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Latest & greatest articles for dementia
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on dementia or other clinical topics then use Trip today.
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Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Memory problems are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific approaches designed to address everyday memory difficulties.The main aim was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed at improving memory functioning (...) for people in the early stages of Alzheimer's disease or vascular dementia. The two types of intervention were considered separately.The CDCIG Specialized Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO and many other databases, was searched on 9 April 2003.RCTs comparing cognitive rehabilitation or cognitive training interventions with comparison conditions, and reporting outcomes for the person with dementia and/or the family caregiver, were considered for inclusion.Six studies
Cholinesterase inhibitors for dementia with Lewy bodies. Dementia with Lewy bodies (DLB) was first described in 1983, and clinical diagnostic criteria were published in the early to mid 1990s. It has been suggested DLB may account for up to 15-25% of cases of dementia among people aged over 65, although autopsy suggests much lower rates. Characteristic symptoms are dementia, marked fluctuation of cognitive ability, early and persistent visual hallucinations and spontaneous motor features (...) symptoms in DLB.To assess the use of cholinesterase inhibitors in DLB.The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 25 February 2002 using the terms 'lewy body', 'Lewy bodies' and 'Lewy'. This register contains records from all major health care databases and trial databases and is updated regularly.Randomized, double-blind trials in which treatment with cholinesterase inhibitors was administered and compared
Folic acid with or without vitamin B12 for cognition and dementia. Folates are vitamins essential to the development of the central nervous system. Insufficient folate activity at the time of conception and early pregnancy can result in congenital neural tube defects. In adult life folate deficiency has been known for decades to produce a characteristic form of anaemia ("megaloblastic"). More recently degrees of folate inadequacy, not severe enough to produce anaemia, have been found (...) to be associated with high blood levels of the amino acid homocysteine. Such degrees of folate inadequacy can arise because of insufficient folates in the diet or because of inefficient absorption or metabolic utilisation of folates due to genetic variations. Conventional criteria for diagnosing folate deficiency may be inadequate for identifying people capable of benefiting from dietary supplementation. High blood levels of homocysteine have been linked with the risk of arterial disease, dementia
Homeopathy for dementia. Dementia is a common illness in older people and has major implications for individuals with the disease, their carers and society. A meta-analysis of population based studies in Europe found the prevalence of dementia in individuals over 65 to be 6.4%. Homeopathy (also spelt "homoeopathy") is a popular form of "complementary" or "alternative" treatment. Some studies have found evidence for efficacy of homeopathic treatment for some conditions, but any mechanism (...) of action of the ultra molecular dilutions used in homeopathy is not comprehensible in terms of current scientific concepts.To evaluate the effectiveness and safety profile of homeopathically prepared medications used in treating dementia, as established by randomized controlled trials.The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 10 May 2002 using the terms alum*, homeop*, "nat sulph" and "natrum sulphate". This Register
Propentofylline for dementia. Propentofylline is a novel therapeutic agent for dementia that readily crosses the blood-brain barrier and acts by blocking the uptake of adenosine and inhibiting the enzyme phosphodiesterase. In vitro and in vivo its mechanism of action appears to be twofold; it inhibits the production of free radicals and reduces the activation of microglial cells. It therefore interacts with the inflammatory processes that are thought to contribute to dementia, and given its (...) mechanism of action is a possible disease modifying agent rather than a purely symptomatic treatment.To determine the clinical efficacy and safety of propentofylline for people with dementia.The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 5 February 2003. Aventis, the manufacturing pharmaceutical company, was asked for data from unpublished studies but declined to enter into correspondence.Unconfounded double-blind
Acetyl-L-carnitine for dementia. Dementia is a common mental health problem affecting 5% of those over 65. Various pathological processes are linked to memory impairment in dementia, particularly those affecting the cholinergic neurotransmitter system. Acetyl-l-carnitine (ALC) is derived from carnitine and is described as having several properties which may be beneficial in dementia. This includes activity at cholinergic neurons, membrane stabilization and enhancing mitochondrial function. Work (...) is to establish whether Acetyl-l-carnitine is clinically effective in the treatment of people with dementia.The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 8 January 2003 using the terms acetyl-l-carnitine, l-carnitine acetyl ester, acetylcarnitine.All double-blind, randomized, trials involving people with dementia in which treatment with ALC was compared with a placebo groupData were extracted by a reviewer (SH) and entered
Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. Postmenopausal women have a greater risk than men of developing Alzheimer disease, but studies of the effects of estrogen therapy on Alzheimer disease have been inconsistent. On July 8, 2002, the study drugs, estrogen plus progestin, in the Women's Health Initiative (WHI) trial were discontinued because of certain (...) increased health risks in women receiving combined hormone therapy.To evaluate the effect of estrogen plus progestin on the incidence of dementia and mild cognitive impairment compared with placebo.The Women's Health Initiative Memory Study (WHIMS), a randomized, double-blind, placebo-controlled clinical trial, began enrolling participants from the Women's Health Initiative (WHI) estrogen plus progestin trial in May 1996. Of the 4894 eligible participants of the WHI study, 4532 (92.6%) postmenopausal
Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. To determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department.Randomised controlled trial.274 cognitively impaired older people (aged 65 or over) presenting to the accident and emergency department after (...) , and mortality.Intention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year's follow up (74% (96/130) and 80% (115/144), relative risk ratio 0.92, 95% confidence interval 0.81 to 1.05). No significant differences were found between groups for secondary outcome measures.Multifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency
Screening for dementia Screening for dementia Screening for dementia Boustani M, Peterson B, Harris R, Lux L J, Krasnov C, Sutton S F, Hanson L, Lohr K N Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Boustani M, Peterson B, Harris R, Lux L J, Krasnov C, Sutton S F, Hanson L, Lohr K N. Screening for dementia. Rockville: Agency (...) for Healthcare Research and Quality (AHRQ). Preventive Services Task Force Systematic Evidence Review No. 20. 2003 Authors' objectives To produce an evidence-based review to support recommendations from the US Preventive Services Task Force (USPSTF) concerning dementia syndrome screening in primary care settings. Authors' conclusions The prevalence and burden of the dementia syndrome are high after age 65. The majority of patients with early dementia are undiagnosed in primary care practices. A brief
Novel antipsychotics for agitation in dementia: a systematic review Novel antipsychotics for agitation in dementia: a systematic review Novel antipsychotics for agitation in dementia: a systematic review Pwee K H, Shukla V K, Herrmann N, Skidmore B Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Pwee K H, Shukla V K, Herrmann N, Skidmore (...) B. Novel antipsychotics for agitation in dementia: a systematic review. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2003: 57 Authors' objectives This assessment critically examines the evidence on the efficacy and safety of novel antipsychotics as compared to placebo and as compared to conventional antipsychotics, for the management of patients with dementia-associated agitation (DAA). Authors' conclusions The efficacy of intramuscular olanzapine for the rapid
End-of-life care and the effects of bereavement on family caregivers of persons with dementia. Although family caregiving has been intensively studied in the past decade, little attention has been paid to the impact of end-of-life care on caregivers who are family members of persons with dementia or to the caregivers' responses to the death of the patient.Using standardized assessment instruments and structured questions, we assessed the type and intensity of care provided by 217 family (...) caregivers to persons with dementia during the year before the patient's death and assessed the caregivers' responses to the death.Half the caregivers reported spending at least 46 hours per week assisting patients with activities of daily living and instrumental activities of daily living. More than half the caregivers reported that they felt they were "on duty" 24 hours a day, that the patient had frequent pain, and that they had had to end or reduce employment owing to the demands of caregiving
Meta-analysis of psychosocial interventions for caregivers of people with dementia Meta-analysis of psychosocial interventions for caregivers of people with dementia Meta-analysis of psychosocial interventions for caregivers of people with dementia Brodaty H, Green A, Koschera A CRD summary This review assessed the effects of psychosocial interventions for people such as family members who provide care at home for people with dementia. The authors concluded that some psychosocial interventions (...) can reduce psychological harm among carers and help people with dementia stay at home longer. The support for the conclusions is not convincing. Authors' objectives To review the outcomes of psychosocial interventions for people who give informal care to people with dementia. Searching MEDLINE (from 1985 to 2000), EMBASE (from 1988 to 2000), PsycINFO (from 1984 to 2000), AgeLine (from 1985 to 2000), CINAHL (from 1985 to 2000), Best Evidence (from 1991 to 2000) and the Cochrane Library (Issue 4
The cost-benefit of cholinesterase inhibitors in mild to moderate dementia: a willingness-to-pay approach The cost-benefit of cholinesterase inhibitors in mild to moderate dementia: a willingness-to-pay approach The cost-benefit of cholinesterase inhibitors in mild to moderate dementia: a willingness-to-pay approach Wu G, Lanctot K L, Herrmann N, Moosa S, Oh P I Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract (...) contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of cholinesterase inhibitors in mild to moderate dementia. Type of intervention Treatment. Economic study type Cost-benefit analysis. Study population The study population comprised non-professional caregivers of outpatients with mild to moderate dementia living in the Toronto (Canada) area, and who were
Evaluating community-based programs for dementia caregivers: the cost implications of adult day services Evaluating community-based programs for dementia caregivers: the cost implications of adult day services Evaluating community-based programs for dementia caregivers: the cost implications of adult day services Gaugler J E, Zarit S H, Townsend A, Stephens M-A P, Greene R Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each (...) abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The provision of adult day centres for the care of dementia patients was examined. The centres provide out-of-home services, including therapeutic activities, health monitoring, socialising, transportation and medical care. Adult day services were used for at least 2 days and 8 hours per week. The day
Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study. To clarify the practice of withholding the artificial administration of fluids and food from elderly patients with dementia in nursing homes.Qualitative, ethnographic study in two phases.10 wards in two nursing homes in the Netherlands.35 patients with dementia, eight doctors, 43 nurses, and 32 families.The clinical course of dementia was considered normal and was rarely reason (...) the artificial administration of fluids and food from elderly patients with dementia are influenced more by the clinical course of the illness, the presumed quality of life of the patient, and the patient's medical condition than they are by advanced planning of care. In an attempt to understand the wishes of the patient doctors try to create the broadest possible basis for the decision making process and its outcome, mainly by involving the family.
The dementias. Dementia affects about 5% of the elderly population over age 65 years and has an unexplained predominance in women and a low rate in some cultures. Different forms of dementia are now distinguished-Alzheimer's disease, dementia with Lewy bodies, frontotemporal dementia, and dementia secondary to disease, such as AIDS dementia. However, such nosological boundaries are being re-evaluated because different dementias are believed to have common underlying neuropathology (...) . Neurochemical and neurobiological research has led to advances in understanding causes of dementia, and functional imaging has allowed identification of possible biomarkers; from these, a range of potential treatment approaches have arisen that focus on enhancement of neurotransmitter function, intervention at the level of amyloid production and deposition, and reduction of secondary risk factors such as hypertension, depression, and hypolipidaemia. Molecular diagnostic testing and genetic counselling
Abnormality of gait as a predictor of non-Alzheimer's dementia. Neurologic abnormalities affecting gait occur early in several types of non-Alzheimer's dementias, but their value in predicting the development of dementia is uncertain.We analyzed the relation between neurologic gait status at base line and the development of dementia in a prospective study involving 422 subjects older than 75 years of age who lived in the community and did not have dementia at base line. Cox proportional-hazards (...) ), there were 125 newly diagnosed cases of dementia, 70 of them cases of Alzheimer's disease and 55 cases of non-Alzheimer's dementia (47 of which involved vascular dementia and 8 of which involved other types of dementia). Subjects with neurologic gait abnormalities had a greater risk of development of dementia (hazard ratio, 1.96 [95 percent confidence interval, 1.30 to 2.96]). These subjects had an increased risk of non-Alzheimer's dementia (hazard ratio, 3.51 [95 percent confidence interval, 1.98
Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. Mild cognitive impairment (MCI) may be a precursor to dementia, at least in some cases. Dementia and MCI are associated with neuropsychiatric symptoms in clinical samples. Only 2 population-based studies exist of the prevalence of these symptoms in dementia, and none exist for MCI.To estimate the prevalence of neuropsychiatric symptoms in dementia and MCI (...) in a population-based study.Cross-sectional study derived from the Cardiovascular Health Study, a longitudinal cohort study.A total of 3608 participants were cognitively evaluated using data collected longitudinally over 10 years and additional data collected in 1999-2000 in 4 US counties. Dementia and MCI were classified using clinical criteria and adjudicated by committee review by expert neurologists and psychiatrists. A total of 824 individuals completed the Neuropsychiatric Inventory (NPI); 362 were
Prevalence of dementia in institutional care. Information about dementia prevalence in residential and nursing care homes helps these institutions to meet residents' needs. We combined residential characteristics ascertained at a screening interview in 1991-93 with dementia diagnoses from assessment interviews in the UK Medical Research Council Cognitive Function and Ageing Study, a population-based study of 13004 elderly people. Almost 5% of people aged 65 years or older lived in institutions (...) --34% (95% CI 30-39) of individuals with dementia. Within institutions, dementia prevalence was 62% (52-71), and was slightly higher in women than in men, with no increase by age. That most residents have dementia has implications for the type of care that institutions provide.
Association between conformational mutations in neuroserpin and onset and severity of dementia. The aggregation of specific proteins is a common feature of the familial dementias, but whether the formation of neuronal inclusion bodies is a causative or incidental factor in the disease is not known. To clarify this issue, we investigated five families with typical neuroserpin inclusion bodies but with various neurological manifestations.Five families with neurodegenerative disease and typical (...) and the topographic distribution of the neuroserpin inclusions plotted.Each of the families was heterozygous for an amino acid substitution that affected the conformational stability of neuroserpin. The least disruptive of these mutations (S49P), as predicted by molecular modelling, resulted in dementia after age 45 years, and presence of neuroserpin inclusions in only a few neurons. By contrast, the most severely disruptive mutation (G392E) resulted, at age 13 years, in progressive myoclonus epilepsy, with many