Screening tools for dementia assessment in UK based ethnic minorities

Aim: The present study investigated whether commonly used screening tools and assessments for dementia were culturally appropriate for older adults from ethnic minorities (EM) groups living in the UK.Methods: Both South Asian and British participants (N = 43) were assessed using the Cross-Linguistic Naming Test, Mini Addenbrooke’s Cognitive Examination, Visual Short-Term Memory Binding Test (VSTMBT), and the Rowland Universal Dementia Assessment Scale. Multi-Ethnic Acculturation Scale and English proficiency, measured with a self-rated scale, were associated with the four respective. No interpreters were used.Results: While members from EM significantly differed from members of the ethnic majority group in traditional neuropsychological tasks, their performance on the VSTMBT yielded results comparable to those drawn from the ethnic majority group. Complex influences seem to drive the sensitivity of traditional neuropsychological tasks to sociocultural factors.Conclusions: This is the first study that subjects the VSTMBT to investigation in EM groups. Older adults from EM showed no impact of their sociocultural backgrounds on the function assessed by this test. However, other tests widely used for the assessment of EM populations proved sensitive to the investigated sociocultural factors. Our results lend support to the suggestion that neuropsychological assessments must abandon the one-size-fits-all notion when it comes to dementia risk detection among EM groups

The contribution of the central executive to visuo-spatial bootstrapping in younger adults, older adults and patients with mild cognitive impairment.

Background. Recent studies on verbal immediate serial recall (Darling & Havelka, 2010; Darling et al., 2012, 2014; Allen et al., 2015) show evidence of the integration of information from verbal and visuo-spatial short term memory with long-term memory representations. This so-called 'visuo-spatial bootstrapping‘ (VSB) pattern, in which verbal serial recall is improved when the information is arranged in a familiar spatially distributed pattern, such as a telephone keypad, is consistent with the existence within working memory of an episodic buffer. Objective. The general purpose was to investigate the structure of working memory, and in particular the relationship between verbal and visuo-spatial working memory. Specifically, this thesis aimed to determine the contribution of the central executive and the implications of the VSB paradigm in younger and older adults and patients with Mild Cognitive Impairment (MCI). Materials and Methods. The first study explored the role of the central executive. The VSB task with digit sequences, visually presented both in single and in a typical keypad display, was administered under conditions of verbal and central executive load. In the second study VSB was investigated in older and younger adults using three conditions: single digit display, typical and random keypad. In the third study, examining performance in VSB in a typical elderly sample compared with people with MCI. Each participant was assessed with a neuropsychological battery of tests and the VSB task composed by single digit and typical keypad display. Results and Conclusion. Central executive load demonstrated to have a negative effect on digit recall performance without affecting the bootstrapping effect. VSB does not need to recruit executive resources. No difference was observed in the bootstrapping pattern as a consequence of age and cognitive difficulties and the beneficial impact of additional visual information was comparable for MCI, older and younger participants.sub_psunpub2300_ethesesunpu

Barriers and facilitators to diagnosing dementia in migrant populations:A systematic review of European health professionals' perspectives

BackgroundRates of dementia are increasing in migrant populations, however, there is evidence that they remain underrepresented in older adult healthcare services. Barriers and facilitators to accessing dementia care have been explored from the viewpoint of migrants and caregivers, however, no review has synthesised the literature pertaining to clinicians' viewpoints. This review aimed to explore clinician perspectives as to the barriers and facilitators in assessing and diagnosing dementia in migrant populations.MethodsA systematic review of the literature was conducted. Databases included EMBASE, CINAHL, PsycINFO, MEDLINE and ProQuest. Qualitative studies from the perspective of European clinicians were included. The methodological quality of each study was assessed using the Critical Appraisals Programme Tool (CASP). The analysis adopted a thematic synthesis approach.ResultsThe review included 11 qualitative studies relating to the diagnosis of dementia in migrants. The quality of the studies was generally high, although few studies reported on the relationship between the researcher and the participants. The data related more to the barriers in diagnosing dementia, and few facilitators were found. Four themes were constructed: (1) service access (2) perceptions of migrant beliefs (3) relationships and (4) quality of the diagnostic process.ConclusionsThe review is limited by the small number of studies available. The findings highlight significant clinical concerns in the diagnosis of migrants, in particular the underrepresentation of migrants within services and the barriers to access they may face. The quality of the diagnostic process was often thought to be undermined by a lack of culturally sensitive assessment tools. Further research on the use of an interpreter in diagnosing dementia is needed

Is it time to change the way we detect Alzheimer’s disease and monitor its progression? Towards affordable and theory-driven approaches from cognitive neurosciences

A large proportion of people suffering from Alzheimer’s disease (AD) worldwide are not receiving a timely diagnosis. The tools currently used to detect AD and monitor its progression are not sensitive to the preclinical stages and lack specificity for correctdiagnosis. Available biomarkers show acceptable levels of sensitivity but remain littlespecific and not accessible to everyone. We embrace the view that enhancing cognitive assessment of AD should be a research priority. This Perspective paper focuses on issues which, to our view, have been preventing cognitive tests from meeting outstanding needs in the early of detection, monitoring, and treatment development of AD dementia.We first outline the limitations of current diagnostic procedures both theoretically and practically. We then provide a rationale for theory-driven cognitive approaches which would allow mapping assessment tools to specific neuropathological stages of the neurodegenerative course of AD. Finally, we propose research strategies that would help test a hypothesis which, though launched five years ago, remains untested.That is: “Which memory system is impaired first in Alzheimer’s disease?

Maximising impactful and locally relevant mental health research::Ethical considerations

Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection.  Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect.</ns4:p

Maximising impactful, locally relevant global mental health research conducted in low and middle income country settings:Ethical considerations

Background: Achieving ethical and meaningful mental health research in diverse global settings requires approaches to research design, conduct, and dissemination that prioritise a contextualised approach to impact and local relevance. Method: Through three case studies presented at the 2021 Global Forum on Bioethics in Research meeting on the ethical issues arising in research with people with mental health conditions, we consider the nuances to achieving ethical and meaningful mental health research in three diverse settings. The case studies include research with refugees Rwanda and Uganda; a neurodevelopmental cohort study in a low resource setting in India, and research with Syrian refugees displaced across the Middle East. Results: Key considerations highlighted across the case studies include how mental health is understood and experienced in diverse contexts to ensure respectful engagement with communities, and to inform the selection of contextually-appropriate and feasible research methods and tools to achieve meaningful data collection.  Related to this is a need to consider how communities understand and engage with research to avoid therapeutic misconception, exacerbating stigma, or creating undue inducement for research participation, whilst also ensuring meaningful benefit for research participation. Central to achieving these is the meaningful integration of the views and perspectives of local stakeholders to inform research design, conduct, and legacy. The case studies foreground the potential tensions between meeting local community needs through the implementation of an intervention, and attaining standards of scientific rigor in research design and methods; and between adherence to procedural ethical requirements such as ethical review and documenting informed consent, and ethical practice through attention to the needs of the local research team. Conclusions: We conclude that engagement with how to achieve local relevance and social, practice, and academic impact offer productive ways for researchers to promote ethical research that prioritises values of solidarity, inclusion, and mutual respect