Dementia

Commentary on: Brodaty H, Arasaratnam C. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry 2012;169:946–53.

Implications for practice and research

Non-pharmacological interventions (NPIs) should be the first line of treatment for the behavioural and psychological symptoms of dementia (BPSD).

Multicomponent NPIs tailored to individual and caregiver n

Behavioral and psychological symptoms are common in dementia, and they are especially stressful for family caregivers. Nonpharmacological (or psychosocial) interventions have been shown to be effective in managing behavioral and psychological symptoms, but mainly in institutional settings. The authors reviewed the effectiveness of community-based nonpharmacological interventions delivered through family caregivers.|Of 1,665 articles identified in a literature search, 23 included unique randomized or pseudorandomized nonpharmacological interventions with family caregivers and outcomes related to the frequency or severity of behavioral and psychological symptoms of dementia, caregiver reactions to these symptoms, or caregiver distress attributed to these symptoms. Studies were rated according to an evidence hierarchy for intervention research.|Nonpharmacological interventions were effective in reducing behavioral and psychological symptoms, with an overall effect size of 0.34 (95%

To present the results of the nonrandomized arm of the Cervical Artery Dissection in Stroke Study (CADISS-NR) trial, comparing anticoagulation and antiplatelets for prevention of recurrent stroke after carotid and vertebral dissection, and perform a meta-analysis of these results with previously published studies comparing the 2 therapeutic strategies.|A total of 88 patients from 22 centers with extracranial carotid and vertebral dissection were recruited within 1 month of symptom onset. The primary endpoint was recurrent stroke at 3 months. A systematic review was performed, and results of published studies included in a meta-analysis with the CADISS-NR results.|In CADISS-NR, one patient in each group had recurrent ischemic stroke (antiplatelet 1/59 [1.69% ], anticoagulation 1/28 [3.57%]). At the primary endpoint of 3 months, 3 (5.08%) antiplatelet patients had recurrent TIA, compared with none in the anticoagulation group. For meta-analysis, there were data from 40 nonrandomized

To document accessible magnetic resonance (MR) brain images, metadata and statistical results from normal older subjects that may be used to improve diagnoses of dementia.|We systematically reviewed published brain image databanks (print literature and Internet) concerned with normal ageing brain structure.|From nine eligible databanks, there appeared to be 944 normal subjects aged 60 years. However, many subjects were in more than one databank and not all were fully representative of normal ageing clinical characteristics. Therefore, there were approximately 343 subjects aged 60 years with metadata representative of normal ageing, but only 98 subjects were openly accessible. No databank had the range of MR image sequences, e.g. T2*, fluid-attenuated inversion recovery (FLAIR), required to effectively characterise the features of brain ageing. No databank supported random subject retrieval; therefore, manual selection bias and errors may occur in studies that use these subjects

A recent Centers for Disease Control and Prevention report found that more persons die at home. This has been cited as evidence that persons dying in the United States are using more supportive care.|To describe changes in site of death, place of care, and health care transitions between 2000, 2005, and 2009.|Retrospective cohort study of a random 20% sample of fee-for-service Medicare beneficiaries, aged 66 years and older, who died in 2000 (n = 270,202), 2005 (n = 291,819), or 2009 (n = 286,282). A multivariable regression model examined outcomes in 2000 and 2009 after adjustment for sociodemographic characteristics. Based on billing data, patients were classified as having a medical diagnosis of cancer, chronic obstructive pulmonary disease, or dementia in the last 180 days of life.|Site of death, place of care, rates of health care transitions, and potentially burdensome transitions (eg, health care transitions in the last 3 days of life).|Our random 20% sample included 848,303 fee

The association between obesity and dementia has been inconsistent, possibly due to changes in body composition often seen in old age. Leptin may be associated with better cognitive function. However, neuroprotection may be inhibited among obese subjects possibly due to leptin resistance. We sought to determine (i) if leptin is associated with risk of dementia or mild cognitive impairment (MCI) in a cohort of very old women, (ii) if this association is modified by obesity, and (iii) if leptin is a stronger risk factor compared with traditional anthropometric measures.|We studied 579 older women (mean age 82.6 years) from the ongoing prospective cohort Study of Osteoporotic Fractures, who were dementia-free at year-16 examination (our study baseline). Leptin (ng/mL) was measured using year-16 frozen serum, and anthropometric measures were collected during the same visit. Diagnosis of dementia/MCI was determined at year-20 examination.|There was evidence for a multiplicative interaction

Type land type 2 diabetes are associated with major complications that shorten life expectancy. Fluctuations in the amount of glucose reaching the brain cause a wide range of alterations to cerebral function, from mild impairment through to dementia-like states and even death. The responsibility is on the patient with diabetes to control his or her blood glucose levels to reduce any mental decline. However, nursing staff should be aware that patients with diabetes experiencing a loss of mental function may have difficulty in understanding information and instructions. This article examines the current literature on loss of mental function as a chronic complication of diabetes.

Homozygous loss-of-function mutations in TREM2, encoding the triggering receptor expressed on myeloid cells 2 protein, have previously been associated with an autosomal recessive form of early-onset dementia.|We used genome, exome, and Sanger sequencing to analyze the genetic variability in TREM2 in a series of 1092 patients with Alzheimer's disease and 1107 controls (the discovery set). We then performed a meta-analysis on imputed data for the TREM2 variant rs75932628 (predicted to cause a R47H substitution) from three genomewide association studies of Alzheimer's disease and tested for the association of the variant with disease. We genotyped the R47H variant in an additional 1887 cases and 4061 controls. We then assayed the expression of TREM2 across different regions of the human brain and identified genes that are differentially expressed in a mouse model of Alzheimer's disease and in control mice.|We found significantly more variants in exon 2 of TREM2 in patients with

23237888 2012 12 14 2013 02 08 1474-4465 12 1 Jan Lancet Neurol 4-6 10.1016/S1474-4422( 12) 70284-3 S1474-4422( 12) 70284-3 Icahn School of Medicine at Mount Sinai and James J Peters VA Medical Center, New York, NY 10029, USA. samuel.gandy@mssm.edu

Reviews the evidence for and against hundreds of preventive health services, recommending tests, and counseling interventions when evidence exists that it is effective.

NGC is the National Guideline Clearinghouse.

NGC is the National Guideline Clearinghouse.

NGC is the National Guideline Clearinghouse.

(1) Screening for delirium, dementia and depression in older adults. (2) Screening for delirium, dementia and depression in older adults 2010 supplement.