The role of primary care doctors in early diagnosis and treatment for persons with dementia

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Practical approach to pharmacological treatment and nonpharmacological intervention of dementia

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Exploring dementia family carers' self-initiated strategies in managing behavioural and psychological symptoms in dementia: A qualitative study

Objectives Carer's self-initiated management strategies of behavioural and psychological symptoms of dementia (BPSD) can inform intervention development. These strategies are affected by cultural values. Little is known about non-Western dementia carers' BPSD management strategies. This study aimed to explore self-initiated strategies in managing BPSD adopted by Chinese carers. Design Qualitative study using thematic framework method. Setting Community setting in Hong Kong. Participants 16 dementia carers with purposive sampling to include carers of different relationships to the people living with dementia (PLwD), education level and living arrangement. Results Six overarching themes emerged from the data: (1) maintaining personhood in PLwD, (2) responding positively to BPSD, (3) explanation and bargaining, (4) responding negatively to BPSD, (5) controlling upsetting thoughts, and (6) getting respite care. Chinese carers treasured warm and supportive family relationships. They identified and minimised triggers to alleviate BPSD. Some carers struggled with care tasks and reacted with confrontation and avoidance. Changing attitudes and getting social and emotional support were described to manage carers' distress. Few self-care strategies including getting respite care were reported. Conclusions Carers' self-initiated strategies largely aligned with existing theoretical frameworks in BPSD management, such as person-centred approach, and echoed Asian culture, which advocates filial piety and supportive family relationships. While these cultural values encourage the engagement of people living with dementia in the normal process of family life, they may also prevent carers from taking time away from care. Interventions could support carers by enhancing their knowledge and skills in managing BPSD, providing social and emotional support, and providing guidance in self-care. Future cross-cultural research could explore factors contributing to how carers manage BPSD and how interventions could be culturally adapted to facilitate carers to apply learnt skills in daily practice and hence benefit the people living with dementia and carer population

Prevalence of depression, anxiety, and apathy symptoms across dementia stages: a systematic review and meta-analysis

OBJECTIVE: The present study aimed to resolve inconsistency in reported prevalence of affective symptoms by dementia stage. METHODS/DESIGN: We conducted a meta-analysis of studies with data on dementia stage and prevalence of depression, anxiety, or apathy assessed using validated tools. We performed random-effects meta-analysis and subgroup analysis on symptom prevalence by dementia stage, according to CDR. RESULTS: The meta-analysis included 5,897 people with dementia from 20 studies. Prevalence rates of depression in mild, moderate, and severe dementia were 38% (95% CI 32-45%), 41% (95% CI 33-49%), and 37% (95% CI 17-56%) respectively. The corresponding prevalence for anxiety was 38% (95% CI 31-45%), 41% (95% CI 31-52%), and 37% (95% CI -8-82%); and 54% (95% CI 45-62%), 59% (95% CI 44-73%), and 43% (95% CI 10-75%) for apathy. The prevalence of depression, anxiety, and apathy did not differ with regard to dementia stage and type. The prevalence of depression in AD was significantly lower when it was assessed using diagnostic criteria compared to screening tools. The prevalence of depression in AD was lowest in America, while anxiety in VaD was higher in Europe than Asia. CONCLUSIONS: Depression, anxiety, and apathy symptoms are highly prevalent across dementia stages. There is no evidence of any changes in prevalence of affective symptom as the illness progresses. Evaluation methods and cultural difference may explain some of the variance, suggesting further investigation of factors that may influence the report of symptoms, such as carer psychosocial characteristics, and more cross-cultural studies are needed. This article is protected by copyright. All rights reserved

Can mindfulness-based interventions benefit people with dementia? Drawing on the evidence from a systematic review in populations with cognitive impairments

Introduction: Non-pharmacological interventions that promote quality of life in people with dementia are urgently needed. To accelerate development, evidence-based psychotherapies used in other populations can be considered. Mindfulness-based interventions with standardised protocols, namely mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR), may be effective in people with dementia, although tailoring for cognitive impairment may be needed. Evidence from other cognitive disorders can inform research. / Areas covered: The authors reviewed 12 studies of MBCT or MBSR conducted in people with cognitive impairments, including ten in stroke, traumatic brain injury, and mild cognitive impairment; and two in dementia. Protocol modifications, outcomes, and evidence quality were analysed. Common themes to address cognitive difficulties included: shortened session duration, use of memory aids, increase in repetition, simplified language, and omitted retreat sessions. / Expert opinion: MBCT and MBSR can be applied without drastic modifications in people with cognitive impairment. Their effectiveness in people with dementia remains unknown: empirical studies using/adapting evidence based MBCT/MBSR protocols in this population is seriously lacking. Studies used a diverse range of outcome measures, which made direct comparison difficult. Further research with high methodological quality, sufficient power and longer follow-up are urgently needed. Development of manuals would enhance the replicability of future studies

Education attainment, intelligence and covid-19: A mendelian randomization study

Background: Evidence of socioeconomic inequality in COVID-19-related outcomes is emerging, with a higher risk of infection and mortality observed among individuals with lower education attainment. We aimed to evaluate the potential interventions against COVID-19 from the socioeconomic perspective, including improvement in education and intelligence. Methods: With a two-sample Mendelian randomization approach using summary statistics from the largest genome-wide association meta-analysis, univariable analysis was adopted to evaluate the total causal effects of genetically determined education attainment and intelligence on COVID-19 outcomes. Multivariable analysis was performed to dissect the potential mechanisms. Results: Genetic predisposition to higher education attainment by 1 SD (4.2 years) was independently associated with reduced risk of COVID-19 severity (OR = 0.508 [95% CI: 0.417–0.617]; p < 0.001). Genetically higher education attainment also lowered the risk of COVID-19 hospitalization (0.685 [0.593–0.791]; p < 0.001), but the association was attenuated after adjustment for beta estimates of intelligence in multivariable analysis. Genetically higher intelligence was associated with reduced risk of COVID-19 hospitalization (0.780 [0.655–0.930]; p = 0.006), with attenuation of association after adjustment for education attainment. Null association was observed for genetically determined education attainment and intelligence with SARS-CoV-2 infection. Conclusion: Education may act independently and jointly with intelligence in improving the COVID-19 outcomes. Improving education may potentially alleviate the COVID-19-related health inequality

Systematic review of the current psychosocial interventions for people with moderate to severe dementia

Objective: Dementia, a global epidemic, currently affects 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial interventions for people with moderate to severe dementia, focusing on improving cognition and quality of life (QoL) to evaluate what treatments are working and whether improvements are possible. / Methods: A systematic search was conducted using six key databases to identify psychosocial interventions for people with moderate to severe dementia, measuring cognition or QoL in randomized controlled trials (RCTs), published between 2000 and 2020. / Results: The search identified 4193 studies, and 74 articles were assessed for full‐text review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence Database Scale. The included RCTs were moderate in quality. / Conclusions: Aromatherapy and reminiscence therapy showed the strongest evidence in improving QoL. There was some evidence that aerobic exercise enhanced cognition, and a multicomponent study improved QoL. However, a quality assessment, using pre‐specified criteria, indicated many methodological weaknesses. While we found improvements in cognition and QoL for moderate to severe dementia, results must be interpreted with caution. Future interventions with rigorous study designs are a pressing need and required before we can recommend specific interventions

Risk of self-harm after the diagnosis of psychiatric disorders in Hong Kong, 2000–10: a nested case-control study

Background Psychiatric disorders are established risk factors for self-harm. However, variation in risk of self-harm by specific psychiatric disorder, stratified by gender and age, is rarely examined using population representative samples. This study aims to investigate the risk of self-harm following the diagnosis of different psychiatric disorders based on inpatient records retrieved from the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Method A cohort of 86,353 people with a first-recorded diagnosis of depression, alcohol abuse/dependence, personality disorders, bipolar disorders, anxiety disorders, schizophrenia, or substance abuse/dependence, along with 134,857 matched controls, were followed between 2000 and 2010. For each diagnostic category, a Cox proportional hazard regression model was fitted to estimate the adjusted hazard ratio (aHR) (95% confidence intervals) of associated self-harm, adjusting for gender, age, admission time, district of residence, and comorbidities. Outcomes The personality disorders and substance abuse/dependence groups had the highest self-harm incidences of 3,174 and 3,018 per 100,000 patient-years, respectively. The highest risk of self-harm was found in the substance abuse/dependence group (aHR, 9·6; 95% CI, 8·4-11·0), followed by the groups with personality disorders (3·7; 2·8-4·9) and alcohol abuse/dependence (3·2; 2·9-3·7). When stratified by gender and age, the highest risk was found in substance abuse/dependence group for both genders (female: aHR, 7·7; 95% CI, 6·0-9·8; male: 10·5; 95% CI, 8·9-12·4) and all age groups (adolescent: aHR, 9·6; 95% CI, 7·2-12·7; young: 10·2; 95% CI, 8·4-12·3; middle-aged: 11·2; 95% CI, 8·0-15·6; Elderly: 3·2; 95% CI, 1·7-6·1). Interpretation First-recorded diagnosis of psychiatric disorders were significantly associated with elevated risks of subsequent self-harm. The associations varied considerably by diagnostic categories across gender-age subgroups. This finding highlighted the needs to develop more efficient and targeted preventive measures in psychiatric care management. Specific attention should be paid to demographic characteristics linked to increased risk within the same diagnostic category

Sustainability of Treatment Effect of a 3-year Early Intervention Programme for First-episode Psychosis in Hong Kong

Parallel Session 1 – Health and Health Services: abstract no. S2published_or_final_versio

Immediate Risk for Cardiovascular Events in Hip Fracture Patients: A Population-Based Cohort Study

Background: Emerging evidence showed that bone metabolism and cardiovascular diseases (CVD) are closely related. We previously observed a potential immediate risk of cardiovascular mortality after hip fracture. However, whether there is an immediate risk of cardiovascular events after hip fracture is unclear. The aim of this study was to evaluate the risk for major adverse cardiovascular events (MACEs) between patients having experienced falls with and without hip fracture. / Methods: This retrospective population-based cohort study used data from a centralized electronic health record database managed by Hong Kong Hospital Authority. Patients having experienced falls with and without hip fracture were matched by propensity score (PS) at a 1:1 ratio. Adjusted associations between hip fracture and risk of MACEs were evaluated using competing risk regression after accounting for competing risk of death. / Results: Competing risk regression showed that hip fracture was associated with increased one-year risk of MACEs (hazard ratio [HR], 1.27; 95% CI, 1.21 to 1.33; p<0.001), with a 1-year cumulative incidence difference of 2.40% (1.94% to 2.87%). The HR was the highest in the first 90-day after hip fracture (HR of 1.32), and such an estimate was continuously reduced in 180-day, 270-day, and 1-year after hip fracture. / Conclusions: Hip fracture was associated with increased immediate risk of MACEs. This study suggested that a prompt evaluation of MACE among older adults aged 65 years and older who are diagnosed with hip fracture irrespectively of cardiovascular risk factors may be important, as early management may reduce subsequent risk of MACE