waldemar G. Mapping morbidity 10 years prior to a diagnosis of young onset Alzheimer's disease. Alzheimers Dement 2024; 20:2373-2383. [PMID: 38294143 PMCID: PMC11032518 DOI: 10.1002/alz.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Early symptoms in young onset Alzheimer's disease (YOAD) may be misinterpreted, causing delayed diagnosis. This population-based study aimed to map morbidity prior to YOAD diagnosis. METHODS In a register-based incidence density matched nested case-control study, we examined hospital-diagnosed morbidity for people diagnosed with YOAD in Danish memory clinics during 2016-2020 compared to controls in a 10-year period. Conditional logistic regression produced incidence rate ratios (IRRs). RESULTS The study included 1745 cases and 5235 controls. YOAD patients had a higher morbidity burden in the year immediately before dementia diagnosis, for certain disorders up to 10 years before. This was especially evident for psychiatric morbidity with the highest increased IRRs throughout the entire period and IRR 1.43 (95% confidence interval 1.14-1.79) in the 5-10-years before dementia diagnosis. DISCUSSION YOAD patients display a different pattern of morbidity up to 10 years prior to diagnosis. Awareness of specific alterations in morbidity may improve efforts toward a timely diagnosis. HIGHLIGHTS Retrospective, nested case-control study of young onset Alzheimer's disease (YOAD). YOAD cases had a higher morbidity burden than controls. YOAD cases had a higher psychiatric morbidity burden up to 10 years before diagnosis. Altered morbidity patterns could serve as an early warning sign of YOAD.
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Affiliation(s)
- Line Damsgaard
- Danish Dementia Research CentreDepartment of NeurologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Janet Janbek
- Danish Dementia Research CentreDepartment of NeurologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Thomas M. Laursen
- National Centre for Register‐based ResearchDepartment of Economics and Business EconomicsAarhus UniversityAarhusDenmark
| | - Peter Høgh
- Department of NeurologyZealand University HospitalRoskildeDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Karsten Vestergaard
- Dementia ClinicDepartment of NeurologyAalborg University HospitalAalborgDenmark
| | - Hanne Gottrup
- Dementia ClinicDepartment of NeurologyAarhus University HospitalAarhusDenmark
| | - Christina Jensen‐Dahm
- Danish Dementia Research CentreDepartment of NeurologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Gunhild Waldemar
- Danish Dementia Research CentreDepartment of NeurologyCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Camic PM, Sullivan MP, Harding E, Gould M, Wilson L, Rossi-Harries S, Grillo A, McKee-Jackson R, Cox SM, Stott J, Brotherhood EV, Windle G, Crutch SJ. 'Misdiagnosed and Misunderstood': Insights into Rarer Forms of Dementia through a Stepwise Approach to Co-Constructed Research Poetry. Healthcare (Basel) 2024; 12:485. [PMID: 38391860 PMCID: PMC10887667 DOI: 10.3390/healthcare12040485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/13/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024] Open
Abstract
This study investigated co-constructed research poetry as a way to understand the lived experiences of people affected by rarer dementia and as a means to use poetry to convey those experiences to healthcare professionals. Using mixed methods, 71 people living with rarer dementia and care-partners (stakeholders) contributed to co-constructing 27 poems with professional poets; stakeholders' verbatim words were analysed with descriptive qualitative analysis. Stakeholders were also surveyed and interviewed about their participation. Healthcare professionals (n = 93) were surveyed to elicit their responses to learning through poetry and its acceptability as a learning tool. Poems conveyed a shared narrative of different aspects of lived experience, often owing to atypical symptoms, misunderstandings by professionals, lack of support pathways, and a continuous struggle to adapt. Stakeholder surveys indicated it was a valuable experience to both co-create and respond to the poems, whilst group interviews revealed people's experiences of the research poetry were characterised by reflection on lived experience, curiosity and exploration. Healthcare professionals' responses reinforced poetry's capacity to stimulate cognitive and affective learning specific to rare dementia support and prompt both empathy and critical thinking in practice. As the largest poetry-based study that we are aware of, this novel accessible approach of creating group poems yielded substantial information about the experiences and needs of those affected by rarer dementia and how poetry can contribute to healthcare education and training.
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Affiliation(s)
- Paul M Camic
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Emma Harding
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Martha Gould
- Independent Researcher, North Bay, ON P1B 8L7, Canada
| | - Lawrence Wilson
- Independent Researcher, Sonic Studios, Rye, East Sussex TN31 7NY, UK
| | - Sam Rossi-Harries
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Adetola Grillo
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON P1B 8L7, Canada
| | - Roberta McKee-Jackson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Susan M Cox
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Joshua Stott
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Gill Windle
- Ageing and Dementia @ Bangor, Dementia Services Development Centre, School of Health Sciences, Bangor University, Bangor LL57 2EE, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
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Volkmer A, Cross L, Highton L, Jackson C, Smith C, Brotherhood E, Harding EV, Mummery C, Rohrer J, Weil R, Yong K, Crutch S, Hardy CJD. 'Communication is difficult': Speech, language and communication needs of people with young onset or rarer forms of non-language led dementia. Int J Lang Commun Disord 2024. [PMID: 38329409 DOI: 10.1111/1460-6984.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND People with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease may experience language and communication difficulties. However, the role of speech and language interventions for people with these non-language led dementias has received little attention. AIMS This study aimed to explore the experiences and perspectives of people living with these conditions, and their families, regarding their language and communication difficulties and how speech and language therapy could address these needs. METHODS This study employed a qualitative design to explore the experiences of people living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy or young onset Alzheimer's disease, and to understand their opinions about speech and language therapy. Participants were recruited from a support service connected to a dementia clinic to attend one of five focus group meetings. Videorecorded focus groups and interviews were transcribed, and reflexive thematic analysis was used to analyse data from people affected by each type of dementia. RESULTS A total of 25 participants were recruited to the study, with representation across the different forms of non-language led dementias. The four main themes identified were: (1) communication difficulties as a key difficulty, (2) loss and loneliness, (3) speech and language therapy, and (4) the role of the caregiver. Sixteen subthemes were also identified which highlighted individual issues across disease types. DISCUSSION Although all the forms of dementia studied here are not considered to be language-led, people with these conditions and/or their care partners identified speech, language and communication as common challenges. These communication difficulties were reported to have a negative impact on their social participation and mental health and participants felt speech and language interventions could help. There is a need for research exploring speech and language interventions developed for and with people with non-language led dementias and their care partners, to ensure they meet the needs of the people they are designed for. WHAT THIS PAPER ADDS What is already known on the subject People with primary progressive aphasia present with speech, language and communication difficulties, and several speech and language interventions have been developed to meet the needs of this population. However, people with non-language led dementias may also experience speech, language and communication difficulties, and little is known about interventions that may address these difficulties. What this paper adds to existing knowledge People living with or caring for somebody with behavioural variant frontotemporal dementia, Lewy body dementia, posterior cortical atrophy and young onset Alzheimer's disease report experiencing speech, language and communication difficulties that impact on the person with dementia's social participation and mood. Participants in this study also shared their opinions about how speech and language interventions could help, from the earliest stages of the disease. What are the potential or actual clinical implications of this work? Speech and language therapists need to address the individual speech, language and communication needs of people with dementias, even those that are not thought to be language-led. Current speech and language therapy service provision does not meet the needs of people with non-language led dementias and further research is required to develop interventions and services to meet these needs.
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Affiliation(s)
- Anna Volkmer
- Psychology and Language Sciences, University College London, London, UK
| | - Lisa Cross
- Psychology and Language Sciences, University College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Lily Highton
- Psychology and Language Sciences, University College London, London, UK
- Whittington Health NHS Trust, London, UK
| | - Connie Jackson
- Psychology and Language Sciences, University College London, London, UK
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Chloe Smith
- Psychology and Language Sciences, University College London, London, UK
- Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Emilie Brotherhood
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Emma V Harding
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Cath Mummery
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jonathan Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rimona Weil
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Keir Yong
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sebastian Crutch
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Chris J D Hardy
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
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Stevens-Neck R, Walton J, Alterkawi S, Brotherhood EV, Camic PM, Crutch SJ, Gerritzen EV, Harding E, McKee-Jackson R, Rossi-Harries S, Street RE, van der Byl Williams M, Waddington C, Wood O, Moore KJ. A mixed methods evaluation of a program exploring predeath grief and loss for carers of people with rarer dementias - CORRIGENDUM. Int Psychogeriatr 2023; 35:751. [PMID: 37129075 DOI: 10.1017/s1041610223000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Fox S. "Give me the knowledge, and I can do what I want with it, it's my right and my choice": Triangulated perspectives on the disclosure of young onset dementia. Dementia (London) 2023; 22:1757-1775. [PMID: 37505214 PMCID: PMC10644682 DOI: 10.1177/14713012231191958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Receiving a diagnosis of young onset dementia is particularly distressing; the person under 65 years is often in employment, with financial commitments, young children, and an active social life. Some of the stress experienced by younger people experiencing cognitive changes can be reduced by an early and accurate diagnosis, but this is contingent on the timing of disclosure and a process which is sensitive and appropriate to the person. The study aim was to explore experiences of giving and receiving a diagnosis of young onset dementia, by triangulating the perspectives of the key parties involved. METHODS A qualitative design was employed, using semi-structured interviews. Participants (N = 47) included people with young onset dementia (n = 10), family members (n = 12), and health and social care professionals (n = 25). Thematic analysis and triangulation enabled identification of overall themes across different participant groups. RESULTS All participant groups agreed on key aspects of good disclosure practice, with two overarching themes: The optimal conditions for disclosure, and how best to disclose a diagnosis. Positive experiences of disclosure were prefaced on having the appropriate space and time; having a support person present; clearly labelling the diagnosis; providing appropriate information at the right pace. Other findings include recommendations for longer appointment times, offering additional support for young families, and for carers of people with atypical presentations (e.g. frontotemporal dementia). CONCLUSION Many people with young onset dementia had unsatisfactory disclosure experiences. Health and social care professionals should provide a 'pre-disclosure' appointment, elicit the amount of information the person may want at the point of disclosure of the diagnosis, balance truth and hope, provide contact details for follow-up, and overall be mindful of the individual in front of them. While young onset dementia may be a life-altering diagnosis, a disclosure meeting which is sensitively undertaken can increase the person's agency, coping ability, and ultimately empower them to live well with their diagnosis.
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Affiliation(s)
- Siobhán Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Oyebode JR, La Fontaine J, Stamou V, O'Malley M, Parkes J, Carter J. Establishing and sustaining high-quality services for people with young onset dementia: the perspective of senior service providers and commissioners. Int Psychogeriatr 2023:1-10. [PMID: 37731261 DOI: 10.1017/s1041610223000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES We aimed to understand the facilitators to developing and sustaining high-quality services for people with young onset dementia (YOD) and their families/supporters. DESIGN This qualitative study used semi-structured interviews with commissioners and service managers, analyzed using inductive thematic analysis. SETTING A purposive sample of providers was selected from diverse areas and contrasting YOD services. PARTICIPANTS Eighteen senior staff from YOD services and two dementia service commissioners took part. MEASUREMENTS For commissioners, key interview topics were experiences of commissioning YOD services, perceived facilitators or barriers, and how future guidance should be structured for ease of use. For service providers, key topics explored experiences of delivering YOD services; what was achievable or challenging; how the service was funded; how it linked with broader provision for YOD in the area; and how guidance should be structured. RESULTS Recorded interviews lasted 30-40 minutes. Seven key facilitators to the development and sustaining of YOD services were identified: having knowledgeable, committed local champions; involvement of people living with YOD and family supporters; initial delivery within existing resources; partnership working within and between sectors; having a reflective, supportive organizational culture; gathering evidence of impact; and having wider support and guidance. CONCLUSIONS Improvements in provision for those with YOD and their families need to be built on understanding of service-level and interpersonal influences as well as on understanding of YOD itself. Our findings highlight a set of facilitators which need to be in place to establish and sustain high-quality YOD services that fit the local context.
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Affiliation(s)
- Jan Rachel Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jenny La Fontaine
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Vasileios Stamou
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Mary O'Malley
- Centre for Applied Mental Health Research, Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Jacqueline Parkes
- Centre for Applied Mental Health Research, Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Janet Carter
- Division of Psychiatry, Faculty of Brain Sciences, Maple House, University College London, London, UK
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Cations M. A devastating loss: driving cessation due to young onset dementia. Age Ageing 2023; 52:afad174. [PMID: 37725970 DOI: 10.1093/ageing/afad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Sturt Road Bedford Park, Adelaide 5042, Australia
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Seath P, Macedo-Orrego LE, Velayudhan L. Clinical characteristics of early-onset versus late-onset Alzheimer's disease: a systematic review and meta-analysis. Int Psychogeriatr 2023:1-17. [PMID: 37431284 DOI: 10.1017/s1041610223000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVES A number of studies have compared Alzheimer's disease (AD), the commonest form of dementia, based on their age of onset, i.e. before the age of 65 years (early-onset AD, EO-AD) to those developing after 65 years of age (late-onset AD, LO-AD), but the differences are not clear. We performed a systematic review and meta-analysis to compare clinical characteristics between EO-AD and LO-AD. DESIGN, MEASUREMENTS, AND PARTICIPANTS Medline, Embase, PsycINFO, and CINAHL databases were systematically searched for studies comparing time to diagnosis, cognitive scores, annual cognitive decline, activities of daily living (ADLs), neuropsychiatric symptoms (NPS), quality of life (QoL), and survival time for EO-AD and LO-AD patients. RESULTS Forty-two studies were included (EO-AD participants n = 5,544; LO-AD participants n = 16,042). An inverse variance method with random effects models was used to calculate overall effect estimates for each outcome. People with EO-AD had significantly poorer baseline cognitive performance and faster cognitive decline but longer survival times than people with LO-AD. There was no evidence that EO-AD patients differ from people with LO-AD in terms of symptom onset to diagnosis time, ADLs, and NPS. There were insufficient data to estimate overall effects of differences in QoL in EO-AD compared to LO-AD. CONCLUSIONS Our findings suggest that EO-AD differs from LO-AD in baseline cognition, cognitive decline, and survival time but otherwise has similar clinical characteristics to LO-AD. Larger studies using standardized questionnaires focusing on the clinical presentations are needed to better understand the impact of age of onset in AD.
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Affiliation(s)
- Paige Seath
- Academic Psychiatry Division, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Luis Enrique Macedo-Orrego
- Departamento de Psiquiatría, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Departamento de atencion especializada de adultos mayores, Instituto Nacional de Salud Mental, Lima, Peru
| | - Latha Velayudhan
- Academic Psychiatry Division, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Scott TL, Rooney D, Liddle J, Mitchell G, Gustafsson L, Pachana NA. A qualitative study exploring the experiences and needs of people living with young onset dementia related to driving cessation: 'It's like you get your legs cut off'. Age Ageing 2023; 52:afad109. [PMID: 37481262 PMCID: PMC10362976 DOI: 10.1093/ageing/afad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND driving disruptions have significant impact on individuals living with dementia, their care partners and family members. Previous studies show that for older people with dementia, stopping driving is one of the hardest things that they cope with. To date, no studies exist that address the expressed needs and experiences of people living with young onset dementia (YOD) who are adjusting to life without driving, whose needs are not well understood and whose needs might be expected to differ from those of older people with dementia. METHODS a multi-perspective, qualitative descriptive phenomenological approach was undertaken. A topic guide was developed in consultation with lived experience experts. In-depth interviews (n = 18) with 10 people with YOD and eight family caregivers were conducted, to elicit lived experiences in relation to changing and cessation of driving. Interviews were recorded and transcribed verbatim. Data were analysed using a hybrid approach, employing deductive and inductive coding. RESULTS core findings reflected the impact and coping strategies employed by people with YOD and their care partners across four themes: (i) losses and burdens, (ii) the unique challenges of YOD, (iii) coping and adjustment and (iv) how to meet needs. CONCLUSIONS driving disruptions often come at a time when people living with YOD are likely to have significant financial and family commitments, or they/their partners may be employed or raising a family, negatively impacting individual's roles and self-identities. Intervention to support emotional and practical adjustment and reduce social isolation is essential for coping.
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Affiliation(s)
- Theresa L Scott
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Donna Rooney
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072 Australia
| | - Geoffrey Mitchell
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD 4111, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
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Stevens-Neck R, Walton J, Alterkawi S, Brotherhood EV, Camic PM, Crutch SJ, Gerritzen EV, Harding E, McKee-Jackson R, Rossi-Harries S, Street RE, van der Byl Williams M, Waddington C, Wood O, Moore KJ. A mixed methods evaluation of a program exploring predeath grief and loss for carers of people with rarer dementias. Int Psychogeriatr 2023:1-12. [PMID: 37128845 DOI: 10.1017/s1041610223000236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Predeath grief conceptualizes complex feelings of loss experienced for someone who is still living and is linked to poor emotional well-being. The Road Less Travelled program aimed to help carers of people with rarer dementias identify and process predeath grief. This study evaluated the feasibility, acceptability, and preliminary effectiveness of this program. DESIGN Pre-post interventional mixed methods study. SETTING Online videoconference group program for carers across the UK held in 2021. PARTICIPANTS Nine family carers of someone living with a rare form of dementia. Eight were female and one male (mean age 58) with two facilitators. INTERVENTION The Road Less Travelled is an online, facilitated, group-based program that aims to help carers of people with rarer dementias to explore and accept feelings of grief and loss. It involved six fortnightly 2-hour sessions. MEASUREMENTS We collected measures for a range of well-being outcomes at baseline (T1), post-intervention (T2), and 3 months post-intervention (T3). We conducted interviews with participants and facilitators at T2. RESULTS Participant attendance was 98% across all sessions. Findings from the semistructured interviews supported the acceptability of the program and identified improvements in carer well-being. Trends in the outcome measures suggested an improvement in quality of life and a reduction in depression. CONCLUSION The program was feasible to conduct and acceptable to participants. Qualitative reports and high attendance suggest perceived benefits to carers, including increased acceptance of grief, and support the need for a larger-scale pilot study to determine effectiveness.
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Affiliation(s)
- Rosie Stevens-Neck
- North East London NHS Foundation Trust, London, UK
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jill Walton
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Shaima Alterkawi
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Emilie V Brotherhood
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Paul M Camic
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Esther V Gerritzen
- Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma Harding
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Roberta McKee-Jackson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Samuel Rossi-Harries
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rebecca E Street
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Millie van der Byl Williams
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Claire Waddington
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Olivia Wood
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Kirsten J Moore
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Parkville, Victoria, Australia
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Kang MJY, Farrand S, Evans A, Chiu WH, Eratne D, Kelso W, Walterfang M, Velakoulis D, Loi SM. Carer burden and behavioral disturbance is similar between younger-onset Alzheimer's disease and behavioral variant frontotemporal dementia. Int Psychogeriatr 2023:1-8. [PMID: 36756758 DOI: 10.1017/s1041610222001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES Carer burden is common in younger-onset dementia (YOD), often due to the difficulty of navigating services often designed for older people with dementia. Compared to Alzheimer's disease (AD), the burden is reported to be higher in behavioral variant frontotemporal dementia (bvFTD). However, there is little literature comparing carer burden specifically in YOD. This study hypothesized that carer burden in bvFTD would be higher than in AD. DESIGN Retrospective cross-sectional study. SETTING Tertiary neuropsychiatry service in Victoria, Australia. PARTICIPANTS Patient-carer dyads with YOD. MEASUREMENTS We collected patient data, including behaviors using the Cambridge Behavioral Inventory-Revised (CBI-R). Carer burden was rated using the Zarit Burden Inventory-short version (ZBI-12). Descriptive statistics and Mann-Whitney U tests were used to analyze the data. RESULTS Carers reported high burden (ZBI-12 mean score = 17.2, SD = 10.5), with no significant difference in burden between younger-onset AD and bvFTD. CBI-R stereotypic and motor behaviors, CBI-R everyday skills, and total NUCOG scores differed between the two groups. There was no significant difference in the rest of the CBI-R subcategories, including the behavior-related domains. CONCLUSION Carers of YOD face high burden and are managing significant challenging behaviors. We found no difference in carer burden between younger-onset AD and bvFTD. This could be due to similarities in the two subtypes in terms of abnormal behavior, motivation, and self-care as measured on CBI-R, contrary to previous literature. Clinicians should screen for carer burden and associated factors including behavioral symptoms in YOD syndromes, as they may contribute to carer burden regardless of the type.
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Affiliation(s)
- Matthew J Y Kang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Evans
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wei-Hsuan Chiu
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Wendy Kelso
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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12
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Abstract
BACKGROUND People with young onset dementia can experience stigmatization and social isolation. Peer support provides an opportunity for social connection and support. However, access to in-person peer support groups varies across the UK, and during the COVID-19 pandemic in-person peer support groups moved online. OBJECTIVES We explored the experiences of people with young onset dementia attending peer support meetings through online videoconferencing platforms, and identified barriers and facilitators. METHODS A focus group study with existing peer support groups for people with young onset dementia that had their meetings online was conducted. Participants were people living with young onset dementia. Participants were recruited through convenience and purposeful sampling. Initial contact was made with the group facilitator to discuss the study purposes and assess eligibility of the group members. The data was analysed thematically by two independent researchers, using an inductive approach. FINDINGS Four focus groups with UK-based peer support groups were conducted through the group's usual platform, including 20 participants. Through online peer support people stayed connected during the pandemic. It provided opportunities to meet people from different places and be involved in research projects. People found it a convenient way of connecting with others without having to travel. However, some missed in-person interaction and digital exclusion and challenges to navigate different platforms were identified as barriers. Organisational skills of the facilitator and support with getting into meetings can help overcome these challenges. CONCLUSION Online platforms can make peer support more accessible for people with young onset dementia as it overcomes geographical barriers as well as barriers for those who feel uncomfortable attending an in-person group. Researchers and policy makers should explore how to implement and overcome barriers to online peer support, so that peer support is more widely accessible and clearly signposted to people with young onset dementia.
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Affiliation(s)
- Esther Vera Gerritzen
- Esther V Gerritzen, Institute of Mental Health, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK.
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13
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Burkinshaw K, Tsourtos G, Cations M. System and policy-level barriers and facilitators for timely and accurate diagnosis of young onset dementia. Int J Geriatr Psychiatry 2023; 38:e5859. [PMID: 36484460 DOI: 10.1002/gps.5859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The multiyear diagnostic journey for young onset dementia (YOD) is fraught with clinical and personal difficulties and poses significant uncertainty for people living with YOD and their families. Most existing research has examined the personal and/or clinical barriers to a timely diagnosis of YOD, but less evidence exists regarding system level factors. The aim of this study is to investigate health professionals' insights for a timely and accurate YOD diagnosis at the system level. DESIGN Grounded theory qualitative study. SETTING AND PARTICIPANTS Semi-structured in-depth interviews with 11 health professionals working across varied healthcare settings were conducted online via videoconference. MEASUREMENTS Data were contrasted and compared within and between transcripts using the constant comparative method. RESULTS Seven themes emerged about barriers and facilitators for timely and accurate diagnosis of YOD: (1) stigma and awareness of YOD; (2) mismatched policy; (3) fractured health system; (4) inadequate pathways for YOD diagnostic care; (5) effective use of General Practitioners; (6) inequitable access and fragmented service navigation; (7) diverse and marginalised groups. CONCLUSION A complex web of systemic and system level barriers contributes to the delay of accurate and timely diagnosis for YOD. Diverse and marginalised groups experience greater inequitable disadvantage regarding YOD diagnostic care. There is an urgent need to focus on YOD diagnosis facilitators at the broader health system level.
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Affiliation(s)
- Kirsty Burkinshaw
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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14
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Kilty C, Cahill S, Foley T, Fox S. Young onset dementia: implications for employment and finances. Dementia (London) 2023; 22:68-84. [PMID: 36254673 PMCID: PMC9772889 DOI: 10.1177/14713012221132374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND People with young onset dementia face unique challenges. Notably, at time of symptom presentation, many people affected by young onset dementia are still employed with significant financial obligations. The aim of this study was to explore the specific impact that young onset dementia has on continued employment and finances and to identify ways to optimise post-diagnostic approaches in this regard. METHODS Purposive sampling, with a maximum variation technique, was used to recruit a small but diverse range of people with young onset dementia in Ireland. In-depth semi-structured interviews were conducted, and data were analysed using Reflexive Thematic Analysis. In total, 22 interviews were conducted with 10 people with young onset dementia and 12 spouses and children. Two themes were constructed: impact of young onset dementia on (I) employment and (II) finances. FINDINGS Participants' lived accounts showed the devastating effect of a diagnosis of young onset dementia on working life, and the resultant financial, social, and psychological consequences. Participants reported having to leave paid employment early, reported losing contracts and retiring on medical grounds. There were financial implications caused by loss of income, and many additional expenses owing to dementia were incurred. In some families, spouses had to take up employment at the same time as a caring role to mitigate the loss of income, and young children were anxious at the resultant occupational and financial tensions. CONCLUSION People diagnosed with young onset dementia encounter significant challenges associated with employment, and individual and family finances. There is a need for more specific information and guidance from healthcare professionals around employment rights, income support and welfare benefits and the pension status for this group of people. Additionally, healthcare professionals should be cognisant of the additional financial burden people face in young onset dementia when advising on services which incur out-of-pocket costs.
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Affiliation(s)
- Caroline Kilty
- Caroline Kilty, School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Republic of Ireland.
| | - Suzanne Cahill
- School of Social Work and Social Policy, Trinity College Dublin Centre for Economic and Social Research on Dementia, NUI Galway and Institute of Gerontology, Jonkoping University, Sweden
| | - Tony Foley
- Department of General Practice, 8795University College Cork, Republic of Ireland
| | - Siobhán Fox
- Centre for Gerontology and Rehabilitation, 8795University College Cork, Republic of Ireland
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15
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Novek S, Menec V. Conceptualizing access to community-based supports from the perspectives of people living with young onset dementia, family members and providers. Dementia (London) 2023; 22:180-196. [PMID: 36377262 PMCID: PMC9772890 DOI: 10.1177/14713012221138145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People living with young onset dementia and their families have significant support needs, but experience difficulties accessing services. This study explored the process of accessing community-based services drawing on semi-structured interviews with people living with dementia, family members and providers in Winnipeg, Canada. Data analysis involved a combination of inductive coding and theoretical analysis using the candidacy framework as a conceptual lens. Forced to navigate services that do not recognize people with young onset dementia as a user group, participants experienced ongoing barriers that generated continuous work and stress for families. Access was constrained by information resources geared towards older adults and restrictive eligibility criteria that constructed people with young onset dementia as "not impaired enough" or "too impaired". At the organizational level, fragmentation and underrepresentation of young onset dementia diminished access. Our findings underscore the need for continuous, coordinated supports alongside broader representation of young onset dementia within research, policy, and practice. We conclude with a discussion of how the candidacy theory could be extended to account for the social and political status of user groups.
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Affiliation(s)
- Sheila Novek
- Sheila Novek, School of Nursing, University of British Columbia.
| | - Verena Menec
- Department of Community Health Sciences, Rady Faculty of Health Sciences, 423134University of Manitoba, Winnipeg, Canada
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16
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Ellajosyula R, Narayanan J, Hegde S, Kamath V, Murgod U, Easwaran V, Seetharam R, Srinivasan M, Watson P. Delay in the diagnosis of dementia in urban India: Role of dementia subtype and age at onset. Int J Geriatr Psychiatry 2022; 37. [PMID: 36383431 DOI: 10.1002/gps.5843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Early diagnosis of dementia is crucial for timely intervention. However, frequently, there is a substantial delay in diagnosis. Therefore, it is essential to recognise and address the barriers to early diagnosis. These have not been systematically studied in India. We at a specialist memory clinic in India investigated the time from symptom onset to diagnosis of dementia and factors contributing to the delay. METHODS In this cross-sectional study, consecutive patients with dementia (n = 855) seen at a private hospital underwent a standard clinical assessment and investigations. The primary outcome variable was time from symptom onset to diagnosis (TTD). The association of age, education, gender, dementia subtype, and age of onset on TTD were examined using a univariate analysis of covariance. RESULTS The median TTD was 24 months; 43% were diagnosed after 24 months. There was a significant association between TTD and age at onset (young onset-median 36 months vs. late onset-24 months) and dementia subtype. Patients with vascular dementia were diagnosed significantly earlier as compared to patients with Alzheimer's disease (AD) and frontotemporal dementia (FTD) [median 18, 24, and 30 months, respectively]. There was no effect of gender or education on the TTD. CONCLUSION About 40% of patients with dementia were diagnosed more than 2 years after symptom onset, particularly young onset dementias and FTD. Our study findings highlight the gaps in diagnosing patients with dementia in urban India and have significant implications for developing and implementing multifaceted interventions to improve the early diagnosis of dementia.
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Affiliation(s)
- Ratnavalli Ellajosyula
- Department of Neurology, Manipal Hospitals, Bangalore, India.,Department of Neurology, Annasawmy Mudaliar Hospital, Bangalore, India
| | - Jwala Narayanan
- Department of Neurology, Manipal Hospitals, Bangalore, India.,Department of Neuropsychology, Annasawmy Mudaliar Hospital, Bangalore, India
| | - Soumya Hegde
- Department of Psychiatry, Annasawmy Mudaliar Hospital, Bangalore, India
| | - Vikram Kamath
- Department of Neurology, Apollo Hospitals, Bangalore, India
| | - Uday Murgod
- Department of Neurology, Manipal Hospitals, Bangalore, India
| | - Vandhana Easwaran
- Department of Neuropsychology, Annasawmy Mudaliar Hospital, Bangalore, India
| | | | | | - Peter Watson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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17
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Kogata T. Strengthening the National Care System for Young Onset Dementia. Int J Public Health 2022; 67:1605099. [PMID: 36405531 PMCID: PMC9668884 DOI: 10.3389/ijph.2022.1605099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tomohiro Kogata
- Obu Center for Dementia Care Research and Practices, Obu, Japan,Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya, Japan,*Correspondence: Tomohiro Kogata,
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18
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Day S, Couzner L, Laver KE, Withall A, Draper B, Cations M. Cross-sector learning collaboratives can improve post-diagnosis care integration for people with young onset dementia. Health Soc Care Community 2022; 30:e6135-e6144. [PMID: 36177663 DOI: 10.1111/hsc.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Post-diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross-sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six-module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross-sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change.
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Affiliation(s)
- Sally Day
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Leah Couzner
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, UNSW Sydney, Adelaide, New South Wales, Australia
| | - Monica Cations
- College of Education, Social Work and Psychology, Flinders University, Adelaide, South Australia, Australia
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19
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Reddy Tallapalli AV, Nashi S, Kamath SD, Srijithesh PR, Kulkarni GB, Alladi S. A Rare Genetic Cause of Young Onset Rapidly Progressive Dementia- First Report from India. Neurol India 2022; 70:781-783. [PMID: 35532660 DOI: 10.4103/0028-3886.344666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We present a case of a 40-year-old man with rapid decline in cognition followed by Parkinsonism, apraxia and stimulus sensitive myoclonus within 9 months of onset. Magnetic Resonance imaging (MRI) showed periventricular confluent white matter changes with persistent diffusion restriction even after 9 months. Clinical exome sequencing showed colony stimulating factor 1 receptor (CSF1R) gene mutation. The phenotype, MRI and genotype are suggestive of adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP). This is the first case being reported from India. Differential diagnosis of young onset dementia is broad. Therefore, finding the exact etiology is challenging. Neuroimaging and genetic analysis greatly aid in the final diagnosis.
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Affiliation(s)
- Ashok Vardhan Reddy Tallapalli
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Sneha D Kamath
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - P R Srijithesh
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
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20
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Tu MH, Tu YH, Lee HJ, Chang P. A Concept of Mobile Support System for the Young Onset Dementia in Taiwan. Stud Health Technol Inform 2021; 284:442-443. [PMID: 34920566 DOI: 10.3233/shti210766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Owing to the increasing population of young onset dementia all over the world. We designed a 6"-display Android mobile system for evaluating the potential patient of Dementia. A pilot test at experienced nursing members showed that they had strong willing of launching this design in their daily practical events.
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Affiliation(s)
- Ming-Hsiang Tu
- School of Nursing, National University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Hsiang Tu
- Department of Industrial Design, Tatung University, Taipei, Taiwan
| | - Huey-Jane Lee
- Taiwan Alzheimer's Disease Association, Taipei, Taiwan
| | - Polun Chang
- Institute of BioMedical Informatics, National Yang-Ming University, Taipei, Taiwan
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21
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Bannon SM, Reichman MR, Wang K, Uppal S, Grunberg VA, Vranceanu AM. A qualitative meta-synthesis of common and unique preferences for supportive services among persons with young onset dementia and their caregivers. Dementia (London) 2021; 21:519-539. [PMID: 34610764 DOI: 10.1177/14713012211048118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Young onset dementias (young onset dementia) produce a myriad of stressors for persons with young onset dementia and their caregivers, yet there is a critical shortage of supportive services that address their needs. To develop such services, it is necessary to first comprehensively understand persons' with young onset dementia and their caregivers' service preferences. Therefore, we conducted a meta-synthesis to integrate and summarize qualitative data on persons' with young onset dementia and caregivers' preferences for supportive services for young onset dementia, defined as support provided by medical providers, psychosocial interventions, and any other resources/services provided to promote positive adjustment in persons with young onset dementia and their caregivers. RESEARCH DESIGN AND METHODS We searched five electronic databases for qualitative articles from inception to January 2020. We extracted and synthesized data from eligible articles using thematic analysis. After removal of duplicates, we screened 219 articles identified through database and hand searches. FINDINGS Forty-three studies met our inclusion criteria. We extracted findings from these 43 studies on preferences within three a priori defined domains: 1) general characteristics of supportive services, 2) format and modality of supportive services, and 3) content for supportive services. Persons with young onset dementia and caregivers predominantly expressed common preferences, with some unique preferences based on their specific roles within the partnership. DISCUSSION AND IMPLICATIONS Persons with young onset dementia and their caregivers endorsed largely overlapping preferences, including having direct contact with providers and the ability to participate together in programs that have content and skills relevant to their specific needs and challenges. Findings can directly inform the format, content, and procedures of supportive services for persons with young onset dementia and their caregivers.
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Affiliation(s)
- Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Mira R Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Katherine Wang
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Simrit Uppal
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 2348Harvard Medical School, Boston, MA, USA
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22
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Hartmann J, Roßmeier C, Riedl L, Dorn B, Fischer J, Slawik T, Fleischhaker M, Hartmann F, Egert-Schwender S, Kehl V, Haller B, Schneider-Schelte H, Dinkel A, Jox RJ, Diehl-Schmid J. Quality of Life in Advanced Dementia with Late Onset, Young Onset, and Very Young Onset. J Alzheimers Dis 2021; 80:283-297. [PMID: 33523011 PMCID: PMC8075393 DOI: 10.3233/jad-201302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Advanced stages of dementia are characterized by severe cognitive and physical impairment. It has not yet been investigated whether persons with young onset dementia (YOD) and late onset dementia (LOD) differ in advanced disease stages. Objectives: To compare quality of life (QoL) between persons with advanced YOD and LOD; to explore the determinants of QoL; to investigate whether YOD and LOD differ with regard to symptoms and care. Methods: The study was performed in the context of EPYLOGE (IssuEs in Palliative care for persons in advanced and terminal stages of YOD and LOD in Germany). Persons with advanced dementia (PWAD) were assessed and caregivers were interviewed. QoL was measured with the proxy rating Quality of Life in Late Stage Dementia (QUALID) scale. Results: 93 persons with YOD and 98 with LOD were included. No significant differences in QoL were detected. Determinants of QoL were similar in YOD and LOD. Behavioral and psychological symptoms of dementia (BPSD), suffering and other distressing symptoms were associated with a lower QoL. In YOD but not in LOD antipsychotic treatment was associated with low QoL. The group of persons who were younger than 65 years at the time of the study visit experienced significantly more distressing symptoms than older PWAD. Conclusion: Overall, persons with advanced YOD do not appear to be disadvantaged compared to old and oldest PWAD. Special attention, however, must be paid to the group of the very young persons who seem to be particularly vulnerable.
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Affiliation(s)
- Julia Hartmann
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Carola Roßmeier
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Lina Riedl
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Bianca Dorn
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Julia Fischer
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Till Slawik
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Mareike Fleischhaker
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Florentine Hartmann
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Silvia Egert-Schwender
- Technical University of Munich, School of Medicine, Münchner Studienzentrum, Munich, Germany
| | - Victoria Kehl
- Technical University of Munich, School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Munich, Germany
| | - Bernhard Haller
- Technical University of Munich, School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Munich, Germany
| | | | - Andreas Dinkel
- Technical University of Munich, School of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Munich, Germany
| | - Ralf J Jox
- Palliative and Supportive Care Service, Chair in Geriatric Palliative Care, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Janine Diehl-Schmid
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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23
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Roβmeier C, Hartmann J, Riedl L, Dorn B, Fischer J, Hartmann F, Egert-Schwender S, Kehl V, Schneider-Schelte H, Jox RJ, Dinkel A, Diehl-Schmid J. How Do Persons with Young and Late Onset Dementia Die? J Alzheimers Dis 2021; 81:843-852. [PMID: 33843681 PMCID: PMC8203230 DOI: 10.3233/jad-210046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND End of life symptoms and symptom management as well as the quality of dying (QoD) of persons with advanced dementia (PWAD) have not yet been systematically studied in Germany. OBJECTIVE 1) To investigate symptoms, treatment and care at the end of life, advance care planning, and circumstances of death of recently deceased PWAD; 2) To determine whether there are differences between young and late onset dementia (YOD and LOD). METHODS The study was performed in the context of the project EPYLOGE (IssuEs in Palliative care for persons in advanced and terminal stages of Young-onset and Late-Onset dementia in Germany). Closest relatives of recently deceased patients with advanced YOD (N = 46) and LOD (N = 54) living at home or in long term care were interviewed. RESULTS Circumstances of death, symptoms, and treatment appeared to be similar between YOD and LOD, except that persons with LOD had significantly more somatic comorbidities and were admitted to hospital in the last three months of life more often than persons with LOD. At end of life, 60% of PWAD appeared to be "at peace". Difficulty swallowing, gurgling, shortness of breath, and discomfort were observed most frequently. Large interindividual differences in suffering and QoD were present. Determinants of QoD were not identified. CONCLUSION Our findings suggest that low QoD was caused by inadequate recognition and/or insufficient treatment of burdensome physical and emotional symptoms. PWADs' needs should be assessed regularly, and strategies focusing on treatment and implementing support for both the patient and caregiver must be established.
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Affiliation(s)
- Carola Roβmeier
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Julia Hartmann
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Lina Riedl
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Bianca Dorn
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Julia Fischer
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Florentine Hartmann
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Silvia Egert-Schwender
- Technical University of Munich, School of Medicine, Münchner Studienzentrum, Munich, Germany
| | - Victoria Kehl
- Technical University of Munich, School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Munich, Germany
| | | | - Ralf J Jox
- Palliative and Supportive Care Service, Chair in Geriatric Palliative Care, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas Dinkel
- Technical University of Munich, School of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Munich, Germany
| | - Janine Diehl-Schmid
- Technical University of Munich, School of Medicine, Department of Psychiatry and Psychotherapy, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Karnatz T, Monsees J, Wucherer D, Michalowsky B, Zwingmann I, Halek M, Hoffmann W, René Thyrian J. Burden of caregivers of patients with frontotemporal lobar degeneration - a scoping review. Int Psychogeriatr 2021; 33:891-911. [PMID: 30982478 DOI: 10.1017/S1041610219000176] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is the second-most common cause of young-onset dementia. Personality and behavior changes lead to high caregiver stress and burden, but little support is available. Our aim is to present the evidence on the characteristics, challenges and unmet needs of caregivers as well as on possible interventions. METHODS We conducted a scoping review on caregiver burden using PubMed, Web of Science and ScienceDirect. A total of 69 articles were considered eligible and were analyzed in the present study. RESULTS Through the analysis of 69 empirical articles, our results show that caregivers of patients with FTLD are often younger in age, have children and find behavioral disturbances to be the most burdensome. Nine studies assessed the needs of and support for caregivers. Ten studies compared the burden in different forms of FTLD, 19 compared FTLD to other types of dementia, and one compared the caregiver burden between two countries. Eight studies reported on interventions for caregivers or interventions taking burden into account. One study assessed the support structure for caregivers of FTLD patients. Five case reports, eight research overviews and three reviews addressed specific needs and challenges. CONCLUSIONS Further research should reproduce and validate efficacious interventions and focus on underage children of FTLD patients and findings from non-Western countries. Additionally, support structures for FTLD caregivers should be assessed and extended. Awareness both in the wider population and among healthcare professionals is an urgent need for the future.
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Abstract
BACKGROUND Dementia is a major global health problem and the search for improved therapies is ongoing. The study of young onset dementia (YOD)-with onset prior to 65 years-represents a challenge owing to the variety of clinical presentations, pathology, and gene mutations. The advantage of the investigation of YOD is the lack of comorbidities that complicate the clinical picture in older adults. Here we explore the origins of YOD. OBJECTIVE To define the clinical diversity of YOD in terms of its demography, range of presentations, neurological examination findings, comorbidities, medical history, cognitive findings, imaging abnormalities both structural and functional, electroencephagraphic (EEG) data, neuropathology, and genetics. METHODS A prospective 20-year study of 240 community-based patients referred to specialty neurology clinics established to elucidate the nature of YOD. RESULTS Alzheimer's disease (AD; n = 139) and behavioral variant frontotemporal (bvFTD; n = 58) were the most common causes with a mean age of onset of 56.5 years for AD (±1 SD 5.45) and 57.1 years for bvFTD (±1 SD 5.66). Neuropathology showed a variety of diagnoses from multiple sclerosis, Lewy body disease, FTD-MND, TDP-43 proteinopathy, adult-onset leukoencephalopathy with axonal steroids and pigmented glia, corticobasal degeneration, unexplained small vessel disease, and autoimmune T-cell encephalitis. Non-amnestic forms of AD and alternative forms of FTD were discovered. Mutations were only found in 11 subjects (11/240 = 4.6%). APOE genotyping was not divergent between the two populations. CONCLUSION There are multiple kinds of YOD, and most are sporadic. These observations point to their stochastic origins.
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Affiliation(s)
- Peter K Panegyres
- Neurodegenerative Disorders Research Pty Ltd, West Perth, Australia
- The University of Western Australia, Nedlands, Australia
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26
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Abstract
Background: Young onset dementia is associated with a longer time to diagnosis compared to late onset dementia. Earlier publications have indicated that atypical presentation is a key contributing factor to the diagnostic delay. Our hypothesis was that even the most common presentation of Alzheimer’s disease is associated with a substantial diagnostic delay in patients < 65 years. Objective: To determine the time to diagnosis, and time lags in the diagnostic pathway in typical young onset Alzheimer’s disease in central Norway. Methods: The main sources of patients were the databases at the Department of Neurology, University Hospital of Trondheim (St. Olav’s Hospital), and Department of Psychiatry, Levanger Hospital. Other sources included key persons in the communities, collaborating hospital departments examining patients with suspected cognitive impairment, and review of hospital records of all three hospitals in the area. Information on the time lags, and the clinical assessment, including the use of biomarkers, was collected from hospital notes. Caregivers were interviewed by telephone. Results: Time from first symptom to diagnosis in typical young onset Alzheimer’s disease was 5.5 years (n = 223, SD 2.8). Time from onset to contact with healthcare services (usually a general practitioner) was 3.4 years (SD 2.3). Time from contact with healthcare services to the first visit at a hospital was 10.3 months (SD 15.5). Time from first visit at a hospital to diagnosis was 14.8 months (SD 22.6). The analysis of cerebrospinal fluid core biomarkers was performed after 8.3 months (SD 20.9). Conclusion: Typical Alzheimer’s disease is associated with a substantial diagnostic delay in younger patients. Raising public awareness, and education of healthcare professionals on the aspects of young onset Alzheimer’s disease is warranted. CSF core biomarkers should be performed earlier in the hospital evaluation process.
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Affiliation(s)
- Marte Kvello-Alme
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.,Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
| | - Geir Bråthen
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, University Hospital of Trondheim, Trondheim, Norway
| | - Linda R White
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Sigrid Botne Sando
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, University Hospital of Trondheim, Trondheim, Norway
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Ortner M, Riedl L, Jox RJ, Hartmann J, Roßmeier C, Dorn B, Kehl V, Egert-Schwender S, Fischer J, Diehl-Schmid J. Suicidal Ideations and Behavior in Patients With Young and Late Onset Dementia. Front Neurol 2021; 12:647396. [PMID: 34385968 PMCID: PMC8353362 DOI: 10.3389/fneur.2021.647396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Data on suicidal ideation, behavior and the risk factors in patients with dementia is scarce. To evaluate the prevalence of death wishes, suicidal ideation, and suicidal behavior of young (YOD) and late onset dementia (LOD) and to identify risk factors for suicidal ideation and behavior. Methods: We interviewed 157 family caregivers of patients with advanced dementia using questions from the Columbia-Suicide Severity Rating Scale to gather information about suicidal ideation and behavior before the onset of symptoms of dementia, after the onset of dementia and within 30 days prior to the interview. At the time of the interview, we also assessed disease severity, cognitive function, and other psychological, behavioral and physical symptoms of the patients as well as the caregivers' psychological well-being. Results: Forty four (28%) of the patients expressed suicidal ideation or behavior at some time after the onset of symptoms, and 14 (9%) of these within the month prior to the assessment. Two patients had attempted suicide after the onset of dementia. There were no statistically significant differences between patients with and without suicidal ideations or behavior with regards to demographics or age at onset of dementia. In patients with advanced dementia, Alzheimer's disease (rather than frontotemporal lobar degeneration), better cognitive function, more severe psychological, behavioral, and physical symptoms, and a reduced quality of life were associated with the expression of suicidal ideation. Conclusions: According to caregivers' reports, majority of patients with dementia did not express suicidal ideation or show suicidal behavior. Patients who expressed suicidal ideation during early stages of dementia often stopped expressing them in advanced stages. It remains unclear if this was due to reduced communication abilities, a reduction of disease awareness, and/ or an adjustment to their situation.
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Affiliation(s)
- Marion Ortner
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ralf J Jox
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Chair in Geriatric Palliative Care, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julia Hartmann
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carola Roßmeier
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bianca Dorn
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- School of Medicine, Klinikum rechts der Isar, Institute for Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany.,Münchner Studienzentrum, Technical University of Munich, Munich, Germany
| | | | - Julia Fischer
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany
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Musa G, Slachevsky A, Muñoz-Neira C, Méndez-Orellana C, Villagra R, González-Billault C, Ibáñez A, Hornberger M, Lillo P. Alzheimer's Disease or Behavioral Variant Frontotemporal Dementia? Review of Key Points Toward an Accurate Clinical and Neuropsychological Diagnosis. J Alzheimers Dis 2021; 73:833-848. [PMID: 31884475 DOI: 10.3233/jad-190924] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the most common neurodegenerative early-onset dementias. Despite the fact that both conditions have a very distinctive clinical pattern, they present with an overlap in their cognitive and behavioral features that may lead to misdiagnosis or delay in diagnosis. The current review intends to summarize briefly the main differences at the clinical, neuropsychological, and behavioral levels, in an attempt to suggest which aspects would facilitate an adequate diagnosis in a clinical setting, especially in Latin American and low- and middle-income countries, where the resources needed for a differential diagnosis (such as MRI or biomarkers) are not always available. A timely diagnosis of AD and FTD have significant implications for the medical management and quality of life of patients and careers.
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Affiliation(s)
- Gada Musa
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Department of Physiopathology, ICBM, Department of Neurosciences, Department of East Neuroscience, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile.,Universidad de los Andes, Santiago, Chile.,Capredena, Health and Rehabilitation Center, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Department of Physiopathology, ICBM, Department of Neurosciences, Department of East Neuroscience, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile.,Gerosciences Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile.,Memory and Neuropsychiatric Clinic (CMYN) Neurology Department- Hospital del Salvador and University of Chile, Providencia, Santiago, Chile.,Departamento de Medicina, Servicio de Neurología, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Carlos Muñoz-Neira
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department- Hospital del Salvador and University of Chile, Providencia, Santiago, Chile.,Research into Memory, Brain Sciences and Dementia Group (ReMemBr Group), Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Carolina Méndez-Orellana
- Carrera de Fonoaudiología, Departamento Ciencias de la Salud, Facultad de Medicina, Universidad Católica de Chile, Santiago, Chile
| | - Roque Villagra
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Department of Physiopathology, ICBM, Department of Neurosciences, Department of East Neuroscience, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile.,Gerosciences Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile
| | - Christian González-Billault
- Gerosciences Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile.,Department of Biology, Faculty of Sciences, Universidad de Chile, Santiago, Chile.,The Buck Institute for Research on Aging, Novato, CA, USA
| | - Agustín Ibáñez
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile.,Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Sydney, Australia
| | | | - Patricia Lillo
- Gerosciences Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile.,Department of Neurology South, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Abstract
Background: The epidemiology of young onset dementia is little researched compared to late onset dementia. Information on incidence rates is vital for medical professionals, and for government planning purposes. Objective: To determine the incidence of young onset dementia in a defined catchment area of central Norway. Methods: The target area was Trøndelag county in central Norway with a total population of 449,796 inhabitants per January 1, 2016. We applied multiple case ascertainment strategies with sources from both primary and secondary healthcare facilities. Included patients received a diagnosis of dementia according to DSM-IV in the ages 30 to 64 years during the years 2015–2017. Subtypes of dementia were diagnosed according to standardized criteria. Incidence rates for dementia and Alzheimer’s disease with dementia were calculated according to age and sex. Results: A total of 89 incident cases were included. Incidence rates for dementia were 14.8 and 25.0 per 100,000 person-years for the age range 30–64 and 45–64, respectively. Corresponding incidence rates for Alzheimer’s disease were 6.7 and 11.8. Alzheimer’s disease represented half of all dementias. A majority of patients above the age of 50 had neurodegenerative disease, whereas non-degenerative disorders were more prevalent in younger patients. Conclusion: Young onset dementia is a significant contributor to the overall occurrence of dementia in central Norway, and Alzheimer’s disease is by far the most common diagnosis.
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Affiliation(s)
- Marte Kvello-Alme
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway.,Department of Psychiatry, Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway
| | - Geir Bråthen
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway.,University Hospital of Trondheim, Department of Neurology, Trondheim, Norway
| | - Linda R White
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway.,University Hospital of Trondheim, Department of Neurology, Trondheim, Norway
| | - Sigrid Botne Sando
- Department of Neuromedicine and Movement Science (INB), NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway.,University Hospital of Trondheim, Department of Neurology, Trondheim, Norway
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30
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Mayrhofer AM, Greenwood N, Smeeton N, Almack K, Buckingham L, Shora S, Goodman C. Understanding the financial impact of a diagnosis of young onset dementia on individuals and families in the United Kingdom: Results of an online survey. Health Soc Care Community 2021; 29:664-671. [PMID: 33745216 DOI: 10.1111/hsc.13334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/07/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
Although literature on postdiagnostic support for people affected by young onset dementia acknowledges financial concerns, this topic has remained underresearched. The aim of this study was to explore the financial impact of a diagnosis of young onset dementia on individuals and families. An online survey, comprising binary yes/no, multiple-response and open-ended questions, was codesigned with people living with young onset dementia. The survey was promoted via networks and online platforms. Data were collected from August to October 2019. Survey respondents across the United Kingdom (n = 55) who had received a diagnosis of young onset dementia were aged between 45 and 64, were at different stages of dementia and had been diagnosed with thirteen different types of dementia. Of the 55 respondents, 71% (n = 39) had received assistance from family members when completing the survey. The main financial impact of a diagnosis of young onset dementia resulted from premature loss of income and reduced and often deferred pension entitlements. In some cases, care-costs became unaffordable. Lack of clarity of processes and procedures around needs assessments, carers' assessments and financial assessments by different organisations resulted in some families having to ask for legal advice and, in some cases, involved lengthy appeal processes. Future research needs to involve Adult Social Care and Third Sector organisations to help codesign and test financial management interventions to support people affected by this progressive health condition.
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Affiliation(s)
- Andrea M Mayrhofer
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Nan Greenwood
- Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK
| | - Nigel Smeeton
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Kathryn Almack
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Shaheen Shora
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- CRIPACC, Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
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31
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Ottoboni G, Stamou V, Chirico I, De Riso L, Allione L, Johannessen A, Chattat R. Needs-appropriate services for people with young onset dementia: The perspectives of healthcare professionals. Dementia (London) 2021; 20:2725-2745. [PMID: 33896232 DOI: 10.1177/14713012211009340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Young onset dementia has become a growing challenge in national healthcare systems. Concerns about the situation have already been expressed; however, they mostly report the views of services end-users. Aimed at finding out useful further improvement, interviews documenting the working experiences of professionals addressing healthcare services to people with young onset dementia (YOD) were analysed qualitatively. The interviews resulted in four themes and twelve categories. The themes regarded services' complexity and responsiveness, the levels of education and knowledge on YOD, the impact that serving people with YOD reflects on staff working experience and quality of life, and a series of proposals aimed at improving services by giving people with YOD and families the provision of care they deserve. Although some of the themes recapped the ones reported in the previous literature, the mixture of internally and externally driven instances represented in the themes depict the complexity of care delivery in the services. Findings are discussed in the light of a pragmatical framework capable of suggesting what changes services should implement to be timely responsive.
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Affiliation(s)
- Giovanni Ottoboni
- Department of Psychology; "Giorgio Prodi" Center for Cancer Research, Alma Mater Studiorum, 9296University of Bologna, Bologna, Italy
| | - Vasileios Stamou
- Department of Psychology, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Ilaria Chirico
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Laura De Riso
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Luisa Allione
- Department of Psychology, 9296University of Bologna, Bologna, Italy
| | - Aud Johannessen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway USN, Norway/ Vestfold Hospital Trust, National Advisory Unit on Ageing and HealthNational Advisory Unit on Ageing and Health, Norway
| | - Rabih Chattat
- Department of Psychology, 9296University of Bologna, Bologna, Italy
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Abstract
Individuals with young onset dementia and their families face unique challenges, such as disruptions to their life cycle and relationships and a dearth of appropriate supports. Financial consequences have also been noted in the literature yet have not been explored in-depth. The purpose of this research was to qualitatively explore carers’ experiences of financial consequences resulting from the young onset dementia of a family member and how these consequences may be managed. Eight carers (7 women and 1 man) provided a written online narrative about their journey with young onset dementia and any financial consequences experienced, with open-ended prompts to elicit details not yet shared. Narratives were inductively coded and analyzed using a thematic narrative approach. Carers described a voluntary or involuntary end to employment for the person with young onset dementia around the time of diagnosis. This engendered ongoing and anticipated financial consequences, combined with the need for carers to balance employment with the provision of care (which often meant early retirement for spousal carers). Common themes were tension between the needs to provide care and earn income, altered financial prospects, costs of care, and lack of available and accessible supports to ameliorate financial consequences. Findings illustrate the reality of financial consequences across the trajectory of young onset dementia. These consequences may manifest differently for spousal and child carers and are not being adequately addressed by existing supports.
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Affiliation(s)
- Melanie Bayly
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
| | - Megan E O'Connell
- Department of Psychology, 7235University of Saskatchewan, Saskatoon, Canada
| | - August Kortzman
- Department of Psychology, 7235University of Saskatchewan, Saskatoon, Canada
| | - Shelley Peacock
- College of Nursing, 7235University of Saskatchewan, Saskatoon, Canada
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
| | - Andrew Kirk
- College of Medicine, 7235University of Saskatchewan, Saskatoon, Canada
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Cartwright AV, Stoner CR, Pione RD, Spector A. The experiences of those affected by parental young onset dementia: A qualitative systematic literature review. Dementia (London) 2021; 20:2618-2639. [PMID: 33517771 PMCID: PMC8564265 DOI: 10.1177/1471301220988231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To develop understanding of the lived experiences of children of people living with young onset dementia, defined as individuals both under and over the age of 18 years whose parent was diagnosed with dementia before the age of 65 years. METHOD A critical appraisal and thematic synthesis of the available qualitative literature regarding the lived experience of individuals whose parent has a diagnosis of young onset dementia. A three-stage approach for conducing thematic synthesis was followed. RESULTS 15 articles were included in the review. Four analytical themes and 11 subthemes were found. The analytical themes were 'making sense of dementia', 'impact of dementia', 'coping' and 'support'. CONCLUSIONS The experiences of those affected by parental young onset dementia vary widely. There is a lack of knowledge and understanding of young onset dementia by professionals and the public, and a scarcity of appropriate support. This has clinical implications for professionals working with families affected by young onset dementia, in particular with regards to service design and delivery.
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Affiliation(s)
- Anna V Cartwright
- Department of Clinical, Educational and Health Psychology, 4919University College London (UCL), UK
| | - Charlotte R Stoner
- Department of Clinical, Educational and Health Psychology, 4919University College London (UCL), UK
| | - Richard D Pione
- Department of Clinical, Educational and Health Psychology, 4919University College London (UCL), UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, 4919University College London (UCL), UK
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Novek S, Menec VH. Age, Dementia, and Diagnostic Candidacy: Examining the Diagnosis of Young Onset Dementia Using the Candidacy Framework. Qual Health Res 2021; 31:498-511. [PMID: 33213257 DOI: 10.1177/1049732320970199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
People living with young onset dementia face significant barriers to diagnosis, resulting in delays, misdiagnoses, and treatment gaps. We examined the process of accessing and delivering a diagnosis of young onset dementia using the candidacy framework as a conceptual lens. Semi-structured interviews were conducted with six people living with dementia, 14 family members, and 16 providers in a western Canadian city. Participants' accounts revealed the diagnosis of young onset dementia as a negotiated process involving patients, family members, and health professionals. Assumptions about age and dementia affected how participants interpreted their symptoms, how they presented to services, and how they, in turn, were perceived by providers. At the organizational level, age-restrictions, fragmentation, and unclear referral pathways further complicated the diagnostic process. Our findings lend support to the growing call for specialist young onset dementia care and point toward several recommendations to develop more age-inclusive diagnostic services.
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Affiliation(s)
- Sheila Novek
- University of Manitoba, Winnipeg, Manitoba, Canada
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O'Malley M, Parkes J, Stamou V, LaFontaine J, Oyebode J, Carter J. International consensus on quality indicators for comprehensive assessment of dementia in young adults using a modified e-Delphi approach. Int J Geriatr Psychiatry 2020; 35:1309-1321. [PMID: 32584457 DOI: 10.1002/gps.5368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 06/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop guidance for clinicians about essential elements that can support clinical decision-making in the diagnostic workup of young onset dementia. METHODS/DESIGN Three iterations of a modified e-Delphi consensus survey comprising 23 international expert clinicians specialising in diagnosis of young onset dementia. OUTCOME MEASURES A priori consensus was pre-defined as 80% of experts ranking statements in the upper threshold on a seven-point Likert scale that ranged from "not important at all" to "absolutely essential" to diagnosis. RESULTS 80% consensus was reached on 48 statements that were rated as "absolutely essential" or "very important" to a comprehensive assessment of dementia in a younger adult. In order to inform a subsequent audit of clinical records in which compliance with these statements was assessed, the statements were divided into a Minimum Standard, (consisting of the 15 statements voted by all experts as being "absolutely essential" or "very important") and a Gold Standard where 48 statements were voted by 80% of the experts as being "absolutely essential" or "very important". The experts' response rate across the three rounds was 91.3%. CONCLUSION A Minimum Standard and Gold Standard have been created for the diagnostic workup of young onset dementia. The standards provide a clinically useful tool for decision-making, particularly for generalists and those with less experience in the field. The standards will be used to inform a UK case note audit of recently diagnosed patients with young onset dementia.
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Affiliation(s)
- Mary O'Malley
- UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Jacqueline Parkes
- UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - Vasileios Stamou
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jenny LaFontaine
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Janet Carter
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
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O'Malley M, Parkes J, Campbell J, Stamou V, LaFontaine J, Oyebode JR, Carter J. Receiving a diagnosis of young onset dementia: Evidence-based statements to inform best practice. Dementia (London) 2020; 20:1745-1771. [PMID: 33124442 PMCID: PMC8216318 DOI: 10.1177/1471301220969269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Better understanding of patient experience is an important driver for service improvements and can act as a lever for system change. In the United Kingdom, the patient experience is now a central issue for the National Health Service Commissioning Board, clinical commissioning groups and the providers they commission from. Traditionally, dementia care in the United Kingdom has focused predominantly on the individual experience of those with late onset dementia, while the voice of those with young onset dementia has been, comparatively, unheard. This study aims to improve the understanding of the personal experience of younger people undergoing investigation for dementia. Methods A modified Delphi approach was undertaken with 18 younger people with dementia and 18 supporters of people with young onset dementia. Questions were informed by a scoping review of the literature (O’Malley, M., Carter, J., Stamou, V., Lafontaine, J., & Parkes, J. (2019a). Receiving a diagnosis of young onset dementia: A scoping review of lived experiences. Ageing & Mental Health, 0(0), 1-12). Summary individual statements were refined over two rounds to a final list of 29 key statements. Results Twenty-seven of these statements were rated as absolutely essential or very important and included (1) for the general practitioner to identify dementia in younger people, (2) clinicians should be compassionate, empathic and respectful during the assessment and particularly sensitive when providing information about a diagnosis, and (3) remembering that receiving the diagnosis is a lot to absorb for a person with dementia and their supporter. Statistical analyses found no difference in the scoring patterns between younger people with dementia and supporters, suggesting similar shared experiences during the diagnostic process. Conclusion Understanding the uniquely personal experience of young people going through the process of diagnosis for dementia is essential to provide person-centred, needs-led, and cost-effective services. Patient’s values and experiences should be used to support and guide clinical decision-making.
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Affiliation(s)
| | - Jacqueline Parkes
- UoN Dementia Research & Innovation Centre, Faculty of Health, Education and Society, 6087University of Northampton, Northampton, UK
| | - Jackie Campbell
- Faculty of Health, Education and Society, 6087University of Northampton, Northampton, UK
| | | | | | - Jan R Oyebode
- Centre for Applied Dementia Studies, Faculty of Health Studies, 1905University of Bradford, Bradford, UK
| | - Janet Carter
- Faculty of Brain Sciences, Division of Psychiatry, Maple House, 4919University College London, London, UK
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Metcalfe A, Jones B, Mayer J, Gage H, Oyebode J, Boucault S, Aloui S, Schwertel U, Böhm M, Tezenas du Montcel S, Lebbah S, De Mendonça A, De Vugt M, Graff C, Jansen S, Hergueta T, Dubois B, Kurz A. Online information and support for carers of people with young-onset dementia: A multi-site randomised controlled pilot study. Int J Geriatr Psychiatry 2019; 34:1455-1464. [PMID: 31111516 DOI: 10.1002/gps.5154] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/04/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The European RHAPSODY project sought to develop and test an online information and support programme for caregivers of individuals diagnosed with young onset dementia. The objectives were to assess user acceptability and satisfaction with the programme and to test outcome measures for a larger effectiveness study. DESIGN A pilot randomised controlled trial in England, France, and Germany was conducted with 61 caregivers for adults with young onset Alzheimer's disease or frontotemporal degeneration. Evaluations at baseline, week 6, and week 12 assessed user acceptability and satisfaction. Use of the programme was measured from online back-end data. Qualitative feedback on user experiences was collected via semi-structured interviews. Measures of caregiver well-being (self-efficacy, stress, burden, frequency of patient symptoms, and caregiver reactions) were explored for use in a subsequent trial. RESULTS Participants logged in online on average once a week over a 6-week period, consulting approximately 31% of programme content. Seventy percent of participants described the programme as useful and easy to use. Eighty-five percent expressed intent to use the resource in the future. Reductions in reported levels of stress and caregivers' negative reactions to memory symptoms were observed following use of the programme. CONCLUSIONS Results indicated that the RHAPSODY programme was acceptable and useful to caregivers. The programme may be complementary to existing services in responding to the specific needs of families affected by young onset dementia. Distribution of the programme is underway in England, France, Germany, and Portugal.
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Affiliation(s)
- Anna Metcalfe
- Hôpital de la Pitié-Salpêtrière, Sorbonne University, Assistance Publique - Hôpitaux de Paris AP-HP, Paris, France
| | - Bridget Jones
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Johannes Mayer
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Sarah Boucault
- Hôpital de la Pitié-Salpêtrière, Sorbonne University, Assistance Publique - Hôpitaux de Paris AP-HP, Paris, France
| | - Sabrina Aloui
- Hôpital de la Pitié-Salpêtrière, Sorbonne University, Assistance Publique - Hôpitaux de Paris AP-HP, Paris, France
| | - Uta Schwertel
- IMC, Information Multimedia Communication AG, Saarbrücken, Germany
| | - Markus Böhm
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sophie Tezenas du Montcel
- Sorbonne Universités, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Said Lebbah
- Hôpital de la Pitié-Salpêtrière, Sorbonne University, Assistance Publique - Hôpitaux de Paris AP-HP, Paris, France
| | | | - Marjolein De Vugt
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Caroline Graff
- Karolinska Institutet, Department NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Bioclinicum J10:20, Solna, Sweden.,Karolinska University Hospital, Theme Aging, Unit for Hereditary Dementias, Solna, Sweden
| | | | - Thierry Hergueta
- Hôpital de la Pitié-Salpêtrière, Sorbonne University, Assistance Publique - Hôpitaux de Paris AP-HP, Paris, France.,Laboratoire de Psychopathologie et Processus de Santé, Institut de Psychologie Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Bruno Dubois
- Hôpital de la Pitié-Salpêtrière, Sorbonne University, Assistance Publique - Hôpitaux de Paris AP-HP, Paris, France
| | - Alexander Kurz
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Cations M, Draper B, Low LF, Radford K, Trollor J, Brodaty H, Sachdev P, Gonski P, Broe GA, Withall A. Non-Genetic Risk Factors for Degenerative and Vascular Young Onset Dementia: Results from the INSPIRED and KGOW Studies. J Alzheimers Dis 2019; 62:1747-1758. [PMID: 29614682 DOI: 10.3233/jad-171027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several brain reserve, vascular risk, and other modifiable factors have been associated with late-onset dementia, but their association with young onset dementia (YOD) has not been adequately explored. OBJECTIVE To examine the association of cognitive reserve enhancing factors, cardiovascular risk factors (including smoking), depression, alcohol use, and traumatic brain injury (TBI) with non-autosomal dominant degenerative and/or vascular YOD. METHODS Data for this matched case-control study were taken from two larger studies conducted in NSW, Australia. One comprised all people with YOD within a geographical region, while the other exclusively included Aboriginal and Torres Strait Islander participants. Dementia diagnosis was confirmed by clinical consensus, and risk exposure was retrospectively self- and/or informant-reported. RESULTS Participants were 96 people with YOD (58.4% with probable Alzheimer's disease) and 175 age-group, sex, and sample matched control participants. Poor educational attainment, low participation in cognitive leisure activity, stroke, transient ischemic attack, and self-reported very heavy alcohol use were related to the risk of primary degenerative and/or vascular YOD. The effect of hypertension and depression varied depending on when they occurred relative to dementia onset. Current smoking was significantly associated with risk in univariate analyses but did not retain significance in multivariate modelling. There was no association with hypercholesterolemia, diabetes, or TBI of any kind. Some compensation for low educational attainment was possible via a complex occupation later in life. CONCLUSION Non-genetic factors have a role in YOD, though the relative importance of each factor may be different to late onset dementia. The timing and severity of exposure, as well as the potential for compensation with later protective exposures, are important considerations for potential prevention strategies.
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Affiliation(s)
- Monica Cations
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Brian Draper
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
| | - Julian Trollor
- Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia.,Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia
| | - Perminder Sachdev
- Dementia Centre for Research Collaboration, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,Centre for Healthy Brain Ageing, UNSW Sydney, Sydney, NSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Peter Gonski
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia.,Division of Aged and Extended Care (Southcare), Sutherland Hospital, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Gerald Anthony Broe
- Neuroscience Research Australia, Sydney, NSW, Australia.,School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
| | - Adrienne Withall
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
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Lim L, Zhang A, Lim L, Choong TM, Silva E, Ng A, Kandiah N. High Caregiver Burden in Young Onset Dementia: What Factors Need Attention? J Alzheimers Dis 2019; 61:537-543. [PMID: 29171995 DOI: 10.3233/jad-170409] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is an increase in prevalence of young onset dementia (YOD). The specific problems among YOD patients and levels of caregiver burden (CB) in this group warrants further evaluation. OBJECTIVE To evaluate and compare level of CB in YOD and late onset dementia (LOD). Also, we sought to understand the specific factors, such as neuropsychiatric symptoms, that may affect the levels of caregiver burden in the YOD group. METHODS Patient-caregiver dyads with YOD and LOD were recruited from a tertiary neurology center. Levels of CB between YOD and LOD were compared among 183 patient-caregiver dyads. CB was quantified using the Zarit Burden Inventory (ZBI). Neuropsychological evaluations as well as the Neuropsychiatric Inventory were performed. Factors that influenced level of CB in YOD group was investigated with regression analyses. RESULTS There were 57 YOD and 126 LOD dyads. Caregivers of YOD subjects reported significantly higher levels of burden compared to caregivers of LOD subjects (ZBI: 17.3 versus 13.94; p = 0.015). 52.6% of YOD caregivers reported a high caregiver burden. When compared to caregivers of LOD, the odds of a caregiver of YOD reporting high caregiver burden was 2.34 (95% CI: 1.22-4.49: p = 0.010). YOD dyads with a high caregiver burden had significantly higher neuropsychiatric inventory scores. Risk factors for high caregiver burden in YOD included family history of dementia and behavioral symptoms including disinhibited behavior, delusions, and apathy. CONCLUSION Targeted support for caregivers of patients with YOD is needed to address the higher CB in this group.
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Affiliation(s)
- Linda Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Angeline Zhang
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Eveline Silva
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Adeline Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke-NUS, Graduate Medical School, Singapore
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Abstract
AIM Despite an estimated 40 000 people diagnosed with young onset dementia (YOD) in the UK, there is a general lack of awareness of the condition when compared with late onset dementia. The aim of this study was to explore the experiences and needs of people living with YOD (younger than 65 years) and gain an understanding of the issues that impact on them. SETTING Participants' homes, support group premises or university rooms. PARTICIPANTS 14 people with a diagnosis of YOD from a northern UK city. DESIGN Semistructured, in-depth interviews were audio recorded, transcribed and analysed cross-sectionally following principles of interpretative phenomenological analysis. RESULTS Four superordinate themes are reported on 'process of diagnosis', 'the impact of living YOD', 'needs of people with YOD' and 'living well with YOD'. Nine subordinate themes captured participant experiences of developing cognitive difficulties, after being diagnosed with YOD, and subsequently living with the condition. Key issues that emerging included a lack of general awareness of YOD; how this can delay help seeking; commonalities in prediagnosis trajectories; retrospective understanding of prediagnosis symptom patterns; the difficulties of obtaining a firm diagnosis; the importance of face-to-face support and difficulties associated with daily living. Participants also described the emotional and psychological impact of the condition and the importance of formal and informal support networks. CONCLUSIONS People who have a diagnosis of YOD regard themselves as distinct from older people with dementia. Despite similar symptoms, the context in which they experience the condition creates a range of distinct psychosocial concerns not commonly well addressed by health and social care services. As awareness of YOD continues to grow, the development (or adaptation) of services that take into account the idiosyncratic needs of people with YOD should be addressed.
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Affiliation(s)
- Luisa I Rabanal
- Salford Institute for Dementia, University of Salford, Salford, UK
| | - John Chatwin
- Salford Institute for Dementia, University of Salford, Salford, UK
| | - Andy Walker
- Salford Institute for Dementia, University of Salford, Salford, UK
| | - Maria O’Sullivan
- Salford Institute for Dementia, University of Salford, Salford, UK
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Mayrhofer AM, Mathie E, McKeown J, Goodman C, Irvine L, Hall N, Walker M. Young onset dementia: Public involvement in co-designing community-based support. Dementia (London) 2018; 19:1051-1066. [PMID: 30122064 PMCID: PMC7180317 DOI: 10.1177/1471301218793463] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Whilst the support requirements of people diagnosed with young onset dementia are
well-documented, less is known about what needs to be in place to provide
age-appropriate care. To understand priorities for service planning and
commissioning and to inform the design of a future study of community-based
service delivery models, we held two rounds of discussions with four groups of
people affected by young onset dementia (n = 31) and interviewed memory services
(n = 3) and non-profit service providers (n = 7) in two sites in England.
Discussions confirmed published evidence on support requirements, but also
reframed priorities for support and suggested new approaches to dementia care at
the community level. This paper argues that involving people with young onset
dementia in the assessment of research findings in terms of what is important to
them, and inviting suggestions for solutions, provides a way for co-designing
services that address the challenges of accessing support for people affected by
young onset dementia.
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Affiliation(s)
| | - Elspeth Mathie
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jane McKeown
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Lisa Irvine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Natalie Hall
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Michael Walker
- Hertfordshire Partnership University Foundation Trust, Logandene, Hertfordshire, UK
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Abstract
Early-onset Alzheimer's disease (EOAD) accounts for 1-5% of Alzheimer's disease cases and is associated with specific ethnicities. It has been our impression that non-Ashkenazi Jews have a higher rate of EOAD and we therefore explored this hypothesis. We performed a retrospective case control study of EOAD cases referred to our cognitive neurology clinic between January 1999 and December 2016. Patients (n = 129) were compared to age- and geographically-matched controls generated from the Second Israeli National Health Survey (n = 1,811). Data on country of origin, education, dementia family history, depression, and vascular risk factors were compared between the groups. The association of non-Ashkenazi Jewish heritage and country of origin with EOAD was calculated using a logistic multivariate regression model. The EOAD group's mean age was 59.6±4.1 years, with a female predominance (64.3%). The EOAD group had a higher percentage of individuals of non-Ashkenazi Jewish origin (64.3% versus 51.4%, p = 0.003) and of Yemenite descent in particular (16.28% versus 6.24%, p < 0.001). On multiple logistic regression analysis, Yemenite Jewish origin was an independently associated with EOAD (OR 2.54, 95% CI 1.4-4.8). There were no significant differences in parameters between non-Ashkenazi and Ashkenazi Jews. Only 4.6% of EOAD cases had a positive EOAD family history. In conclusion, EOAD is over-represented among non-Ashkenazi Jews. Yemenite origin is independently associated with EOAD and the majority of patients with EOAD have no family history of Alzheimer's disease. Further evaluation with genetic studies is warranted.
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Affiliation(s)
- Ophir Keret
- Cognitive Neurology Clinic, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Department of Neurology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzippy Shochat
- Statistical Consultancy Service, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Israel Steiner
- Cognitive Neurology Clinic, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Department of Neurology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Glik
- Cognitive Neurology Clinic, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Department of Neurology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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van Duinen-van den IJssel JCL, Appelhof B, Zwijsen SA, Smalbrugge M, Verhey FRJ, de Vugt ME, Zuidema SU, Koopmans RTCM, Bakker C. Behavior and Evolution of Young ONset Dementia part 2 (BEYOND-II) study: an intervention study aimed at improvement in the management of neuropsychiatric symptoms in institutionalized people with young onset dementia. Int Psychogeriatr 2018; 30:437-46. [PMID: 28595662 DOI: 10.1017/S1041610217000941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:Both neuropsychiatric symptoms (NPS) and psychotropic drug use (PDU) are common in institutionalized People with Young Onset Dementia (PwYOD) and can produce negative outcomes such as reduced quality of life and high workload. In community-dwelling PwYOD, NPS are found to be associated with unmet care needs. This emphasizes the importance of a care program for the management of NPS in institutionalized PwYOD that also addresses unmet care needs and PDU. The objectives of the Behavior and Evolution of Young ONset Dementia part 2 (BEYOND-II) study are to develop a care program for the management of NPS in institutionalized PwYOD and to evaluate its effectiveness. METHODS The care program consists of an educational program combined with an intervention to manage NPS with the following five steps: the evaluation of psychotropic drug prescription, detection, analysis (including the detection of unmet needs), treatment and the evaluation of NPS. A stepped wedge design will be used to evaluate its effectiveness. The primary outcomes are agitation and aggression and other NPS. The secondary outcomes are PDU, quality of life, the workload of nursing staff and job satisfaction. Additionally, a process analysis and a cost-consequence analysis will be conducted. CONCLUSIONS The study protocol of the Beyond-II study describes the development, implementation and evaluation of a care program for the management of NPS in institutionalized PwYOD. This care program provides a structured method for the management of NPS, in which unmet needs and PDU are also addressed.
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Millenaar JK, Bakker C, van Vliet D, Koopmans RTCM, Kurz A, Verhey FRJ, de Vugt ME. Exploring perspectives of young onset dementia caregivers with high versus low unmet needs. Int J Geriatr Psychiatry 2018. [PMID: 28643900 DOI: 10.1002/gps.4749] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study is part of the Research to Assess Policies and Strategies for Dementia in the Young project. Information about specific needs in young onset dementia (YOD) will provide the basis for the development of an e-health intervention to assist caregivers in coping with YOD in several European countries. OBJECTIVE The aim was to investigate the issues caregivers of people with YOD face. METHODS A qualitative content analysis method was used to analyse interviews with YOD caregivers. Quantitative data of the Needs in Young Onset Dementia study were used to select caregivers based on a ranking of unmet needs, to capture differences and similarities between caregivers that experienced high levels of unmet needs versus those with low levels of unmet needs. Needs were assessed with the Camberwell Assessment of Needs in the Elderly. RESULTS Findings revealed the following themes: (i) acceptance; (ii) perception of the relationship; (iii) role adaptation; (iv) Availability of appropriate services; (v) social support; and (vi) awareness in the person with dementia and acceptance of help. Several factors seemed more apparent in the caregivers who experienced few unmet needs opposed to the caregivers who experienced more unmet needs. CONCLUSION The current study provides an in-depth perspective on the caregiver's experiences and emphasizes specific themes that could be addressed in future interventions. This might contribute to a caring situation in which the caregiver experiences less unmet needs. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joany K Millenaar
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christian Bakker
- Florence, Mariahoeve Center for Specialized Care in Young-Onset Dementia, Den Haag, The Netherlands
- Department of Primary and Community Care: Center for Family Medicine, Geriatric Care and Public Health, Radboudumc Alzheimer Centre Nijmegen, Radboud University, Nijmegen, The Netherlands
| | - Deliane van Vliet
- Department of Primary and Community Care: Center for Family Medicine, Geriatric Care and Public Health, Radboudumc Alzheimer Centre Nijmegen, Radboud University, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care: Center for Family Medicine, Geriatric Care and Public Health, Radboudumc Alzheimer Centre Nijmegen, Radboud University, Nijmegen, The Netherlands
- Joachim en Anna Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Alexander Kurz
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein E de Vugt
- School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
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Lebert F, Leroy M, Pasquier F, Strubel D. Young onset demented patients in French cognitive-behavioral specialized units. ACTA ACUST UNITED AC 2016; 14:194-200. [PMID: 27277152 DOI: 10.1684/pnv.2016.0607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The number of patients with young onset dementia (YOD) (first symptoms beginning before the age of 60 years) is estimated around 5,000 in France. On account of the usual severity of behavioral symptoms in these patients, the need for cognitive-behavioral specialized unit (UCC) is expected. To determine the number and characteristics of YOD patients cared for in UCC in France during the year 2013. A specific questionnaire was sent to the 84 French UCC. The questionnaire was completed by 55 UCC (65%), whose 33 received 179 YOD patients. The diagnosis was Alzheimer's disease in 50% of the cases and frontotemporal dementia in 30%. The main reasons for the hospitalization in UCC were the severity of behavioral symptoms in 86% of cases, the need to alleviate the caregiver burden in 31% and the waiting for a place in a nursing home in 23%. Mean duration of hospitalization was 40.4 ± 20.5 days. At the end of hospitalization 51% of the patients returned to their original living accomodation and 39% entered into a nursing home. The main reason of YOD patients hospitalization reject was the care team's fear in the UCC without experience. The severity of the behavioral troubles was the major issue while the necessary ethical reflection raised by the YOD patients management was a positive aspect. The teams rated how ready do they feel about taking care of YOD patients on a scale from 0 to 100, the median was 35. The welcoming of YOD patients in UCC is necessary, however the severity of the behavioral troubles and the care teams fear prompt to set up specific education and to increase of the number of staff for YOD patients management.
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Diehl-Schmid J, Richard-Devantoy S, Grimmer T, Förstl H, Jox R. Behavioral variant frontotemporal dementia: advanced disease stages and death. A step to palliative care. Int J Geriatr Psychiatry 2017; 32:876-881. [PMID: 27374872 DOI: 10.1002/gps.4540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the present study was to gain insight into the living and care situation in advanced behavioral variant frontotemporal dementia (bvFTD), to describe symptoms and findings in advanced bvFTD, and to evaluate somatic comorbidities and circumstances of death. METHODS Standardized interviews were conducted with family caregivers of 83 patients with bvFTD. Forty-four percent of the patients were already deceased at the time of the interview. RESULTS At the time of the interview or death, respectively, 47% of the patients lived in a nursing home. The median time between symptom onset and nursing home admission was 5.0 ± 5.5 years. In moderate and severe dementia stages almost all patients suffered from severe disabilities including impairment of language, gait, swallowing, and of the ability to care for themselves. Sixteen percent of the patients had got enteral tube feeding. Comorbid somatic diseases were diagnosed in 46% of the patients. Twenty-three percent of the deceased patients had been admitted into a hospital before death. Cardiovascular disease and respiratory disease, mostly pneumonia, were the most frequent causes of death. CONCLUSIONS Advanced bvFTD is characterized by severe cognitive impairment and physical disabilities. BvFTD leads to a premature death. Our findings stress the importance of strategies that maximize patient comfort in advanced disease stages and allow for a peaceful death. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- J Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar of Technical University of Munich, Munich, Germany
| | - S Richard-Devantoy
- McGill University, Department of Psychiatry, and Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Canada.,Hôpital de Saint-Jérôme, CISSS des Laurentides, Saint-Jérôme, Canada, and Laboratoire de Psychologie des Pays de la Loire, Université d'Angers, Angers, France
| | - T Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar of Technical University of Munich, Munich, Germany
| | - H Förstl
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar of Technical University of Munich, Munich, Germany
| | - R Jox
- Institute of Ethics, History, and Theory of Medicine, Ludwig Maximilians Universität München, Munich, Germany
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Spreadbury JH, Kipps C. Measuring younger onset dementia: What the qualitative literature reveals about the 'lived experience' for patients and caregivers. Dementia (London) 2017; 18:579-598. [PMID: 28114802 DOI: 10.1177/1471301216684401] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The qualitative research on young onset dementia is providing insights about the 'lived experience' of patients and caregivers. However, findings from these studies have seldom been integrated into descriptive overviews. Our aim was to search the qualitative research, to integrate the qualitative findings, and offer an account of the lived experience for patients and caregivers. METHOD The search of the qualitative research formed part of a broader comprehensive literature search investigating salient measurement issues in the young onset dementia psychosocial research. Five electronic databases were searched (Medline, CINAHL, PsycINFO, Embase, the Cochrane Library) plus supplementary searching of reference sections and use of online search engines. We identified 23 qualitative articles. RESULTS In the pre-diagnostic period, patients experience changes in cognition and functioning but may be uncertain about changes and their significance. Caregivers may observe changes, think of explanations, and are important in instigating medical intervention. Obtaining a diagnosis may be a demanding process and the possibility of dementia may not be anticipated. In the post-diagnostic period, patients and caregivers use several strategies to cope and adjust. Patients can withdraw from established responsibilities while caregivers assume compensatory roles/duties. Patients perceive changes in their identity while caregivers perceive changes in the caregiver-patient relationship. Both can experience grief, isolation, and stigma. DISCUSSION The diagnosis of dementia elicits significant changes in thinking, emotion, and lifestyle that patients and caregivers are unlikely to be ready for. Both receive insufficient support or guidance in particular of a psychological nature on how to cope and adjust.
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Affiliation(s)
- John H Spreadbury
- Faculty of Medicine, University of Southampton, UK; Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, UK
| | - Christopher Kipps
- Faculty of Medicine, University of Southampton, UK; Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, UK; Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, UK
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Abstract
The proliferation of community-based activity programs for people with dementia suggests an appetite for new approaches to support quality of life and well-being for this population. Such groups also have potential to promote social citizenship, although this remains poorly understood. This article presents findings from a subset of data from an ethnographic study of a community-based program for people with young onset dementia; it focuses on Paul's Club and the experiences of 12-15 members who are physically healthy, with moderate to moderately severe dementia. Analysis suggests how aspects of social citizenship are constructed and revealed through the Club's everyday practice of walking in the neighbourhood. Three major themes emerged: Keeping the focus off dementia; Creating a place of belonging; and Claiming a place in the community How the group balances consideration of members' vulnerability and agency is discussed, and the article concludes with implications for future practice and research initiatives.
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Affiliation(s)
- Alison Phinney
- School of Nursing, University of British Columbia, British Columbia, Canada
| | - Elizabeth Kelson
- School of Nursing, University of British Columbia, British Columbia, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, British Columbia, Canada
| | - Deborah O'Connor
- School of Social Work, University of British Columbia, British Columbia, Canada
| | - Barbara Purves
- School of Audiology and Speech Sciences, University of British Columbia, British Columbia, Canada
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Abstract
BACKGROUND Research is beginning to demonstrate the unique psychosocial effects of young onset dementia. Theorising remains at an early stage and there has been little discussion about measurement and methodological issues. Our aim was to conduct a comprehensive literature search of the young onset dementia psychosocial research, and to identify the domains of experience measured with patients and caregivers. METHOD We conducted a search of five electronic databases (Medline, CINAHL, PsycINFO, Embase, the Cochrane Library) using equivalent database controlled vocabulary terms. We supplemented this search by using free text searches within electronic databases, searching reference sections of salient papers, and using online search engines. We defined psychosocial as referring to patient and caregiver psychological, behavioural, and social functioning in the context of living with young onset dementia. RESULTS We identified 72 published articles, 49 quantitative and 23 qualitative. The quantitative articles form the focus of the present review. We identified 10 domains of patient experience measured and 14 domains of caregiver experience. The patient domains measured most often were behaviour, cognition, functioning, and severity, and reflected a focus on symptoms and clinical features. Quality of Life (QoL) was the patient domain measured least often. The caregiver domains measured most often were mental health and burden, and reflected a focus on psychological well-being and coping. CONCLUSION The scope of measurement is broader in caregivers than patients. QoL although under-researched may be a useful domain to measure in future research. Risk factors, measurement and methodological issues are discussed.
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Affiliation(s)
- J H Spreadbury
- Faculty of Medicine, University of Southampton, Southampton, UK; Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC), Wessex, UK
| | - C M Kipps
- Faculty of Medicine, University of Southampton, Southampton, UK; Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC), Wessex, UK; Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Uflacker A, Edmondson MC, Onyike CU, Appleby BS. Caregiver burden in atypical dementias: comparing frontotemporal dementia, Creutzfeldt-Jakob disease, and Alzheimer's disease. Int Psychogeriatr 2016; 28:269-73. [PMID: 26435062 DOI: 10.1017/S1041610215001647] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Caregiver burden is a significant issue in the treatment of dementia and a known contributor to institutionalization of patients with dementia. Published data have documented increased caregiver burden in behavioral variant frontotemporal dementia (bvFTD) compared to Alzheimer's disease (AD). Another atypical dementia with high-perceived caregiver burden is sporadic Creutzfeldt-Jakob disease (sCJD), but no formal studies have assessed this perception. The aim of this study was to compare caregiver burden across atypical dementia etiologies. METHODS 76 adults with atypical dementia (young-onset AD [YOAD], bvFTD, language variant FTD [lvFTD], and sCJD) were administered an abbreviated version of the Zarit Burden Interview (ZBI), Neuropsychiatric Inventory (NPI-Q), and other assessment instruments during a five-year time period at Johns Hopkins Hospital (JHH). A Cox regression model examined differences between disease categories that impact mean ZBI scores. RESULTS Mean ZBI scores were significantly different between dementia etiologies, with bvFTD and sCJD having the highest caregiver burden (p = 0.026). Mean NPI-Q caregiver distress scores were highest in bvFTD and sCJD (p = 0.002), with sCJD and bvFTD also having the highest number of endorsed symptom domains (p = 0.012). On regression analyses, an interactive variable combining final diagnosis category and NPI-Q total severity score demonstrated statistically significant differences in mean ZBI scores for sCJD and bvFTD. CONCLUSIONS This study demonstrates that bvFTD and sCJD have increased levels of caregiver burden, NPI-Q caregiver distress, total severity scores, and number of endorsed symptom domains. These results suggest that higher caregiver burden in bvFTD and sCJD are disease specific and possibly related to neuropsychiatric symptoms.
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