World Alzheimer report 2015: the global impact of dementia

Today, over 46 million people live with dementia worldwide, more than the population of Spain. This number is estimated to increase to 131.5 million by 2050. Dementia also has a huge economic impact. Today, the total estimated worldwide cost of dementia is US $818 billion, and it will become a trillion dollar disease by 2018. This means that if dementia care were a country, it would be the world’s 18th largest economy, more than the market values of companies such as Apple (US$ 742 billion), Google (US$368 billion) and Exxon (US$ 357 billion). In many parts of the world, there is a growing awareness of dementia, but across the globe it remains the case that a diagnosis of dementia can bring with it stigma and social isolation. Today, we estimate that 94% of people living with dementia in low and middle income countries are cared for at home. These are regions where health and care systems often provide limited or no support to people living with dementia or to their families. The 2015 World Alzheimer Report updates data on the prevalence, incidence, cost and trends of dementia worldwide. It also estimates how these numbers will increase in the future, leaving us with no doubt that dementia, including Alzheimer’s disease and other causes, is one of the biggest global public health and social care challenges facing people today and in the future. Authors Prof Martin Prince The Global Observatory for Ageing and Dementia Care, King’s College London, UK Prof Anders Wimo Department of Neurobiology, Care sciences and Society, Karolinska Institute, Stockholm, Sweden Dr Maëlenn Guerchet The Global Observatory for Ageing and Dementia Care, King’s College London, UK Miss Gemma-Claire Ali The Global Observatory for Ageing and Dementia Care, King’s College London, UK Dr Yu-Tzu Wu Cambridge Institute of Public Health, University of Cambridge, UK Dr Matthew Prina The Global Observatory for Ageing and Dementia Care, King’s College London, UK Alzheimer\u27s Disease Internationa

Helping carers to care: the 10/66 dementia research group's randomized control trial of a caregiver intervention in Peru

OBJECTIVE There is a need, in the absence of formal services, to design interventions aimed at improving the lives of people with dementia and their families. This study tested the effectiveness of the 10/66 caregiver intervention among people with dementia and their caregivers in Lima, Peru. METHOD Design/participants: a randomized controlled trial was performed involving 58 caregivers of people with dementia that received the intervention in the beginning of the trial (n = 29) or six months later (n = 29). The intervention consisted of three modules: 1) assessment (one session); 2) basic education about dementia (two sessions); and 3) training regarding specific problem behaviors (two sessions). Main outcome measures: Caregivers and patients with dementia were assessed at baseline and after six months. For caregivers, the measures included strain (Zarit Burden Interview), psychological distress (SRQ-20), and quality of life (WHOQOL-BREF). Dementia patients completed scales assessing behavioral and psychological symptoms (NPI-Q) and quality of life (DEMQOL). RESULTS Caregivers in the intervention group reported significantly decreased strain measures six months after the intervention compared to controls. No group differences were found in respect to the caregivers' psychological distress and to quality of life in both caregivers and patients. CONCLUSION The 10/66 intervention seems to be as effective as similar interventions used in more developed countries

Predictors of mortality among elderly people living in a south Indian urban community; a 10/66 Dementia Research Group prospective population-based cohort study

Abstract Background Eighty percent of deaths occur in low and middle income countries (LMIC), where chronic diseases are the leading cause. Most of these deaths are of older people, but there is little information on the extent, pattern and predictors of their mortality. We studied these among people aged 65 years and over living in urban catchment areas in Chennai, south India. Methods In a prospective population cohort study, 1005 participants were followed-up after three years. Baseline assessment included sociodemographic and socioeconomic characteristics, health behaviours, physical, mental and cognitive disorders, disability and subjective global health. Results At follow-up, 257 (25.6%) were not traced. Baseline characteristics were similar to the 748 whose vital status was ascertained; 154 (20.6%) had died. The mortality rate was 92.5/1000 per annum for men and 51.0/1000 per annum for women. Adjusting for age and sex, mortality was associated with older age, male sex, having no friends, physical inactivity, smaller arm circumference, dementia, depression, poor self-rated health and disability. A parsimonious model included, in order of aetiologic force, male sex, smaller arm circumference, age, disability, and dementia. The total population attributable risk fraction was 0.90. Conclusion A balanced approach to prevention of chronic disease deaths requires some attention to proximal risk factors in older people. Smoking and obesity seem much less relevant than in younger people. Undernutrition is preventable. While dementia makes the largest contribution to disability and dependency, comorbidity is the rule, and more attention should be given to the chronic care needs of those affected, and their carers. </jats:sec

World Alzheimer report 2016: improving healthcare for people living with dementia: coverage, quality and costs now and in the future

The World Alzheimer Report 2016, Improving healthcare for people living with dementia: Coverage, quality and costs now and in the future, reviews research evidence on the elements of healthcare for people with dementia, and, using economic modelling, suggests how it should be improved and made more efficient. The report argues that current dementia healthcare services are over-specialised, and that a rebalancing is required with a more prominent role for primary and community care. This would increase capacity, limit the increased costs associated with scaling up coverage of care, and, coupled with the introduction of care pathways and case management, improve the coordination and integration of care. Modelling of the costs of care pathways was carried out in Canada, China, Indonesia, Mexico, South Africa, South Korea and Switzerland, to estimate the costs of dementia healthcare under different assumptions regarding delivery systems. The report was researched and authored by Prof Martin Prince, Ms Adelina Comas-Herrera, Prof Martin Knapp, Dr Maëlenn Guerchet and Ms Maria Karagiannidou from The Global Observatory for Ageing and Dementia Care, King’s College London and the Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science

Health-related quality-of-life assessment in dementia:evidence of cross-cultural validity in Latin America

All health-related quality-of-life (HRQL) measures for dementia have been developed in high-income countries and none were validated for cross-cultural use. Yet, the global majority of people living with dementia reside in low- and middle-income countries. We therefore investigated the measurement invariance of a set of self- and informant-report HRQL measures developed in the United Kingdom when used in Latin America. Self-reported HRQL was obtained using (DEMQOL) at a memory assessment service in the United Kingdom (n = 868) and a population cohort study in Latin America (n = 417). Informant reports were collected using DEMQOL-Proxy at both sites (n = 909 and n = 495). Multiple-group confirmatory bifactor models for ordered categorical item responses were estimated to evaluate measurement invariance. Results support configural, metric, and scalar invariance for the concept of general HRQL in DEMQOL and DEMQOL-Proxy. The dominant impact of general HRQL on item responses was evident across U.K. English and Ibero American Spanish versions of DEMQOL (ωh = 0.87-0.90) and DEMQOL-Proxy (ωh = 0.88-0.89). Ratings of positive emotion did not show a major impact on general HRQL appraisal, particularly for Latin American respondents. Item information curves show that self- and informant-reports were highly informative about the presence rather than the absence of HRQL impairment. We found no major difference in conceptual meaning, sensitivity, and relevance of DEMQOL and DEMQOL-Proxy for older adults in the United Kingdom and Latin America. Further replication is needed for consensus over which HRQL measures are appropriate for making cross-national comparisons in global dementia research. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age - a life course perspective

Background: In Pakistan, preference for boys over girls is deeply culturally embedded. From birth, many women experience gendered disadvantages, less access to scarce resources, poorer health care, higher child mortality, limited education, less employment outside of the home and circumscribed autonomy. The prevalence of psychological morbidity is exceptionally high among women. We hypothesise that, among women of childbearing age, gender disadvantage is an independent risk factor for psychological morbidity. Methods: A cross-sectional catchment area survey of 525 women aged 18 to 35 years living in Islamabad and Rawalpindi. The effect of gender disadvantage was assessed as a latent variable using structural equation modelling. Indicators were parental gender preference, low parental care, parental overprotection, limited education, early age at marriage, marital dissatisfaction and low autonomy. Psychological morbidity was assessed using the 20 item Self Reporting Questionnaire (SRQ). Results: Gender disadvantage was independently predictive of psychological morbidity. Among married women, socio-economic status did not predict psychological morbidity, and the effect of education was mediated through gender disadvantage rather than socioeconomic status (SES). The women\u27s own preference for a male child was strongly predicted by their perceptions of having been disadvantaged by their gender in their families of origin. Conclusions: The high prevalence of psychological morbidity among women in Pakistan is concerning given recently reported strong associations with low birth weight and infant stunting. Social action, public policies and legislation are indicated to reduce culturally embedded preferences. Neglect of these fundamentals will entrench consequent inequities including gender bias in access to education, a key millennium development goal

Cross-sectional associations of depressive symptom severity and functioning with health service use by older people in low-and-middle income countries

Background: Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs). Methods: A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis. Results: After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated with “any community HSU” (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01–1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02–1.26) but not “any community HSU”. Conclusions: Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems

Solar High-energy Astrophysical Plasmas Explorer (SHAPE). Volume 1: Proposed concept, statement of work and cost plan

The concept of the Solar High-Energy Astrophysical Plasmas Explorer (SHAPE) is studied. The primary goal is to understand the impulsive release of energy, efficient acceleration of particles to high energies, and rapid transport of energy. Solar flare studies are the centerpieces of the investigation because in flares these high energy processes can be studied in unmatched detail at most wavelenth regions of the electromagnetic spectrum as well as in energetic charged particles and neutrons

Nephrogenic systemic fibrosis risk and liver disease.

Objective. Evaluate the incidence of nephrogenic systemic fibrosis (NSF) in patients with liver disease in the peritransplant period. Materials and Methods. This IRB approved study retrospectively reviewed patients requiring transplantation for cirrhosis, hepatocellular carcinoma (HCC), or both from 2003 to 2013. Records were reviewed identifying those having gadolinium enhanced MRI within 1 year of posttransplantation to document degree of liver disease, renal disease, and evidence for NSF. Results. Gadolinium-enhanced MRI was performed on 312 of 837 patients, including 23 with severe renal failure (GFR &lt; 30 mL/min/1.73 cm(2)) and 289 with GFR &gt; 30. Two of 23 patients with renal failure developed NSF compared to zero NSF cases in 289 patients with GFR &gt; 30 (0/289; P &lt; 0.003). High dose gadodiamide was used in the two NSF cases. There was no increased incidence of NSF with severe liver disease (1/71) compared to nonsevere liver disease (1/241; P = 0.412). Conclusion. Renal disease is a risk factor for NSF, but in our small sample our evidence suggests liver disease is not an additional risk factor, especially if a low-risk gadolinium agent is used. Noting that not all patients received high-risk gadolinium, a larger study focusing on patients receiving high-risk gadolinium is needed to further evaluate NSF risk in liver disease in the peritransplant period