Challenges in dementia care: Comparing key issues from Brazil and the United Kingdom

The United Kingdom-Brazil Dementia Workshop took place in July 2019 in the city of Belo Horizonte, MG, Brazil, with an interdisciplinary group of health and care professionals from the United Kingdom and from Brazil to address challenges in diagnosis, public perception and care of dementia. The aim of this article is to present the results identified in relation to challenges in the care of dementia, including recommendations that could potentially guide local and State/Municipal authorities and care services for people with dementia in the future. Four key issues were prioritised to identify challenges and generate possible solutions in Brazil and the United Kingdom: I) limitations of current health systems; II) continuous and long-term support for family carers (pre-diagnosis, mourning); III) support for people with advanced dementia and end-of-life care; IV) support for people with young-onset dementia. In both countries, carers feel left without post-diagnostic support; information on the progression of dementia is lacking and some people do not even have a specific diagnosis; encouraging and providing training for carers best manage some of the symptoms is imperative; preparation for end of life care and support carers after the death of their loved ones remains highly needed; strengthening services and qualification of health professionals, also creating protocols to guide dementia-related services represent a common challenge to overcome. The authors outline recommendations according to the issues identified to assist future formulation of adequate policies and services for people with dementia and carers

Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis

Interest is growing in the role of infectious agents in the pathogenesis of dementia, but current evidence is limited. We conducted a systematic review and meta-analysis to investigate the effect of any of eight human herpesviruses on development of dementia or mild cognitive impairment (MCI). We searched the Cochrane Library, Embase, Global Health, Medline, PsycINFO, Scopus, Web of Science, clinical trials registers and grey literature sources from inception to December 2017 for observational studies with cohort, case control or self-controlled designs, or randomised controlled trials of interventions against herpesviruses. Pooled effect estimates and 95% confidence intervals (CIs) were generated through random effects meta-analyses across studies with the same design, outcome, and virus type, method and site of measurement. We included 57 studies across various geographic settings. Past infection with herpesviruses, measured by IgG seropositivity, was generally not associated with dementia risk. A single cohort study rated moderate quality showed an association between varicella zoster virus reactivation (ophthalmic zoster) and incident dementia (HR 2.97; 95%CI, 1.89 to 4.66). Recent infection with, or reactivation of, herpes simplex virus type 1 or type 1/2 unspecified, cytomegalovirus and human herpes virus-6 measured by serum IgM, high titre IgG or clinical disease may be associated with dementia or MCI, though results were inconsistent across studies and overall evidence rated very low quality. Longitudinal population studies with robust repeated virus measurements taken sufficiently proximal to dementia onset are needed to establish whether, when and among whom herpesviruses affect dementia risk

Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis.

Interest is growing in the role of infectious agents in the pathogenesis of dementia, but current evidence is limited. We conducted a systematic review and meta-analysis to investigate the effect of any of eight human herpesviruses on development of dementia or mild cognitive impairment (MCI). We searched the Cochrane Library, Embase, Global Health, Medline, PsycINFO, Scopus, Web of Science, clinical trials registers and grey literature sources from inception to December 2017 for observational studies with cohort, case control or self-controlled designs, or randomised controlled trials of interventions against herpesviruses. Pooled effect estimates and 95% confidence intervals (CIs) were generated through random effects meta-analyses across studies with the same design, outcome, and virus type, method and site of measurement. We included 57 studies across various geographic settings. Past infection with herpesviruses, measured by IgG seropositivity, was generally not associated with dementia risk. A single cohort study rated moderate quality showed an association between varicella zoster virus reactivation (ophthalmic zoster) and incident dementia (HR 2.97; 95%CI, 1.89 to 4.66). Recent infection with, or reactivation of, herpes simplex virus type 1 or type 1/2 unspecified, cytomegalovirus and human herpes virus-6 measured by serum IgM, high titre IgG or clinical disease may be associated with dementia or MCI, though results were inconsistent across studies and overall evidence rated very low quality. Longitudinal population studies with robust repeated virus measurements taken sufficiently proximal to dementia onset are needed to establish whether, when and among whom herpesviruses affect dementia risk

Regional research priorities in brain and nervous system disorders

The characteristics of neurological, psychiatric, developmental and substance-use disorders in low-and middle-income countries are unique and the burden that they have will be different from country to country. Many of the differences are explained by the wide variation in population demographics and size, poverty, conflict, culture, land area and quality, and genetics. Neurological, psychiatric, developmental and substance-use disorders that result from, or are worsened by, a lack of adequate nutrition and infectious disease still afflict much of sub-Saharan Africa, although disorders related to increasing longevity, such as stroke, are on the rise. In the Middle East and North Africa, major depressive disorders and post-traumatic stress disorder are a primary concern because of the conflict-ridden environment. Consanguinity is a serious concern that leads to the high prevalence of recessive disorders in the Middle East and North Africa and possibly other regions. The burden of these disorders in Latin American and Asian countries largely surrounds stroke and vascular disease, dementia and lifestyle factors that are influenced by genetics. Although much knowledge has been gained over the past 10 years, the epidemiology of the conditions in low-and middle-income countries still needs more research. Prevention and treatments could be better informed with more longitudinal studies of risk factors. Challenges and opportunities for ameliorating nervous-system disorders can benefit from both local and regional research collaborations. The lack of resources and infrastructure for health-care and related research, both in terms of personnel and equipment, along with the stigma associated with the physical or behavioural manifestations of some disorders have hampered progress in understanding the disease burden and improving brain health. Individual countries, and regions within countries, have specific needs in terms of research priorities.Fil: Ravindranath, Vijayalakshmi. Indian Institute of Science; IndiaFil: Dang, Hoang Minh. Vietnam National University; VietnamFil: Goya, Rodolfo Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Bioquímicas de La Plata ; ArgentinaFil: Mansour, Hader. University of Pittsburgh; Estados Unidos. Mansoura University; EgiptoFil: Nimgaonkar, Vishwajit L.. University of Pittsburgh; Estados UnidosFil: Russell, Vivienne Ann. University of Cape Town; SudáfricaFil: Xin, Yu. Peking University; Chin

Climate, extreme weather and the health of older people: An umbrella review and framework for action

Background: Older people are affected more severely and unequally by disturbances in climate and ecosystems. Directly, from extreme weather events such as heat waves, flooding, and severe storms; and indirectly, through droughts and compromised water safety catalysing food insecurity, displacement and poverty. Limited understanding of the impacts and interfaces of climate and extreme weather on older people and subgroups at potential increased risk hinders our ability to plan and respond effectively to protecting older populations as climatic instability continues. Objectives: To progress this agenda, our work aims to i) systematically assess the health impacts of extreme weather on older people ii) synthesise the evidence to examine interfaces and subgroups at increased risk iii) develop a framework to inform responses. Methods: An umbrella review is being conducted to systematically examine and synthesise the links between extreme weather events and health impacts on older people. The review will include original or primary research published between 2013 and 2023. Electronic searches will be conducted in Medline via Ovid, Embase via Ovid, Web of Science, CINAHL via EbscoHost, Cochrane Library, ASSIA via Proquest and PsycINFO via EbscoHost. Reference lists of retrieved articles will be checked for further relevant studies and experts in the field will be consulted to identify any further potentially relevant papers. Quality will be assessed using STROBE checklists and a narrative synthesis of the results conducted. Findings: The results of this review will provide a comprehensive and up-to-date understanding of the impacts of climate instability and extreme weather events on the health and wellbeing of older people. It will be used to develop a framework demonstrating the interfaces between climate, extreme weather and the health of older people which will inform guidance on which subgroups are at increased risk and which actions and responses are needed

Climate, extreme weather and the health of older people: An umbrella review and framework for action

Background: Older people are affected more severely and unequally by disturbances in climate and ecosystems. Directly, from extreme weather events such as heat waves, flooding, and severe storms; and indirectly, through droughts and compromised water safety catalysing food insecurity, displacement and poverty. Limited understanding of the impacts and interfaces of climate and extreme weather on older people and subgroups at potential increased risk hinders our ability to plan and respond effectively to protecting older populations as climatic instability continues. Objectives: To progress this agenda, our work aims to i) systematically assess the health impacts of extreme weather on older people ii) synthesise the evidence to examine interfaces and subgroups at increased risk iii) develop a framework to inform responses. Methods: An umbrella review is being conducted to systematically examine and synthesise the links between extreme weather events and health impacts on older people. The review will include original or primary research published between 2013 and 2023. Electronic searches will be conducted in Medline via Ovid, Embase via Ovid, Web of Science, CINAHL via EbscoHost, Cochrane Library, ASSIA via Proquest and PsycINFO via EbscoHost. Reference lists of retrieved articles will be checked for further relevant studies and experts in the field will be consulted to identify any further potentially relevant papers. Quality will be assessed using STROBE checklists and a narrative synthesis of the results conducted. Findings: The results of this review will provide a comprehensive and up-to-date understanding of the impacts of climate instability and extreme weather events on the health and wellbeing of older people. It will be used to develop a framework demonstrating the interfaces between climate, extreme weather and the health of older people which will inform guidance on which subgroups are at increased risk and which actions and responses are needed