Non-genetic risk and protective factors for sporadic degenerative and vascular young onset dementia

Young onset dementia (with symptom onset before age 65, YOD) has a significant personal and public health impact. Despite this, little is known about its cause and non-genetic factors have been sparsely investigated. Existing studies have not considered the timing or severity of exposure, which is important in late onset dementia (LOD). They have also failed to exclude directly-inherited cases and those occurring secondarily to another disease. This thesis examined the risk for sporadic degenerative and vascular YOD associated with six selected non-genetic factors: cognitive reserve enhancing factors, cardiovascular risk factors, smoking, depression, alcohol use, and traumatic brain injury (TBI). It established the role of exposure timing and severity, as well as interrelationships existing between factors. Data were taken from two epidemiological studies conducted in Sydney, Australia, one of which exclusively included Aboriginal and Torres Strait Islander participants. Dementia diagnosis was confirmed via clinical consensus and risk exposure was retrospectively self- and/or informant-reported. Participants were 96 people with YOD (58.4% with Alzheimer’s disease) and 179 age-group and sex matched control participants. Poor educational attainment, low lifetime participation in cognitive leisure activity, stroke or TIA, smoking, and heavy alcohol use were significantly related to risk for primary degenerative and vascular YOD. Some compensation for low educational attainment was possible via a complex occupation later in life. The effect of hypertension and depression varied depending on when they occurred relative to dementia onset. There was no effect of mild-moderate alcohol use, hypercholesterolemia, diabetes, or TBI of any kind. Cumulative risk exposure was detrimental, particularly where lack of access to or participation in cognitive-reserve enhancing factors clustered with cardiovascular risk factors. The results of this thesis suggest that non-genetic factors have a role in YOD as they do in LOD. Compared with their same-age peers, people with YOD experience a lifetime of disadvantage starting from early in life. The timing and severity of exposure, as well as the potential for compensation with later protective exposures, are important considerations. Efforts to address early life disadvantage and facilitate upward social mobility will be beneficial in delaying dementia to later in life

Rehabilitation in dementia care

The Accepted Manuscript (AM) is the final draft author manuscript, as accepted for publication by a journal, including modifications based on referees’ suggestions, before it has undergone copyediting, typesetting and proof correction. This is sometimes referred to as the post-print version. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: [email protected] rehabilitation is increasingly accepted as valuable in the management of chronic disease. Whereas traditional rehabilitation models focussed on recovery, maintaining independence and delaying functional decline are now considered worthwhile aims even where full recovery is not feasible. Despite this, rehabilitation is notably absent from dementia care literature and practice. People with dementia report frustration with the lack of availability of structured post-diagnosis pathways like those offered for other conditions. Alternative terms such as ‘re-ablement’ are used to refer to rehabilitation-like services, but lack an evidence-base to guide care. This commentary will discuss possible reasons for the resistance to accept multidisciplinary rehabilitation as part of dementia care, and identifies the value of doing so for people with dementia, their families, and for health professionals

Single- and double-scattering production of four muons in ultraperipheral PbPb collisions at the Large Hadron Collider

We discuss production of two $\mu^+\mu^-$ pairs in ultraperipheral ultrarelativistic heavy ion collisions at the LHC. We take into account electromagnetic (two-photon) double-scattering production and for a first time direct $\gamma\gamma$ production of four muons in one scattering. We study the unexplored process $\gamma \gamma \to \mu^+\mu^-\mu^+\mu^-$. We present predictions for total and differential cross sections. Measurable nuclear cross sections are obtained and corresponding differential distributions and counting rates are presented.Comment: 13 pages, 11 figures, 1 tabl

Delivering Trauma-Informed Care in a Hospital Ward for Older Adults With Dementia: An Illustrative Case Series

IntroductionUp to 70% of older adults have experienced a psychologically traumatic event in their life. Traumatic events can have lifelong effects on functioning and emotion regulation and can affect behavior and experiences in care settings. Common healthcare practices and environments can be re-traumatizing for trauma survivors. These features may trigger behavior change (e.g., aggression and agitation) particularly after the onset of dementia. However, very little research exists to understand how the effects of traumatic events manifest in aged care settings. Trauma-informed care is a framework in which the potential impact of trauma is acknowledged, and practices and procedures are adapted to maximize feelings of control and safety for the patient. Trauma-informed care is an innovative approach with little published evidence in acute geriatric settings.MethodsWe present a series of cases to demonstrate how psychological trauma can affect the experience of inpatient care for older people. The cases detail the patients' relevant background, triggers and behaviors followed by the steps taken by staff to support the patient and respond to their trauma-related needs. These cases describe how the principles of trauma-informed care can be applied to recognize when past psychologically traumatic events are impacting the older adult in hospital. The outcomes of these interventions are reported on in terms of their impact on challenging behavior, patient experiences and satisfaction with care, and/or staff confidence and skill.FindingsA range of past events negatively impacted the patients during their time in hospital, including childhood abuse, military service, and domestic violence. Staff implemented strategies to accommodate trauma-related needs while providing care that improved safety and reduced patient distress. Principles of trauma-informed care were applied where able, including providing choices and enabling autonomy. However, organizational and environmental features of inpatient wards continued to pose risks for re-traumatisation.ConclusionsTrauma-informed care is an under-utilized yet potentially beneficial approach to care for older adults in the hospital setting. The cases detailed here demonstrated that the impact of psychological trauma requires an individualized response from staff which when effectively implemented can promote staff and patient safety, reduce the risk of re-traumatisation, and minimize adverse events

Health Professional Perspectives on Rehabilitation for People With Dementia

© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. This author accepted manuscript is made available following 12 month embargo from date of publication (February 2019) in accordance with the publisher’s archiving policyMultidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from key advocates. Clinician views regarding the relevance of rehabilitation in dementia care are not well known. This qualitative study explored the perspectives of health professionals regarding barriers to provision of multidisciplinary rehabilitation programs for people with dementia

Providing trauma-informed aged and dementia care (Seminar Series on Ageing)

More than 70 per cent of older people have experienced a psychologically traumatic event in their lives. The effects of these events can continue into late life in ways that can be difficult for professionals to understand. This webinar will provide practical advice to all professionals working with older people and people with dementia about how to deliver safe and accessible care for all older people who have experienced traumatic events. Attendees will learn about the wide-ranging effects of psychological trauma in older adulthood and be introduced to trauma-informed care, gaining pragmatic skills in assessing and responding to trauma-related needs. Presented Friday 7 May, 2021

Trauma-focussed treatments with older adults (Seminar Series on Ageing)

This webinar will describe what is known from the research about how trauma presents in older adults and those with dementia, provide practical advice for delivering trauma-focussed treatments, and discuss adaptations to therapy that may be required for this population. Attendees will gain pragmatic skills in assessing and responding to trauma-related needs. More than 70% of older people have experienced a psychologically traumatic event in their lives. Events that occur in late-life can trigger traumatic stress symptoms, and older people can experience the re-emergence of previously well-managed traumatic stress. Symptoms may appear differently than in younger people, especially in the presence of co-morbid cognitive impairment. It is essential that mental health professionals understand how to identify, assess, and treat traumatic stress symptoms. Presented on May 13th 2022

Trauma screening tools for aged care: A scoping review

This scoping review will identify the availability of trauma assessment tools, and examine their suitability for informing aged care practice

Ethnic disparities in the uptake of anti-dementia medication in young and late-onset dementia.

OBJECTIVES:People with dementia can face barriers when trying to access care after a diagnosis, particularly in young-onset dementia (YOD). Little is known about the effects of ethnicity on the use of anti-dementia medication and variations between age groups. The aim of this study was to analyze national data on variations in the uptake of anti-dementia medication between people with YOD and late-onset dementia (LOD). DESIGN:Cross-sectional longitudinal cohort study. SETTING:Data from the U.S. National Alzheimer's Coordinating Centre were obtained from September 2005 to March 2019. PARTICIPANTS:First visits of people with a diagnosis of Alzheimer's disease (AD) dementia, Lewy body dementia (LBD), and Parkinson's disease dementia (PDD) were included. MEASUREMENTS:Logistic regression was used to analyze the effects of education and ethnicity on use of cholinesterase inhibitors and memantine, accounting for YOD/LOD, gender, living situation, severity stage, and comorbidities. RESULTS:In total, 15,742 people with AD dementia and LBD/PDD were included, with 11,019 PwD having completed a first follow-up visit. Significantly more people with YOD used memantine than those with LOD, while fewer used cholinesterase inhibitors. PwD from minority ethnic backgrounds used memantine and cholinesterase inhibitors less often than those from a White ethnic background. Logistic regression analysis showed that ethnicity was a significant determinant of both memantine and cholinesterase inhibitors usage, while education was only a significant determinant for memantine usage. CONCLUSIONS:Findings highlight the impact of social factors on current usage of anti-dementia medication and the need for more resources to enable equitable use of anti-dementia medication