Understanding and predicting the longitudinal course of dementia

PURPOSE OF REVIEW: To date, most research in dementia has focused either on the identification of dementia risk prediction or on understanding changes and predictors experienced by individuals before diagnosis. Despite little is known about how individuals change after dementia diagnosis, there is agreement that changes occur over different time scales and are multidomain. In this study, we present an overview of the literature regarding the longitudinal course of dementia. RECENT FINDINGS: Our review suggests the evidence is scarce and findings reported are often inconsistent. We identified large heterogeneity in dementia trajectories, risk factors considered and modelling approaches employed. The heterogeneity of dementia trajectories also varies across outcomes and domains investigated. SUMMARY: It became clear that dementia progresses very differently, both between and within individuals. This implies an average trajectory is not informative to individual persons and this needs to be taken into account when communicating prognosis in clinical care. As persons with dementia change in many more ways during their patient journey, heterogeneous disease progressions are the result of disease and patient characteristics. Prognostic models would benefit from including variables across a number of domains. International coordination of replication and standardization of the research approach is recommended

Availability of Cognitive Resources in Early Life Predicts Transitions Between Cognitive States in Middle and Older Adults From Europe

BACKGROUND AND OBJECTIVES: The existing literature highlights the importance of reading books in middle-to-older adulthood for cognitive functioning; very few studies, however, have examined the importance of childhood cognitive resources for cognitive outcomes later in life.RESEARCH DESIGN AND METHODS: Using data from 11 countries included in the Survey of Health, Ageing, and Retirement in Europe (SHARE) data set ( N  = 32,783), multistate survival models (MSMs) were fit to examine the importance of access to reading material in childhood on transitions through cognitive status categories (no cognitive impairment and impaired cognitive functioning) and death. Additionally, using the transition probabilities estimated by the MSMs, we estimated the remaining years of life without cognitive impairment and total longevity. All models were fit individually in each country, as well as within the pooled SHARE sample. RESULTS: Adjusting for age, sex, education, and childhood socioeconomic status, the overall pooled estimate indicated that access to more books at age 10 was associated with a decreased risk of developing cognitive impairment (adjusted hazard ratio = 0.79, confidence interval: 0.76-0.82). Access to childhood books was not associated with risk of transitioning from normal cognitive functioning to death, or from cognitive impairment to death. Total longevity was similar between participants reporting high (+1 standard deviation [ SD]) and low (-1 SD) number of books in the childhood home; however, individuals with more access to childhood books lived a greater proportion of this time without cognitive impairment. DISCUSSION AND IMPLICATIONS: Findings suggest that access to cognitive resources in childhood is protective for cognitive aging processes in older adulthood.</p

De variatie in ouder worden begrijpen en beïnvloeden, dat is onze drijfveer. Een overzicht van het onderzoek van de afdeling Geriatrie van het UMC St Radboud

Bespreking onderzoek De kansen die de grote variatie tussen ouderen biedt, bijvoorbeeld die tussen de zeer succesvol oud geworden Hendrikje van Andel-Schipper (115 jaar) en de gemiddelde verpleeghuispatiënt, vormen de drijfveer voor ons onderzoek. Niet zozeer achteruitgang, maar veel meer heterogeniteit in de wijze waarop de achteruitgang optreedt kenmerkt veroudering

Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals

BACKGROUND: Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors. METHODS: Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians’ judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores. RESULTS: Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001). CONCLUSION: This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care

ASO Visual Abstract:Improved Postoperative Outcomes After Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

This study (https://doi.org/10.1245/s10434-022-12623-9) aimed to assess the effect of a multimodal prehabilitation program on perioperative outcomes in colorectal cancer patients using an emulated target trial design. The study identified potential benefits of prehabilitation in daily clinical practice

ASO Visual Abstract:Improved Postoperative Outcomes After Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

This study (https://doi.org/10.1245/s10434-022-12623-9) aimed to assess the effect of a multimodal prehabilitation program on perioperative outcomes in colorectal cancer patients using an emulated target trial design. The study identified potential benefits of prehabilitation in daily clinical practice