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Advanced Dementia

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https://www.readbyqxmd.com/read/28822692/complex-clinical-intersection-palliative-care-in-patients-with-dementia
#1
REVIEW
Ellen E Lee, Beverly Chang, Steven Huege, Jeremy Hirst
Because of the rapidly growing older population and increases in longevity, rates of dementia have been rising. Clinical challenges of treating dementia include limited resources and lack of curative therapies. Palliative care approaches improve quality of life and alleviate suffering for dementia patients at the end of life, although implementation may be limited by societal acceptance and feasibility. This review examines the published literature on pain assessments, pain and behavior interventions, tools for advanced care planning, and clinical concerns in dementia patients...
June 29, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28815019/therapeutic-potential-of-systemic-brain-rejuvenation-strategies-for-neurodegenerative-disease
#2
REVIEW
Alana M Horowitz, Saul A Villeda
Neurodegenerative diseases are a devastating group of conditions that cause progressive loss of neuronal integrity, affecting cognitive and motor functioning in an ever-increasing number of older individuals. Attempts to slow neurodegenerative disease advancement have met with little success in the clinic; however, a new therapeutic approach may stem from classic interventions, such as caloric restriction, exercise, and parabiosis. For decades, researchers have reported that these systemic-level manipulations can promote major functional changes that extend organismal lifespan and healthspan...
2017: F1000Research
https://www.readbyqxmd.com/read/28813238/strategies-for-building-trust-with-the-caregiver-of-a-patient-with-end-stage-dementia
#3
Helen Stanton Chapple
This case describes a patient with advanced dementia and an unrealistic spouse, presenting an apparent dilemma about nutrition for physicians. By eliciting the perspective of the caregiver, the physicians can gain insight and rebuild trust that protects the interests of both the patient and the spouse. Their goal needs to shift from resolving the professional ethical dilemma to affirming the immeasurable contribution of the caregiver, acknowledging her journey, asking for her advice, and enabling the work of making meaning in the time available...
July 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28811048/receipt-of-nephrology-care-and-clinical-outcomes-among-veterans-with-advanced-ckd
#4
Enrica Fung, Tara I Chang, Glenn M Chertow, I-Chun Thomas, Steven M Asch, Manjula Kurella Tamura
BACKGROUND: Clinical practice guidelines recommend referral to nephrology when estimated glomerular filtration rate (eGFR) decreases to <30mL/min/1.73m(2); however, evidence for benefits of nephrology care are mixed. STUDY DESIGN: Observational cohort using landmark analysis. SETTINGS & PARTICIPANTS: A national cohort of veterans with advanced chronic kidney disease, defined as an outpatient eGFR≤30mL/min/1.73m(2) for January 1, 2010, through December 31, 2010, and a prior eGFR<60mL/min/1...
August 12, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28808912/molecular-imaging-and-updated-diagnostic-criteria-in-lewy-body-dementias
#5
REVIEW
Nicolaas I Bohnen, Martijn L T M Müller, Kirk A Frey
PURPOSE OF REVIEW: The aims of the study were to review recent advances in molecular imaging in the Lewy body dementias (LBD) and determine if these may support the clinical but contested temporal profile distinction between Parkinson disease (PD) with dementia (PDD) versus dementia with Lewy bodies (DLB). RECENT FINDINGS: There do not appear to be major regional cerebral metabolic or neurotransmitter distinctions between PDD and DLB. However, recent studies highlight the relative discriminating roles of Alzheimer proteinopathies...
August 14, 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28806610/risk-factors-of-transition-from-mild-cognitive-impairment-to-alzheimer-s-disease-and-death-a-cohort-study
#6
Haihong Xue, Qianqian Sun, Long Liu, Liye Zhou, Ruifeng Liang, Runlian He, Hongmei Yu
BACKGROUND: Knowledge of risk factors is essential for developing strategies that prevent or minimise transitions from mild cognitive impairment (MCI) to Alzheimer's disease (AD) and death. The aim of this study was to assess risk factors for progression to AD and death among Chinese individuals with cognitive impairment. METHODS: We conducted a multisite, population-based cohort study on 437 community-dwelling elderly MCI residents in Taiyuan, China from 2010 to 2014...
July 18, 2017: Comprehensive Psychiatry
https://www.readbyqxmd.com/read/28805188/managing-faecal-incontinence-in-people-with-advanced-dementia-resident-in-care-homes-finch-study-a-realist-synthesis-of-the-evidence
#7
Claire Goodman, Christine Norton, Marina Buswell, Bridget Russell, Danielle Harari, Rowan Harwood, Brenda Roe, Jo Rycroft-Malone, Vari M Drennan, Mandy Fader, Michelle Maden, Karen Cummings, Frances Bunn
BACKGROUND: Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. OBJECTIVE: To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes. DESIGN: A realist synthesis...
August 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28801443/the-provision-of-medical-assistance-in-dying-protocol-for-a-scoping-review
#8
Simon J W Oczkowski, Ian Ball, Carol Saleh, Gaelen Kalles, Anatoli Chkaroubo, Mike Kekewich, Paul Miller, Marianne Dees, Andrea Frolic
INTRODUCTION: Medical assistance in dying (MAID), a term encompassing both euthanasia and assisted suicide, was decriminalised in Canada in 2015. Although Bill C-14 legislated eligibility criteria under which patients could receive MAID, it did not provide guidance regarding the technical aspects of providing an assisted death. Therefore, we propose a scoping review to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of MAID, in order to identify knowledge gaps and areas for future research...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28797857/level-of-care-preferences-among-nursing-home-residents-with-advanced-dementia
#9
Susan L Mitchell, Jennifer A Palmer, Angelo E Volandes, Laura C Hanson, Daniel Habtemariam, Michele L Shaffer
CONTEXT: Delivering goal-directed care is a hallmark of high quality palliative care, but requires an understanding of preferences. OBJECTIVES: To describe and identify factors associated with level of care preferences among proxies of nursing home residents with advanced dementia. METHODS: Nursing home residents with advanced dementia and their proxies (N=402 dyads) were recruited from 62 Boston-area facilities as part of an ongoing randomized clinical trial...
August 7, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28793905/the-liverpool-care-pathway-a-systematic-review-discarded-in-cancer-patients-but-good-enough-for-dying-nursing-home-patients
#10
Bettina S Husebø, Elisabeth Flo, Knut Engedal
BACKGROUND: The Liverpool Care Pathway (LCP) is an interdisciplinary protocol, aiming to ensure that dying patients receive dignified and individualized treatment and care at the end-of-life. LCP was originally developed in 1997 in the United Kingdom from a model of cancer care successfully established in hospices. It has since been introduced in many countries, including Norway. The method was withdrawn in the UK in 2013. This review investigates whether LCP has been adapted and validated for use in nursing homes and for dying people with dementia...
August 9, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28792325/a-smile-and-a-chat-go-a-long-way
#11
Ela Hamer
Many of my clinical placements have involved working with patients with advanced dementia. At first, I was unsure how to communicate with someone who is disorientated and has memory loss, and I let others take the lead.
August 9, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28781776/unraveling-the-genes-implicated-in-alzheimer-s-disease
#12
Mohan Giri, Abhilasha Shah, Bibhuti Upreti, Jayanti Chamling Rai
Alzheimer's disease (AD) is a heterogeneous neurodegenerative disorder and it is the most common form of dementia in the elderly. Early onset AD is caused by mutations in three genes: Amyloid-β precursor protein, presenilin 1 (PSEN1) and PSEN2. Late onset AD (LOAD) is complex and apolipoprotein E is the only unanimously accepted genetic risk factor for its development. Various genes implicated in AD have been identified using advanced genetic technologies, however, there are many additional genes that remain unidentified...
August 2017: Biomedical Reports
https://www.readbyqxmd.com/read/28780493/can-an-observational-pain-assessment-tool-improve-time-to-analgesia-for-cognitively-impaired-older-persons-a-cluster-randomised-controlled-trial
#13
Margaret Fry, Lynn Chenoweth, Glenn Arendts
OBJECTIVE: The primary objective of the study was to measure the impact of an observational pain assessment dementia tool on time from ED arrival to first dose of analgesic medicine. METHODS: A multisite cluster randomised controlled trial was conducted to test the Pain Assessment in Advanced Dementia (PAINAD) tool. Patients aged 65 years or older suspected of a long bone fracture were screened for cognitive impairment using the Six-Item Screening (SIS) tool. Patients scoring 4 or less on SIS (intervention sites) were assessed for pain using PAINAD...
August 5, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28778021/neural-correlates-of-obstacle-negotiation-in-older-adults-an-fnirs-study
#14
Michelle Chen, Sarah Pillemer, Sarah England, Meltem Izzetoglu, Jeannette R Mahoney, Roee Holtzer
Older adults are less efficient at avoiding obstacles compared to young adults, especially under attention-demanding conditions. Using functional near-infrared-spectroscopy (fNIRS), recent studies implicated the prefrontal cortex (PFC) in cognitive control of locomotion, notably under dual-task walking conditions. The neural substrates underlying Obstacle Negotiation (ON), however, have not been established. The current study determined the role of the PFC in ON during walking in seniors. Non-demented older adults (n=90; mean age=78...
July 18, 2017: Gait & Posture
https://www.readbyqxmd.com/read/28777176/circadian-rhythm-sleep-wake-disorders
#15
Milena Pavlova
PURPOSE OF REVIEW: The endogenous circadian rhythms are one of the cardinal processes that control sleep. They are self-sustaining biological rhythms with a periodicity of approximately 24 hours that may be entrained by external zeitgebers (German for time givers), such as light, exercise, and meal times. This article discusses the physiology of the circadian rhythms, their relationship to neurologic disease, and the presentation and treatment of circadian rhythm sleep-wake disorders...
August 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28772095/advance-directives-among-nursing-home-residents-with-mild-moderate-and-advanced-dementia
#16
Jennifer Tjia, Marisa Dharmawardene, Jane L Givens
OBJECTIVE: To describe prevalence and content of AD documentation among NH residents by dementia stage. BACKGROUND: The prevalence of advance directives (ADs) among nursing home (NH) residents with mild, moderate, and advanced dementia remains unclear. METHODS: Population-based, cross-sectional study of all licensed NHs in five U.S. states. Subjects included all long-stay (>90 day) NH residents with dementia, aged ≥65 years, and a Cognitive Performance Scale (CPS) score ≥1 from the 2007 to 2008 Minimum Data Set 2...
August 3, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28766695/prevention-of-alzheimer-s-disease-lessons-learned-and-applied
#17
James E Galvin
Alzheimer's disease (AD) affects more than 5 million Americans, with substantial consequences for individuals with AD, families, and society in terms of morbidity, mortality, and healthcare costs. With disease-modifying treatment trials unsuccessful at the present time and only medications to treat symptoms available, an emerging approach is prevention. Advances in diagnostic criteria, biomarker development, and greater understanding of the biophysiological basis of AD make these initiatives feasible. Ongoing pharmacological trials using anti-amyloid therapies are underway in sporadic and genetic forms of AD, although a large number of modifiable risk factors for AD have been identified in observational studies, many of which do not appear to exert effects through amyloid or tau...
August 2, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28760730/designing-serious-computer-games-for-people-with-moderate-and-advanced-dementia-interdisciplinary-theory-driven-pilot-study
#18
Chariklia Tziraki, Rakel Berenbaum, Daniel Gross, Judith Abikhzer, Boaz M Ben-David
BACKGROUND: The field of serious games for people with dementia (PwD) is mostly driven by game-design principals typically applied to games created by and for younger individuals. Little has been done developing serious games to help PwD maintain cognition and to support functionality. OBJECTIVES: We aimed to create a theory-based serious game for PwD, with input from a multi-disciplinary team familiar with aging, dementia, and gaming theory, as well as direct input from end users (the iterative process)...
July 31, 2017: JMIR Serious Games
https://www.readbyqxmd.com/read/28760133/surface-ecg-interatrial-block-guided-treatment-for-stroke-prevention-rationale-for-an-attractive-hypothesis
#19
Antoni Bayés de Luna, Manuel Martínez-Sellés, Antoni Bayés-Genís, Roberto Elosua, Adrian Baranchuk
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with stroke, cognitive impairment, and cardiovascular death. Some predisposing factors - as aging, diabetes, hypertension - induce and maintain electrophysiological and ultrastructural remodeling that usually includes fibrosis. Interatrial conduction disturbances play a crucial role in the initiation of atrial fibrosis and in its associated complications. The diagnosis of interatrial blocks (IABs) is easy to perform using the surface ECG...
July 31, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28756165/pathways-to-care-among-persons-with-dementia-study-from-a-tertiary-care-center
#20
Sk Altaf Hossien, Santosh Loganathan, Meena Kolar Sridara Murthy, Sivakumar Palanimuthu Thangaraju, Srikala Bharath, Mathew Varghese
The prevalence of dementia is increasing rapidly, specifically in low and middle income countries (LAMIC) due to demographic aging. Help seeking is delayed and usually sought at an advanced stage of illness and many are yet to receive a formal diagnosis. We interviewed 35 caregivers of persons with Dementia (as per ICD-10) using a semi-structured questionnaire, the Short Explanatory Model Interview (SEMI). We explored the pathways taken by caregivers of people with dementia en route to a tertiary care centre and the interactions they had with different health care providers...
July 27, 2017: Asian Journal of Psychiatry
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