The relationship of dementia prevalence in older adults with intellectual disability (ID) to age and severity of ID

Background: Previous research has shown that adults with intellectual disability (ID) may be more at risk of developing dementia in old age than expected. However, the effect of age and ID severity on dementia prevalence rates has never been reported. We investigated the predictions that older adults with ID should have high prevalence rates of dementia that differ between ID severity groups and that the age-associated risk should be shifted to a younger age relative to the general population. Method: A two-staged epidemiological survey of 281 adults with ID without Down syndrome (DS) aged >60 years; participants who screened positive with a memory task, informant-reported change in function or with the Dementia Questionnaire for Persons with Mental Retardation (DMR) underwent a detailed assessment. Diagnoses were made by psychiatrists according to international criteria. Prevalence rates were compared with UK prevalence and European consensus rates using standardized morbidity ratios (SMRs). Results: Dementia was more common in this population (prevalence of 18.3%, SMR 2.77 in those aged >65 years). Prevalence rates did not differ between mild, moderate and severe ID groups. Age was a strong risk factor and was not influenced by sex or ID severity. As predicted, SMRs were higher for younger age groups compared to older age groups, indicating a relative shift in age-associated risk. Conclusions: Criteria-defined dementia is 2–3 times more common in the ID population, with a shift in risk to younger age groups compared to the general population

Criminal neighbourhoods: does the density of prior offenders encourage others to commit crime?

Using crime data over a period of a decade for Glasgow, this paper explores whether the density of prior offenders in a neighbourhoods has an influence on the propensity of others to (re)commence offending. The study shows that the number of ‘newly active’ offenders in a neighbourhood in the current quarter is positively associated with the density of prior offenders for both violent and property crime from the previous two years. In the case of ‘newly active’ property offenders, the relationship with active prior offenders is only apparent when prior offender counts exceed the median. The paper postulates that intraneighbourhood social mechanisms may be at work to create these effects. The results suggest that policies which concentrate offenders in particular neighbourhoods may increase the number of ‘newly active’ offenders, and point to evidence of a threshold at which these effects take place

The Relationship of Bilingualism Compared to Monolingualism to the Risk of Cognitive Decline or Dementia: A Systematic Review and Meta-Analysis

BACKGROUND: Bilingualism may contribute to cognitive reserve, protect against cognitive decline, and delay the onset of dementia. OBJECTIVE: We systematically reviewed evidence about the effect of bilingualism on subsequent cognitive decline or dementia. METHODS: We searched electronic databases and references for longitudinal studies comparing cognitive decline in people who were bilingual with those who were monolingual and evaluated study quality. We conducted meta-analyses using random effects models to calculate pooled odds ratio of incident dementia. RESULTS: We included 13/1,156 eligible articles. Meta-analysis of prospective studies of the effects of bilingualism on future dementia gave a combined Odds Ratio of dementia of 0.96 (95% CI 0.74-1.23) in bilingual participants (n = 5,527) compared to monolinguals. Most retrospective studies found that bilingual people were reported to develop symptoms of cognitive decline at a later age than monolingual participants. CONCLUSION: We did not find that bilingualism protects from cognitive decline or dementia from prospective studies. Retrospective studies are more prone to confounding by education, or cultural differences in presentation to dementia services and are therefore not suited to establishing causative links between risk factors and outcomes

Long-term implementation of the Managing Agitation and Raising QUality of lifE intervention in care homes: A qualitative study

OBJECTIVES: The dementia care home workforce receive little specific training. There are successful interventions, improving care outcomes, but it is unclear whether or how to sustain these effects. The Managing Agitation and Raising Quality of Life (MARQUE) intervention aimed to train care home staffto reduce resident's agitation and improve their quality of life. It was designed for sustainability, with implementation plans agreed with managers. MARQUE improves quality of life. In this separate study, we aimed to examine implementation around two years later. METHODS: and design: We explored practice change since the intervention and considered current implementation of home specific action plans, enablers or barriers, and perceived benefits or harms of implementation using semi-structured interviews with staff working in the trial homes who received the MARQUE intervention. RESULTS: 6/10 intervention homes participated. We interviewed 25 staff, 20-30 months after the MARQUE study. In all homes, staff reported that at least one MARQUE component was sustained. Three themes emerged about sustained practice change: (i) communication, (ii) respect and understanding of roles, and (iii) ability to try new things. Notable changes included improved team working and feelings of competence, positive attitude to residents rather than blame for agitation and avoidance, and more pleasant activities. Leadership support was important. CONCLUSIONS: It is possible to sustain some change over years in care homes. This study indicates factors which help or impede. These factors individually and together could lead to long-term improved quality of life of residents in homes where it is implemented and sustained. This article is protected by copyright. All rights reserved

The Minimum Clinically Important Difference on the Sleep Disorders Inventory for People with Dementia

Objectives: Sleep disturbances in dementia causes distress to people with dementia and their family carers and are associated with care home admission. The Sleep Disorders Inventory (SDI) is a validated questionnaire of sleep disturbances in dementia often used to measure treatment effectiveness, but the minimum clinically important difference (MCID) is unknown. Methods: We triangulated three investigative methods to determine the MCID of the SDI. Using data on SDI from a randomised controlled trial (RCT) with 62 participants in an intervention for sleep disorders in dementia, we (1) calculated distribution‐based values where MCID = 0.33 of a SD (SD) (2) an anchor based approach using quality of life (measured using DEMQOL‐Proxy) as an anchor. We also employed a Delphi consensus process asking 12 clinicians, sleep researchers and family carers to rate which changes on vignettes were equivalent to a MCID. Results: We found that 0.33 SD in the SDI = 4.86. Reduction in SDI total score was not significantly correlated with improvement in DEMQOL‐Proxy (Pearson's correlation = −0.01; P = 0.96) score. The Delphi consensus required two rounds to reach a consensus and concluded that changes equivalent to three points on the SDI equated to the MCID. Conclusions: Taking into account both the distribution‐based values and the Delphi process we used a whole number at the midpoint and judged the minimum clinically important difference MCID to be equal to four points. We note the clinicians and carers opinions from the Delphi process determined the MCID to be lower at three points

Marriage and risk of dementia: systematic review and meta-analysis of observational studies

BACKGROUND: Being married is associated with healthier lifestyle behaviours and lower mortality and may reduce risk for dementia due to life-course factors. We conducted a systematic review and meta-analysis of studies of the association between marital status and the risk of developing dementia. METHODS: We searched medical databases and contacted experts in the field for relevant studies reporting the relationship, adjusted for age and sex, between marital status and dementia. We rated methodological quality and conducted random-effects meta-analyses to summarise relative risks of being widowed, divorced or lifelong single, compared with being married. Secondary stratified analyses with meta-regression examined the impact of clinical and social context and study methodology on findings. RESULTS: We included 15 studies with 812 047 participants. Compared with those who are married, lifelong single (relative risk=1.42 (95% CI 1.07 to 1.90)) and widowed (1.20 (1.02 to 1.41)) people have elevated risk of dementia. We did not find an association in divorced people. Further analyses showed that less education partially confounds the risk in widowhood and worse physical health the elevated risk in lifelong single people. Compared with studies that used clinical registers for ascertaining dementia diagnoses, those which clinically examined all participants found higher risk for being unmarried. CONCLUSIONS: Being married is associated with reduced risk of dementia than widowed and lifelong single people, who are also underdiagnosed in routine clinical practice. Dementia prevention in unmarried people should focus on education and physical health and should consider the possible effect of social engagement as a modifiable risk factor

Accuracy of general hospital dementia diagnoses in England: Sensitivity, specificity, and predictors of diagnostic accuracy 2008–2016

Introduction: Recognizing dementia in general hospitals allows for tailored care. We aimed to assess hospital dementia diagnosis accuracy, changes over time, and predictors of correct identification. Method: Retrospective cohort study of people over 65 years, using data from a large mental health care database as gold standard, linked to 2008–2016 English hospital data. Results: In 21,387 people who had 138,455 admissions, we found sensitivity and specificity of dementia recording, respectively, to be 78.0% and 92.0% for each person's complete records, and 63.3% and 96.6% for each nonelective admission. Diagnostic sensitivity increased between 2008 and 16. Accurate general hospital recording of the presence of dementia was lower in ethnic minority groups, younger, single people, and those with physical illness. Discussion: Dementia diagnosis recording in general hospitals is increasing but remains less likely in some groups. Clinicians should be aware of this inequity and have a higher index of clinical suspicion in these groups

The photospheric solar oxygen project: IV. 3D-NLTE investigation of the 777 nm triplet lines

The solar photospheric oxygen abundance is still widely debated. Adopting the solar chemical composition based on the "low" oxygen abundance, as determined with the use of three-dimensional (3D) hydrodynamical model atmospheres, results in a well-known mismatch between theoretical solar models and helioseismic measurements that is so far unresolved. We carry out an independent redetermination of the solar oxygen abundance by investigating the center-to-limb variation of the OI IR triplet lines at 777 nm in different sets of spectra with the help of detailed synthetic line profiles based on 3D hydrodynamical CO5BOLD model atmospheres and 3D non-LTE line formation calculations with NLTETD. The idea is to simultaneously derive the oxygen abundance,A(O), and the scaling factor SH that describes the cross-sections for inelastic collisions with neutral hydrogen relative the classical Drawin formula. The best fit of the center-to-limb variation of the triplet lines achieved with the CO5BOLD 3D solar model is clearly of superior quality compared to the line profile fits obtained with standard 1D model atmospheres. Our best estimate of the 3D non-LTE solar oxygen abundance is A(O) = 8.76 +/- 0.02, with the scaling factor SH in the range between 1.2 and 1.8. All 1D non-LTE models give much lower oxygen abundances, by up to -0.15 dex. This is mainly a consequence of the assumption of a $\mu$-independent microturbulence.Comment: 25 pages, 17 figures, 7 tables (Accepted for publication in A&A

How people with dementia and carers understand and react to social functioning changes in mild dementia: a UK-based qualitative study

OBJECTIVES: To analyse people with dementia and their family carers' attribution of social changes in dementia and the consequences of these attributions. DESIGN: Qualitative study, using a semi-structured interview guide. Individual interviews continued to theoretical saturation. Two researchers independently analysed interview transcripts. SETTING AND PARTICIPANTS: People with mild dementia and family carers purposively selected from London-based memory services for diverse demographic characteristics to encompass a range of experiences. PRIMARY AND SECONDARY OUTCOMES: Attribution of social changes experienced by the person with dementia and the consequences of these attributions. RESULTS: We interviewed nine people with dementia and nine carers, encompassing a range of age, ethnicity and educational backgrounds.Both groups reported that the person with dementia had changed socially. People with dementia tended to give one or two explanations for social change, but carers usually suggested several. People with dementia were often socially embarrassed or less interested in going out, and they or their relatives' physical illness or fear of falls led to reduced social activity. Carers often attributed not going out to a choice or premorbid personality. Carers found that their relative needed more support to go out than they could give and carers needed time to themselves because of carer stress or other problems from which they shielded the person with dementia. Additionally, there was decreased opportunity to socialise, as people were bereaved of friends and family. Participants acknowledged the direct impact of dementia symptoms on their ability to socially engage but sometimes decided to give up socialising when they knew they had dementia. There were negative consequences from social changes being attributed to factors such as choice, rather than dementia. CONCLUSION: Clinicians should ask about social changes in people with dementia. Explaining that these may be due to dementia and considering strategies to overcome them may be beneficial