Protocol for the IDEAL-2 longitudinal study: Following the experiences of people with dementia and their primary carers to understand what contributes to living well with dementia and enhances active life

Background There is a major need for longitudinal research examining the experiences of people with dementia and their primary carers, as relatively little is known about how the factors associated with capability to ‘live well’ vary over time. The main aim of the IDEAL-2 study is to investigate how and why, over time, people with dementia and their primary carers might vary in their capability to live well with dementia, whilst exploring both their use of health and care services and their unmet needs. Methods IDEAL-2 will build on the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort of 1547 people (who, at recruitment between July 2014 and July 2016, had mild-to-moderate dementia), and their 1283 primary carers in Great Britain. The existing cohort will be enriched with additional participants with mild-to-moderate dementia (and their primary carers where available and willing) from the following groups: people with rarer forms of dementia, and/or those who are ≥90 years or < 65 years of age at time of recruitment. We will assess the primary outcome, capability to live well with dementia, and the factors influencing it using questionnaires at yearly intervals for 3 years. Additionally, we will seek to link the cohort data with administrative data to obtain information about health service use. Some participants will be invited for in-depth face-to-face interviews. The cohort study will be supplemented by linked research focusing on: the co-production of new measures of living well; including the perspectives of people with advanced dementia living in residential care settings; including people with dementia from black, Asian, and minority ethnic groups; and understanding the experience of people living with undiagnosed dementia. Discussion IDEAL-2 will provide evidence about the key indicators of, and factors associated with, living well over the course of dementia and how these differ for particular subgroups. It will tell us which combinations of services and support are most beneficial and cost-effective. Moreover, the IDEAL-2 study will gather evidence from under-researched groups of people with dementia, who are likely to have their own distinct perceptions of living well.Alzheimer’s Society & The University of Exete

Body mass index and cognitive function: the potential for reverse causation

Background/Objective: Higher late life body mass index (BMI) is unrelated to or even predicts lower risk of dementia in late-life, a phenomenon that may be explained by reverse causation due to weight loss during pre-clinical phases of dementia. We aim to investigate the association of baseline BMI and changes in BMI with dementia in a large prospective cohort, and to examine whether weight loss predicts cognitive function. Methods: Using a national cohort of adults average age 58 at baseline in 1994 (n=7,029), we investigated the associations between baseline BMI in 1994 and memory scores from 2000 to 2010. We also examined the association of BMI change from 1994 to 1998 with memory scores from 2000 to 2010. Lastly, to investigate reverse causation, we examined whether memory scores in 1996 predicted BMI trajectories from 2000 to 2010. Results: Baseline overweight predicted better memory scores 6 to 16 years later (β=0.012, 95%CI=0.001; 0.023). Decline in BMI predicted lower memory scores over the subsequent 12 years (β= -0.026, 95%CI= -0.041; -0.011). Lower memory scores at mean age 60 in 1996 predicted faster annual rate of BMI decline during follow-up (β= -0.158 kg/m2 per year, 95% CI= -0.223;-0.094). Conclusion: Consistent with reverse causation, greater decline in BMI over the first four years of the study was associated with lower memory scores over the next decade and lower memory scores was associated with a decline in BMI. These findings suggest that pre-clinical dementia predicts weight loss for people as early as their late 50s

Type 2 diabetes and 10-year risk of dementia and cognitive impairment among older Mexican Americans

OBJECTIVE-Type 2 diabetes has been linked with increased risk of dementia and cognitive impairment among older adults and with premature mortality in young and middleaged adults. No studies have evaluated the association between diabetes and dementia amon

Racial/ethnic differences in dementia risk among older type 2 diabetic patients: The diabetes and aging study

OBJECTIVE: Although patients with type 2 diabetes have double the risk of dementia, potential racial/ethnic differences in dementia risk have not been explored in this population. We evaluated racial/ethnic differences in dementia and potential explanator

Type 2 diabetes and 10-year risk of dementia and cognitive impairment among older Mexican Americans

OBJECTIVE-Type 2 diabetes has been linked with increased risk of dementia and cognitive impairment among older adults and with premature mortality in young and middleaged adults. No studies have evaluated the association between diabetes and dementia amon

Will biomarker-based diagnosis of Alzheimer's disease maximize scientific progress? Evaluating proposed diagnostic criteria

A recently published framework for the diagnosis of Alzheimer’s disease (AD) in research studies would allow diagnosis on the sole basis of two biomarkers (β-amyloid and pathologic tau), even in people with no objective or subjective memory or cognitive changes. This revision will have substantial implications for future Alzheimer’s research, and the changes should be rigorously evaluated before widespread adoption. We propose three principles for evaluating any revision to diagnostic frameworks for AD: (1) does the revision improve the validity of the diagnosis; (2) does the revision improve the reliability or reduce the expense of the diagnosis; and (3) will the revision foster innovative and rigorous research across populations. The new diagnostic framework is unlikely to achieve any of these goals. Instead, it has the potential to handicap future researchers, and slow progress towards identifying effective strategies to prevent or treat AD