Mild Cognitive Impairment and Driving Cessation

Driving cessation is associated with significant morbidity in older people. People with mild cognitive impairment (MCI) may be at particular risk of this | Dementia and Geriatric Cognitive Disorders

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Very little research has examined driving in this population. Given this, we sought to identify predictors of driving cessation in people with MCI.

One hundred and eighty-five people with MCI were recruited from 9 memory clinics around Australia. People with MCI and their carers reported their driving status and completed measures of cognition, function, neuropsychiatric symptoms, and medication use at regular intervals over a 3-year period.

Of the 144 people still driving at baseline, 50 (27.0%) stopped driving during the study. Older age, greater cognitive and functional impairment, and greater decline in cognition and function at 6 months predicted subsequent driving cessation. Twenty-nine of the 50 people (58%) who stopped driving were diagnosed with dementia during the study; all except one of whom ceased driving after their dementia diagnosis.

A significant proportion of people diagnosed with MCI stop driving over the following 3 years. This cannot be entirely attributed to developing dementia. Easily assessable characteristics – such as age, cognition, and function – and changes in these measures over 6 months predict driving cessation.

Full reference: Connors, M.H. et al. (2017) Mild Cognitive Impairment and Driving Cessation: A 3-Year Longitudinal Study. Dementia and Geriatric Cognitive Disorders. Vol. 44 (no. 1-2) pp. 63-70

Dementia numbers set to rise to 1.2 million by 2040 in England & Wales

Experts are predicting that there will be 1.2 million people in England and Wales living with dementia by 2040 – a rise of 57% from 2016 – due to increased life expectancy.

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A study  published in The BMJ  says that although the number of newly diagnosed cases of dementia is falling, the overall prevalence will increase substantially as people live longer and deaths from other causes, such as heart disease, continue to decline.

The team of researchers  based at University College London (UCL) and the University of Liverpool, set out to predict the future burden of dementia with more certainty by developing a mathematical model that takes account of disease trends and death rates alongside the effects of increasing life expectancy.  They calculated that there were currently 767,000 people living with dementia in England and Wales and the number would increase to more than 1.2 million by 2040.

Full story at OnMedica

Full reference: Ahmadi-Abhari, S et al.  Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040: modelling study BMJ Published 05 July 2017

 

 

Interventions to prevent cognitive decline & dementia

Evidence supporting three interventions that might slow cognitive decline and the onset of dementia is encouraging but insufficient to justify a public health campaign focused on their adoption | ScienceDaily

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Cognitive training, blood pressure management for people with hypertension, and increased physical activity all show modest but inconclusive evidence that they can help prevent cognitive decline and dementia, but there is insufficient evidence to support a public health campaign encouraging their adoption, says a new report from the National Academies of Sciences, Engineering, and Medicine.  Additional research is needed to further understand and gain confidence in their effectiveness, said the committee that conducted the study and wrote the report.

The effect of moderate drinking on brain structure

A new study on BMJ.com, examines the effect of moderate drinking on brain structure. Heavy drinking is known to have a deleterious effect on our brains, and is linked to dementias. However, for sometime it’s been thought that moderate drinking is actually protective.

In this Podcast, Anya Topiwala, clinical lecturer in old age psychiatry at the University of Oxford, discusses the association between alcohol consumption and those structural elements.

Reference to the research: Topiwala, A et al. Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study. BMJ 2017; 357 (Published 06 June 2017)

The future burden of disability in the UK

2.8 million people over 65 will need nursing and social care by 2025 – largely because of a significant rise in dementia-related disability, research finds.

Research published by the Lancet Public Health medical journal says cases of disability related to dementia will rise by 40% among people aged 65 to 84, with other forms of disability increasing by about 31%.

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The investigators used a detailed model to produce estimates of the prevalence of disability due to cardiovascular disease, dementia, and other causes in people aged 65 years or older in England and Wales to the year 2025.

They found a 25% increase from 2015 in the number of older people who will be living with disability, representing 560 000 additional elderly people in England and Wales who will need care for their disabling condition, and showed that the largest relative increases will be in dementia cases.  They also predicted that although life expectancy among people older than 65 years will increase by 1·7 years, 0·7 of these years will be lived with disability.

Having identified these challenges, the authors have recommended increased capacity in formal social care and improved support for informal social care arrangements, along with enhanced interventions against predictable risk factors for non-communicable diseases disability, such as smoking, diet, and physical activity.

Full reference: Guzman-Castillo, Maria et al. | Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling studyThe Lancet Public Health Published online 23rd May 2017

Blueberry concentrate improves brain function in older people

Drinking concentrated blueberry juice improves brain function in older people, according to research by the University of Exeter. | ScienceDaily | Applied Physiology, Nutrition, and Metabolism

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In the study, healthy people aged 65-77 who drank concentrated blueberry juice every day showed improvements in cognitive function, blood flow to the brain and activation of the brain while carrying out cognitive tests. There was also evidence suggesting improvement in working memory.

Of the 26 healthy adults in the study, 12 were given concentrated blueberry juice providing the equivalent of 230g of blueberries once a day, while 14 received a placebo.

Before and after the 12-week period, participants took a range of cognitive tests while an MRI scanner monitored their brain function and resting brain blood flow was measured.

Compared to the placebo group, those who took the blueberry supplement showed significant increases in brain activity in brain areas related to the tests.

Full reference: Bowtell, J. et al . Enhanced task related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation. Applied Physiology, Nutrition, and Metabolism, March 2017

Trends in diagnosis and treatment for people with dementia in the UK 2005-2015

Donegan, K. et al. The Lancet Public Health | Published online: 23 February 2017

Image shows proportion of CPRD (Clinical Practice Research Datalink) population diagnosed with dementia in the UK by region between July, 2005, and June, 2015

Background: The objectives of this study were to describe changes in the proportion of people diagnosed with dementia and the pharmacological treatments prescribed to them over a 10 year period from 2005 to 2015 at a time of UK policy strategies and prioritisation of dementia. We aimed to explore the potential impact of policy on dementia care.

Interpretation: Over the 10 years studied, there is evidence of a sustained positive change in diagnosis rates of dementia and in the quality of drug treatment provided to those diagnosed. The prescription of antidementia drugs more than doubled and the prescription of potentially hazardous antipsychotics halved after the introduction of national dementia strategies. These data support the formulation and delivery of national policy to improve the quality of care for people with dementia.

Read the full article here