1 Dementia Current Awareness Newsletter July 2015 2 Contents Your Friendly Local Librarian… ................................................................................................................ 2 New Cochrane Library Systematic Reviews on Dementia ...................................................................... 3 New from NICE ......................................................................................... Error! Bookmark not defined. New from Department of Health and Public Health England................................................................. 5 NHS Behind the Headlines ...................................................................................................................... 5 Recent Literature Searches on Dementia ................................................ Error! Bookmark not defined. Current Awareness Database Articles on Dementia............................................................................... 6 Dementia caring .................................................................................................................................. 6 Medical.............................................................................................................................................. 29 Therapies........................................................................................................................................... 76 Other ................................................................................................................................................. 83 Journal Tables of Contents.................................................................................................................... 96 Alzheimer’s and Dementia ................................................................................................................ 96 Dementia: The International Journal of Social Research and Practice ............................................. 96 Age and Ageing ................................................................................................................................. 96 Journal of the American Geriatrics Society ....................................................................................... 96 Your Friendly Local Librarian… Whatever your information needs, the library is here to help. As your outreach librarian I offer literature searching services as well as training and guidance in searching the evidence and critical appraisal – just email me at library@uhbristol.nhs.uk OUTREACH: Your Outreach Librarian can help facilitate evidence-based practise for all in the dementia team, as well as assisting with academic study and research. We can help with literature searching, obtaining journal articles and books, and setting up individual current awareness alerts. We also offer one-to-one or small group training in literature searching, accessing electronic journals, and critical appraisal. Get in touch: library@uhbristol.nhs.uk LITERATURE SEARCHING: We provide a literature searching service for any library member. For those embarking on their own research it is advisable to book some time with one of the librarians for a 1 to 1 session where we can guide you through the process of creating a well-focused literature research and introduce you to the health databases access via NHS Evidence. Please email requests to library@uhbristol.nhs.uk 3 New Cochrane Library Systematic Reviews on Dementia Regional Cerebral Blood Flow Single Photon Emission Computed Tomography for detection of Frontotemporal dementia in people with suspected dementia Cochrane Database of Systematic Reviews - 23 June 2015 Abstract: Background: In the UK, dementia affects 5% of the population aged over 65 years and 25% of those over 85 years. Frontotemporal dementia (FTD) represents one subtype and is thought to account for up to 16% of all degenerative dementias. Although the core of the diagnostic process in dementia rests firmly on clinical and cognitive assessments, a wide range of investigations are available to aid diagnosis. Regional cerebral blood flow (rCBF) single-photon emission computed tomography (SPECT) is an established clinical tool that uses an intravenously injected radiolabelled tracer to map blood flow in the brain. In FTD the characteristic pattern seen is hypoperfusion of the frontal and anterior temporal lobes. This pattern of blood flow is different to patterns seen in other subtypes of dementia and so can be used to differentiate FTD. It has been proposed that a diagnosis of FTD, (particularly early stage), should be made not only on the basis of clinical criteria but using a combination of other diagnostic findings, including rCBF SPECT. However, more extensive testing comes at a financial cost, and with a potential risk to patient safety and comfort. Objectives:To determine the diagnostic accuracy of rCBF SPECT for diagnosing FTD in populations with suspected dementia in secondary/tertiary healthcare settings and in the differential diagnosis of FTD from other dementia subtypes. Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery Cochrane Dementia and Cognitive Improvement Group Published Online: 15 JUN 2015 Abstract Background: Hip fracture is a major fall-related injury which causes significant problems for individuals, their family and carers. Over 40% of people with hip fracture have dementia or cognitive impairment, and their outcomes after surgery are poorer than those without dementia. It is not clear which care and rehabilitation interventions achieve the best outcomes for these people. Objectives: (a) To assess the effectiveness of models of care including enhanced rehabilitation strategies designed specifically for people with dementia following hip fracture surgery compared to usual care. 4 (b) To assess the effectiveness for people with dementia of models of care including enhanced rehabilitation strategies which are designed for all older people, regardless of cognitive status, following hip fracture surgery compared to usual care. Opioids for agitation in dementia UK Database of Uncertainties about the Effects of Treatments - UK DUETS - 10 June 2015 - Known Uncertainties Record type: Uncertainties identified in research recommendations Source: Cochrane Dementia and Cognitive Improvement Group Why is there uncertainty? Reliable up-to-date systematic reviews have revealed important continuing uncertainties about treatment effects Original uncertainty: Implications for research Randomised placebo controlled trials of opioids for agitation in dementia are needed. Such studies should investigate the tolerability and safety of opioids. This would be best achieved using a placebo design. Agitation is a complex phenomenon and it would be useful for trials to seek to identify those manifestations of agitation that best respond to the intervention and what level of agitation warrants treatment. A more challenging task would be to identify those causes of agitation that best respond to the intervention, including how to more reliably distinguish agitation caused by pain. New from NICE Supporting people who need social care, as they move between hospital and home: NICE consults on draft guidance 25 June 2015 The National Institute for Health and Care Excellence (NICE) has published a draft health and social care guideline to help manage the complicated needs of adults being admitted to and discharged from hospital who are receiving or need support from social care. The focus of the guideline is on adults with health and social care needs – and who have or will need support from a range of practitioners such as family doctors, social workers, physiotherapists, or community nurses. The draft NICE social care guideline places people at the heart of decisions as they move between hospital and their own home, a care home or other living arrangements. 5 The draft guideline recommends ways to integrate effectively social care with medical support during transition to and from hospital. It addresses how services should work together and with the person, their family and carers, to make sure they are admitted for medical treatment in a timely way and spend no longer in hospital than is necessary. New from Department of Health and Public Health England Policy paper - Update 2010 to 2015 government policy: dementia From: Department of Health and The Rt Hon Norman Lamb First published: 25 March 2013 Last updated: 8 May 2015, see all updates Part of: Dementia This publication was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government This policy paper shows the policy of the 2010 to 2015 Conservative and Liberal Democrat coalition government. NHS Behind the Headlines Exposing the evidence behind the lurid newspaper headlines and how the media has (mis)reported health news: Poor sleep quality linked to Alzheimer's disease Wednesday June 3 2015 Alzheimer's is linked to abnormal clumps of protein in the brain "Sleepless nights … could raise your odds of developing Alzheimer's," is the claim in the Daily Mail. A new US study did find a link between poor sleep quality and higher levels of clumps of abnormal proteins in the brain (known as beta-amyloid plaques), but no cause and effect relationship between sleep quality and Alzheimer’s disease was proven. 6 Current Awareness Database Articles on Dementia Below is a selection of articles on dementia recently added to the healthcare databases, grouped in the following categories: Dementia caring Medical Therapies Other If you would like any of the following articles in full text, or if you would like a more focused search on your own topic, then get in touch: library@uhbristol.nhs.uk Dementia caring Title: Achieving effective dementia care in the community Citation: British Journal of Community Nursing, Jun 2015, vol. 20, no. 6, p. 308., Author(s): Mendes, Aysha Abstract: Community nurses' role in managing a patient's dementia symptoms and other comorbidities, and devising a care plan that takes into consideration each individual's preferences and background. [ORIGINAL] 7 references Title: Inter-country exploration of factors associated with admission to long-term institutional dementia care: evidence from the RightTimePlaceCare study Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1338-1350, Author(s): Verbeek, Hilde, Meyer, Gabriele, Challis, David, Zabalegui, Adelaida, Soto, Maria E., Saks, Kai, Leino-Kilpi, Helena, Karlsson, Staffan, Hamers, Jan P.H. Abstract: Aim. To explore inter-country variation of factors associated with institutionalization of people with dementia. Background. There is an urgent need for evidence on whether factors associated with admission to institutional dementia care are applicable across healthcare systems, as increasing evidence suggests that these factors could be countryspecific. Design. A prospective cohort study. Method. Primary data were collected in eight European countries, at baseline and after 3 months follow-up (November 2010-April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223 patients lived at home and were at risk of institutionalization. Associations between care setting (institution vs. home) and factors shown to influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were studied. Results. Considerable differences 7 were found between the eight countries in characteristics of people with dementia who had been recently admitted to ILTC. However, caregiver burden appeared the most consistent factor associated with institutionalization in all analyses. Indications for the importance of independence in activities of daily life were found as well, although country differences may be more prominent for this factor. Conclusion. Evidence was found for two common factors, crucial in the process of institutionalization across countries: caregiver burden and independency in activities of daily life. However, this study also suggests that admission to institutional dementia care is context-specific, as wide variation exists in factors associated with institutionalization across countries. Tailored bestpractice strategies are needed to reflect variations in response to these needs. [PUBLICATION] 37 references Title: Predicting institutional long-term care admission in dementia: a mixed-methods study of informal caregivers' reports Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1351-1362, Author(s): Afram, Basema, Verbeek, Hilde, Bleijlevens, Michel H.C., Challis, David, Leino-Kilpi, Helena, Karlsson, Staffan, Soto, Maria E., Renom-Guiteras, Anna, Saks, Kai, Zabalegui, Adelaida, Hamers, Jan P.H. Abstract: Aim. To investigate agreement between: (1) expected reasons and actual reasons for admission of people with dementia according to informal caregivers; (2) scores on measurement instruments prior to admission and the actual reasons for admission according to informal caregivers. Background. Timely admission of people with dementia is a crucial issue. Information is highly warranted on whether informal caregivers are capable of prior identification of causes of admission and, can thus be considered a reliable prospective source on causes of admission. Design. A cohort study among informal caregivers of people with dementia who made a transition to institutional long-term care. Methods. Qualitative data on the expected and actual reasons for admission were collected via open-ended questions at baseline and follow-up. Furthermore, at baseline, data were collected using measurement instruments to measure preadmission characteristics. Interviews took place between November 2010-April 2012. After categorizing the answers, the agreement between the expected and actual reasons was calculated. Furthermore, bivariate associations were calculated between the actual reasons for admission and scores on corresponding measurement instruments. Results/Findings. For most informal caregivers, there was agreement between their statements on the expected reason and the actual reason for admission. A third of the caregivers showed no conformity. Bivariate associations showed that there is also agreement between the actual reasons for admission and scores on corresponding measurement instruments. Conclusion. Informal caregivers can be considered reliable sources of information regarding what causes the admission of a person with dementia. Professional care should anticipate informal caregivers' statements and collaborate with them to strive for timely and appropriate admission. [PUBLICATION] 35 references 8 Title: Changes in caregiver burden and health-related quality of life of informal caregivers of older people with Dementia: evidence from the European RightTimePlaceCare prospective cohort study Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1378-1391, Author(s): Bleijlevens, Michel H.C., Stolt, Minna, Stephan, Astrid, Zabalegui, Adelaida, Saks, Kai, Sutcliffe, Caroline, Lethin, Connie, Soto, Maria E., Zwakhalen, Sandra M.G. Abstract: Aims. To describe differences in caregiver burden and health-related quality of life of informal caregivers of people with dementia in eight European countries and assess changes after transition from home to institutional long-term care. Background. Country differences in the experience of burden and health-related quality of life are rarely described. Design. Prospective cohort study. Methods. Data on burden and health-related quality of life were collected at baseline (conducted between November 2010-April 2012) and follow-up (after 3 months) using face-to-face interviews. Two groups of informal caregivers included those: (1) of people with dementia recently admitted to institutional long-term care facilities; and those (2) of people with dementia receiving home care. Statistical analyses focused on descriptive comparisons between groups and countries. Results. Informal caregivers of about 2014 were interviewed. Informal caregivers of people with dementia at home experienced more burden compared with informal caregivers of recently institutionalised people with dementia. Almost no differences in health-related quality of life were found between groups. Large differences between countries on outcomes were found. Informal caregivers of people with dementia who made the transition to an institutional long-term care facility experienced a statistically significant decrease in burden and psychological distress at followup. Conclusion. Cross-country differences may be related to differences in health and social care systems. Taking this into account, informal caregiver interventions need to be tailored to (country specific) contexts and (individual) needs. Findings highlight the positive impact of admission to institutional long-term care on informal caregiver well-being. [PUBLICATION] 64 references Title: Older persons with dementia at risk for institutionalization in eight European countries: a cross-sectional study on the perceptions of informal caregivers and healthcare professionals Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1392-1404, Author(s): Stephan, Astrid, Afram, Basema, Koskenniemi, Jaana, Verbeek, Hilde, Soto, Maria E., Bleijlevens, Michel H.C., Sutcliffe, Caroline, Lethin, Connie, Risco, Ester, Saks, Kai, Hamers, Jan P.H., Meyer, Gabriele Abstract: Aims. To explore the perceptions of informal caregivers and healthcare professionals regarding potential reasons for the institutionalization of older persons with dementia in eight European countries. Background. Healthcare professionals may have an important role in facilitating informal caregivers' decision-making regarding institutionalization. Little is known about the perceptions of informal caregivers and healthcare professionals prior to institutionalization. Design. Cross-sectional survey in eight European countries (November 2010-January 2012). Methods. Healthcare professionals reported why they clinically judged persons with dementia at risk for institutionalization. Informal caregivers reported potential reasons from their perspectives. Answers were openly coded and categorized. Variation between informal caregivers and healthcare 9 professionals was investigated (agreement on at least one potential reason per case/proportion of maximum attainable kappa). Results. Judgements of healthcare professionals and informal caregivers on 1160 persons with dementia were included. A total of 22 categories emerged. Approximately 90% of informal caregivers reported potential reasons. In 41% of the cases, informal caregivers and healthcare professionals agreed on at least one reason. Discrepancy was high for potential reasons related to caregiver burden. For the most frequent categories (caregiver burden, caregiver unable to provide care, neuropsychiatric symptoms, overall deterioration, care dependency), 24-41% of the attainable kappa was achieved. Differences between countries emerged indicating more favourable agreement in Finland, Sweden and Estonia and lowest agreement in England and Spain. Conclusion. Agreement between healthcare professionals and informal caregivers on potential reasons for institutionalization was low-to-moderate. Healthcare professionals are challenged to develop a detailed understanding of the perspectives and perceived burden of informal caregivers. [PUBLICATION] 46 references Title: The association between positive-negative reactions of informal caregivers of people with dementia and health outcomes in eight European countries: a cross-sectional study Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1417-1434, Author(s): Alvira, M. Carme, Risco, Ester, Cabrera, Esther, Farre, Marta, Hallberg, Ingalill Rahm, Bleijlevens, Michel H.C., Meyer, Gabriele, Koskenniemi, Jaana, Soto, Maria E., Zabalegui, Adelaida Abstract: Aim. To describe the associations between positive and negative reactions of informal caregivers of people with dementia and health outcomes across eight European Countries. Background. Caring for someone with dementia may have implications for the caregiver's own health and for the care recipient. These consequences could be associated with caregivers' reactions to the process of care. Design. Association study based on cross-sectional data. Methods. Participants were people with dementia and their informal caregivers living at home or in long-term care institutions. Data were collected between November 2010-April 2012 using the Caregiver Reaction Assessment (with dimensions of self-esteem, lack of family support, financial problems, disrupted schedule and health problems) and associations were sought with informal caregiver burden, quality of life and psychological well-being and with dementia sufferers' neuropsychiatric symptoms, comorbidity and dependency in activities of daily living using correlation coefficients. Results. Data from 2014 participants were used. Variability across countries was noted, as well as differences between care at home and in long-term care institutions. In general, self-esteem and lack of family support correlated with caregiver burden and psychological well-being. Associations were also found between disrupted schedule and caregiver burden, psychological well-being and quality of life. Health problems were clearly associated with caregiver burden, psychological wellbeing and quality of life. Conclusion. Study results support links between the reactions of informal caregivers of people with dementia and health outcomes. These may have implications in terms of how services are addressed. [PUBLICATION] 55 references 10 Title: Change in quality of life of people with dementia recently admitted to long-term care facilities Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1435-1447, Author(s): Beerens, Hanneke C., Zwakhalen, Sandra M.G., Verbeek, Hilde, Ruwaard, Dirk, Ambergen, Antonius W., Leino-Kilpi, Helena, Stephan, Astrid, Zabalegui, Adelaida, Soto, Maria, Saks, Kai, Bökberg, Christina, Sutcliffe, Caroline L., Hamers, Jan P.H. Abstract: Aim. To assess which factors are associated with change in quality of life of people with dementia who have recently been admitted to long-term care facilities. Background. Many people with dementia will be admitted to long-term care facilities at some point during their disease. It is currently unknown which factors are associated with improvement and/or deterioration of quality of life immediately following admission. Design. An observational and longitudinal survey. Methods. Data on 343 people with dementia who have been recently admitted to long-term care facilities across eight European countries were collected between November 2010-April 2012. Quality of life was assessed by people with dementia and their proxies using the 'Quality of Life-Alzheimer's Disease scale'. Explanatory variables included cognitive status, comorbidities, activities of daily living, depressive symptoms and neuropsychiatric symptoms. Descriptive and multilevel regression analyses were performed. Results. Better cognitive abilities at baseline were associated with a decrease in self-reported quality of life. Greater dependency and more depressive symptoms at baseline were associated with declined proxy-reported quality of life. Furthermore, an increased dependency and an increase of depressive symptoms between baseline and follow-up were associated with a decreased proxy-reported quality of life. On an individual level, three groups were identified, namely people whose quality of life: (1) decreased; (2) stayed the same; and (3) increased. [PUBLICATION] 56 references Title: Self- and Carer-Rated Pain in People With Dementia: Influences of Pain in Carers Citation: Journal of Pain and Symptom Management, Jun 2015, vol. 49, no. 6, p. 1042-1049 Author(s): Orgeta, Vasiliki, Orrell, Martin, Edwards, Rhiannon Tudor, Hounsome, Barry, Woods, Bob Abstract: Context: Although pain is frequent in people with dementia (PwD), evidence on the prevalence and factors influencing ratings of pain in dementia is limited. Carer variables are often associated with bias in proxy ratings of pain, but few studies have examined the role of caregiver pain in influencing these ratings. Objectives: This study explored the prevalence of pain in PwD in a large U.K. sample. A secondary aim was to identify factors influencing ratings of pain in people with mild to moderate dementia and whether carer pain systematically influences proxy ratings. Methods: This was a cross-sectional study of 488 caregiving dyads living in the community. Self- and carer-rated pain was assessed as part of the EuroQoL-5D (EQ-5D). Depression and anxiety for the PwD were measured by the Cornell Scale for Depression in Dementia and the Rating of Anxiety in Dementia Scale. The Hospital Anxiety and Depression Scale was used to measure anxiety and depressive symptoms in carers. Using logistic regression modeling, we examined the relationship between self- and carer-rated (proxy) pain in PwD and psychological distress, functional ability, and health status. Carer variables included self-rated health, strain, anxiety, depression, and caregiver 11 pain. Results: A total of 45% of PwD reported pain, whereas carer-rated pain was higher (59%). Selfrated pain was more frequent in those with lower self-rated health (adjusted odds ratio [AOR] 0.97; 95% CI 0.96-0.99, P = 0.001) and higher anxiety (AOR 1.07; 95% CI 1.01-1.12, P = 0.013). Carer-rated (proxy) pain was additionally predicted by poor proxy-rated health in the PwD (AOR 0.98; 95% CI 0.96-0.99, P = 0.006) and carers' own experience of pain (AOR 0.36; 95% CI 0.21-0.63, P = 0.001). Conclusion: Our results indicate that pain is very frequently reported in PwD and that the presence of pain is associated with high levels of anxiety. Caregiver pain affects carers' perceptions of pain in PwD. [PUBLICATION] 47 references Title: Most appropriate placement for people with dementia: individual experts' vs. expert groups' decisions in eight European countries Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1363-1377 Author(s): Saks, Kai, Tiit, Ene-Margit, Verbeek, Hilde, Raamat, Katrin, Armolik, Angelika, Leibur, Jelena, Meyer, Gabriele, Zabalegui, Adelaida, Leino-Kilpi, Helena, Karlsson, Staffan, Soto, Maria, Tucker, Sue Abstract: Aims. To investigate the extent of variability in individuals' and multidisciplinary groups' decisions about the most appropriate setting in which to support people with dementia in different European countries. Background. Professionals' views of appropriate care depend on care systems, cultural background and professional discipline. It is not known to what extent decisions made by individual experts and multidisciplinary groups coincide. Design. A modified nominal group approach was employed in eight countries (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the UK) as part of the RightTimePlaceCare Project. Methods. Detailed vignettes about 14 typical case types of people with dementia were presented to experts in dementia care (n = 161) during November and December 2012. First, experts recorded their personal judgements about the most appropriate settings (home care, assisted living, care home, nursing home) in which to support each of the depicted individuals. Second, participants worked in small groups to reach joint decisions for the same vignettes. Results. Considerable variation was seen in individuals' recommendations for more than half the case types. Cognitive impairment, functional dependency, living situation and caregiver burden did not differentiate between case types generating high and low degrees of consensus. Group-based decisions were more consistent, but country-specific patterns remained. Conclusions. A multidisciplinary approach would standardize the decisions made about the care needed by people with dementia on the cusp of care home admission. The results suggest that certain individuals could be appropriately diverted from care home entry if suitable community services were available. [PUBLICATION] 61 references Title: Dementia care in European countries, from the perspective of people with dementia and their caregivers Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1405-1416, 0309-2402 (June 2015) 12 Author(s): Karlsson, Staffan, Bleijlevens, Michel, Roe, Brenda, Saks, Kai, Martin, Maria Soto, Stephan, Astrid, Suhonen, Riita, Zabalegui, Adelaida, Hallberg, Ingalill R. Abstract: Aim. To investigate persons with dementia and their informal caregivers' views of intersectoral information, communication and collaboration throughout the trajectory of dementia care, in eight European countries. Background. Living with dementia and being next of kin to a person with dementia means having to live through stages that have different characteristics, needs, challenges and requirements. Design. Qualitative research. Focus groups were conducted in England, Estonia, Finland, France, Germany, The Netherlands, Spain and Sweden. Methods. Persons with dementia and their informal caregivers (N = 137) participated in focus group interviews during 2011. Content analysis generated a tentative model of information, communication and collaboration for people with dementia and their caregivers, which was then tested. Results. The core finding was that information, communication and collaboration were to be focused on the persons with dementia and the informal caregivers. Entering into the trajectory of the disease and its consequences was addressed as an important point of departure. The relation to professional care required establishing a trusting relationship, tailor-made intervention and a single person or organization to contact. Professional knowledge and commitment, variation in service and care adapted to needs were important. Conclusion. As focus of care is on the person with dementia and their informal caregivers, a dyadic approach seems most suitable for dementia care. A trusting relationship and a specific person or organization to contact seem to be indicators of best practice, as does adaptation to the needs of the person with dementia and their informal caregiver. [PUBLICATION] 34 references Title: Factors influencing the degree of eating ability among people with dementia Citation: Journal of Clinical Nursing, Jun 2015, vol. 24, no. 11-12, p. 1707-1717, Author(s): Lee, Kyoung Min, Song, Jun-Ah Abstract: To explore the degree of eating ability in people with dementia and identify what factors affect their eating ability. Appropriate food consumption is important to human life. Although eating difficulties are common among people with dementia, little is known about what factors might influence their eating ability. Descriptive, cross-sectional study. A total of 149 people with dementia residing in nursing facilities in Seoul or the Gyeonggi area of Korea were evaluated using the Korean Mini-Mental State Examination, Korean Activities of Daily Living Scale and Eating Behaviour Scale. Data were analysed using descriptive statistics, one-way analysis of variance, Pearson correlation coefficient and multiple regression analysis. The participants showed a moderate level of dependency with respect to eating ability and were most dependent on the use of utensils. There were significant differences in eating ability according to general characteristics such as duration of residence, duration of illness, degree of visual impairment, eating place, and diet type. The eating ability of the participants was significantly correlated with cognitive function and physical function. Cognitive function, physical function, duration of illness, eating place (living room or dining room), and diet type (soft or liquid) significantly predicted eating ability in people with dementia. The findings of this study suggest that it is necessary to thoroughly assess the eating ability of people with dementia and to develop appropriate training programs to maintain or improve their remaining eating ability. The creation of a pleasurable physical and social environment for eating might also be 13 helpful. These findings would be able to serve a useful basis in the development of materials for nursing intervention programs for people with dementia during mealtimes by improving the techniques and care qualities of nursing caregivers. [PUBLICATION] 33 references Title: The Impact of Living Arrangements on Dementia Caregiver's Sleep Quality. Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p. Author(s): Simpson, Cherie, Carter, Patricia Abstract: In the United States half of the 15 million informal caregivers of persons with Alzheimer's disease or a related dementia (PWDs) do not live with the PWD. This paper compares the sleep quality and health of 59 community-dwelling caregivers living with the PWD and 21 living apart from the PWD. Variables of interest were caregiving experience (hours caregiving, problematic behaviors of the PWD, caregivers' perception of dementia severity), sleep quality, and health (perceived health, stress, and depressive symptoms). Parametric unpaired t tests were used to calculate the differences between key variables. Multiple regression models were constructed, controlling for age, gender, behavior index, and dementia severity to examine the variance explained by living arrangements on sleep quality and health. Caregivers living apart from the PWD experienced the same level of poor sleep quality as did caregivers living with the PWD. The living arrangements of the caregiver did not make a unique contribution to sleep quality or health variables except for reports of unhealthy days. Given the importance of good quality sleep for health, the findings highlight the importance of evaluating caregivers living apart from the PWD for sleep problems with the same level of concern as one would have for those living with the PWD. © The Author(s) 2014. Title: Needs of informal caregivers during transition from home towards institutional care in dementia: a systematic review of qualitative studies. Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 891-902 (June 2015) Author(s): Afram, Basema, Verbeek, Hilde, Bleijlevens, Michel H C, Hamers, Jan P H Abstract: Alongside providing care, informal caregivers of people with dementia often need support and guidance themselves, especially during difficult periods such as the care-transition from home towards a nursing home. Knowledge on needs of informal caregivers during this period is sparse. This study aims to provide insight into problems and needs of informal caregivers caring for people with dementia during care-transition from home-based care to institutional long-term care. A systematic electronic search in CINAHL, Cochrane, Medline, PsycINFO, Pubmed and Web of Knowledge. All qualitative articles up to September 2013 were considered. The included articles underwent a quality appraisal. Thematic analysis was used to analyze problems and needs described in the articles. Thirteen publications were included providing 14 topics comprising needs and problems of informal caregivers during the care-transition period. The most stated topics were: "emotional concerns" (e.g. grief and shame about the decision), "knowledge/information" (e.g. 14 understanding the care system) and "support" (e.g. need for counseling). Similar topics were found prior and after admission, with examples specific to the either the home or nursing home situation. The care-transition period should be considered a continuum, as similar needs and problems were identified prior and after admission. This should be kept in mind in developing support and guidance for informal caregivers during this process. Whereas currently the situation prior and post admission are seen and treated as adjacent stages, they should be considered one integrated stage. Multicomponent programmes should be offered that are designed in a continuous way, starting prior to admission, and continuing after. Title: Qualitative study on needs and wishes of early-stage dementia caregivers: the paradox between needing and accepting help. Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 927-936 (June 2015) Author(s): Boots, Lizzy M M, Wolfs, Claire A G, Verhey, Frans R J, Kempen, Gertrudis I J M, de Vugt, Marjolein E Abstract: Early individualized interventions for informal dementia caregivers can prevent overburdening in the later stages. However, the needs of early-stage dementia caregivers (EDC) remain largely unknown. This study aimed to explore the needs and wishes and need for care of EDC to maximize the benefit of potential programs for EDC and tailor interventions accordingly. Four focus group interviews with 28 informal caregivers of people with dementia (PwD) were analyzed using inductive content analysis. Both EDC and caregivers in the later stages were included to compare perceived EDC needs from different points in the caregiver career. Four themes were identified: the early-stage needs paradox, barriers in acceptance, facilitators in acceptance, and a transition from loss to adaptation. The retrospective view provided by later-stage caregivers differed from the view of EDC; EDC struggled with acknowledging needs due to fear of stigma and low acceptance. EDC stressed the importance of acceptance as a prerequisite for adequate adaptation, but were hindered by lack of knowledge, difficulty acknowledging changes, and focus on loss. In contrast, better understanding of the disease, increasing personal time, structuring ones day, and using appropriate humor can reduce negative communication, increase positive encounters and caregiver-confidence, contributing to positive interaction with the care recipient and an increase in well-being. Early therapeutic interventions could help caregivers identify their needs, increase knowledge about changes in roles and relationship reciprocity, and focus on enhancement of the positive, intact experiences to prevent caregiver burden. Title: Evaluation of a problem-solving (PS) techniques-based intervention for informal carers of patients with dementia receiving in-home care. Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 937-948 (June 2015) Author(s): Chiu, Mary, Pauley, Tim, Wesson, Virginia, Pushpakumar, Dunstan, Sadavoy, Joel 15 Abstract: The value of care provided by informal carers in Canada is estimated at $26 billion annually (Hollander et al., 2009). However, carers' needs are often overlooked, limiting their capacity to provide care. Problem-solving therapy (PST), a structured approach to problem solving (PS) and a core principle of the Reitman Centre CARERS Program, has been shown to alleviate emotional distress and improve carers' competence (Chiu et al., 2013). This study evaluated the effectiveness of problem-solving techniques-based intervention based on adapted PST methods, in enhancing carers' physical and emotional capacity to care for relatives with dementia living in the community. 56 carers were equally allocated to a problem-solving techniques-based intervention group or a control arm. Carers in the intervention group received three 1 hr visits by a care coordinator (CC) who had been given advanced training in PS techniques-based intervention. Coping, mastery, competence, burden, and perceived stress of the carers were evaluated at baseline and postintervention using standardized assessment tools. An intention-to-treat analysis utilizing repeated measures ANOVA was performed on the data. Post-intervention measures completion rate was 82% and 92% for the intervention and control groups, respectively. Carers in the intervention group showed significantly improved task-oriented coping, mastery, and competence and significantly reduced emotion-oriented coping, burden and stress (p < 0.01-0.001). Control carers showed no change. PS techniques, when learned and delivered by CCs as a tool to coach carers in their day-today caregiving, improves carers' caregiving competence, coping, burden, and perceived stress. This may reduce dependence on primary, psychiatric, and institutional care. Results provide evidence that establishing effective partnerships between inter-professional clinicians in academic clinical health science centers, and community agencies can extend the reach of the expertise of specialized health care institutions. Title: Dementia care in European countries - findings from the RightTimePlaceCare study. Citation: Journal of advanced nursing, Jun 2015, vol. 71, no. 6, p. 1336-1337 (June 2015) Author(s): Perry, Lin Title: Inter-country exploration of factors associated with admission to long-term institutional dementia care: evidence from the RightTimePlaceCare study. Citation: Journal of advanced nursing, Jun 2015, vol. 71, no. 6, p. 1338-1350 (June 2015) Author(s): Verbeek, Hilde, Meyer, Gabriele, Challis, David, Zabalegui, Adelaida, Soto, Maria E, Saks, Kai, Leino-Kilpi, Helena, Karlsson, Staffan, Hamers, Jan P H, RightTimePlaceCare Consortium Abstract: To explore inter-country variation of factors associated with institutionalization of people with dementia. There is an urgent need for evidence on whether factors associated with admission to institutional dementia care are applicable across healthcare systems, as increasing evidence suggests that these factors could be country-specific. A prospective cohort study. Primary data were collected in eight European countries, at baseline and after 3 months follow-up (November 2010April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223 patients lived at home and were at risk of 16 institutionalization. Associations between care setting (institution vs. home) and factors shown to influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were studied. Considerable differences were found between the eight countries in characteristics of people with dementia who had been recently admitted to ILTC. However, caregiver burden appeared the most consistent factor associated with institutionalization in all analyses. Indications for the importance of independence in activities of daily life were found as well, although country differences may be more prominent for this factor. Evidence was found for two common factors, crucial in the process of institutionalization across countries: caregiver burden and independency in activities of daily life. However, this study also suggests that admission to institutional dementia care is context-specific, as wide variation exists in factors associated with institutionalization across countries. Tailored best-practice strategies are needed to reflect variations in response to these needs. © 2015 John Wiley & Sons Ltd. Title: A break-even analysis for dementia care collaboration: partners in dementia care. Citation: Journal of general internal medicine, Jun 2015, vol. 30, no. 6, p. 804-809 (June 2015) Author(s): Morgan, Robert O, Bass, David M, Judge, Katherine S, Liu, C F, Wilson, Nancy, Snow, A Lynn, Pirraglia, Paul, Garcia-Maldonado, Maurilio, Raia, Paul, Fouladi, N N, Kunik, Mark E Abstract: Dementia is a costly disease. People with dementia, their families, and their friends are affected on personal, emotional, and financial levels. Prior work has shown that the "Partners in Dementia Care" (PDC) intervention addresses unmet needs and improves psychosocial outcomes and satisfaction with care. We examined whether PDC reduced direct Veterans Health Administration (VHA) health care costs compared with usual care. This study was a cost analysis of the PDC intervention in a 30-month trial involving five VHA medical centers. Study subjects were veterans (N = 434) 50 years of age and older with dementia and their caregivers at two intervention (N = 269) and three comparison sites (N = 165). PDC is a telephone-based care coordination and support service for veterans with dementia and their caregivers, delivered through partnerships between VHA medical centers and local Alzheimer's Association chapters. We tested for differences in total VHA health care costs, including hospital, emergency department, nursing home, outpatient, and pharmacy costs, as well as program costs for intervention participants. Covariates included caregiver reports of veterans' cognitive impairment, behavior problems, and personal care dependencies. We used linear mixed model regression to model change in log total cost postbaseline over a 1-year follow-up period. Intervention participants showed higher VHA costs than usual-care participants both before and after the intervention but did not differ significantly regarding change in log costs from pre- to post-baseline periods. Pre-baseline log cost (p ≤ 0.001), baseline cognitive impairment (p ≤ 0.05), number of personal care dependencies (p ≤ 0.01), and VA service priority (p ≤ 0.01) all predicted change in log total cost. These analyses show that PDC meets veterans' needs without significantly increasing VHA health care costs. PDC addresses the priority area of care coordination in the National Plan to Address Alzheimer's Disease, offering a low-cost, structured, protocol-driven, evidence-based method for effectively delivering care coordination. 17 Title: Stability of Diagnoses of Cognitive Impairment, Not Dementia in a Veterans Affairs Primary Care Population. Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1105-1111 Author(s): Holsinger, Tracey, Plassman, Brenda L, Stechuchak, Karen M, Burke, James R, Coffman, Cynthia J, Williams, John W Abstract: To describe the stability of cognitive impairment, not dementia (CIND) in a longitudinal cohort of primary care veterans. To examine the association between baseline brief cognitive screening tests, demographic and clinical characteristics, and cognitive decline. Follow-up cognitive assessment after an average of 2.5 years of a cohort of veterans in primary care whose baseline status was CIND or normal cognition. Three Department of Veterans Affairs primary care clinics. Subjects with CIND at baseline and a sampling of subjects with baseline normal cognition. Veterans underwent a standard assessment, including neuropsychological tests and informant interview. Of 293 potentially eligible individuals, 186 enrolled in the follow-up study. Of the 131 subjects with a baseline diagnosis of CIND, 16 (12%) progressed to dementia, 88 (67%) continued to have a diagnosis of CIND, and 27 (21%) improved to normal cognition. Of the 55 subjects with a baseline diagnosis of normal cognition, one (2%) progressed to dementia, 17 (31%) progressed to CIND, and 37 (67%) remained cognitively normal. In bivariate analyses, poorer performance on baseline cognitive screening tests was associated with cognitive decline, whereas Framingham Stroke Risk Profile (FSRP) and education were not. Similarly, higher scores on cognitive screening tests were associated with return to normal cognition. In multivariable logistic regression models, lower baseline Mini-Cog and Modified Mini-Mental State scores were associated with cognitive decline, whereas Memory Impairment Screen scores, FSRP, and years of education were not. A minority of subjects had worsening of cognitive function sufficient to change diagnostic category. Over an average of 2.5 years, subjects diagnosed with CIND at baseline reverted to normal cognition at a higher rate than progressed to dementia. Cognitive screening tests addressing multiple domains of cognitive impairment were predictive of cognitive decline. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society. Title: Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program: A Care Coordination Program for Home-Based Dementia Care and Caregiver Support in a Veterans Affairs Medical Center. Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1203-1208 Author(s): D'Souza, Maria F, Davagnino, Judith, Hastings, S Nicole, Sloane, Richard, Kamholz, Barbara, Twersky, Jack Abstract: Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination program of the Durham Veteran's Affairs Medical Center in Durham, North Carolina, that provides home-based dementia care and caregiver support for individuals with dementia and their family caregivers, including attention to behavioral symptoms, functional impairment, and home safety, on a consultation basis. The objectives of this study were to describe the COACH program in its first 2 years of operation, assess alignment of program components with quality measures, report 18 characteristics of program participants, and compare rates of placement outside the home with those of a nontreatment comparison group using a retrospective cohort design. Participants were community-dwelling individuals with dementia aged 65 and older who received primary care in the medical center's outpatient clinics and their family caregivers, who were enrolled as dyads (n = 133), and a control group of dyads who were referred to the program and met clinical eligibility criteria but did not enroll (n = 29). Measures included alignment with Dementia Management Quality Measures and time to placement outside the home during 12 months of follow-up after referral to COACH. Results of the evaluation demonstrated that COACH aligns with nine of 10 clinical process measures identified using quality measures and that COACH delivers several other valuable services to enhance care. Mean time to placement outside the home was 29.6 ± 14.3 weeks for both groups (P = .99). The present study demonstrates the successful implementation of a home-based care coordination intervention for persons with dementia and their family caregivers that is strongly aligned with quality measures. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society. Title: Policy Recommendation: The National Center for Prevention of Resident-to-Resident Aggression in Dementia. Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 532. Author(s): Caspi, Eilon Title: Critical decisions for older people with advanced dementia: a prospective study in long-term institutions and district home care. Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 535.e13 Author(s): Toscani, Franco, van der Steen, Jenny T, Finetti, Silvia, Giunco, Fabrizio, Pettenati, Francesca, Villani, Daniele, Monti, Massimo, Gentile, Simona, Charrier, Lorena, Di Giulio, Paola, End of Life Observatory-Prospective Study on DEmentia Patients Care (EoLO-PSODEC) Research Group, End of Life Observatory-Prospective Study on DEmentia Patients Care EoLO-PSODEC Research Group Abstract: To describe and compare the decisions critical for survival or quality of life [critical decisions (CDs)] made for patients with advanced dementia in nursing homes (NHs) and home care (HC) services. Prospective cohort study with a follow-up of 6 months. Lombardy Region (NHs) and Reggio-Emilia and Modena Districts (HC), Italy. Patients (496 total; 315 in NHs and 181 in HC) with advanced dementia (Functional Assessment Staging Tool score ≥7) and expected survival ≥2 weeks. At baseline, the patients' demographic data, date of admission and of dementia diagnosis, type of dementia, main comorbidities, presence of pressure sores, ongoing treatments, and current prescriptions were abstracted from clinical records. At baseline and every 15 days thereafter, information regarding the patients' general condition and CDs (deemed critical by the doctor or team) was collected by an interview with the doctor. For each CD, the physician reported the problem that led to the decision, that was eventually made, the purpose of the decision, whether the decision had been discussed with and/or communicated to the family, who made the final 19 decision, whether the decision was maintained after 1 week, whether it corresponded to what the doctor would have judged appropriate, and the expected survival of the patient (≤15 days). For 267 of the 496 patients (53.8%; 60.3% in NHs and 42.5% at home), 644 CDs were made; for 95 patients, more than 1 CD was made. The problems that led to a CD were mainly infections (respiratory tract and other infections; 46.6%, 300/644 CDs); nutritional/hydration problems (20.6%; 133 CDs); and the worsening of a pre-existing disease (9.3%; 60 CDs). The most frequent type of decision concerned the prescription of antibiotics (overall 41.1%, 265/644; among NH patients 44.6%, 218/488; among HC patients, 30.2%, 47/156). The decision to hospitalize the patient was more frequently reported for HC than NH patients (25.5% vs 3.1%). The most frequent purposes of the CDs in both settings were reducing symptoms or suffering (more so in NHs; 81.1% vs 57.0% in HC) and prolonging survival (NH 27.5%; HC 23.1%; multiple purposes were possible). For 26 decisions (3.8%), the purpose was to ease death or not to prolong life. Decisions critical for the survival or quality of life of patients with advanced dementia were made for approximately one-half of the patients during a 6-month time frame, and such decisions were made more frequently in NHs than in HC. HC patients were more frequently hospitalized, and a sizeable minority of these patients were treated with the goal of prolonging survival. Italian patients with advanced dementia may benefit from the implementation of palliative care principles, and HC patients may benefit from the implementation of measures to avoid hospitalizing patients near the end of life. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. Title: Are we providing the best possible care for dementia patients? Citation: Neurodegenerative disease management, Jun 2015, vol. 5, no. 3, p. 217-224 (June 2015) Author(s): Borisovskaya, Anna, Chen, Kathryn, Borson, Soo Abstract: SUMMARY Healthcare for patients with dementia is often reactive, poorly organized and fragmented. We discuss opportunities for improvements in the care of individuals living with dementia at home that can be implemented by physicians in their practices today. In particular, we argue that systematic identification and diagnosis of cognitive impairment and dementia in their early stages, coupled with a coherent, evidence-informed management framework, would benefit patients with dementia substantially and ease the burden of their caregivers. We emphasize that dementia influences all aspects of patient care, and each medical decision must be passed through the filter of knowledge that patients with dementia have special needs that can be identified and addressed. Title: Relatives' participation in everyday care in special care units for persons with dementia. Citation: Nursing ethics, Jun 2015, vol. 22, no. 4, p. 404-416 (June 2015) Author(s): Helgesen, Ann Karin, Athlin, Elsy, Larsson, Maria Abstract: Research concerning relatives' participation in the everyday care related to persons living in special care units for persons with dementia is limited. To examine relatives' participation in their 20 near one's everyday care, the level of burden experienced and important factors for participation, in this special context. The study had a cross-sectional design, and data collection was carried out by means of a study-specific questionnaire. A total of 233 relatives from 23 different special care units participated. The study was approved by the Norwegian Social Science Data Services. A great majority of relatives reported that they visited weekly and were the resident's spokesperson, but seldom really participated in decisions concerning their everyday care. Participation was seldom reported as a burden. This study indicated that relatives were able to make a difference to their near one's everyday life and ensure quality of care based on their biographical expertise, intimate knowledge about and emotional bond with the resident. Since knowing the resident is a prerequisite for providing individualised care that is in line with the resident's preferences, information concerning these issues is of utmost importance. This study prompts reflection about what it is to be a spokesperson and whether everyday care is neglected in this role. Even though relatives were satisfied with the care provided, half of them perceived their participation as crucial for the resident's well-being. This indicated that relatives were able to offer important extras due to their biographical expertise, intimate knowledge about and emotional bond with the resident. Good routines securing that written information about the residents' life history and preferences is available and used should be implemented in practice. © The Author(s) 2014. Title: Pain and Psychological Well-Being Among People with Dementia in Long-Term Care. Citation: Pain medicine (Malden, Mass.), Jun 2015, vol. 16, no. 6, p. 1083-1089 (June 2015) Author(s): Lee, Kyung Hee, McConnell, Eleanor S, Knafl, George J, Algase, Donna L Abstract: To examine the relationship between self-reported pain and psychological well-being of people with dementia (PWD) living in residential long-term care as indicated by displays of observed emotional expression over the daytime period. Secondary analysis using repeated measures of selfreport and observational data. A total of 177 PWD were included from 17 nursing homes and six assisted living facilities in Michigan and Pennsylvania. Negative emotional expression was used as an indicator of reduced psychological well-being. Pain was assessed through PWD's response to a question about presence of pain obtained at each observation. Cognitive impairment was assessed using the Mini-Mental Status Examination. Linear mixed models were used that accounted for correlation of negative emotional expression measurements over time for each participant and between participants within the same facility. Among 171 participants who were able to express their pain, 44% of PWD reported pain once or more during the daytime period. Severity of cognitive impairment was related to expression of negative emotion. PWD with pain displayed more negative emotional expression than PWD without pain. Routine pain assessment is feasible among PWD with moderate to severe dementia and positive report of pain is associated with greater observed negative emotional expression, an indicator of reduced psychological well-being. Improving pain management holds potential for enhancing psychological well-being among PWD living in residential long-term care. Wiley Periodicals, Inc. 21 Title: Support for families of patients dying with dementia: A qualitative analysis of bereaved family members' experiences and suggestions. Citation: Palliative & supportive care, Jun 2015, vol. 13, no. 3, p. 435-442 (June 2015) Author(s): Muders, Pia, Zahrt-Omar, Corinna Aruna, Bussmann, Sonja, Haberstroh, Julia, Weber, Martin Abstract: To explore and document the needs of family caregivers of patients dying with dementia and to identify how healthcare professionals can adequately support them. We employed a crosssectional survey containing open-ended questions that were analyzed using qualitative methods. Receiving information about the diagnosis and disease trajectory of dementia is essential for the caregiving families of people dying with the disease. However, at present the communication of information offered by professionals is not experienced as satisfying. Further aspects that require improvement concern issues related to time constraints, as well as practical and emotional support from professionals in the care setting. Family members would also like professionals to better assist them during and after the dying process. Family members face multiple burdens while caring for their demented relatives and need more professional support during the course of the disease trajectory as well as in the terminal phase. Title: Caregiver burden in end-of-life care: Advanced cancer and final stage of dementia. Citation: Palliative & supportive care, Jun 2015, vol. 13, no. 3, p. 583-589 (June 2015) Author(s): Costa-Requena, Gema, Espinosa Val, MaCarmen, Cristòfol, Ramon Abstract: Considering two advanced illnesses, cancer and end-stage dementia, the aim of this study was to describe the symptoms of caregiver psychological distress and burden. In this cross-sectional study, regression analyses were calculated to explain the influence of psychological distress in caregiver burden. A t test was employed to compare differences between the symptoms of caregiver burden. The percentage of psychological distress was similar between caregivers of cancer patients (77.6%) and caregivers of dementia patients (72.4%). In the regression analysis, cancer caregiver distress accounted for 27.9% of the variance in symptoms of burden, while dementia caregiver distress accounted for 24.4% of the variance in symptoms of burden. No significant differences were revealed when comparing caregiver burden symptoms between caregivers of the two advanced illnesses (t = 0.06; p = 0.94). In end-of-life care for patients with dementia, due to significant levels of caregiver distress and burden symptoms, there is a need to support caregivers in the same way as is done for caregivers of cancer patients. Title: Comfort goal of care and end-of-life outcomes in dementia: A prospective study. Citation: Palliative medicine, Jun 2015, vol. 29, no. 6, p. 538-546 (June 2015) Author(s): van Soest-Poortvliet, Mirjam C, van der Steen, Jenny T, de Vet, Henrica Cw, Hertogh, Cees Mpm, Deliens, Luc, Onwuteaka-Philipsen, Bregje D 22 Abstract: Many people with dementia die in a nursing home. A comfort care goal may be beneficial. Little research has examined the relationship between care goals and outcome. To investigate whether family satisfaction with end-of-life care and quality of dying is associated with whether or not dementia patients have a comfort goal shortly after admission. Prospective data collection from 28 long-term care facilities (the Dutch End of Life in Dementia study). We included 148 patients who died after prospective follow-up. Main outcomes were family satisfaction (End-of-Life in DementiaSatisfaction with Care scale; range: 10-40) and quality of dying (End-of-Life in Dementia-Comfort Assessment in Dying; range: 14-42). We performed generalized estimating equations regression analyses to analyze whether these outcomes are associated with a comfort goal established shortly after admission compared with another or no care goal as reported by the physician. Families of patients were more satisfied with end-of-life care when a comfort goal was established shortly after admission. We found this pattern only for patients who died within 6 months of admission (adjusted b: 4.5; confidence interval: 2.8, 6.3 vs -1.2; confidence interval: -3.0, 0.6 for longer stay). For quality of dying, no such association was found. We found that family satisfaction with care is related to a comfort care goal shortly after admission, but quality of dying did not. Establishing a comfort goal at an early stage may be important to the family. Advance care planning interventions should be studied for their effects on patient and family outcome. © The Author(s) 2015. Title: Pareidolia in Parkinson's disease without dementia: A positron emission tomography study. Citation: Parkinsonism & related disorders, Jun 2015, vol. 21, no. 6, p. 603-609 (June 2015) Author(s): Uchiyama, Makoto, Nishio, Yoshiyuki, Yokoi, Kayoko, Hosokai, Yoshiyuki, Takeda, Atsushi, Mori, Etsuro Abstract: Pareidolia, which is a particular type of complex visual illusion, has been reported to be a phenomenon analogous to visual hallucinations in patients with dementia with Lewy bodies. However, whether pareidolia is observed in Parkinson's disease (PD) or whether there are common underlying mechanisms of these two types of visual misperceptions remains to be elucidated. A test to evoke pareidolia, the Pareidolia test, was administered to 53 patients with PD without dementia and 24 healthy controls. The regional cerebral metabolic rate of glucose was measured using 18Ffluorodeoxyglucose positron emission tomography in the PD patients. PD patients without dementia produced a greater number of pareidolic illusions compared with the controls. Pareidolia was observed in all of the patients having visual hallucinations as well as a subset of those without visual hallucinations. The number of pareidolic illusions was correlated with hypometabolism in the bilateral temporal, parietal and occipital cortices. The index of visual hallucinations was correlated with hypometabolism in the left parietal cortex. A region associated with both pareidolia and visual hallucinations was found in the left parietal lobe. Our study suggests that PD patients without dementia experience pareidolia more frequently than healthy controls and that posterior cortical dysfunction could be a common neural mechanism of pareidolia and visual hallucinations. Pareidolia could represent subclinical hallucinations or a predisposition to visual hallucinations in Lewy body disease. Copyright © 2015 Elsevier Ltd. All rights reserved. 23 Title: Function Focused Care for Assisted Living Residents With Dementia. Citation: The Gerontologist, Jun 2015, vol. 55 Suppl 1, p. S13. (June 2015) Author(s): Galik, Elizabeth, Resnick, Barbara, Lerner, Nancy, Hammersla, Margaret, Gruber-Baldini, Ann L Abstract: Assisted living (AL) residents with dementia require assistance with activities of daily living, encounter limited opportunities to engage in physical activity, and often exhibit challenging behavioral symptoms. The Function Focused Care Intervention for the Cognitively Impaired (FFC-CI) teaches and motivates direct care workers (DCWs) to engage residents with dementia in activities that optimize function and activity while minimizing behavioral symptoms. The purpose of this study was to test the impact of FFC-CI on function, physical activity, behavior, and falls. A clusterrandomized trial included 96 residents with dementia and 76 DCWs from 4 ALs. Generalized estimating equations were used to evaluate outcomes at 3 and 6 months. There were no treatment by time differences with regard to resident behavior, mood, counts of physical activity based on actigraphy, falls, and function. There were significant increases in physical activity based on kilocalories burned (p = .001), time spent in physical activity based on survey results (p = .001), and time spent in repetitive behaviors, such as wandering (p = .01) among the control group over time. There were no treatment by time differences with regard to DCW beliefs, knowledge, or performance of FFC, except for less decline in job satisfaction among the treatment group (p = .002). Treatment fidelity with regard to delivery and receipt were poor due to high staff attrition in the treatment group (46% vs. 16%) and limited site support. The findings from this study can be used to adapt future FFC intervention studies to improve treatment fidelity and optimize intervention efficacy. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Title: The Association Between Characteristics of Care Environments and Apathy in Residents With Dementia in Long-term Care Facilities. Citation: The Gerontologist, Jun 2015, vol. 55 Suppl 1, p. S27. (June 2015) Author(s): Jao, Ying-Ling, Algase, Donna L, Specht, Janet K, Williams, Kristine Abstract: Apathy is highly prevalent in dementia but often overlooked. Environment-based interventions have demonstrated positive impact on apathy, yet, influential environmental components are largely understudied. This study examined the relationship between care environments and apathy in long-term care residents with dementia. This study was exploratory and employed a descriptive and repeated observation design. A sample of 40 was selected from a parent study with 185 participants from 28 facilities. Three videos from each participant were coded to measure apathy and environmental stimulation. Data on ambiance, crowding, staff familiarity, light, and sounds were extracted from the parent study. Generalized linear mixed models were used for analysis. The clarity and strength of environmental stimulation were significantly associated with a lower apathy level. An increase of 1 point on stimulation clarity and strength corresponded to a decrease of 1.3 and 1.9 points on apathy score, respectively (p < .0001). Other environmental factors 24 did not show significant effect on apathy. This study explored influential environmental features on apathy in dementia. Findings suggest that care environments that contain clear and sufficient environmental stimulation are significantly associated with lower resident apathy levels. Findings will guide environmental design and interventions for dementia care. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Title: Caregiver Person-Centeredness and Behavioral Symptoms in Nursing Home Residents With Dementia: A Timed-Event Sequential Analysis. Citation: The Gerontologist, Jun 2015, vol. 55 Suppl 1, p. S61. (June 2015) Author(s): Gilmore-Bykovskyi, Andrea L, Roberts, Tonya J, Bowers, Barbara J, Brown, Roger L Abstract: Evidence suggests that person-centered caregiving approaches may reduce dementiarelated behavioral symptoms; however, little is known about the sequential and temporal associations between specific caregiver actions and behavioral symptoms. The aim of this study was to identify sequential associations between caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and the temporal variation within these associations. Videorecorded observations of naturally occurring interactions (N = 33; 724min) between 12 nursing home (NH) residents with dementia and eight certified nursing assistants were coded for caregiver person-centered actions, task-centered actions, and resident behavioral symptoms and analyzed using timed-event sequential analysis. Although caregiver actions were predominantly personcentered, we found that resident behavioral symptoms were significantly more likely to occur following task-centered caregiver actions than person-centered actions. Findings suggest that the person-centeredness of caregivers is sequentially and temporally related to behavioral symptoms in individuals with dementia. Additional research examining the temporal structure of these relationships may offer valuable insights into the utility of caregiver person-centeredness as a lowcost strategy for improving behavioral symptom management in the NH setting. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Title: Economics of the Iceberg: Informal Care Provided to French Elderly with Dementia. Citation: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, Jun 2015, vol. 18, no. 4, p. 368-375 (June 2015) Author(s): Paraponaris, Alain, Davin, Bérengère Abstract: Dementia has a substantial effect on patients and their relatives, who have to cope with medical, social, and economic changes. In France, most elderly people with dementia live in the community and receive informal care, which has not been well characterized. Using a sample of 4680 people aged 75 years and older collected in 2008 through a national comprehensive survey on health and disability, we compared the economic value of the care received by 513 elderly people 25 with dementia to that received by a propensity score- matched set of older people without dementia. More than 85% of elderly people with dementia receive informal care; the estimation of its economic value ranges from €4.9 billion (proxy good method) to €6.7 billion (opportunity cost method) per year. The informal care provided to people with dementia has substantial annual costs; further work should be done to examine the social and economic roles foregone as a result of this care. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved. Title: Leisure time activities and mental health in informal dementia caregivers. Citation: Applied Psychology: Health and Well-Being, Jun 2015, (Jun 11, 2015), Author(s): Schüz, Benjamin, Czerniawski, Alana, Davie, Nicola, Miller, Lisa, Quinn, Michael G., King, Carolyn, Carr, Andrea, Elliott, Kate‐Ellen J., Robinson, Andrew, Scott, Jenn L. Abstract: Objectives Dementia prevalence and the demand for dementia care are increasing. Informal caregiving accounts for a large proportion of dementia care, but can come at high cost for caregivers. Informal dementia caregivers are at higher risk for mental health problems than the general population. This study examines whether perceived change in leisure activities is one working mechanism linking stress and burden experience in dementia caregiving to lower mental health (depressive symptoms, anxiety symptoms, and reduced satisfaction with life), and whether there are group‐based leisure activities that can buffer this detrimental effect. Methods A total of 346 informal Australian dementia caregivers (88.15% female, age 18–82 years) participated in an online study. Results Mediation and moderation analyses using multiple regression demonstrated that perceived changes in leisure activities linked caregiving stress and burden to lower mental health, and that membership in groups engaging in affiliation or social activities attenuates negative effects of caregiving. Conclusion Informal dementia caregivers benefit from satisfying leisure activities. In particular, engaging in social activities and self‐help groups buffered the negative impact of caregiving. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: The Sociocultural Context of Caregiving Experiences for Vietnamese Dementia Family Caregivers. Citation: Asian American Journal of Psychology, Jun 2015, (Jun 15, 2015), 1948-1985 (Jun 15, 2015) Author(s): Meyer, Oanh L., Nguyen, Kim Hanh, Dao, To Nhu, Vu, Phuoc, Arean, Patricia, Hinton, Ladson Abstract: The goal of this qualitative study was to describe the beliefs and experiences of Vietnamese caregivers caring for a family member with dementia and to elicit their ideas about promising interventions. We recruited 10 caregivers from support groups, the Alzheimer’s Association, and local community-based organizations in Northern California. We conducted semistructured in-depth interviews with all caregivers, as well as a focus group to obtain ideas about supportive strategies. Several themes emerged from the data: (a) Filial piety was influential in 26 caregiving; (b) A sense of loss/grief or trauma was pervasive; and (c) Caregivers had clear sources of stress and sources of support. An overarching theme underlying these 3 topics was that cultural beliefs, values, and expectations impacted the caregiving experience. Suggestions for promising interventions included education, language-congruent and/or telephone support groups, case management, inclusion of the care recipient in the intervention, and importance of credibility of the intervention. It also may be valuable to include an understanding of cultural values and promotion of spirituality and religion as key components. Findings highlight targets for dementia caregiver interventions to reduce burden and distress in an understudied population. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Caregiver report of apathy predicts dementia in parkinson's disease. Citation: Parkinsonism & Related Disorders, Jun 2015, (Jun 9, 2015), 1353-8020 (Jun 9, 2015) Author(s): Fitts, Whitney, Weintraub, Daniel, Massimo, Lauren, Chahine, Lama, Chen-Plotkin, Alice, Duda, John E., Hurtig, Howard I., Rick, Jacqueline, Trojanowski, John Q., Dahodwala, Nabila Abstract: INTRODUCTION: Apathy is a common, troublesome symptom in Parkinson's disease (PD). However, little is known about its relationship with long-term cognition. We sought to determine if a caregiver-reported apathy measure predicts the development of PD dementia. METHODS: Nondemented PD patients were recruited as part of a longitudinal study of cognition. Demographics, medications, Dementia Rating Scale-2, Unified Parkinson's Disease Rating Scale, Geriatric Depression Scale and the Neuropsychiatric Inventory-Questionnaire (NPI-Q) ratings were obtained. Apathy was defined as an NPI-Q apathy score ≥1. Participants were evaluated annually with cognitive and functional assessments until the end of the study period or a physician consensus diagnosis of dementia was assigned. Cox proportional hazard models were used to assess the effects of baseline apathy on dementia development while controlling for other clinical and demographic factors. RESULTS: Of 132 PD patients 12.1% (N = 16) scored in the apathetic range at baseline. A total of 19.6% (N = 26) individuals developed dementia over the course of the study, 8 of whom (30.8% of future dementia patients) had baseline apathy. In bivariate analyses baseline apathy, older age, and worse cognitive, motor, and depressive symptom scores predicted the development of dementia. In a multivariate analysis the predictive effects of baseline apathy were still significant (HR = 3.56; 95% CI = 1.09–11.62; p = 0.04). CONCLUSIONS: A simple, caregiver-reported measure of apathy is an independent predictor of progression to dementia in PD. This highlights the importance of apathy as a clinical characteristic of PD and could prove useful for the prediction of future dementia. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Joint Trajectories of Cognitive Functioning and Challenging Behavior for Persons Living With Dementia in Long-Term Care. Citation: Psychology and Aging, Jun 2015, (Jun 8, 2015), 0882-7974 (Jun 8, 2015) Author(s): Robitaille, Annie, Garcia, Linda, McIntosh, Cameron 27 Abstract: The current study examines the longitudinal relationship between dementia-related challenging behaviors (e.g., vocal disruption, physical aggression, repetitive behaviors, and restlessness) and cognitive functioning in the long-term care (LTC) context. A multivariate latent growth curve model within the structural equation modeling (SEM) framework was applied to data collected from 16,804 older adults upon admission to LTC and every 3 months for a period of 2.5 years. Increases in challenging behaviors were characterized by a significant positive linear and negative quadratic trend (i.e., a subtle leveling off at later assessment times), whereas increases in cognitive impairment were characterized by a positive linear trend. On average, individuals who were more cognitively impaired upon entry into LTC and who exhibited a steeper increase in cognitive impairment also exhibited more challenging behaviors at entry into LTC and a steeper increase in challenging behaviors, respectively. At the within-person level, individuals demonstrating an increase in cognitive impairment at a specific occasion were also more likely to demonstrate an increase in challenging behaviors at that same occasion; however, the magnitude of these effects was very small, suggesting limited practical implications. This study provides novel empirical evidence about the coevolution of cognitive impairment and challenging behaviors, going beyond prior research that has been either cross-sectional in nature, examined longitudinal change in only 1 variable, or simply looked at linear trends without attempting to explore the possibility of nonlinear change. Most importantly, this longitudinal examination of persons with dementia living in LTC has implications for how challenging behaviors can be better managed and for how new strategies can be implemented to prevent challenging behaviors. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: A pilot randomised controlled trial to compare changes in quality of life for participants with early diagnosis dementia who attend a ‘Living Well with Dementia’ group compared to waiting-list control. Citation: Aging & Mental Health, Jun 2015, vol. 19, no. 6, p. 526-535, 1360-7863 (Jun 2015) Author(s): Marshall, Ann, Spreadbury, John, Cheston, Richard, Coleman, Peter, Ballinger, Claire, Mullee, Mark, Pritchard, Jane, Russell, Cynthia, Bartlett, Elizabeth Abstract: Objectives: The aim of this paper is to report a pilot study in which participants who had recently received a diagnosis of dementia were randomised to either a 10-week group intervention or a waiting-list control. Method: Memory clinic staff with limited previous experience of group therapy were trained to lead a 10-week group therapy intervention called ‘Living Well with Dementia’. Fifty-eight participants, all of whom had received a diagnosis of Alzheimer's disease, vascular or Lewy body dementia within the previous 18 months, were randomised to receive either the intervention or treatment as usual (waiting-list control). Data collection occurred at baseline, within two weeks after the intervention finished and at 10-week follow-up. Results: The study met its recruitment targets, with a relatively low attrition rate for the intervention arm. The acceptability of the intervention and research methods was examined qualitatively and will be reported on elsewhere. For the primary outcome, measure of quality of life in Alzheimer's disease (QoL-AD), and secondary outcome, self-esteem, there was some evidence of improvement in the intervention group compared to the control group. There was, also, evidence of a reduction in cognitive functioning in the treatment group compared to the control. Such reported differences should be 28 treated with caution because they are obtained from a pilot and not a definitive study. Conclusion: This pilot study succeeded in collecting data to inform a future definitive cost effectiveness clinical trial of Living Well with Dementia group therapy. (PsycINFO Database Record (c) 2015 APA, all rights reserved) Title: Hospice referral after inpatient psychiatric treatment of individuals with advanced dementia from a nursing home. Citation: American Journal of Hospice & Palliative Medicine, Jun 2015, vol. 32, no. 4, p. 437-439, 1049-9091 (Jun 2015) Author(s): Epstein-Lubow, Gary, Fulton, Ana Tuya, Marino, Louis J., Teno, Joan Abstract: This report addresses the discharge disposition following inpatient psychiatric treatment for advanced dementia. The total population included 685 305 Medicare fee-for-service decedents with advanced cognitive and functional impairment, with a mean age of 85.9 years who had resided in a nursing home. In the last 90 days of life, 1027 (0.15%) persons received inpatient psychiatry treatment just prior to the place of care where the individual died. Discharge dispositions included 132 (12.9%) persons to a medical hospital, 728 (70.9%) to nursing home without hospice services, 73 (7.1%) to hospice services in a nursing home, 32 (3.1%) to home without hospice services, and 16 (1.6%) to hospice services at home. Overall, the rate of referral to hospice services for advanced dementia was relatively low. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Using mobile devices and apps to support reflective learning about older people with dementia. Citation: Behaviour & Information Technology, Jun 2015, vol. 34, no. 6, p. 613-631, Author(s): Pitts, Kristine, Pudney, Kevin, Zachos, Konstantinos, Maiden, Neil, Krogstie, Birgit, Jones, Sara, Rose, Malcolm, MacManus, Julie, Turner, Ian people with dementia, in spite of the growing challenges that the condition poses for society. To design such technologies, an existing model of computer-support reflective learning was instantiated with findings from a pre-design study in one residential home. The result was a mobile device running an adapted enterprise social media app to support person-centred care. Evaluations of the device and app in two residential homes revealed that use of the app both motivated and increased different styles of care note recording, but little reflective learning was identified or reported. The results suggest the need for more comprehensive and flexible computer-based support for reflective learning about residents in their care—and new designs of this more comprehensive support are also introduced. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) 29 Medical Title: Diagnosis of dementia Citation: Nursing Standard, Jun 2015, vol. 29, no. 43, p. 36-41 Author(s): Sandilyan, Malarvizhi Babu, Dening, Tom Abstract: There are two stages to making a diagnosis of dementia: establishing the presence of a dementia syndrome and determining the likely cause. Dementia should be distinguished from mild cognitive impairment, in which any cognitive and functional changes are less marked. Diagnosis of dementia is essentially clinical but investigations are helpful in excluding other disorders and in determining the underlying cause of the condition. International diagnostic criteria exist for the most common causes of dementia and these are useful for clinical and research purposes. At and following diagnosis, patients and their families require information, support and guidance about the future. [PUBLICATION] 25 references Title: Signs and symptoms of dementia Citation: Nursing Standard, Jun 2015, vol. 29, no. 41, p. 42-51, Author(s): Sandilyan, Malarvizhi Babu, Dening, Tom Abstract: Dementia series 3: The clinical features of dementia are usually considered in two groups: cognitive and non-cognitive symptoms. Among cognitive symptoms, problems with memory are typical of most forms of dementia, but problems with language and executive functioning are also prevalent. Non-cognitive symptoms is a somewhat unsatisfactory general term for a group of problems that include mood disorders, psychotic symptoms and various other changes in behaviour. In assessment and management, it is important to look for underlying causes of symptoms and try to understand the perspective of the individual with dementia, because their behaviour may be communicating an important message. [PUBLICATION] 39 references Title: Australia's dementia diagnosis Citation: Australian Nursing and Midwifery Journal, Jun 2015, vol. 22, no. 11, p. 19-23, Author(s): Keast, Karen Abstract: Dementia and its most common form, Alzheimer's disease, is now the second leading cause of death in Australia. With 342,800 Australians now living with dementia and that figure expected to rise to almost 900,000 by 2050, experts warn the nation must prepare to confront the rising tide of Alzheimer's, writes Karen Keast. [Publication] 0 references 30 Title: Dementia with Lewy bodies Citation: British Journal of Neuroscience Nursing, Jun 2015, vol. 11, no. 3, p. 146-149, Author(s): Abeysuriya, Rajeeva, Walker, Zuzana Abstract: Epidemiology, features, diagnosis and management of dementia with Lewy bodies (DLB). [ORIGINAL] 18 references Title: Worldwide research finds dementia affects women more than men. Citation: Nursing older people, Jun 2015, vol. 27, no. 6, p. 9., 1472-0795 (June 25, 2015) Author(s): Berry, Lisa Abstract: WOMEN ARE much more likely to be affected by dementia than men, according to a global report. Title: Biomarkers to track progress of genetic frontotemporal dementia. Citation: Nursing older people, Jun 2015, vol. 27, no. 6, p. 15., Abstract: Frontotemporal dementia is a neurodegenerative disorder characterised by loss of neurons in the frontal and temporal lobes. It is a common cause of early-onset dementia but can also start in older age. It presents with behavioural symptoms or language disturbance (primary progressive aphasia), and patients can also develop symptoms of motor neurone disease. It is a highly heritable disease with one third of patients having a family history and a mutation in one of three genes. The ideal time to treat neurodegenerative disease may be before clinical presentation, at a point where the minimum of irreversible neuronal loss has occurred and cognitive function is still preserved. Title: CLINICAL PRACTICE. Advanced Dementia. Citation: The New England journal of medicine, Jun 2015, vol. 372, no. 26, p. 2533-2540 Author(s): Mitchell, Susan L Title: Informing a patient they have dementia is a clinical judgement. Citation: Nursing standard (Royal College of Nursing (Great Britain) : 1987), Jun 2015, vol. 29, no. 42, p. 33 Author(s): Owen, Michael 31 Abstract: Although I respect Professor Jane Andrews' views on informing patients of a diagnosis of dementia (letters June 3), I have difficulty agreeing entirely. It is important to take into account factors such as the extent of the problem, the person's own views about wishing to know or not and, crucially, whether any treatment can be offered. Title: Variant of multiple sclerosis with dementia and tumefactive demyelinating brain lesions. Citation: World journal of clinical cases, Jun 2015, vol. 3, no. 6, p. 525-532 Author(s): Hamed, Sherifa A Abstract: We describe an unusual clinical and diagnostic feature of a patient with multiple sclerosis (MS). A 25-year-old woman was admitted to the Neurology department (December 2009) with one month history of rapid cognitive deterioration. She had poor cognition, dysphasia, reduction in visual acuity and temporal pallor of the optic discs. She had prolonged latencies of P100 component of visual evoked potentials (VEPs). Magnetic resonance imaging (MRI)-brain showed multifocal large (≥ 3 cm) white-matter hypointense lesions in T1W and hyperintense in T2W and fluid-attenuated inversion recovery images and patchy enhancement. A diagnosis of tumefactive MS was given. She received two consecutive 5-d courses of 1 g daily intravenous methylprednisolone for 2 mo and oral prednisolone in dose of 80 mg twice/daily in between. At the 3(rd) month, Mini Mental State Examination and VEPs returned to normal but not the MRI. Patient continued oral steroids after hospital discharge (March 2010) for 9 mo with significant MRI improvement after which tapering of steroids started for a year. The patient refused immunomodulation therapy due to her low socioeconomic status. Neither clinical relapse nor new MRI lesions were observed throughout the next 4 years. In spite of the aggressive course of tumefactive MS variant, good prognosis may be seen in some patients. Title: Subcortical whiter matter hyperintensities within the cholinergic pathways of patients with dementia and parkinsonism. Citation: Journal of the neurological sciences, Jun 2015, vol. 353, no. 1-2, p. 44-48 Author(s): Park, Hyung-Eun, Park, In-Seok, Oh, Yoon-Sang, Yang, Dong-Won, Lee, Kwang-Soo, Choi, Hyun-Seok, Ahn, Kook-Jin, Kim, Joong-Seok Abstract: White matter hyperintensities (WMHs) in the cholinergic pathways are associated with cognitive performance in Alzheimer's disease (AD) and Parkinson disease dementia (PDD). This study aimed to evaluate the relationship between loss of white matter cholinergic pathways and cognitive function in patients with AD, diffuse Lewy body disease (DLB), and PDD. The subjects included 20 patients with AD, 17 with DLB, 21 with PDD, and 20 healthy controls. The extent of WMHs within cholinergic pathways was assessed using the Cholinergic Pathways Hyperintensities Scale (CHIPS) and was compared among the different diseases. The mean CHIPS scores were similar among the three dementia groups (AD vs. DLB vs. PDD=34.6±17.9 vs. 32.4±14.1 vs. 31.8±14.5, p=0.781 by ANCOVA) and higher than those of controls (11.5±7.6, p=0.001 by ANCOVA). Losses of cholinergic 32 pathways were similar among AD, DLB, and PDD groups, and more severe cognitive dysfunction was associated with elevated WMHs. These findings suggest that interruption of acetylcholine pathways may be related to cognitive dysfunction in these three diseases, even though they have different pathological mechanisms. Copyright © 2015 Elsevier B.V. All rights reserved. Title: Deficiency or dementia? Exploring B12 deficiency after urostomy. Citation: British journal of nursing (Mark Allen Publishing), Jun 2015, vol. 24, no. 11, p. 594-597 Author(s): Boucher, Michelle, Bryan, Sandra, Dukes, Suzie Abstract: Vitamin B12 deficiency can be misdiagnosed as a variety of other illnesses, and if left untreated can lead to irreversible damage to the brain and nervous system. This article discusses the case of a 70-year-old female with a urostomy, well known to the stoma care department, who shortly after a routine parastomal hernia repair developed severe confusion, immobility and was unable to communicate. Subsequent investigations ruled out a cerebrovascular accident (CVA) and a diagnosis of rapidly progressing vascular dementia was made. An incidental finding of a low vitamin B12 level was identified and treatment commenced. She was transferred to a community hospital and her family were told to 'prepare for the worst'. It was, in fact, the vitamin B12 deficiency that was causing her symptoms of vascular dementia, and once treatment was established she underwent a 'miraculous' improvement, returning to normal life. This article discusses vitamin B12 deficiency and why patients with a urostomy are at risk of developing it; highlights the key role of the stoma care nurse and his or her knowledge of the patient; explores the importance of testing vitamin B12 levels in this group of patients; and discusses key learning and recommendations for practice. Title: Diabetes: A risk factor for cognitive impairment and dementia? Citation: Neurology, Jun 2015, vol. 84, no. 23, p. 2300-2301 Author(s): Singh-Manoux, Archana, Schmidt, Reinhold Title: Tetrahydrocannabinol for neuropsychiatric symptoms in dementia: A randomized controlled trial. Citation: Neurology, Jun 2015, vol. 84, no. 23, p. 2338-2346 Author(s): van den Elsen, Geke A H, Ahmed, Amir I A, Verkes, Robbert-Jan, Kramers, Cees, Feuth, Ton, Rosenberg, Paul B, van der Marck, Marjolein A, Olde Rikkert, Marcel G M Abstract: To study the efficacy and safety of low-dose oral tetrahydrocannabinol (THC) in the treatment of dementia-related neuropsychiatric symptoms (NPS). This is a randomized, doubleblind, placebo-controlled study. Patients with dementia and clinically relevant NPS were randomly assigned to receive THC 1.5 mg or matched placebo (1:1) 3 times daily for 3 weeks. Primary outcome 33 was change in Neuropsychiatric Inventory (NPI), assessed at baseline and after 14 and 21 days. Analyses were based on intention-to-treat. Twenty-four patients received THC and 26 received placebo. NPS were reduced during both treatment conditions. The difference in reduction from baseline between THC and placebo was not significant (mean difference NPItotal: 3.2, 95% confidence interval [CI] -3.6 to 10.0), nor were changes in scores for agitation (Cohen-Mansfield Agitation Inventory 4.6, 95% CI -3.0 to 12.2), quality of life (Quality of Life-Alzheimer's Disease -0.5, 95% CI -2.6 to 1.6), or activities of daily living (Barthel Index 0.6, 95% CI -0.8 to 1.9). The number of patients experiencing mild or moderate adverse events was similar (THC, n = 16; placebo, n = 14, p = 0.36). No effects on vital signs, weight, or episodic memory were observed. Oral THC of 4.5 mg daily showed no benefit in NPS, but was well-tolerated, which adds valuable knowledge to the scarce evidence on THC in dementia. The benign adverse event profile of this dosage allows study of whether higher doses are efficacious and equally well-tolerated. This study provides Class I evidence that for patients with dementia-related NPS, low-dose THC does not significantly reduce NPS at 21 days, though it is well-tolerated. © 2015 American Academy of Neurology. Title: Functional proteomics of synaptic plasma membrane ATP-ases of rat hippocampus: effect of l-acetylcarnitine and relationships with Dementia and Depression pathophysiology. Citation: European journal of pharmacology, Jun 2015, vol. 756, p. 67-74 (June 5, 2015) Author(s): Ferrari, Federica, Gorini, Antonella, Villa, Roberto Federico Abstract: Synaptic energy state and mitochondrial dysfunction are crucial factors in many brain pathologies. l-acetylcarnitine, a natural derivative of carnitine, improves brain energy metabolism, and has been proposed for the Therapy of many neurological and psychiatric diseases. The effects of the drug on the maximum rate (Vmax) of enzymatic activities related to hippocampal synaptic energy utilization were evaluated, in the perspective of its employment for Dementias and Depression Therapy. Two types of synaptic plasma membranes (SPM1 and SPM2) were isolated from the hippocampus of rats treated with l-acetylcarnitine (30 and 60mg/kg i.p., 28 days, 5 days/week). Acetylcholinesterase (AChE); Na(+), K(+), Mg(2+)-ATP-ase; ouabain-insensitive Mg(2+)-ATP-ase; Na(+), K(+)-ATP-ase; Ca(2+), Mg(2+)-ATP-ase activities were evaluated. In control animals, enzymatic activities were differently expressed in SPM1 , being the evaluated enzymatic activities higher in SPM2. Subchronic treatment with l-acetylcarnitine (i) did not modify AChE on both SPMs; (ii) increased Na(+), K(+), Mg(2+)-ATP-ase, ouabain-insensitive Mg(2+)-ATP-ase and Na(+), K(+)-ATP-ase at the dose of 30 and 60mg/kg on SPM1 and SPM2; (iii) increased Ca(2+), Mg(2+)-ATP-ase activity on both SPMs at the dose of 60mg/kg. These results have been discussed considering the pathophysiology and treatment of Dementias and Depression because, although referred to normal healthy animals, they support the notion that l-acetylcarnitine may have positive effects in these pathologies. Copyright © 2015 Elsevier B.V. All rights reserved. Title: Erratum to: Sequential distribution of pTDP-43 pathology in behavioral variant frontotemporal dementia (bvFTD). Citation: Acta neuropathologica, Jun 2015, vol. 129, no. 6, p. 929. (June 2015) 34 Author(s): Brettschneider, Johannes, Del Tredici, Kelly, Irwin, David J, Grossman, Murray, Robinson, John L, Toledo, Jon B, Lee, Edward B, Fang, Lubin, Van Deerlin, Vivianna M, Ludolph, Albert C, Lee, Virginia M-Y, Braak, Heiko, Trojanowski, John Q Title: Treatment adherence in patients with Alzheimer's disease referred to an Italian center for dementia. Citation: Aging clinical and experimental research, Jun 2015, vol. 27, no. 3, p. 395-396 Author(s): Sinforiani, Elena, Bernini, Sara, Picascia, Marta, Malinverni, Paola, Zucchella, Chiara Title: SWI or T2*: Which MRI Sequence to Use in the Detection of Cerebral Microbleeds? The Karolinska Imaging Dementia Study. Citation: AJNR. American journal of neuroradiology, Jun 2015, vol. 36, no. 6, p. 1089-1095 Author(s): Shams, S, Martola, J, Cavallin, L, Granberg, T, Shams, M, Aspelin, P, Wahlund, L O, Kristoffersen-Wiberg, M Abstract: Cerebral microbleeds are thought to have potentially important clinical implications in dementia and stroke. However, the use of both T2* and SWI MR imaging sequences for microbleed detection has complicated the cross-comparison of study results. We aimed to determine the impact of microbleed sequences on microbleed detection and associated clinical parameters. Patients from our memory clinic (n = 246; 53% female; mean age, 62) prospectively underwent 3T MR imaging, with conventional thick-section T2*, thick-section SWI, and conventional thin-section SWI. Microbleeds were assessed separately on thick-section SWI, thin-section SWI, and T2* by 3 raters, with varying neuroradiologic experience. Clinical and radiologic parameters from the dementia investigation were analyzed in association with the number of microbleeds in negative binomial regression analyses. Prevalence and number of microbleeds were higher on thick-/thin-section SWI (20/21%) compared with T2*(17%). There was no difference in microbleed prevalence/number between thick- and thin-section SWI. Interrater agreement was excellent for all raters and sequences. Univariate comparisons of clinical parameters between patients with and without microbleeds yielded no difference across sequences. In the regression analysis, only minor differences in clinical associations with the number of microbleeds were noted across sequences. Due to the increased detection of microbleeds, we recommend SWI as the sequence of choice in microbleed detection. Microbleeds and their association with clinical parameters are robust to the effects of varying MR imaging sequences, suggesting that comparison of results across studies is possible, despite differing microbleed sequences. © 2015 by American Journal of Neuroradiology. Title: Influence of microglial activation on neuronal function in Alzheimer's and Parkinson's disease dementia. 35 Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no. 6, p. 608 Author(s): Fan, Zhen, Aman, Yahyah, Ahmed, Imtiaz, Chetelat, Gaël, Landeau, Brigitte, Ray Chaudhuri, K, Brooks, David J, Edison, Paul Abstract: Alzheimer's disease (AD) and Parkinson's disease (PD) are the two common neurodegenerative diseases characterized by progressive neuronal dysfunction in the presence of pathological microglial activation. 10 AD, 10 mild cognitive impairment (MCI), 11 PD dementia (PDD), and 16 controls underwent magnetic resonance imaging, [11C](R)PK11195 (1-[2-chlorophenyl]-Nmethyl-N-[1-methyl-propyl]-3-isoquinoline carboxamide), [11C]PIB (11C-Pittsburgh compound B), [18F]FDG-PET (18F-2-fluoro-2-deoxyglucose positron emission tomography) scans. Parametric images were interrogated using region of interest (ROI), biological parametric mapping (BPM) and statistical parametric mapping analysis, and neuropsychometric tests. Using BPM analysis, AD, MCI, and PDD subjects demonstrated significant correlation between increased microglial activation and reduced glucose metabolism (rCMRGlc). AD and MCI subjects also showed significant positive correlation between amyloid and microglial activation. Levels of cortical microglial activation were negatively correlated with Mini-Mental State Examination in both AD and PDD. The significant inverse correlations between cortical levels of microglial activation and rCMRGlc in AD and PDD suggest cortical neuroinflammation may drive neuronal dysfunction in these dementias. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved. Title: Existing data sets to support studies of dementia or significant cognitive impairment and comorbid chronic conditions. Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no. 6, p. 622-638 Author(s): Bell, Janice F, Fitzpatrick, Annette L, Copeland, Catherine, Chi, Gloria, Steinman, Lesley, Whitney, Robin L, Atkins, David C, Bryant, Lucinda L, Grodstein, Francine, Larson, Eric, Logsdon, Rebecca, Snowden, Mark Abstract: Dementia or other significant cognitive impairment (SCI) are often comorbid with other chronic diseases. To promote collaborative research on the intersection of these conditions, we compiled a systematic inventory of major data resources. Large data sets measuring dementia and/or cognition and chronic conditions in adults were included in the inventory. Key features of the resources were abstracted including region, participant sociodemographic characteristics, study design, sample size, accessibility, and available measures of dementia and/or cognition and comorbidities. 117 study data sets were identified; 53% included clinical diagnoses of dementia along with valid and reliable measures of cognition. Most (79%) used longitudinal cohort designs and 41% had sample sizes greater than 5000. Approximately 47% were European-based, 40% were USbased, and 11% were based in other countries. Many high-quality data sets exist to support collaborative studies of the effects of dementia or SCI on chronic conditions and to inform the development of evidence-based disease management programs. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved. 36 Title: Atherosclerotic calcification is related to a higher risk of dementia and cognitive decline. Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no. 6, p. 639 Author(s): Bos, Daniel, Vernooij, Meike W, de Bruijn, Renée F A G, Koudstaal, Peter J, Hofman, Albert, Franco, Oscar H, van der Lugt, Aad, Ikram, M Arfan Abstract: Longitudinal data on the role of atherosclerosis in different vessel beds in the etiology of cognitive impairment and dementia are scarce and inconsistent. Between 2003-2006, 2364 nondemented persons underwent computed tomography of the coronaries, aortic arch, extracranial, and intracranial carotid arteries to quantify atherosclerotic calcification. Participants were followed for incident dementia (n = 90) until April 2012. At baseline and follow-up participants also underwent a cognitive test battery. Larger calcification volume in all vessels, except in the coronaries, was associated with a higher risk of dementia. After adjustment for relevant confounders, extracranial carotid artery calcification remained significantly associated with a higher risk of dementia [hazard ratio per standard deviation increase in calcification volume: 1.37 (1.05, 1.79)]. Additional analyses for Alzheimer's disease only or censoring for stroke showed similar results. Larger calcification volumes were also associated with cognitive decline. Atherosclerosis, in particular in the extracranial carotid arteries, is related to a higher risk of dementia and cognitive decline. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved. Title: Frequent use of opioids in patients with dementia and nursing home residents: A study of the entire elderly population of Denmark. Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no. 6, p. 691-699 Author(s): Jensen-Dahm, Christina, Gasse, Christiane, Astrup, Aske, Mortensen, Preben Bo, Waldemar, Gunhild Abstract: Pain is believed to be undertreated in patients with dementia; however, no larger studies have been conducted. The aim was to investigate prevalent use of opioids in elderly with and without dementia in the entire elderly population of Denmark. A register-based cross-sectional study in the entire elderly (≥65 years) population in 2010 was conducted. Opioid use among elderly with dementia (N = 35,455) was compared with elderly without (N = 870,645), taking age, sex, comorbidity, and living status into account. Nursing home residents (NHRs) used opioids most frequently (41%), followed by home-living patients with dementia (27.5%) and home-living patients without dementia (16.9%). Buprenorphine and fentanyl (primarily patches) were commonly used among NHRs (18.7%) and home-living patients with dementia (10.7%) but less often by home-living patients without dementia (2.4%). Opioid use in the elderly Danish population was frequent but particularly in patients with dementia and NHR, which may challenge patient safety and needs further investigation. 37 Title: Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no. 6, p. 718-726 Author(s): Baumgart, Matthew, Snyder, Heather M, Carrillo, Maria C, Fazio, Sam, Kim, Hye, Johns, Harry Abstract: An estimated 47 million people worldwide are living with dementia in 2015, and this number is projected to triple by 2050. In the absence of a disease-modifying treatment or cure, reducing the risk of developing dementia takes on added importance. In 2014, the World Dementia Council (WDC) requested the Alzheimer's Association evaluate and report on the state of the evidence on modifiable risk factors for cognitive decline and dementia. This report is a summary of the Association's evaluation, which was presented at the October 2014 WDC meeting. The Association believes there is sufficient evidence to support the link between several modifiable risk factors and a reduced risk for cognitive decline, and sufficient evidence to suggest that some modifiable risk factors may be associated with reduced risk of dementia. Specifically, the Association believes there is sufficiently strong evidence, from a population-based perspective, to conclude that regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking, and hypertension) reduce the risk of cognitive decline and may reduce the risk of dementia. The Association also believes there is sufficiently strong evidence to conclude that a healthy diet and lifelong learning/cognitive training may also reduce the risk of cognitive decline. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved. Title: Delusion of pregnancy: an unusual symptom in the context of dementia. Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p. 341-345 Author(s): Cipriani, Gabriele, Di Fiorino, Mario Abstract: Delusions can complicate practically all brain disorders. They may be dramatic and bizarre. An example is the so-called delusion of pregnancy. To identify the characteristic of a psychotic symptom, the phenomenon of delusion of pregnancy, in the context of dementia. MEDLINE and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2014. Search terms used included delusion of pregnancy, uncommon presentation, behavioral and psychological symptoms, dementia, Alzheimer's disease, and frontotemporal dementia (FTD). Publications found through this indexed search were reviewed for further relevant references. We included case reports that highlight the relationship and overlap between dementia presenting as schizophrenia-like psychosis and schizophrenia. Literature on delusion of pregnancy in the course of dementia consists mostly of case reports and small samples of patients. Psychotic phenomena such as delusion of pregnancy may be a feature in some cases of dementia. If this bizarre features of 38 dementia appears as early presentation of FTD whose usual onset is in the presenium, it may be mistaken for schizophrenia. © The Author(s) 2014. Title: Cognitive fluctuations as a challenge for the assessment of decision-making capacity in patients with dementia. Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p. 360-363 Author(s): Trachsel, Manuel, Hermann, Helena, Biller-Andorno, Nikola Abstract: Decision-making capacity (DMC) is an indispensable prerequisite for medical treatment choices, including consent to treatment, treatment discontinuation, and refusal of treatment. In patients with dementia, DMC is often affected. A particular challenge in assessing DMC are cognitive fluctuations that may lead to a fluctuation in DMC as well. Cognitive fluctuations are a diagnostic core feature of dementia with Lewy bodies and occur in Parkinson's and Alzheimer's diseases. In this article, these challenges are discussed and suggestions for assessing the DMC of patients with dementia with cognitive fluctuations are presented. © The Author(s) 2014. Title: Agenesis of corpus callosum and frontotemporal dementia: a casual finding? Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p. 375-379 Author(s): Calabrò, Rocco Salvatore, Spadaro, Letteria, Marra, Angela, Balletta, Tina, Cammaroto, Simona, Bramanti, Placido Abstract: Agenesis of corpus callosum (AgCC) is a congenital malformation characterized by total or partial absence of corpus callosum with a good neuropsychological profile. Frontotemporal dementia (FTD) is the third most common cause of cortical dementia, and it is characterized by alterations in personality and social relationship, often associated with deficits in attention, abstraction, planning, and problem solving. Herein, we report a case of a 73-year-old woman presenting with FTD associated with primary AgCC. The possible "causal or casual" relationship between these 2 different conditions should be investigated in large prospective studies. © The Author(s) 2014. Title: Gait and apathy as relevant symptoms of subcortical vascular dementia. Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p. 390-399 Author(s): Moretti, Rita, Cavressi, Monica, Tomietto, Paola 39 Abstract: Subcortical vascular dementia relates to small-vessel disease and hypoperfusion, resulting in focal and diffuse ischemic white matter lesions. The main target of the disease are the frontal subcortical neural networks. There is no clinical standard definition of the pathology, on the contrary, everyday clinical practice suggests dominant behavioral alterations and dysexecutive syndrome. The aim of this study was to investigate gait disorders, behavioral alteration, and drug intake of a subcortical population with dementia (n = 1155). A complete neuropsychological examination was conducted at baseline and every 6 months, and the results were compared. Our data suggest that there is a significant increment in apathy levels and a dramatic decrease in gait and equilibrium control in the patients examined during follow-up. Subcortical vascular dementia may be associated with gait and balance alteration and apathy per se; we suggest to implement clinical data with these major aspects. © The Author(s) 2014. Title: The Peripheral Sympathetic Neuron is Intact in Alzheimer's Disease and Behavioral Variant of Frontotemporal Dementia. Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p. 400-404 Author(s): Struhal, Walter, Javor, Andrija, Benesch, Thomas, Vosko, Milan R, Ransmayr, Gerhard Abstract: The study was undertaken to evaluate the postganglionic sympathetic sudomotor function employing the quantitative sudomotor axon reflex test (QSART) in tauopathies Alzheimer's disease (AD) and behavioral variant of frontotemporal dementia (bvFTD). Patients were recruited in a prospective pilot study. A structured history was taken and QSART was recorded. In all, 15 patients with AD (7 female) and 14 patients with bvFTD (9 female) were included. Mean age (±standard deviation) of patients with AD and bvFTD was 74 ± 9 and 71 ± 10 years, respectively. Severe sudomotor dysfunction (Composite Autonomic Severity sudomotor score 3) was present in 3 (20%) patients with AD and 0 (0%) patients with bvFTD (P = .037). The upper extremity was only involved in 1 patient with AD and 1 patient with bvFTD. Sweat results of the 4 recording sites did not differ between both groups. Patients' history correlated with severe autonomic symptoms as assessed with QSART. Postganglionic sudomotor involvement in AD and bvFTD is most likely not part of the disease. © The Author(s) 2014. Title: Occupational exposures and risk of dementia-related mortality in the prospective Netherlands Cohort Study. Citation: American journal of industrial medicine, Jun 2015, vol. 58, no. 6, p. 625-635 Author(s): Koeman, Tom, Schouten, Leo J, van den Brandt, Piet A, Slottje, Pauline, Huss, Anke, Peters, Susan, Kromhout, Hans, Vermeulen, Roel Abstract: Occupational exposures may be associated with non-vascular dementia. We analyzed the effects of occupational exposures to solvents, pesticides, metals, extremely low frequency magnetic fields (ELF-MF), electrical shocks, and diesel motor exhaust on non-vascular dementia related 40 mortality in the Netherlands Cohort Study (NLCS). Exposures were assigned using job-exposure matrices. After 17.3 years of follow-up, 682 male and 870 female cases were available. Analyses were performed using Cox regression. Occupational exposure to metals, chlorinated solvents and ELF-MF showed positive associations with non-vascular dementia among men, which seemed driven by metals (hazard ratio ever high vs. background exposure: 1.35 [0.98-1.86]). Pesticide exposure showed statistically significant, inverse associations with non-vascular dementia among men. We found no associations for shocks, aromatic solvents, and diesel motor exhaust. Consistent positive associations were found between occupational exposure to metals and non-vascular dementia. The finding on pesticides is not supported in the overall literature. © 2015 Wiley Periodicals, Inc. Title: Heart coherence: a new tool in the management of stress on professionals and family caregivers of patients with dementia. Citation: Applied psychophysiology and biofeedback, Jun 2015, vol. 40, no. 2, p. 75-83 Author(s): Sarabia-Cobo, C M Abstract: We describe a stress management intervention intended to reduce the damage and stress impact on the heart physiology and function of a group of caregivers (professional and nonprofessional) who work with patients with dementia. The intervention consisted in applying heart coherence techniques in a population of 72 caregivers of patients with dementia (42 professional and 29 non-professional caregivers) who had high scores in heart stress and burden tests. Six months after the training they were able to generate appropriate patterns of heart coherence, with a statistically significant decrease in their heart overload. We conclude that training in techniques of heart coherence and positive psychology had effective results on the stress management of the participant caregivers. This was a simple, inexpensive technique with lasting results. To our knowledge this is the first research in Spain studying the application of heart coherence techniques to caregivers of people with dementia. Title: Drug persistency of cholinesterase inhibitors for patients with dementia of Alzheimer type in Korea. Citation: Archives of pharmacal research, Jun 2015, vol. 38, no. 6, p. 1255-1262, Author(s): Ahn, So-Hyeon, Choi, Nam-Kyong, Kim, Ye-Jee, Seong, Jong-Mi, Shin, Ju-Young, Jung, SunYoung, Park, Byung-Joo Abstract: This study examined 1-year persistency with cholinesterase inhibitors (ChEIs) for the treatment of elderly Alzheimer's dementia (AD) patients in Korea. Korean Health Insurance Review & Assessment Service database from January 2005 to June 2006 was used. Patients aged 65 or older with AD diagnosis who were first prescribed a ChEI were included. The 1-year persistence, persistency rate, and switching patterns during the follow-up period were identified. Mean time to drug discontinuation was analyzed, and persistency rates between different patient factors were compared. The 1-year persistency rate of newly treated 6,461 AD patients was 24.0 %, while 50 % of 41 study patients discontinued treatment by 91 days from initiation. Persistency rates of female patients (22.8 %), patients in rural areas (12.7 %), and primary care (10.2 %) were relatively low (p < 0.001). Persistency rate differed between age groups (p < 0.001). Overall proportion of switching was 6.6 %. The 1-year persistency rate of ChEIs for AD patients in Korea did not reach those of previous researches in other countries. Patients less likely to remain on therapy should be especially monitored to optimize treatment persistence. Title: Dementia and the protective role of cognitive reserve. Citation: Arquivos de neuro-psiquiatria, Jun 2015, vol. 73, no. 6, p. 473. (June 2015) Author(s): Laks, Jerson Title: PON-1 and ferroxidase activities in older patients with mild cognitive impairment, late onset Alzheimer's disease or vascular dementia. Citation: Clinical chemistry and laboratory medicine : CCLM / FESCC, Jun 2015, vol. 53, no. 7, p. 1049-1056, Author(s): Cervellati, Carlo, Romani, Arianna, Bergamini, Carlo M, Bosi, Cristina, Sanz, Juana Maria, Passaro, Angelina, Zuliani, Giovanni Abstract: A large body of evidence suggests that not only cerebral but also systemic oxidative stress (OxS) might be involved in the pathogenesis of late onset Alzheimer's disease (LOAD) and vascular dementia (VAD), as well as of the prodromal phase of dementia, the so-called mild cognitive impairment (MCI). In the present study, we evaluated whether paraoxonase 1 (PON-1) and ferroxidase (FeOx) activities, because of their well acknowledged effectiveness as systemic antioxidants, might be associated with dementia and/or MCI. Serum arylesterase and paraoxonase of PON-1, along with FeOx I (ceruloplasmin-related) and II activities were assessed in 223 MCI, 162 LOAD, 65 VAD patients, and in 143 older normal cognitive controls. Among the enzymatic activities examined, only arylesterase significantly changed across the groups (ANOVA: p<0.001), with similar lower levels in MCI, LOAD, and VAD compared to controls. By multivariate logistic regression analysis we showed that, in respect to controls, low levels (under the median value) of serum arylesterase were independently associated with an increase in the likelihood of being affected by LOAD [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.5-5.0], VAD (OR 2.7, 95% CI 1.2-6.2), or MCI (OR 2.3, 95% CI 1.3-3.8). Overall, our results suggest that depression of PON-1, and in particular, of arylesterase activity, in serum might be an early feature of dementia-related diseases. Further longitudinal exploration of the role of this enzyme in the onset and progression of these disorders are required. Title: Is it time to replace the Abbreviated Mental Test Score as a screening tool for dementia? Citation: Clinical medicine (London, England), Jun 2015, vol. 15 Suppl 3, p. s9. 42 Author(s): Willmott, Michelle Title: Considerations during intravenous sedation in geriatric dental patients with dementia. Citation: Clinical oral investigations, Jun 2015, vol. 19, no. 5, p. 1107-1114 Author(s): Sugimura, Mitsutaka, Kudo, Chiho, Hanamoto, Hiroshi, Oyamaguchi, Aiko, Morimoto, Yoshinari, Boku, Aiji, Niwa, Hitoshi Abstract: We retrospectively assessed the usability and precautions required during intravenous sedation (IVS) for dental treatment in geriatric outpatients with dementia. We investigated the intraoperative complications in 65 cases (25 geriatric dental patients with dementia) under IVS, from the standpoint of local anesthesia usage, water usage during treatment, and content of treatment. Circulatory complications occurred in 46.2 % and respiratory complications in 52.3 % of all cases (n = 65). Bradycardia occurred in 13.8 % and hypotension in 12.3 % of cases in the former, while coughing spells occurred in 41.5 % and snoring in 16.9 % of cases in the latter. Many of the local anesthesia usage cases did not require water usage, such as during tooth extraction (p < 0.0001). Water usage cases, such as for caries treatment, needed longer sedation and treatment times, resulting in more propofol usage (p < 0.001, p < 0.0001, and p < 0.01, respectively). Many coughing spells developed in the water usage cases (p < 0.05). 81.8 % of snoring and 63.3 % of circulatory complications, such as hypotension and bradycardia, developed in the tooth extraction cases (p < 0.05). All the scheduled dental treatments in dementia patients were smoothly performed under IVS. However, stringent attention should be paid to the prevention of aspiration of fluids retained in the pharynx, airway obstruction due to therapeutic maneuvers, respiratory inhibition by sedatives, and hemodynamic fluctuations caused by invasive procedures under local anesthesia. In the future, with the growing need for dental procedures in dementia patients, dentists will require training in the general management of such patients. Title: Cognitive and Functional Decline in Patients With Mild Alzheimer Dementia With or Without Comorbid Diabetes. Citation: Clinical therapeutics, Jun 2015, vol. 37, no. 6, p. 1195-1205 Author(s): Ascher-Svanum, Haya, Chen, Yun-Fei, Hake, Ann, Kahle-Wrobleski, Kristin, Schuster, Dara, Kendall, David, Heine, Robert J Abstract: Although diabetes is recognized as a risk factor for the development of cognitive impairment and for accelerated progression to Alzheimer disease (AD), it is unclear whether patients with diabetes who have already progressed to AD have a different rate of cognitive and functional decline compared with that in those without diabetes. This post hoc exploratory analysis compared cognitive and functional decline over an 18-month period in patients with mild AD dementia with and without comorbid diabetes. Decline in quality of life was assessed as a secondary objective. In a post hoc exploratory analysis, we analyzed data from the placebo groups of three 18-month, randomized, placebo-controlled trials of solanezumab and semagacestat in patients with AD. Data 43 from patients with mild AD dementia (Mini-Mental State Examination [MMSE] score, 20-26) and comorbid diabetes at baseline were compared with data from patients with mild AD dementia without diabetes at baseline. Cognition was assessed using the 14-item AD Assessment ScaleCognitive Subscale (ADAS-Cog14) and the MMSE. Functioning was assessed with the AD Cooperative Study-Activities of Daily Living Inventory (instrumental subset) (ADCS-iADL). Quality of life was assessed using the European Quality of Life-5 Dimensions scale, proxy version (proxy utility score and visual analog scale score), and the Quality of Life in AD scale, self-report and proxy (caregiver) versions. Group comparisons of changes from baseline to 18 months in cognitive, functional, and quality-of-life measures employed a repeated-measures model adjusted for propensity score, study, baseline cognition score (functional or quality of life), age, sex, level of education, genotype of the apolipoprotein E gene, and concurrent use of an acetylcholinesterase inhibitor or memantine. At baseline, patients with mild AD dementia with and without diabetes did not significantly differ on the cognitive measures, but those without diabetes were functioning at a significantly higher level. At 18 months, compared with patients without diabetes, those with diabetes showed a numerically but statistically nonsignificantly lesser cognitive decline (least squares mean between-group differences: ADAS-Cog14 score, 1.61 [P = 0.21]; MMSE score, -0.40 [P = 0.49]) and a statistically significantly lesser functional decline (least squares mean between-group difference in ADCS-iADL score, -3.07; P = 0.01). The 2 groups did not differ on declines in the quality-of-life measures. The present findings suggest that diabetes may influence the rate of functional decline among patients with mild AD dementia. These results require replication in studies that address the limitations of the present post hoc exploratory analysis and that explore the potential causes of the observed differences. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved. Title: Differential Cognitive and Affective Theory of Mind Abilities at Mild and Moderate Stages of Behavioral Variant Frontotemporal Dementia. Citation: Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology, Jun 2015, vol. 28, no. 2, p. 63-70 Author(s): Torralva, Teresa, Gleichgerrcht, Ezequiel, Torres Ardila, María Juliana, Roca, María, Manes, Facundo F Abstract: To study the affective and cognitive components of theory of mind (ToM) performance in patients with behavioral variant frontotemporal dementia (bvFTD), focusing on differential impairment at mild and moderate disease stages. ToM, a central capacity for appropriate social behavior, is critically impaired in patients with bvFTD, even early in the disease. No previous study has explored how the cognitive and affective components of ToM may relate differentially to disease severity. We assessed 40 patients with an established diagnosis of bvFTD and 18 healthy controls, using a complete neuropsychological battery that featured executive function and ToM tasks. We used patients' Clinical Dementia Rating scores to classify them as having either mild or moderate bvFTD. Both groups of patients showed deficits in the affective and cognitive components of ToM relative to the controls. The patients with mild bvFTD outperformed the group with moderate bvFTD in cognitive ToM capacities; however, affective ToM was equally impaired in both bvFTD groups. The cognitive, but not the affective, component of ToM correlated with performance on the executive function tests. Our results suggest that affective ToM is markedly diminished even during the initial 44 stages of bvFTD; as the disease progresses, deficits in cognitive ToM become more prominent. These findings may relate to the pattern of cortical atrophy described for bvFTD. We also found significant correlations between the cognitive component of ToM and executive functions. Title: On the Relationship Between Semantic Knowledge and Prejudice About Social Groups in Patients with Dementia. Citation: Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology, Jun 2015, vol. 28, no. 2, p. 71-79 Author(s): Carnaghi, Andrea, Silveri, Maria Caterina, Rumiati, Raffaella I Abstract: Patterns of brain-damaged individuals' deficits in categorizing living versus non-living things indicate separation of semantic knowledge categories in the brain. Recent work in patients with dementia suggested that semantic knowledge about social groups differs from knowledge about living and non-living things. In this study we analyzed patients' social appraisal by testing whether their degree of impairment in social-group knowledge predicted their social-group evaluative reactions (prejudice). We hypothesized that impaired knowledge about social groups would correlate with either heightened or reduced prejudice. In Rumiati et al, Cogn Neurosci (2014) http://dx.doi.org/10.1080/17588928.2013.876981, we had given a sorting task to 21 patients with frontotemporal dementia or dementia of the Alzheimer type and 23 healthy controls, to test their knowledge of social groups and living and non-living things. In this study we asked the same participants to evaluate social groups. We used controls' evaluations to rank 20 social groups from extremely negative to extremely positive. We used patients' severity of deficit in sorting social groups to predict the patients' evaluations of the groups, controlling for their levels of deficit in sorting living and non-living items. We also compared the evaluations by patients±deficits in socialgroup sorting to controls' evaluations. The patients with impaired social-group knowledge evaluated the less-admired groups more positively than did controls, and the more-admired groups less positively. Impaired social-group knowledge, not a general semantic loss, predicts reduced evaluative bias. Our findings are consistent with neuroimaging evidence for a relationship between semantic and evaluative social-group processes. Title: Temporal Variant Frontotemporal Dementia Is Associated with Globular Glial Tauopathy. Citation: Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology, Jun 2015, vol. 28, no. 2, p. 92-97 Author(s): Clark, Camilla N, Lashley, Tammaryn, Mahoney, Colin J, Warren, Jason D, Revesz, Tamas, Rohrer, Jonathan D Abstract: Frontotemporal dementia (FTD) is a clinically and pathologically heterogeneous neurodegenerative disorder associated with atrophy of the frontal and temporal lobes. Most patients with focal temporal lobe atrophy present with either the semantic dementia subtype of FTD or the behavioral variant subtype. For patients with temporal variant FTD, the most common cause 45 found on post-mortem examination has been a TDP-43 (transactive response DNA-binding protein 43 kDa) proteinopathy, but tauopathies have also been described, including Pick's disease and mutations in the microtubule-associated protein tau (MAPT) gene. We report the clinical and imaging features of 2 patients with temporal variant FTD associated with a rare frontotemporal lobar degeneration pathology known as globular glial tauopathy. The pathologic diagnosis of globular glial tauopathy should be considered in patients with temporal variant FTD, particularly those who have atypical semantic dementia or an atypical parkinsonian syndrome in association with the right temporal variant. Title: Lost in spatial translation - A novel tool to objectively assess spatial disorientation in Alzheimer's disease and frontotemporal dementia. Citation: Cortex; a journal devoted to the study of the nervous system and behavior, Jun 2015, vol. 67, p. 83-94 Author(s): Tu, Sicong, Wong, Stephanie, Hodges, John R, Irish, Muireann, Piguet, Olivier, Hornberger, Michael Abstract: Spatial disorientation is a prominent feature of early Alzheimer's disease (AD) attributed to degeneration of medial temporal and parietal brain regions, including the retrosplenial cortex (RSC). By contrast, frontotemporal dementia (FTD) syndromes show generally intact spatial orientation at presentation. However, currently no clinical tasks are routinely administered to objectively assess spatial orientation in these neurodegenerative conditions. In this study we investigated spatial orientation in 58 dementia patients and 23 healthy controls using a novel virtual supermarket task as well as voxel-based morphometry (VBM). We compared performance on this task with visual and verbal memory function, which has traditionally been used to discriminate between AD and FTD. Participants viewed a series of videos from a first person perspective travelling through a virtual supermarket and were required to maintain orientation to a starting location. Analyses revealed significantly impaired spatial orientation in AD, compared to FTD patient groups. Spatial orientation performance was found to discriminate AD and FTD patient groups to a very high degree at presentation. More importantly, integrity of the RSC was identified as a key neural correlate of orientation performance. These findings confirm the notion that i) it is feasible to assess spatial orientation objectively via our novel Supermarket task; ii) impaired orientation is a prominent feature that can be applied clinically to discriminate between AD and FTD and iii) the RSC emerges as a critical biomarker to assess spatial orientation deficits in these neurodegenerative conditions. Copyright © 2015 Elsevier Ltd. All rights reserved. Title: Auditory hedonic phenotypes in dementia: A behavioural and neuroanatomical analysis. Citation: Cortex; a journal devoted to the study of the nervous system and behavior, Jun 2015, vol. 67, p. 95-105 46 Author(s): Fletcher, Phillip D, Downey, Laura E, Golden, Hannah L, Clark, Camilla N, Slattery, Catherine F, Paterson, Ross W, Schott, Jonathan M, Rohrer, Jonathan D, Rossor, Martin N, Warren, Jason D Abstract: Patients with dementia may exhibit abnormally altered liking for environmental sounds and music but such altered auditory hedonic responses have not been studied systematically. Here we addressed this issue in a cohort of 73 patients representing major canonical dementia syndromes (behavioural variant frontotemporal dementia (bvFTD), semantic dementia (SD), progressive nonfluent aphasia (PNFA) amnestic Alzheimer's disease (AD)) using a semi-structured caregiver behavioural questionnaire and voxel-based morphometry (VBM) of patients' brain MR images. Behavioural responses signalling abnormal aversion to environmental sounds, aversion to music or heightened pleasure in music ('musicophilia') occurred in around half of the cohort but showed clear syndromic and genetic segregation, occurring in most patients with bvFTD but infrequently in PNFA and more commonly in association with MAPT than C9orf72 mutations. Aversion to sounds was the exclusive auditory phenotype in AD whereas more complex phenotypes including musicophilia were common in bvFTD and SD. Auditory hedonic alterations correlated with grey matter loss in a common, distributed, right-lateralised network including antero-mesial temporal lobe, insula, anterior cingulate and nucleus accumbens. Our findings suggest that abnormalities of auditory hedonic processing are a significant issue in common dementias. Sounds may constitute a novel probe of brain mechanisms for emotional salience coding that are targeted by neurodegenerative disease. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved. Title: A Risk-Benefit Assessment of Dementia Medications: Systematic Review of the Evidence. Citation: Drugs & aging, Jun 2015, vol. 32, no. 6, p. 453-467 Author(s): Buckley, Jacob S, Salpeter, Shelley R Abstract: There is no cure for dementia, and no treatments exist to halt or reverse the course of the disease. Treatments are aimed at improving cognitive and functional outcomes. Our objective was to review the basis of pharmacological treatments for dementia and to summarize the benefits and risks of dementia treatments. We performed a systematic literature search of MEDLINE through November 2014, for English-language trials and observational studies on treatment of dementia and mild cognitive impairment. Additional references were identified by searching bibliographies of relevant publications. Whenever possible, pooled data from meta-analyses or systematic reviews were obtained. Studies were included for review if they were randomized trials or observational studies on dementia or mild cognitive impairment that evaluated efficacy outcomes or adverse outcomes associated with treatment. Studies were excluded if they evaluated non-FDA approved treatments, or if they evaluated treatment in disorders other than dementia and mild cognitive impairment. The literature search found 540 potentially relevant studies, of which 257 were included in the systematic review. In pooled trial data, cholinesterase inhibitors (ChEIs) produce small improvements in cognitive, functional, and global benefits in patients with mild to moderate Alzheimer's and Lewy body dementia, but the clinical significance of these effects are unclear. There is no significant benefit seen for vascular dementia. The efficacy of ChEI treatment appears to wane over time, with minimal benefit seen after 1 year. There is no evidence for benefit for those with 47 advanced disease or those aged over 85 years. Adverse effects are significantly increased with ChEIs, in a dose-dependent manner. A two- to fivefold increased risk for gastrointestinal, neurological, and cardiovascular side effects is related to cholinergic stimulation, the most serious being weight loss, debility, and syncope. Those aged over 85 years have double the risk of adverse events compared with younger patients. Memantine monotherapy may provide some cognitive benefit for patients with moderate to severe Alzheimer's and vascular dementia, but the benefit is small and may wane over the course of several months. Memantine exhibits no significant benefit in mild dementia or Lewy body dementia or as an add-on treatment with ChEIs. Memantine has a relatively favorable side-effect profile, at least under controlled trial conditions. ChEIs produce small, short-lived improvements in cognitive function in mild to moderate dementia, which may not translate into clinically meaningful effects. Marginal benefits are seen with severe disease, long-term treatment, and advanced age. Cholinergic side effects, including weight loss, debility, and syncope, are clinically significant and could be especially detrimental in the frail elderly population, in which the risks of treatment outweigh the benefits. Memantine monotherapy may have minimal benefits in moderate to severe dementia, balanced by minimal adverse effects. Title: Does dementia matter: is dementia an important factor in 999 call-outs to older people? Citation: Emergency medicine journal : EMJ, Jun 2015, vol. 32, no. 6, p. e14. Author(s): Buswell, Marina, Amado, Sarah, Goodman, Claire, William, Julia, Fleming, Jane, Lumbard, Phillip, Prothero, Larissa Abstract: Care for older people with dementia (OPWD) is a major concern across all care settings. Ambulance services are in the spotlight as pressures on emergency services and calls for admission avoidance are policy priorities. Around 1/3 of emergency call-outs are to people 75 and over, a significant proportion of whom may have dementia. There is a perception that dementia may be an issue but we do not understand how much this affects use of emergency services. We reviewed 358 ambulance service paper-based patient care records (PCRs) to test the feasibility of using them as a source of information about ambulance service use by OPWD and, conducted critical incident reviews of 999 callouts to understand factors associated with emergency ambulance call-outs. We took our emerging findings to a stakeholder meeting where we established areas of consensus and key research questions. Fifty-two (14.5%) of the PCRs reviewed had dementia recorded, this is in line with current prevalence estimates for ≥75-year-olds. However, we had to use paper PCRs as dementia recording in ePCRs is more complex. The critical incident reviews identified a wide spectrum of experience of emergency ambulance use by OPWD and their carers, from pre-diagnosis through to end-of-life scenarios. It was new for many of the stakeholders to think about the role of ambulance services in the care of OPWD. There was consensus that the contribution family and paid carers make in decision making; explaining the OPWD's needs and changed condition, is underused. There is little current research that understands what ambulance clinicians are doing with respect to caring for OPWD. Research questions should focus on how communication between the person with dementia, formal/informal carers, healthcare professionals and emergency services affects the care provided for older people with dementia during and immediately after urgent care events. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. 48 Title: Heart failure and dementia: survival in relation to types of heart failure and different dementia disorders. Citation: European journal of heart failure, Jun 2015, vol. 17, no. 6, p. 612-619 Author(s): Cermakova, Pavla, Lund, Lars H, Fereshtehnejad, Seyed-Mohammad, Johnell, Kristina, Winblad, Bengt, Dahlström, Ulf, Eriksdotter, Maria, Religa, Dorota Abstract: Heart failure (HF) and dementia frequently coexist, but little is known about their types, relationships to each other and prognosis. The aims were to (i) describe patients with HF and dementia, assess (ii) the proportion of specific dementia disorders in types of HF based on ejection fraction and (iii) the prognostic role of types of HF and dementia disorders. The Swedish Heart Failure Registry (RiksSvikt) and The Swedish Dementia Registry (SveDem) were record-linked. Associations between dementia disorders and HF types were assessed with multinomial logistic regression and survival was investigated with Kaplan-Meier analysis and multivariable Cox regression. We studied 775 patients found in both registries (55% men, mean age 82 years). Ejection fraction was preserved in 38% of patients, reduced in 34%, and missing in 28%. The proportions of dementia disorders were similar across HF types. Vascular dementia was the most common dementia disorder (36%), followed by other dementias (28%), mixed dementia (20%), and Alzheimer disease (16%). Over a mean follow-up of 1.5 years, 76% of patients survived 1 year. We observed no significant differences in survival with regard to HF type (P = 0.2) or dementia disorder (P = 0.5). After adjustment for baseline covariates, neither HF types nor dementia disorders were independently associated with survival. Heart failure with preserved ejection fraction was the most common HF type and vascular dementia was the most common dementia disorder. The proportions of dementia disorders were similar across HF types. Neither HF types nor specific dementia disorders were associated with survival. © 2015 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. Title: Do statins cause or prevent dementia? Citation: European journal of neurology : the official journal of the European Federation of Neurological Societies, Jun 2015, vol. 22, no. 6, p. 885-886 Author(s): Lavie, C J, DiNicolantonio, J J, O'Keefe, J H, Milani, R V Title: Decreased prevalence of dementia associated with statins: a national population-based study. Citation: European journal of neurology : the official journal of the European Federation of Neurological Societies, Jun 2015, vol. 22, no. 6, p. 912-918 (June 2015) Author(s): Chuang, C-S, Lin, C-L, Lin, M-C, Sung, F-C, Kao, C-H 49 Abstract: Dementia is a neurodegenerative disorder that presents a progressive decline in cognitive function and loss of short-term memory with age. Several studies have shown that statin, an oral lipid-lowering drug, may reduce the risk of developing dementia. The objective of this study is to explore the association between statin and the development of dementia. The data analyzed in this study were retrieved from the National Health Insurance Research Database in Taiwan. The sample consisted of 123 300 patients ≥ 20 years of age, including 61 650 dementia patients with statin use and 61 650 patients without statin use who were eligible for inclusion in this study. Univariate and multivariate Cox proportional hazard regression analyses were performed to measure the effects of statin use on the risk of dementia. The beneficial effect of statin on dementia was significant after adjusting for sociodemographic factors and comorbidities (adjusted hazard ratio of 0.92, 95% confidence interval 0.86-0.98). The sex- and age-specific analysis of adjusted hazard ratios showed a higher beneficial effect from statin treatment in women than in men, and the effect became more significant with age. Statin therapy may help prevent the development of dementia, and both hydrophilic and lipophilic statins produce similar effects. However, the preventive characters and associated mechanisms must be further explored and identified. © 2014 The Author(s) European Journal of Neurology © 2014 EAN. Title: Re: The association between chronic obstructive pulmonary disease and dementia: a population-based retrospective cohort study. Citation: European journal of neurology : the official journal of the European Federation of Neurological Societies, Jun 2015, vol. 22, no. 6, p. e70. (June 2015) Author(s): Liao, K-M Title: Reply: The association between chronic obstructive pulmonary disease and dementia: a population-based retrospective cohort study. Citation: European journal of neurology : the official journal of the European Federation of Neurological Societies, Jun 2015, vol. 22, no. 6, p. e71. (June 2015) Author(s): Liao, W-C, Lin, C-L, Chang, S-N, Tu, C-Y, Kao, C-H Title: Dementia in patients with atrial fibrillation and the value of the Hachinski ischemic score. Citation: Geriatrics & gerontology international, Jun 2015, vol. 15, no. 6, p. 770-777 Author(s): Di Nisio, Marcello, Prisciandaro, Michele, Rutjes, Anne Ws, Russi, Ilaria, Maiorini, Luisa, Porreca, Ettore Abstract: To assess the prevalence of vascular dementia, mixed dementia and Alzheimer's disease in patients with atrial fibrillation, and to evaluate the accuracy of the Hachinski ischemic score for these subtypes of dementia. A nested case-control study was carried out. A total of 103 of 784 50 consecutive patients evaluated for cognitive status at the Ambulatory Geriatric Clinic had a diagnosis of atrial fibrillation. Controls without atrial fibrillation were randomly selected from the remaining 681 patients using a 1:2 matching for sex, age and education. The prevalence of vascular dementia was twofold in patients with atrial fibrillation compared with controls (21.4% vs 10.7%, P = 0.024). Alzheimer's disease was also more frequent in the group with atrial fibrillation (12.6% vs 7.3%, P = 0.046), whereas mixed dementia had a similar distribution. The Hachinski ischemic score poorly discriminated between dementia subtypes, with misclassification rates between 46% (95% CI 28-66) and 70% (95% CI 55-83). In patients with atrial fibrillation, these rates ranged from 55% (95% CI 3277) to 69% (95% CI 39-91%). In patients in whom the diagnosis of dementia was excluded, the Hachinski ischemic score suggested the presence of vascular dementia in 11% and mixed dementia in 30%. Vascular dementia and Alzheimer's disease, but not mixed dementia, are more prevalent in patients with atrial fibrillation. The discriminative accuracy of the Hachinski ischemic score for dementia subtypes in atrial fibrillation is poor, with a significant proportion of misclassifications. Geriatr Gerontol Int 2015; 15: 770-777. © 2014 Japan Geriatrics Society. Title: Psychiatrists, mental health provision and 'senile dementia' in England, 1940s-1979. Citation: History of psychiatry, Jun 2015, vol. 26, no. 2, p. 182-199, 0957-154X Author(s): Hilton, Claire Abstract: Until around 1979, 'confused' or mentally unwell people over 65 years of age tended to be labelled as having 'senile dementia'. Senile dementia was usually regarded as a single, inevitably hopeless condition, despite gradually accumulating clinical and pathological evidence to the contrary. Specific psychiatric services for mental illness in older people began to emerge in the 1950s, but by 1969 there were fewer than 10 dedicated services nationally. During the 1970s, 'old age psychiatrists' established local services and campaigned nationally for them. By 1979, about 100 old age psychiatrists were leading multi-disciplinary teams in half the health districts in England. This paper explores the tortuous development of these new services, focusing on provision for people with dementia. © The Author(s) 2015. Title: Improving clinician-carer communication for safer hospital care: a study of the 'TOP 5' strategy in patients with dementia. Citation: International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua, Jun 2015, vol. 27, no. 3, p. 175-182 Author(s): Luxford, Karen, Axam, Anne, Hasnip, Fiona, Dobrohotoff, John, Strudwick, Maureen, Reeve, Rebecca, Hou, Changhao, Viney, Rosalie Abstract: To examine the impact of implementing a clinician-carer communication tool for hospitalized patients with dementia. Surveys were conducted with clinicians and carers about perceptions and experiences. Implementation process and costs were explored through surveys of local staff. Time series analysis was conducted on incident-reported falls, usage of non-regular anti- 51 psychotics and one-to-one nursing. Twenty-one hospitals in Australia. Surveys were returned by 798 clinicians, 240 carers and 21 local liaison staff involved in implementation. Implementation of a communication tool over 12 months. The process of implementation was documented. Outcome measures included clinician and carer perceptions, safety indicators (incident-reported falls and usage of non-regular anti-psychotics), resource use and costs. Clinicians and carers reported high levels of acceptability and perceived benefits for patients. Clinicians rated confidence in caring for patients with dementia as being significantly higher after the introduction of TOP 5, (M = 2.93, SD = 0.65), than prior to TOP 5 (M = 2.74, SD = 0.75); F(1,712) = 11.21, P < 0.05. When analysed together, there was no change in incident-reported falls across all hospitals. At one hospital with a matched control ward, an average of 6.85 fewer falls incidents per month occurred in the intervention ward compared with the matched control ward (B = -6.85, P < 0.05). Our findings indicate that the use of a simple, low-cost communication strategy for patient care is associated with improvements in clinician and carer experience with potential implications for patient safety. Minimally, TOP 5 represents 'good practice' with a low risk of harm for patients. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved. Title: Cognitive stimulation in cognitively impaired individuals and cognitively healthy individuals with a family history of dementia: short-term results from the "Allena-Mente" randomized controlled trial. Citation: International journal of geriatric psychiatry, Jun 2015, vol. 30, no. 6, p. 631-638 Author(s): Polito, Letizia, Abbondanza, Simona, Vaccaro, Roberta, Valle, Eleonora, Davin, Annalisa, Degrate, Alessandro, Villani, Simona, Guaita, Antonio Abstract: We evaluated the short-term efficacy of a protocol of cognitive stimulation (CS), compared with a sham intervention, on cognitive performance in cognitively healthy individuals with a family history of dementia (NDFAM) and in non-demented individuals with cognitive impairment (CI). We performed a randomized controlled trial of CS in NDFAM and CI. CS consisted in 10 twice weekly meetings of CS focused on a specific cognitive area. CS was compared with a sham intervention (CT) using Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Corsi test. All study participants were typed for the presence of apolipoprotein E (APOE)-Ɛ4. Cognitively healthy NDFAM showed a higher net cognitive gain after CS, as reflected in their MoCA score, and a borderline significant net increase in visuospatial memory (Corsi test) compared with those receiving the CT. APOE-Ɛ4 carriers showed a less significant improvement on the Corsi test with respect to APOE-Ɛ4 non-carriers. In the CI sample, the MoCA and Corsi test results did not differ between the cognitively stimulated subjects and the controls. No changes in MMSE scores were found in either sample of subjects. These findings suggest that CS as structured in this study is an effective treatment in cognitively healthy individuals, whereas it is less effective in individuals with CI. Moreover, evaluation of APOE-Ɛ4 status provided evidence of a substantial genetic contribution to the efficacy of CS on visuospatial memory as measured using the Corsi test. Copyright © 2014 John Wiley & Sons, Ltd. 52 Title: Validation of the Montreal Cognitive Assessment (MoCA) in Spanish as a screening tool for mild cognitive impairment and mild dementia in patients over 65 years old in Bogotá, Colombia. Citation: International journal of geriatric psychiatry, Jun 2015, vol. 30, no. 6, p. 655-662 (June 2015) Author(s): Gil, Laura, Ruiz de Sánchez, Carolina, Gil, Fabián, Romero, Sara Julieta, Pretelt Burgos, Felipe Abstract: The Montreal Cognitive Assessment (MoCA) was developed as a simple screening tool for cognitive impairment. This study is the first validation in Latin America of the MoCA in Spanish (MoCA-S), which was developed in Colombia (South America). Aiming to perform the first validation of the MoCA-S, we developed a study of concordance by conformity to assess the MoCA-S compared with diagnostic consensus by interdisciplinary assessment in the Memory Clinic (the best diagnostic method available) and to evaluate the psychometric properties of the MoCA-S. A total of 193 subjects were evaluated, 109 of whom were patients, including 26 who met the mild cognitive impairment (MCI) clinical criteria, based on neuropsychological testing, and 83 who had mild dementia (MD). The remaining 84 participants were healthy subjects from the community. The psychometric evaluation of the MoCA-S was appropriate. Using a cutoff score of ≥ 23, the MoCA had sensitivities of 76.0% to detect MCI and 92.7% to detect MD and a specificity of 79.8%. The percentage of patients clearly labeled by the MoCA-S was 85%. The MoCA-S is a valid screening tool and is useful for identifying MCI and MD in Colombia. The MoCA-S is valid and adequate for application in Colombia with good internal consistency, inter-observer reliability, and content validity. However, the average educational level was high in this study; thus, caution should be exercised when extrapolating these results to individuals with lower educational levels. Copyright © 2014 John Wiley & Sons, Ltd. Title: Six-item cognitive impairment test (6CIT): pragmatic diagnostic accuracy study for dementia and MCI. Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 991-997 Author(s): Abdel-Aziz, K, Larner, A J Abstract: The six-item cognitive impairment test (6CIT) is a brief cognitive screening instrument (CSI) recommended for use in primary care settings. There are very few studies of 6CIT performance in secondary care settings. We undertook a pragmatic diagnostic accuracy study of 6CIT in consecutive patients referred over the course of one year to a neurology-led cognitive function clinic, and compared its performance for the diagnosis of dementia and mild cognitive impairment (MCI) to that of the simultaneously administered Mini-Mental State Examination (MMSE). In a cohort of 245 patients with dementia prevalence around 20%, 6CIT proved quick and easy to use and acceptable to patients. It had good sensitivity (0.88) and specificity (0.78) for dementia diagnosis; it was more sensitive than MMSE (0.59) but less specific (0.85). For MCI diagnosis, 6CIT was again more sensitive (0.66) than MMSE (0.51) but less specific (0.70 vs. 0.75). Weighted comparisons showed net benefit for 6CIT compared to MMSE for both dementia and MCI diagnosis. 6CIT effect sizes (Cohen's d) were large for dementia diagnosis and moderate for MCI diagnosis. 6CIT is an acceptable and accurate test for the assessment of cognitive problems, its performance being more sensitive than the MMSE. 6CIT use should be considered as a viable alternative to MMSE in the secondary care setting. 53 Title: Effect of depression and diabetes mellitus on the risk for dementia: a national populationbased cohort study. Citation: JAMA psychiatry, Jun 2015, vol. 72, no. 6, p. 612-619 (June 1, 2015) Author(s): Katon, Wayne, Pedersen, Henrik Sondergaard, Ribe, Anette Riisgaard, Fenger-Grøn, Morten, Davydow, Dimitry, Waldorff, Frans Boch, Vestergaard, Mogens Abstract: Although depression and type 2 diabetes mellitus (DM) may independently increase the risk for dementia, no studies have examined whether the risk for dementia among people with comorbid depression and DM is higher than the sum of each exposure individually. To examine the risk for all-cause dementia among persons with depression, DM, or both compared with persons with neither exposure. We performed a national population-based cohort study of 2 454 532 adults, including 477 133 (19.4%) with depression, 223 174 (9.1%) with DM, and 95 691 (3.9%) with both. We included all living Danish citizens 50 years or older who were free of dementia from January 1, 2007, through December 31, 2013 (followed up through December 31, 2013). Dementia was ascertained by physician diagnosis from the Danish National Patient Register or the Danish Psychiatric Central Register and/or by prescription of a cholinesterase inhibitor or memantine hydrochloride from the Danish National Prescription Registry. Depression was ascertained by psychiatrist diagnosis from the Danish Psychiatric Central Research Register or by prescription of an antidepressant from the Danish National Prescription Registry. Diabetes mellitus was identified using the National Diabetes Register. We estimated the risk for all-cause dementia associated with DM, depression, or both using Cox proportional hazards regression models that adjusted for potential confounding factors (eg, demographics) and potential intermediates (eg, medical comorbidities). During 13 834 645 person-years of follow-up, 59 663 participants (2.4%) developed dementia; of these, 6466 (10.8%) had DM, 15 729 (26.4%) had depression, and 4022 (6.7%) had both. The adjusted hazard ratio for developing all-cause dementia was 1.83 (95% CI, 1.80-1.87) for persons with depression, 1.20 (95% CI, 1.17-1.23) for persons with DM, and 2.17 (95% CI, 2.10-2.24) for those with both compared with persons who had neither exposure. The excess risk for all-cause dementia observed for individuals with comorbid depression and DM surpassed the summed risk associated with each exposure individually, especially for persons younger than 65 years (hazard ratio, 4.84 [95% CI, 4.21-5.55]). The corresponding attributable proportion due to the interaction of comorbid depression and DM was 0.25 (95% CI, 0.13-0.36; P < .001) for those younger than 65 years and 0.06 (95% CI, 0.02-0.10; P = .001) for those 65 years or older. Depression and DM were independently associated with a greater risk for dementia, and the combined association of both exposures with the risk for all-cause dementia was stronger than the additive association. Title: Pulmonary function as a risk factor for dementia death: an individual participant metaanalysis of six UK general population cohort studies. Citation: Journal of epidemiology and community health, Jun 2015, vol. 69, no. 6, p. 550-556 Author(s): Russ, Tom C, Starr, John M, Stamatakis, Emmanuel, Kivimäki, Mika, Batty, G David 54 Abstract: In addition to being associated with all-cause mortality and cardiovascular disease mortality, lung function has been linked with dementia. However, existing studies typically provide imprecise estimates due to small numbers of outcome events and are based on unrepresentative samples of the general population. Individual participant meta-analysis of six cohort studies from the Health Survey for England and the Scottish Health Survey (total N=54 671). Dementia-related mortality was identified by mention of dementia on any part of the death certificate (mean followup 11.7 years). Study-specific Cox proportional hazard models of the association between lung function and dementia-related death were pooled using random effect meta-analysis to produce overall results. There was a dose-response association between poorer lung function and a higher risk of dementia-related death (age- and sex-adjusted HR compared to highest quartile of forced expiratory volume in 1 s (FEV1), 95% CI: second quartile 1.32, 0.99 to 1.76; third quartile 1.78, 1.30 to 2.43; fourth (lowest) quartile 2.74, 1.73 to 4.32). There was no significant heterogeneity in studyspecific estimates (I(2)=0%). Controlling for height, socioeconomic status, smoking and general health attenuated but did not remove the association (second quartile 1.15, 0.82 to 1.62; third quartile 1.37, 0.96 to 1.94; fourth quartile 2.09, 1.17 to 3.71). Results for forced vital capacity and peak flow were similar. In these general population samples, the relation between three measures of lung function and dementia death followed a dose-response gradient. Being in the bottom quartile of lung function was associated with a doubling of the risk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. Title: Perceptions of tissue storage in a dementia population among spouses and offspring. Citation: Journal of genetic counseling, Jun 2015, vol. 24, no. 3, p. 503-511 Author(s): Martin, Megan M, Rothwell, Erin W, Venne, Vickie L, Foster, Norman L Abstract: Cognitively impaired patients with dementia often rely on health advocates or guardians, such as spouses or adult offspring, to consent for medical procedures. These family members may also decide whether an autopsy is performed after death or whether their family member donates tissues. However, spouses are not genetically related to the patient and may have different perspectives than genetically related family members when making medical decisions with genetic implications, such as participation in a tissue repository (biobank). Interviews were conducted with spouses and adult offspring of individuals with a progressive dementing disease. Both spouses and offspring were supportive of the patient with dementia to participate in tissue storage. The top perceived benefits of tissue storage in both offspring and spouses were future value for family members and advancement of medical knowledge. Concerns included misuse of the tissue and insurance discrimination. Although the personal genetic implications differ between spouses and offspring, they share similar attitudes about the importance of tissue banking for the individual with a dementing disease. Title: Clinicopathological Study of Patients With C9ORF72-Associated Frontotemporal Dementia Presenting With Delusions. 55 Citation: Journal of geriatric psychiatry and neurology, Jun 2015, vol. 28, no. 2, p. 99-107, Author(s): Shinagawa, Shunichiro, Naasan, Georges, Karydas, Anna M, Coppola, Giovanni, Pribadi, Mochtar, Seeley, William W, Trojanowski, John Q, Miller, Bruce L, Grinberg, Lea T Abstract: Several clinical studies point to a high prevalence of psychotic symptoms in frontotemporal dementia associated with C9ORF72 mutations, but clinicopathological studies addressing the association between C9ORF72 mutations and delusions are lacking. Seventeen patients with pathologically proven frontotemporal lobar degeneration (FTLD) associated with C9ORF72 mutations were identified from Neurodegenerative Disease Brain Bank. Of the 17 cases with C9ORF72 mutation, 4 exhibited well-defined delusions. The clinical history, neurological examination, neuropsychological testing, neuroimaging analysis, and postmortem assessment of the patients with delusions were evaluated and compared with the other cases. The content of the delusions was mixed including persecution, infidelity, and grandiosity. All cases showed parkinsonism; voxel-based morphometry analysis showed greater precuneus atrophy in patients with delusions than those without delusions. All 4 had unclassifiable FTLD with TAR DNA-binding protein inclusions, with characteristics of both type A and type B. Three cases had additional τ pathology and another had αsynuclein pathology. C9ORF72 carriers with well-defined delusions likely associated with additional pathologies and parietal atrophy in neuroimaging. Patients presenting with middle-aged onset of delusions should be screened for C9ORF72 mutations, especially if family history and parkinsonism are present. © The Author(s) 2014. Title: Risk of dementia in older adults with low versus high occupation-based motivational processes: differential impact of frequency and proximity of social network. Citation: Journal of geriatric psychiatry and neurology, Jun 2015, vol. 28, no. 2, p. 126-135, Author(s): Fankhauser, Sonja, Forstmeier, Simon, Maercker, Andreas, Luppa, Melanie, Luck, Tobias, Riedel-Heller, Steffi G Abstract: This study investigates the impact of occupation-based motivational processes and social network variables on the incidence of dementia over 8 years. Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based longitudinal study of individuals aged 75 years and older (n=1692 at baseline). Motivational processes were estimated based on the main occupation using the Occupational Information Network database. In a Cox proportional hazard model, motivational processes were not associated with the risk of dementia (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74-1.16). Individuals with a higher frequency of social contact at baseline had a significantly lower risk of dementia (HR: 0.96, 95% CI: 0.91-0.99), while proximity of social contacts was not linked to the risk of dementia (HR: 1.03, 95% CI: 0.98-1.08). In individuals with low indices of motivational processes, the frequency of social contacts was associated with a lower risk of dementia (HR: 0.94, 95% CI: 0.88-1.00). On the other hand, proximity of social contacts was linked to a higher risk of dementia in individuals with high indices of motivational processes (HR: 1.09, 95% CI: 1.01-1.19). Results indicate that the frequency and proximity of social contacts have a differential impact on the risk of dementia according to lower or higher indices of motivational processes, while the impact of motivational processes on risk of dementia could not be confirmed. 56 Future studies should carefully disentangle different aspects of social interactions and their association with motivational processes. © The Author(s) 2014. Title: The Times They Are a-Changin': Clock Drawing and Prediction of Dementia. Citation: Journal of geriatric psychiatry and neurology, Jun 2015, vol. 28, no. 2, p. 145-155, Author(s): Amodeo, Sean, Mainland, Brian J, Herrmann, Nathan, Shulman, Kenneth I Abstract: Identification of individuals who will eventually develop dementia is critical for early intervention, treatment, and care planning. The clock drawing test (CDT) is a widely used cognitive screening tool that has been well accepted among clinicians and patients for its ease of use and short administration time. This review explores the value of the CDT for predicting the later development of dementia in cognitively intact older adults and patients with mild cognitive impairment (MCI). Additionally, we reviewed studies that examined the ability of the CDT to monitor declines in cognitive functioning over time. A PubMed literature search for articles that included a longitudinal analysis of the CDT was conducted. The search included articles published up to June 2013 and manual cross-referencing of bibliographies. Relevant studies were categorized, summarized, and critiqued. The consensus from the studies reviewed suggests that the CDT is a useful measure of cognitive decline over time. Conceptual clock drawing errors (eg, misrepresentation of time) detected this decline most effectively. In addition, the CDT appears to differentiate at baseline between cognitively intact older adults who will develop dementia up to 2 years postbaseline. Finally, the CDT has been found to differentiate between patients with MCI who will progress to dementia up to 6 years postbaseline. The CDT appears useful for the longitudinal assessment of cognitive impairment and together with other validated measures may be helpful for predicting conversion to dementia. Cost-effective and practical ways of predicting risk of dementia will become increasingly critical as we develop disease-modifying treatments. © The Author(s) 2014. Title: Behavioral Characteristics of Bowel Movement and Urination Needs in Patients With Dementia in Taiwan. Citation: Journal of gerontological nursing, Jun 2015, vol. 41, no. 6, p. 22, Author(s): Shih, Yen-Hua, Wang, Chi-Jane, Sue, En-Ping, Wang, Jing-Jy Abstract: Patients with dementia, especially those with advanced dementia, may not be able to express their bowel movement and urination needs using lucid language, and instead do so through behaviors. The aim of the current study was to understand and compare the behavioral characteristics of bowel movement and urination needs in patients with dementia. Observations were made by caregivers of 187 patients with dementia based on the Behavior Checklist developed by the research team for bowel movement and urination. Sixteen behavioral characteristics were identified for both bowel movement and urination; among these, anxiety, taking off/putting on clothes inappropriately, restlessness, attempting to go elsewhere, scratching skin, repeated behavior, and making strange sounds were commonly reported. Facial expressions of sorrow, 57 restlessness, and anxiety were the three most common behaviors related to bowel movement needs, whereas anxiety, taking off/putting on clothes inappropriately, and constant moaning were the most common behaviors for urination needs. The findings suggest that the common behavioral characteristics could be seen as indicators of excretion need and the others can be used to distinguish between the need for bowel movement and urination. Copyright 2015, SLACK Incorporated. Title: Dementia and Hopfield model. Citation: Journal of neural transmission (Vienna, Austria : 1996), Jun 2015, vol. 122, no. 6, p. 773-777 Author(s): Thuraisingham, R A Abstract: Disruption in the neural network has been observed in the clinical studies on dementia. This is investigated here, theoretically, via the macroscopic thermodynamic properties of the Hopfield model to determine whether such a disruption in the network is possible. The analysis is carried out using a mean field theory. The results show a bifurcation in the network in the absence of direct energy input. This is seen when the average connective energy of the neuron becomes equal to or less than its thermal energy. The number of firing neurons that exceed the inactive neurons is then zero and the behavior of the neurons is random. The model further suggests that direct energy input will postpone the degradation of the neural network, suggesting that external mental stimuli will slow this disruption. However, if the neuronal connections are already weak, then improvements will not be marked Title: Frontomedian cortex is central for moral deficits in behavioural variant frontotemporal dementia. Citation: Journal of neurology, neurosurgery, and psychiatry, Jun 2015, vol. 86, no. 6, p.700-701 Author(s): Schroeter, Matthias L, Bzdok, Danilo, Eickhoff, Simon B, Neumann, Jane Title: Second-generation antipsychotic drug use in hospital inpatients with dementia: the impact of a safety warning on rates of prescribing. Citation: Journal of public health (Oxford, England), Jun 2015, vol. 37, no. 2, p. 346-352 Author(s): McIlroy, Graham, Thomas, Sarah K, Coleman, Jamie J Abstract: Behavioural and psychological symptoms of dementia are distressing for patients and are frequently treated with second-generation antipsychotics. Concerns about the drugs' safety resulted in a Medicines and Healthcare Products Regulatory Agency (MHRA) warning against their use in March 2009. Second-generation antipsychotic drug use was determined amongst patients with dementia admitted to the University Hospitals Birmingham National Health Service Foundation Trust, between July 2005 and December 2011. An interrupted time series analysis was carried out to investigate changes in rates of prescribing following the safety warning. Risperidone was analysed separately, in accordance with its limited licence for use in older adults with dementia, granted in 58 October 2008. Before the safety warning, second-generation antipsychotic use was increasing in patients with dementia. After the MHRA warning, their use fell by 1.9% per month compared with that before. Use of risperidone continued to rise over the same period, often against the terms of its licence. Drug safety warnings may influence prescribing practice, although continued use of antipsychotics in dementia could reflect a lack of alternative treatment options. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Title: The effect of telemedicine on the duration of treatment in dementia patients. Citation: Journal of telemedicine and telecare, Jun 2015, vol. 21, no. 4, p. 214-218 Author(s): Cheong, Chae-Kyo, Lim, Kyu-Hyoung, Jang, Jae-Won, Jhoo, Jin Hyeong Abstract: We studied 442 patients who met the DSM-IV-TR criteria for dementia and whose treatment was initiated at the Kangwon National University Hospital (KNUH) in Chuncheon. Over a five-year period, there were 259 patients who regularly visited the KNUH dementia clinic in person, and 168 patients who received medical services from the dementia clinic via telemedicine. The telemedicine patients attended a public health centre in Hongcheon, a facility located in a rural area about 50 km south east of the KNUH. The mean treatment duration was significantly longer for the telemedicine group than for the clinical visit group (P < 0.001), with durations of 26.6 and 14.6 months, respectively. Low Clinical Dementia Rating scores (hazard ratio = 1.47, 95% confidence interval = 1.26-1.71) and use of telemedicine (hazard ratio = 0.55, 95% confidence interval = 0.420.72) were found to be independent predictive factors of increased treatment duration. These findings suggest that telemedicine may be useful in slowing disease progression in dementia patients in rural areas. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav. Title: Healthcare Proxy Awareness of Suspected Infections in Nursing Home Residents with Advanced Dementia. Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1084-1090 Author(s): Givens, Jane L, Spinella, Sara, Ankuda, Claire K, D'Agata, Erika, Shaffer, Michele L, Habtemariam, Daniel, Mitchell, Susan L Abstract: To determine healthcare proxy involvement in decision-making regarding infections in individuals with advanced dementia. Prospective cohort study. Thirty-five Boston-area nursing homes (NHs). NH residents with advanced dementia and their proxies (N = 362). Charts were abstracted monthly (up to 12 months) for documentation of suspected infections and provider-proxy discussions for each episode. Proxies were interviewed within 8 weeks of the infection to determine their awareness and decision-making involvement. Factors associated with proxy awareness and discussion documentation were identified. There were 496 suspected infections; proxies were reached for interview for 395 (80%). Proxy-provider discussions were documented for 207 (52%) episodes, yet proxies were aware of only 156 (39%). Proxies participated in decision-making for 89 (57%) episodes of which they were aware. Proxy awareness was associated with antimicrobial use 59 (adjusted odds ratio (AOR) = 3.43, 95% confidence interval (CI) = 1.94-6.05), hospital transfer (AOR = 3.00, 95% CI = 1.19-7.53), infection within 30 days of death (AOR = 3.32, 95% CI = 1.54-7.18), and fewer days between infection and study interview (AOR = 2.71, 95% CI = 1.63-4.51). Discussion documentation was associated with the resident residing in a dementia special care unit (AOR = 1.71, 95% CI = 1.04-2.80), the resident not on hospice (AOR = 3.25, 95% CI = 1.31-8.02), more provider visits (AOR = 1.71, 95% CI = 1.07-2.75), proxy visits of more than 7 h/wk (AOR = 1.93, 95% CI = 1.02-3.67), and episode within 30 days of death (AOR = 3.99, 95% CI = 1.98-8.02). Proxies are unaware of and do not participate in decision-making for most suspected infections that NH residents with advanced dementia experience. Proxy awareness of episodes and documentation of provider-proxy discussions are not congruent. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society. Title: Dementia Diagnosis and Influenza Vaccination in French Nursing Home Residents. Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1256-1258 (June 2015) Author(s): Gallini, Adeline, Gardette, Virginie, Lapeyre-Mestre, Maryse, de Souto Barreto, Philipe, Vellas, Bruno, Andrieu, Sandrine, Rolland, Yves Title: Outcomes of Cognitive Fluctuations in Dementia Patients. Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1258-1260 Author(s): Sin, Gwen Li, Mainland, Brian J, Lee, Jimmy, Ornstein, Tisha J, Shulman, Kenneth I, Herrmann, Nathan Title: Reversible Methotrexate-Induced Dementia: A Case Report. Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1273-1274 Author(s): Dautzenberg, Lauren, Jessurum, Naomi, Dautzenberg, Paul L J, Keijsers, Carolina J P W Title: From admission to death: prevalence and course of pain, agitation, and shortness of breath, and treatment of these symptoms in nursing home residents with dementia. Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 475-481 Author(s): Hendriks, Simone A, Smalbrugge, Martin, Galindo-Garre, Francisca, Hertogh, Cees M P M, van der Steen, Jenny T Abstract: Burdensome symptoms frequently develop as part of the dementia trajectory and influence quality of life. We explore the course of symptoms and their treatment during nursing 60 home stay to help target adequate symptom management. Data were collected as part of the Dutch End of Life in Dementia study, a longitudinal observational study with up to 3.5 years of follow-up. Physicians performed assessments at baseline, semiannually, and shortly after death of pain, agitation, shortness of breath, and treatment provided for these symptoms. Long-term care facilities (28) in the Netherlands. Newly admitted nursing home residents (372) in variable stages of dementia. We described prevalence and course of symptoms, and treatment provided for these symptoms. We used generalized estimating equations to evaluate the longitudinal change in symptoms and their treatment, and the associations between the symptoms of pain and agitation, as well as between stage of dementia and symptoms. Pain was common (varying from 47% to 68% across the semiannual assessments) and frequently persistent (36%-41% of all residents); it increased to 78% in the last week of life. Agitation was the most common symptom (57%-71%), and also frequently persistent (39%-53%), yet it decreased to 35% in the last week of life. Shortness of breath was less common (16%-26%), but it increased to 52% at the end of life. Pain was not significantly associated with agitation. Advanced dementia was associated with more pain only. Treatment changed in particular at the end of life. Pain was treated mostly with acetaminophen (34%-52%), and at the end of life with parenteral opioids (44%). Agitation was mostly treated nonpharmacologically (78%-92%), and at the end of life anxiolytics were the most frequently prescribed treatment (62%). Overall, aerosolized bronchodilators were the most frequently prescribed treatment for shortness of breath (29%-67%), but at the end of life, this was morphine (69%). Pain and agitation were common and frequently persisted in residents with dementia during nursing home stay, but symptom management intensified only at the end of life. Symptom control may be suboptimal from admission, and a stronger focus on symptom control is needed at an earlier stage than the end of life. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. Title: Risk of subsequent dementia among patients with bipolar disorder or major depression: a nationwide longitudinal study in taiwan. Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 504-508 Author(s): Chen, Mu-Hong, Li, Cheng-Ta, Tsai, Chia-Fen, Lin, Wei-Chen, Chang, Wen-Han, Chen, Tzeng-Ji, Pan, Tai-Long, Su, Tung-Ping, Bai, Ya-Mei Abstract: Both major depression and bipolar disorder are associated with an increased risk of developing dementia. However, the differential risk of dementia between major depression and bipolar disorder is rarely investigated. Using the Taiwan National Health Insurance Research Database, a total of 2291 patients aged ≥55 years (major depression: 1946 and bipolar disorder: 345) and 2291 age-and sex-matched controls were enrolled between 1998 and 2008, and followed to the end of 2011. Participants who developed dementia during the follow-up were identified. Both patients with bipolar disorder [hazard ratio (HR) 5.58, 95% confidence interval (CI) 4.26-7.32] and those with major depression (HR 3.02, 95% CI 2.46-3.70) had an increased risk of developing dementia in later life, after adjusting for demographic data and medical comorbidities. The sensitivity tests after excluding the 1-year (bipolar disorder: HR 4.73, 95% CI 3.50-6.35; major depression: HR 2.62, 95% CI 2.11-3.25) and 3-year (HR 3.92, 95% CI 2.78-5.54; HR 2.21, 95% CI 1.732.83, respectively) follow-up duration also revealed consistent findings. Furthermore, patients with 61 bipolar disorder were associated with an 87% increased risk (HR 1.87, 95% CI 1.48-2.37) of subsequent dementia compared with patients with major depression. Midlife individuals with bipolar disorder or major depression were associated with an elevated risk of developing dementia in later life. Further studies may be required to clarify the underlying mechanisms among major depression, bipolar disorder, and dementia, and to investigate whether prompt intervention may decrease this risk. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. Title: Pharmacologic Treatment of Behavioral and Psychological Symptoms of Dementia in Nursing Homes: Update of the 2008 JAMDA Recommendations. Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 527-532 Author(s): Anguish, Isabelle, Locca, Jean-François, Büla, Christophe, Zumbach, Serge, Bugnon, Olivier Title: Frontotemporal Dementia-Like Syndrome Following Recall of Childhood Sexual Abuse. Citation: Journal of traumatic stress, Jun 2015, vol. 28, no. 3, p. 240-246 (June 2015) Author(s): Cohen, Lisa J, Brody, David Abstract: Numerous psychopathological syndromes have been attributed to posttraumatic stress, both at the time of the trauma and many years later. To date, however, there is little literature on pseudodementia as a delayed traumatic stress response. The authors present a case history of a 50year-old woman who developed severe cognitive impairment following retrieval of previously forgotten memories of childhood sexual abuse. Her cognitive condition deteriorated rapidly and dramatically. Neuropsychological assessment and clinical presentation led to a diagnosis of frontotemporal dementia (vs. corticobasal degeneration). Detailed neurologic and medical evaluations could not identify any underlying physical cause. Her condition progressively worsened over 9 months, at which point memantine, an N-methyl-D-aspartate receptor antagonist, was begun. The patient regained full functioning over the next year. Although an organic cause could not be ruled out, it was likely that recovery of traumatic memories was contributory to the patient's condition, as ongoing psychotherapy had begun 1 year into the course. If additional cases with similar presentations are reported, such cases would corroborate the notion that persistent, severe, and reversible cognitive impairment constitutes a previously unrecognized and atypical posttraumatic response. © 2015 International Society for Traumatic Stress Studies. Title: Increased Risk of Dementia in Patients With Chronic Obstructive Pulmonary Disease. Citation: Medicine, Jun 2015, vol. 94, no. 23, p. e930. (June 2015) Author(s): Liao, Kuang-Ming, Ho, Chung-Han, Ko, Shian-Chin, Li, Chung-Yi Abstract: Neurodegenerative disease in patients with chronic obstructive pulmonary disease (COPD) was observed. We aim to clarify the risk of dementia in patients with COPD.The study used claims 62 data from Taiwan's National Health Insurance Research Database. Subjects were those who received a discharge diagnosis of COPD between January 1, 2002 and December 31, 2011. Only the first hospitalization was enrolled, and the index date was the first day of admission. Patients younger than 40 years or those with a history of Alzheimer disease (AD) or Parkinson disease (PD) before the index date were excluded. The patients with COPD were then followed until receiving a diagnosis of AD or PD, death, or the end of the study. Control subjects were selected from hospitalized patients without a history of COPD, AD, or PD and were matched according to age (±3 years), gender, and the year of admission at a 2:1 ratio. The comorbidities were measured from 1 year before the index date based on the ICD-9-CM codes. The study included 8640 patients with COPD and a mean age of 68.76 (±10.74) years. The adjusted hazard ratio of developing dementia (AD or PD) was 1.74 (95% confidence interval = 1.55-1.96) in patients with COPD compared with patients without COPD after adjusting for age, gender, and comorbidities.This nationwide cohort study demonstrates that the risk of dementia, including AD and PD, is significantly increased in patients with COPD compared with individuals in the general population. Title: Dementia Increases Severe Sepsis and Mortality in Hospitalized Patients With Chronic Obstructive Pulmonary Disease. Citation: Medicine, Jun 2015, vol. 94, no. 23, p. e967. (June 2015) Author(s): Liao, Kuang-Ming, Lin, Tzu-Chieh, Li, Chung-Yi, Yang, Yea-Huei Kao Abstract: Dementia increases the risk of morbidity and mortality in hospitalized patients. However, information on the potential effects of dementia on the risks of acute organ dysfunction, severe sepsis and in-hospital mortality, specifically among inpatients with chronic obstructive pulmonary disease (COPD), is limited.The observational analytic study was inpatient claims during the period from 2000 to 2010 for 1 million people who were randomly selected from all of the beneficiaries of the Taiwan National Health Insurance in 2000. In total, 1406 patients with COPD and dementia were admitted during the study period. Hospitalized patients with COPD and free from a history of dementia were randomly selected and served as control subjects (n = 5334). The patient groups were matched according to age (±3 years), gender, and the year of admission, with a control/dementia ratio of 4. Only the first-time hospitalization data for each subject was analyzed. Logistic regression models were used to calculate the odds ratio (OR) of outcome measures (acute organ dysfunction, severe sepsis, and mortality), controlling for confounding factors (age, sex, comorbidity, infection site, hospital level, and length of stay).In COPD patients with dementia, the incidence rate of severe sepsis and hospital mortality was 17.1% and 4.8%, respectively, which were higher than the controls (10.6% and 2.3%). After controlling for potential confounding factors, dementia was found to significantly increase the odds of severe sepsis and hospital mortality with an adjusted OR (OR) of 1.38 (95% confidence interval [CI] 1.10-1.72) and 1.69 (95% CI 1.18-2.43), respectively. Dementia was also significantly associated with an increased OR of acute respiratory dysfunction (adjusted OR 1.39, 95% CI 1.09-1.77).In hospitalized COPD patients, the presence of dementia may increase the risks of acute respiratory dysfunction, severe sepsis, and hospital mortality, which warrants the attention of health care professionals. 63 Title: Increased Risk of Dementia in Patients With Erectile Dysfunction: A Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study. Citation: Medicine, Jun 2015, vol. 94, no. 24, p. e990. (June 2015) Author(s): Yang, Chun-Ming, Shen, Yuan-Chi, Weng, Shih-Feng, Wang, Jhi-Joung, Tien, Kai-Jen Abstract: Erectile dysfunction (ED) is a well-known predictor for future cardiovascular and cerebrovascular disease. However, the relationship between ED and dementia has rarely been examined. This study investigates the longitudinal risk for Alzheimer's disease and non-Alzheimer dementia in patients with ED.We collected a random sample of 1,000,000 individuals from Taiwan's National Health Insurance database. From this sample, we identified 4153 patients with newly diagnosed ED between 2000 and 2009 and compared them with a matched cohort of 20,765 patients without ED. All patients were tracked for 7 years from the index date to identify which of them subsequently developed dementia.During the 7-year follow-up period, the incidence rate of dementia in the ED cohort was 35.33 per 10,000 person-years. In the comparison groups, it was 21.67 per 10,000 person-years. After adjustment for patients characteristics and comorbidities, patients with ED were 1.68-times more likely to develop dementia than patients without ED (95% CI = 1.34-2.10, P < 0.0001). In addition, older patients and those with diabetes, hypertension, chronic kidney disease, stroke, depression, and anxiety were found to be at increased risk for dementia. Analyzing the data by dementia type, we found the hazard risk for Alzheimer's disease and nonAlzheimer dementia to be greater in patients with ED (adjusted HR 1.68, 95% CI = 1.31-2.16, P < 0.0001 and 1.63, 95% CI = 1.02-2.62, P = 0.0429, respectively). Log-rank test revealed that patients with ED had significantly higher cumulative incidence rates of dementia than those without (P < 0.0001).Patients with ED are at an increased risk for dementia later in life. Title: The effects of rasagiline on cognitive deficits in Parkinson's disease patients without dementia: A randomized, double-blind, placebo-controlled, multicenter study. Citation: Movement disorders : official journal of the Movement Disorder Society, Jun 2015, vol. 30, no. 7, p. 1009. (June 2015) Author(s): Hanagasi, Hasmet A Title: Neurodegenerative disease: Balancing BMI-rethinking the relationships between obesity, ageing and risk of dementia. Citation: Nature reviews. Endocrinology, Jun 2015, vol. 11, no. 6, p. 315. (June 2015) Author(s): Sargent, Jennifer 64 Title: White matter integrity in dementia with Lewy bodies: a voxel-based analysis of diffusion tensor imaging. Citation: Neurobiology of aging, Jun 2015, vol. 36, no. 6, p. 2010-2017 (June 2015) Author(s): Nedelska, Zuzana, Schwarz, Christopher G, Boeve, Bradley F, Lowe, Val J, Reid, Robert I, Przybelski, Scott A, Lesnick, Timothy G, Gunter, Jeffrey L, Senjem, Matthew L, Ferman, Tanis J, Smith, Glenn E, Geda, Yonas E, Knopman, David S, Petersen, Ronald C, Jack, Clifford R, Kantarci, Kejal Abstract: Many patients with dementia with Lewy bodies (DLB) have overlapping Alzheimer's disease (AD)-related pathology, which may contribute to white matter (WM) diffusivity alterations on diffusion tensor imaging (DTI). Consecutive patients with DLB (n = 30), age- and sex-matched AD patients (n = 30), and cognitively normal controls (n = 60) were recruited. All subjects underwent DTI, 18F 2-fluoro-deoxy-d-glucose, and (11)C Pittsburgh compound B positron emission tomography scans. DLB patients had reduced fractional anisotropy (FA) in the parietooccipital WM but not elsewhere compared with cognitively normal controls, and elevated FA in parahippocampal WM compared with AD patients, which persisted after controlling for β-amyloid load in DLB. The pattern of WM FA alterations on DTI was consistent with the more diffuse posterior parietal and occipital glucose hypometabolism of 2-fluoro-deoxy-d-glucose positron emission tomography in the cortex. DLB is characterized by a loss of parietooccipital WM integrity, independent of concomitant ADrelated β-amyloid load. Cortical glucose hypometabolism accompanies WM FA alterations with a concordant pattern of gray and WM involvement in the parietooccipital lobes in DLB. Copyright © 2015 Elsevier Inc. All rights reserved. Title: Brain atrophy and white-matter hyperintensities are not significantly associated with incidence and severity of postoperative delirium in older persons without dementia. Citation: Neurobiology of aging, Jun 2015, vol. 36, no. 6, p. 2122-2129 (June 2015) Author(s): Cavallari, Michele, Hshieh, Tammy T, Guttmann, Charles R G, Ngo, Long H, Meier, Dominik S, Schmitt, Eva M, Marcantonio, Edward R, Jones, Richard N, Kosar, Cyrus M, Fong, Tamara G, Press, Daniel, Inouye, Sharon K, Alsop, David C, SAGES Study Group Abstract: Postoperative delirium is a common complication in older people and is associated with increased mortality, morbidity, institutionalization, and caregiver burden. Although delirium is an acute confusional state characterized by global impairments in attention and cognition, it has been implicated in permanent cognitive impairment and dementia. The pathogenesis of delirium and the mechanisms leading to these disabling consequences remain unclear. The present study is the first to address the potential predisposing role of brain morphologic changes toward postoperative delirium in a large prospective cohort of patients undergoing elective surgery using state-of-the-art magnetic resonance imaging (MRI) techniques conducted before admission. We investigated the association of MRI-derived quantitative measures of white-matter damage, global brain, and hippocampal volume with the incidence and severity of delirium. Presurgical white-matter hyperintensities (WMHs), whole brain, and hippocampal volume were measured in 146 consecutively enrolled subjects, ≥70 years old, without dementia who were undergoing elective surgery. These 3 presurgical MRI indices were tested as predictors of incidence and severity of subsequent delirium. Out of 146 subjects, 32 (22%) developed delirium. We found no statistically 65 significant differences in WMH, whole brain, or hippocampal volume between subjects with and without delirium. Both unadjusted and adjusted (age, gender, vascular comorbidity, and general cognitive performance) regression analyses demonstrated no statistically significant association between any of the MRI measures with respect to delirium incidence or severity. In persons without dementia, preexisting cerebral WMHs, general and hippocampal atrophy may not predispose to postoperative delirium or worsen its severity. Copyright © 2015 Elsevier Inc. All rights reserved. Title: Testing family-centered, function-focused care in hospitalized persons with dementia. Citation: Neurodegenerative disease management, Jun 2015, vol. 5, no. 3, p. 203-215 (June 2015) Author(s): Boltz, Marie, Chippendale, Tracy, Resnick, Barbara, Galvin, James E Abstract: SUMMARY Aim: Hospital-acquired disability causes decreased quality of life for patients with dementia and family caregivers, and increased societal costs. A comparative, repeated measures study tested the feasibility and preliminary efficacy of the family-centered, functionfocused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and family caregivers (FCGs). The intervention group demonstrated better activities of daily living and walking performance, and less severity/duration of delirium and hospital readmissions, but no significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less anxiety but no significant differences in depression, strain and mutuality. Fam-FFC presents a possible pathway to meeting the Triple Aim of improved patient care, improved patient health and reduced costs for persons with dementia. Title: Diagnosing dementia in adults with Down's syndrome. Citation: Neurodegenerative disease management, Jun 2015, vol. 5, no. 3, p. 249-256 (June 2015) Author(s): Prasher, Vee P, Sachdeva, Niyati, Tarrant, Nick Abstract: SUMMARY Individuals with Down's syndrome (DS) are living longer and many will survive into their fifth or sixth decade of life. Among the DS population, the prevalence of dementia in Alzheimer's disease increases from 9.4% in age group 30-39 years to 54.5% age group 60-69 years. The psychopathology of dementia in Alzheimer's disease is similar to that seen in the general population although differences are apparent due to the underlying intellectual disability in DS and on the reliance on collateral information from informants. The diagnostic workup follows accepted practice although neuropsychological tests and neuroimaging will only be adjuncts to the clinical assessment; such investigations have limited diagnostic value. Presently, research is focused on identifying genetic and biological measures of Alzheimer's disease in DS. Title: Hippocampal sclerosis in the parkinsonism-dementia complex of Guam: quantitative examination of neurons, neurofibrillary tangles, and TDP-43 immunoreactivity in CA1. Citation: Neuropathology : official journal of the Japanese Society of Neuropathology, Jun 2015, vol. 35, no. 3, p. 224-235 66 Author(s): Oyanagi, Kiyomitsu, Yamazaki, Mineo, Hashimoto, Tomoyo, Asakawa, Mika, Wakabayashi, Koichi, Takahashi, Hitoshi Abstract: The cornu ammonis 1 (CA1) area in the hippocampus of the parkinsonism-dementia complex (PDC) of Guam was examined quantitatively with special references to the number of neurons, intraneuronal (i) and extracellular (e) neurofibirillary tangles (NFTs), and TDP-43 (43-kDa trans-activation-responsive region DNA-binding protein)-immunopositive structures, in 24 Chamorro patients with PDC of Guam and seven control Chamorro Guamanians (both groups having no ischemic or anoxic complications). The results were that: (i) in the patients with mildly involved PDC, total numbers of neurons, iNFTs and eNFTs were almost the same as those of neurons of controls; (ii) in patients severely involved, total numbers of neurons, iNFTs and eNFTs decreased markedly; (iii) the decrease of the number of pyramidal neurons in CA1 with positive nuclear TDP-43 was intimately correlated with the decrease in total neuron numbers; (iv) whereas the numbers of neurons and TDP-43-immunopositive intracytoplasmic aggregation in the CA1 area were inversely correlated; and (v) depression of nuclear TDP-43 immuonostainability was not affected by the presence or absence of NFTs. In conclusion, hippocampal sclerosis exists in PDC; there is a possibility of elimination of eNFTs which appeared in the CA1 in patients with PDC and loss of the neurons correlates with disappearance of nuclear TDP-43, but not with appearance of intraneurocytoplasmic TDP-43 aggregation or iNFTs. © 2015 Japanese Society of Neuropathology. Title: Autopsy case of spinocerebellar ataxia type 31 with severe dementia at the terminal stage. Citation: Neuropathology : official journal of the Japanese Society of Neuropathology, Jun 2015, vol. 35, no. 3, p. 273-279 (June 2015) Author(s): Adachi, Tadashi, Kitayama, Michio, Nakano, Toshiya, Adachi, Yoshiki, Kato, Shinsuke, Nakashima, Kenji Abstract: Spinocerebellar ataxia type 31 (SCA31) is an autosomal dominant cerebellar ataxia commonly observed in Japan. However, few neuropathological examinations have been conducted. Here we report the case of a 76-year-old Japanese male SCA31 patient. He noticed dysarthria and difficulty walking at 65 years old. His symptoms subsequently deteriorated, although he could still walk with assistance at 70 years. At 73 years, when he could no longer walk, he was admitted to our hospital. He showed severe limb and truncal ataxia. His father and older brother had shown the same symptoms. Brain magnetic resonance imaging showed cerebellar atrophy of the anterior lobe and white matter hyperintensities. He was diagnosed with SCA31 by genetic analysis. Gradually, his cognitive functions and ability to communicate declined. He died of respiratory failure at the age of 76. Neuropathological examination revealed severe Purkinje cell loss that was accentuated in the anterior lobe of the cerebellum. Furthermore, the remaining Purkinje cells showed abnormal processes (that is, halo-like amorphous materials), as has been reported previously. Severe deposition of hyperphosphorylated tau-positive neurites, many senile plaques and amyloid angiopathy were observed in the neocortex. Our findings suggest that in SCA31, accelerated tau and amyloid pathology in the neocortex might induce dementia at the terminal stage. © 2014 Japanese Society of Neuropathology. 67 Title: Investigation of Aβ phosphorylated at serine 8 (pAβ) in Alzheimer's disease, dementia with Lewy bodies and vascular dementia. Citation: Neuropathology and applied neurobiology, Jun 2015, vol. 41, no. 4, p. 428-444 (June 2015) Author(s): Ashby, Emma L, Miners, James S, Kumar, Sathish, Walter, Jochen, Love, Seth, Kehoe, Patrick G Abstract: Deposition of amyloid beta (Aβ) in the brain is one of the defining abnormalities of Alzheimer's disease (AD). Phosphorylation of Aβ at serine 8 (pAβ) has been implicated in its aggregation in vitro and pAβ level has been shown to be significantly elevated in AD. We aimed to assess the specificity of pAβ for AD and have investigated associations of pAβ with parenchymal and cerebrovascular accumulation of Aβ, disease progression, angiotensin-converting enzyme activity and APOE genotype. The distribution of pAβ was studied by immunohistochemistry in sporadic and familial AD, pure dementia with Lewy bodies (DLB), pure vascular dementia (VaD) and age-matched controls. Soluble and insoluble (guanidine-extractable) pAβ level was measured by enzyme-linked immunosorbent assay (ELISA) in the midfrontal and parahippocampal cortex in sporadic AD (n = 20, 10 with Braak tangle stages of III-IV and 10 of stages V-VI), DLB (n = 10), VaD (n = 10) and agematched controls (n = 20). We found pAβ to be associated with only a subset of Aβ plaques and vascular deposits in sporadic and familial AD, with absent or minimal immunohistochemically detectable pAβ in control, DLB and VaD brains. In both brain regions, insoluble pAβ level was significantly elevated only in advanced AD (Braak tangle stage of V or VI) and in the parahippocampus soluble and insoluble pAβ level increased with the number of APOE ε4 alleles. These results indicate that pAβ accumulation in the parenchyma and vasculature is largely restricted to late-stage AD (Braak tangle stage V-VI). © 2014 British Neuropathological Society. Title: Synaptic protein levels altered in vascular dementia. Citation: Neuropathology and applied neurobiology, Jun 2015, vol. 41, no. 4, p. 533-543 (June 2015) Author(s): Sinclair, Lindsey I, Tayler, Hannah M, Love, Seth Abstract: Cerebral ischaemia is the defining pathophysiological abnormality in most forms of vascular dementia (VAD), but the pathogenesis of the dementia remains poorly understood. In Alzheimer's disease (AD), there is early loss of synaptic proteins, but these have been little studied in VAD. We measured synaptophysin, postsynaptic density protein 95 (PSD-95), drebrin, synaptosomalassociated protein 25 (SNAP-25) and vascular endothelial growth factor (VEGF) by enzyme-linked immunosorbent assays in superior temporal cortex from 11 patients with VAD and, initially, 11 nondementia controls. We corrected for neuronal content by measurement of neuron-specific enolase. A further 11 controls were subsequently used in a validation study. Simulation of post-mortem delay found that PSD-95 was stable at 4°C but declined slightly at RT. SNAP-25 and drebrin showed good post-mortem stability. Previous studies had shown good post-mortem preservation of synaptophysin and VEGF. The VAD cases had lower synaptophysin (but P > 0.05 in initial study), significantly lower SNAP-25 (P = 0.024) and significantly higher drebrin (P = 0.020). On comparison with the second 68 control group, the reduction in synaptophysin was significant (P = 0.008), and the other results were confirmed. There is probably a reduction in presynaptic proteins in the temporal cortex in VAD, although not as marked as in AD. In VAD, there is also an increase in drebrin, which may be a response to reduced synaptic input. © 2015 The Authors. Neuropathology and Applied Neurobiology published by John Wiley & Sons Ltd on behalf of British Neuropathological Society. Title: A theory of fine structure image models with an application to detection and classification of dementia. Citation: Quantitative imaging in medicine and surgery, Jun 2015, vol. 5, no. 3, p. 356-367, 22234292 Author(s): O'Neill, William, Penn, Richard, Werner, Michael, Thomas, Justin Abstract: Estimation of stochastic process models from data is a common application of time series analysis methods. Such system identification processes are often cast as hypothesis testing exercises whose intent is to estimate model parameters and test them for statistical significance. Ordinary least squares (OLS) regression and the Levenberg-Marquardt algorithm (LMA) have proven invaluable computational tools for models being described by non-homogeneous, linear, stationary, ordinary differential equations. In this paper we extend stochastic model identification to linear, stationary, partial differential equations in two independent variables (2D) and show that OLS and LMA apply equally well to these systems. The method employs an original nonparametric statistic as a test for the significance of estimated parameters. We show gray scale and color images are special cases of 2D systems satisfying a particular autoregressive partial difference equation which estimates an analogous partial differential equation. Several applications to medical image modeling and classification illustrate the method by correctly classifying demented and normal OLS models of axial magnetic resonance brain scans according to subject Mini Mental State Exam (MMSE) scores. Comparison with 13 image classifiers from the literature indicates our classifier is at least 14 times faster than any of them and has a classification accuracy better than all but one. Our modeling method applies to any linear, stationary, partial differential equation and the method is readily extended to 3D whole-organ systems. Further, in addition to being a robust image classifier, estimated image models offer insights into which parameters carry the most diagnostic image information and thereby suggest finer divisions could be made within a class. Image models can be estimated in milliseconds which translate to whole-organ models in seconds; such runtimes could make real-time medicine and surgery modeling possible. Title: Frontotemporal lobar dementia and amyotrophic lateral sclerosis associated with c9orf72 expansion. Citation: Revue neurologique, Jun 2015, vol. 171, no. 6-7, p. 475-481, 0035-3787 (2015 Jun-Jul) Author(s): Le Ber, I 69 Abstract: An intronic GGGGCC repeat expansion in c9orf72 gene has been identified as the most common genetic cause of frontotemporal lobar dementia (FTLD), amyotrophic lateral sclerosis (ALS) and FTLD-ALS. The discovery of c9orf72 gene has led to important scientific progresses and has considerably changed our clinical practice over the last few years. This paper summarizes the common and less typical phenotypes associated with c9orf72 expansion, the complex pathological pattern characterized by p62/dipeptide repeat aggregates, as well as the pathological mechanisms by which the expansion might produce neurodegeneration implicating loss-of-function, RNA toxicity, RNA-binding protein sequestration and accumulation of dipeptide repeats. We also discuss the recommendations and limits for genetic testing and counseling in clinical practice. Copyright © 2015 Elsevier Masson SAS. All rights reserved. Title: Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack and Stroke: (II) Effect of Attrition on Follow-Up. Citation: Stroke; a journal of cerebral circulation, Jun 2015, vol. 46, no. 6, p. 1494-1500 (June 2015) Author(s): Pendlebury, Sarah T, Chen, Ping-Jen, Welch, Sarah J V, Cuthbertson, Fiona C, Wharton, Rose M, Mehta, Ziyah, Rothwell, Peter M, Oxford Vascular Study Abstract: Cognitive outcomes in cohorts and trials are often based only on face-to-face clinic assessment. However, cognitive impairment is strongly associated with increased morbidity and mortality, leading to substantial loss to clinic follow-up. In the absence of previous population-based data, we determined the effect of such attrition on measured risk of dementia after transient ischemic attack and stroke. Patients with transient ischemic attack or stroke prospectively recruited (2002-2007) into the Oxford Vascular (OXVASC) study had baseline clinical/cognitive assessment and follow-up to 2014. Dementia was diagnosed through face-to-face clinic interview, supplemented by home visits and telephone assessment in patients unable to attend clinic and by hand-searching of primary care records in uncontactable patients. Of 1236 patients (mean age/SD, 75.2/12.1 years; 582 men), 527 (43%) died by 5-year follow-up. Follow-up assessment rates (study clinic, home visit, or telephone) of survivors were 947 in 1026 (92%), 857 in 958 (89%), 792 in 915 (87%), and 567 in 673 (84%) at 1, 6, 12 months and 5 years. Dementia developed in 260 patients, of whom 110 (42%; n=50 primary care records, n=49 home visit, and n=11 telephone follow-up) had not been available for face-to-face clinic follow-up at the time of diagnosis. The 5-year cumulative incidence of postevent dementia was 29% (26%-32%) overall but was only 17% (14% to 19%) in clinic assessed versus 45% (39%-51%) in nonclinic-assessed patients (P difference<0.001). Exclusion of patients unavailable for clinic follow-up reduces the measured risk of postevent dementia. Use of multiple follow-up methods, including home visits, telephone assessments, and consent, to access primary care records substantially increases ascertainment of longer-term dementia outcomes. © 2015 American Heart Association, Inc. Title: Re: cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. Citation: The Journal of urology, Jun 2015, vol. 193, no. 6, p. 2035. (June 2015) 70 Author(s): Wein, Alan J Title: Oxidative stress and cognition amongst adults without dementia or stroke: Implications for mechanistic and therapeutic research in psychiatric disorders. Citation: Psychiatry Research, Jun 2015, vol. 227, no. 2-3, p. 127-134, Author(s): Newton, Dwight F., Naiberg, Melanie R., Goldstein, Benjamin I. Abstract: Oxidative stress has been implicated in cognitive deficits in disease states such as dementia and stroke. However, growing evidence shows similar associations in individuals without these conditions. We therefore set out to systematically review the literature on this topic. MEDLINE searches were conducted of medical subject-headings neuropsychology, cognition, cognition disorders, or neuropsychological tests, cross-referenced with oxidative stress, or superoxide. Exclusion criteria were dementia and stroke studies, absence of human subjects, and absence of quantifiable oxidative stress/cognition measures. The search yielded 883 results, of which 19 studies (consisting of 3662 total subjects) were included in this review. The majority of studies indicated that frontal cognitive functions were most often impaired, and lipid peroxidation was most commonly associated with impairments. Literature on learning, memory, and general cognitive function was less robust. A substantial proportion of the literature on this topic is based on psychiatric populations. Frontal-executive dysfunction implicates frontal brain regions, which are known to be susceptible to oxidative damage. Further studies are needed, and those examining psychiatric populations may be especially fruitful. Focusing on youth may yield enhanced signal detection. Further study is needed to identify which antioxidant interventions work best for which cognitive functions and for which patients. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Prevalence and incidence of dementia among indigenous populations: A systematic review. Citation: International Psychogeriatrics, Jun 2015, (Jun 19, 2015), 1041-6102 (Jun 19, 2015) Author(s): Warren, Laura A., Shi, Qiyun, Young, Kue, Borenstein, Amy, Martiniuk, Alexandra Abstract: Background: Indigenous populations may be at increased risk, compared with majority populations, for the development of dementia due to lower education levels and socio-economic status, higher rates of diabetes, hypertension, cardiovascular disease and alcohol abuse, an aging population structure, and poorer overall health. This is the first systematic review investigating the prevalence and incidence of dementia in indigenous populations worldwide. Methods: This systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE, Embase, and PsycInfo for relevant papers published up to April 2015. Studies were included if they reported prevalence or incidence, the disease typically occurred after the age of 45, the study population included indigenous people, and the study was conducted in the general population. Results: Fifteen studies representing five countries (Canada, Australia, the USA, Guam, Brazil) met the inclusion criteria. Dementia prevalence ranged from 0.5% to 20%. Retrospective studies relying 71 on medical records for diagnoses had much lower prevalence rates and a higher risk of bias than population-based prospective studies performing their own diagnoses with culturally appropriate cognitive assessment methods. Conclusions: The prevalence of dementia among indigenous populations appears to be higher than it is for non-indigenous populations. Despite a building body of evidence supporting the need for dementia research among indigenous populations, there is a paucity of epidemiological research, none of which is of high quality. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Medial temporal regional argyrophilic grain as a possible important factor affecting dementia in parkinson's disease. Citation: Neuropathology, Jun 2015, (Jun 16, 2015), 0919-6544 (Jun 16, 2015) Author(s): Homma, Taku, Mochizuki, Yoko, Takahashi, Kazushi, Komori, Takashi Abstract: Argyrophilic grain (ArG) is the main pathological feature of argyrophilic grain disease (AGD) and is clinically characterized by cognitive impairment, behavioral abnormalities, personality changes, and emotional imbalances. However, ArG can not only be found in AGD but also in various other neurological disorders, including Parkinson's disease (PD). The association of ArG with psychosis and/or dementia in various neurological disorders remains unknown; in this study, we have investigated this in PD. The distribution and degree of ArG deposition, spongiform change in the transentorhinal cortex (TER SpC), and phosphorylated alpha‐synuclein‐positive neurites in CA2/3 were assessed, and we used formalin‐fixed, paraffin‐embedded specimens obtained from the anterior/posterior medial temporal region of 20 autopsy cases diagnosed as PD. These cases were clinically divided into two groups: PD without dementia (PDND) and PD with dementia (PDD). Most PDD cases revealed scattered to numerous ArG or moderate to severe TER SpC, both of which were rarely observed in the PDND group. Furthermore, by the degree of ArG density and TER SpC, the PDD group was further divided into three subtypes: PDD with ArG, with TER SpC and without ArG/TER SpC. Scattered‐to‐numerous ArG and/or moderate‐to‐severe TER SpC were observed only in PDD, which suggested that both ArG and TER SpC could be important factors affecting dementia in PD and that their distribution and degree are equally important. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Magnetization transfer MRI in dementia disorders, Huntington's disease and parkinsonism. Citation: Journal of the Neurological Sciences, Jun 2015, vol. 353, no. 1-2, p. 1-8, 0022-510X (Jun 15, 2015) Author(s): Tambasco, Nicola, Nigro, Pasquale, Romoli, Michele, Simoni, Simone, Parnetti, Lucilla, Calabresi, Paolo Abstract: Magnetic resonance imaging is the most used technique of neuroimaging. Using recent advances in magnetic resonance application it is possible to investigate several changes in neurodegenerative disease. Among different techniques, magnetization-transfer imaging (MTI), a 72 magnetic resonance acquisition protocol assessing the magnetization exchange between protons bound to water and those bound to macromolecules, is able to identify microstructural brain tissue changes peculiar of neurodegenerative diseases. This review provides a report on the MTI technique and its use in the dementia disorders, Huntington's disease and parkinsonisms, comprehensive of the predictive values of MTI in the identification of early-phase disease. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Common aging signature in the peripheral blood of vascular dementia and alzheimer’s disease. Citation: Molecular Neurobiology, Jun 2015, (Jun 23, 2015), 0893-7648 (Jun 23, 2015) Author(s): Luo, Hongbo, Han, Guangchun, Wang, Jiajia, Zeng, Fan, Li, Yuanming, Shao, Shaoju, Song, Fuhai, Bai, Zhouxian, Peng, Xing, Wang, Yan-Jiang, Shi, Xiangqun, Lei, Hongxing Abstract: Alzheimer’s disease (AD) and vascular dementia (VaD) are the two most dominant forms of dementia in elderly people. Due to the large overlap between AD and VaD in clinical observations, great controversies exist regarding the distinction and connection between these two types of senile dementia. Here for the first time, we resort to the gene expression pattern of the peripheral blood to compare AD and VaD objectively. In our previous work, we have demonstrated that the dysregulation of gene expression in AD is unique among the examined diseases including neurological diseases, cancer, and metabolic diseases. In this study, we found that the dysregulation of gene expression in AD and VaD is quite similar to each other at both functional and gene levels. Interestingly, the dysregulation started at the early stages of the diseases, namely mild cognitive impairment (MCI) and vascular cognitive impairment (VCI). We have also shown that this signature is distinctive from that of peripheral vascular diseases. Comparison with aging studies revealed that the most profound change in AD and VaD, namely ribosome, is consistent with the accelerated aging scenario. This study may have implications to the common mechanism between AD and VaD. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Divergent brain functional network alterations in dementia with lewy bodies and alzheimer's disease. Citation: Neurobiology of Aging, Jun 2015, (Jun 2, 2015), 0197-4580 (Jun 2, 2015) Author(s): Peraza, Luis R., Taylor, John-Paul, Kaiser, Marcus Abstract: The clinical phenotype of dementia with Lewy bodies (DLB) is different from Alzheimer's disease (AD), suggesting a divergence between these diseases in terms of brain network organization. To fully understand this, we studied functional networks from resting-state functional magnetic resonance imaging in cognitively matched DLB and AD patients. The DLB group demonstrated a generalized lower synchronization compared with the AD and healthy controls, and this was more severe for edges connecting distant brain regions. Global network measures were significantly different between DLB and AD. For instance, AD showed lower small-worldness than 73 healthy controls, while DLB showed higher small-worldness (AD < controls < DLB), and this was also the case for global efficiency (DLB > controls > AD) and clustering coefficient (DLB < controls < AD). Differences were also found for nodal measures at brain regions associated with each disease. Finally, we found significant associations between network performance measures and global cognitive impairment and severity of cognitive fluctuations in DLB. These results show network divergences between DLB and AD which appear to reflect their neuropathological differences. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Sequential distribution of pTDP-43 pathology in behavioral variant frontotemporal dementia (bvFTD): Erratum. Citation: Acta Neuropathologica, Jun 2015, vol. 129, no. 6, p. 929., 0001-6322 (Jun 2015) Author(s): Brettschneider, Johannes, Del Tredici, Kelly, Irwin, David J., Grossman, Murray, Robinson, John L., Toledo, Jon B., Lee, Edward B., Fang, Lubin, Van Deerlin, Vivianna M., Ludolph, Albert C., Lee, Virginia M.-Y., Braak, Heiko, Trojanowski, John Q. Abstract: Reports an error in "Sequential distribution of pTDP-43 pathology in behavioral variant frontotemporal dementia (bvFTD)" by Johannes Brettschneider, Kelly Del Tredici, David J. Irwin, Murray Grossman, John L. Robinson, Jon B. Toledo, Lubin Fang, Vivianna M. Van Deerlin, Albert C. Ludolph, Virginia M.-Y. Lee, Heiko Braak and John Q. Trojanowski (Acta Neuropathologica, 2014[Mar], Vol 127[3], 423-439). In the original article, one of the authors was missing from the list of authors. The updated list of authors is present in the erratum. (The following abstract of the original article appeared in record 2014-01257-001). We examined regional distribution patterns of phosphorylated 43-kDa TAR DNA-binding protein (pTDP-43) intraneuronal inclusions in frontotemporal lobar degeneration (FTLD). Immunohistochemistry was performed on 70 μm sections from FTLD-TDP autopsy cases (n = 39) presenting with behavioral variant frontotemporal dementia. Two main types of cortical pTDP-43 pathology emerged, characterized by either predominantly perikaryal pTDP-43 inclusions (cytoplasmic type, cFTLD) or long aggregates in dendrites (neuritic type, nFTLD). Cortical involvement in nFTLD was extensive and frequently reached occipital areas, whereas cases with cFTLD often involved bulbar somatomotor neurons and the spinal cord. We observed four patterns indicative of potentially sequential dissemination of pTDP-43: cases with the lowest burden of pathology (pattern I) were characterized by widespread pTDP-43 lesions in the orbital gyri, gyrus rectus, and amygdala. With increasing burden of pathology (pattern II) pTDP-43 lesions emerged in the middle frontal and anterior cingulate gyrus as well as in anteromedial temporal lobe areas, the superior and medial temporal gyri, striatum, red nucleus, thalamus, and precerebellar nuclei. More advanced cases showed a third pattern (III) with involvement of the motor cortex, bulbar somatomotor neurons, and the spinal cord anterior horn, whereas cases with the highest burden of pathology (pattern IV) were characterized by pTDP-43 lesions in the visual cortex. We interpret the four neuropathological patterns in bvFTD to be consistent with the hypothesis that pTDP-43 pathology can spread sequentially and may propagate along axonal pathways. (PsycINFO Database Record (c) 2015 APA, all rights reserved) 74 Title: Parkinson’s disease dementia: A neural networks perspective. Citation: Brain: A Journal of Neurology, Jun 2015, vol. 138, no. 6, p. 1454-1476 Author(s): Gratwicke, James, Jahanshahi, Marjan, Foltynie, Thomas Abstract: In the long-term, with progression of the illness, Parkinson’s disease dementia affects up to 90% of patients with Parkinson’s disease. With increasing life expectancy in western countries, Parkinson’s disease dementia is set to become even more prevalent in the future. However, current treatments only give modest symptomatic benefit at best. New treatments are slow in development because unlike the pathological processes underlying the motor deficits of Parkinson’s disease, the neural mechanisms underlying the dementing process and its associated cognitive deficits are still poorly understood. Recent insights from neuroscience research have begun to unravel the heterogeneous involvement of several distinct neural networks underlying the cognitive deficits in Parkinson’s disease dementia, and their modulation by both dopaminergic and non-dopaminergic transmitter systems in the brain. In this review we collate emerging evidence regarding these distinct brain networks to give a novel perspective on the pathological mechanisms underlying Parkinson’s disease dementia, and discuss how this may offer new therapeutic opportunities. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Olfactory function and neuropsychological profile to differentiate dementia with lewy bodies from alzheimer's disease in patients with mild cognitive impairment: A 5-year follow-up study. Citation: Journal of the Neurological Sciences, Jun 2015, (Jun 10, 2015), 0022-510X (Jun 10, 2015) Author(s): Yoon, Jung Han, Kim, Min, Moon, So Young, Yong, Seok Woo, Hong, Ji Man Abstract: BACKGROUND: Mild cognitive impairment (MCI) is a well-known precursor of Alzheimer's disease (AD) but often also precedes dementia with Lewy bodies (DLB). The early differentiation of DLB from AD is important to delay disease progression. Olfactory dysfunction is a well-known early sign of both AD and Lewy body disorders, including Parkinson's disease (PD) and DLB. Thus, the aim of the present study was to determine whether olfactory and neuropsychological tests can aid in the differentiation of DLB from AD at the MCI stage. METHODS: The present study included 122 MCI patients who were monitored until they developed dementia or until their condition stabilized; the follow-up period averaged 4.9years (range: 3.9–6.2years). Baseline olfactory function as measured with the Cross-Cultural Smell Identification (CCSI) test and neuropsychological data were compared. RESULTS: During the follow-up period, 32 subjects developed probable AD (MCI-AD), 18 had probable DLB (MCI-DLB), 45 did not convert to dementia (MCI-stable), and eight developed a nonAD/DLB dementia. The mean CCSI score (95% confidence interval [CI]) in patients with MCI-DLB (4.6; 95% CI: 4.0–5.3) was significantly lower than that of MCI-AD patients (6.4; 95% CI: 6.0–6.7, p<0.001) and MCI-stable patients (7.3; 95% CI: 6.9–7.8, p<0.001). The area under the curve of the receiver operating characteristic to discriminate MCI-DLB from MCI-AD using CCSI scores was (0.84; 95% CI: 0.72–0.97). Frontal-executive function and visuospatial ability was worse in patients with MCI-DLB, while verbal recognition memory impairment was greater in those with MCI-AD. CONCLUSION: Olfactory and neuropsychological tests can help predict conversion to DLB or AD in patients with MCI. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) 75 Title: Identifying phenomenological differences and recovery of cognitive and non-cognitive symptomatology among delirium superimposed upon dementia patients (dsd) versus those without dementia (dad) in an acute geriatric care setting. Citation: International Psychogeriatrics, Jun 2015, (Jun 9, 2015), 1041-6102 (Jun 9, 2015) Author(s): Chong, Edward, Tay, Laura, Chong, Mei Sian Abstract: ABSTRACT Background: Phenomenological differences between delirium superimposed on dementia (DsD) versus delirium in the absence of dementia (DaD) remain poorly understood. We aimed to identify phenomenological differences in delirium symptoms (cognitive and non-cognitive) and compare delirium recovery trajectories between DsD and DaD. Methods: We conducted a prospective observational study on individuals admitted to the Geriatric Monitoring Unit (GMU), a five-bed unit specializing in managing older adults with delirium, between December 2010 and August 2012 (n = 234; mean age 84.1 ± 7.4). We collected data on demographics, comorbidities, severity of illness, cognitive and functional scores, and number of precipitants. Cognitive status was assessed using locally validated Chinese Mini-Mental State Examination (CMMSE) and delirium severity assessed using Delirium Rating Scale-Revised-98 (DRS-R98). Delirium disease trajectory was plotted over five days. Results: DsD patients had a longer duration of delirium with slower recovery in terms of cognition and delirium severity scores compared with DaD patients (0.33 (0.0–1.00) vs. 1.0 (0.36–2.00) increase in CMMSE per day, p < 0.001, and 1.49 ± 1.62 vs. 2.63 ± 2.28 decrease in DRS-R98 severity per day, p < 0.001). When cognitive and non-cognitive sub-scores of DRS-R98 were examined separately, we observed steeper recovery in both sub-scores in DaD patients. These findings remained significant after adjusting for significant baseline differences. Conclusions: Our findings of slower cognitive symptom recovery in DsD patients suggest cognitive reserve play a role in delirium syndrome development and recovery. This merits further studies to potentially aid in appropriate discharge planning and to identify potential pharmacological and non-pharmacological cognitive interventions for hospitalized older persons with delirium. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Lost in spatial translation—A novel tool to objectively assess spatial disorientation in Alzheimer's disease and frontotemporal dementi Citation: Cortex: A Journal Devoted to the Study of the Nervous System and Behavior, Jun 2015, vol. 67, p. 83-94, 0010-9452 (Jun 2015) Author(s): Tu, Sicong, Wong, Stephanie, Hodges, John R., Irish, Muireann, Piguet, Olivier, Hornberger, Michael Abstract: Spatial disorientation is a prominent feature of early Alzheimer's disease (AD) attributed to degeneration of medial temporal and parietal brain regions, including the retrosplenial cortex (RSC). By contrast, frontotemporal dementia (FTD) syndromes show generally intact spatial orientation at presentation. However, currently no clinical tasks are routinely administered to objectively assess spatial orientation in these neurodegenerative conditions. In this study we investigated spatial 76 orientation in 58 dementia patients and 23 healthy controls using a novel virtual supermarket task as well as voxel-based morphometry (VBM). We compared performance on this task with visual and verbal memory function, which has traditionally been used to discriminate between AD and FTD. Participants viewed a series of videos from a first person perspective travelling through a virtual supermarket and were required to maintain orientation to a starting location. Analyses revealed significantly impaired spatial orientation in AD, compared to FTD patient groups. Spatial orientation performance was found to discriminate AD and FTD patient groups to a very high degree at presentation. More importantly, integrity of the RSC was identified as a key neural correlate of orientation performance. These findings confirm the notion that i) it is feasible to assess spatial orientation objectively via our novel Supermarket task; ii) impaired orientation is a prominent feature that can be applied clinically to discriminate between AD and FTD and iii) the RSC emerges as a critical biomarker to assess spatial orientation deficits in these neurodegenerative conditions. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Therapies Title: Starting out - I learned that music is a great way to converse with dementia patients. Citation: Nursing standard (Royal College of Nursing (Great Britain) : 1987), Jun 2015, vol. 29, no. 42, p. 29. (June 17, 2015) Author(s): Seikiera, Leanne Abstract: In my second year of nurse training, I applied to become a dementia champion at the trust where I was completing most of my clinical placements. Title: Review: In patients with dementia who live in care homes, some nondrug interventions reduce agitation. Citation: Annals of internal medicine, Jun 2015, vol. 162, no. 12, p. JC3. (June 16, 2015) Author(s): Lim, Lionel S Title: Chores and sense of self: gendered understandings of voices of older married women with dementia. Citation: International journal of older people nursing, Jun 2015, vol. 10, no. 2, p. 127-135 Author(s): Hellström, Ingrid, Eriksson, Henrik, Sandberg, Jonas Abstract: Marital relationships in dementia are forged between the person with dementia and the care partner, and such relationships have an impact on the way in which dementia is understood and experienced. The everyday work that underpins the relationship is usually divided between spouses and based on traditional divisions of household chores. The aim was to describe how older 77 women with dementia express the importance of their homes and their chores in everyday life. Seven women with dementia, who were cohabiting with their husbands, were interviewed on up to five occasions at home during a five-to-six-year period on the following themes: the home, their dementia illness, everyday life, their relationships with their husbands and dignity and autonomy. The qualitative analysis showed three different patterns in the women's narratives: keeping the core of the self through the home, keeping the self through polarising division of labour and keeping the self through (re-) negotiations of responsibilities. The feeling of one's home and home-related chores is an essential way to express who you are. The women stated that household chores are the centre of their lives despite their dementia disease and that the home, even though it shrinks, still makes the women see themselves as an important person, namely the 'competent wife'. Nurses need to be aware that 'doing gender' may be a means of preserving personhood as well as of sustaining couplehood in dementia. © 2014 John Wiley & Sons Ltd. Title: What carers and family said about music therapy on behaviours of older people with dementia in residential aged care. Citation: International journal of older people nursing, Jun 2015, vol. 10, no. 2, p. 146-157 Author(s): Tuckett, Anthony G, Hodgkinson, Brent, Rouillon, Lisa, Balil-Lozoya, Tania, Parker, Deborah Abstract: This study sought to evaluate the effectiveness of group music therapy (MT) intervention on behaviours of older people with dementia. Reported here are qualitative data from five, semistructured focus groups; two comprising a total of seven family members and three comprising a total of 23 staff members. A number of core themes emerged: temporality, effect and policy with a number of subthemes. The MT effect is tempered by the temporality of (i) the older person's dementia state, (ii) the session and (iii) the psychosomatic effect on the older person. Music therapy is perceived to (i) evoke memories and facilitate reminiscence, (ii) act as a diversion (has an instrumental value) and it is contentious to discount the (iii) dichotomy between music and therapist in terms of the overall effect. Finally, policymakers need to know that MT is (i) highly prized and more, not less, MT is recommended. Findings from this study illustrate that the timing of the MT session has consequences for the workflow in the residential aged care facility; MT has a psychosomatic effect and participants here evaluate this as temporal. Care providers and family members acknowledge the instrumental value of MT and its helping with cognition and exercise. They have mixed views about the effects of the music and the effect on the older person by the therapist but most definitely want policymakers to ensure more, not less, planned and better funded MT is part of ongoing care in the residential aged care context. Areas for future research and policy are also highlighted. These views on group MT in residential aged care can initiate critical reflection on current practices and systems. Research is needed exploring the timing and scheduling of MT sessions at different times in the day for older person with dementia exhibiting negative behaviours. © 2014 John Wiley & Sons Ltd. 78 Title: Replication and extension of a check-in procedure to increase activity engagement among people with severe dementia. Citation: Journal of applied behavior analysis, Jun 2015, vol. 48, no. 2, p. 460-465 (June 2015) Author(s): Engstrom, Elin, Mudford, Oliver C, Brand, Denys Abstract: Engelman, Altus, and Mathews (1999) evaluated a procedure to ensure that staff checked in with elderly residents in a nursing home and offered activity choices. We report findings of a replication, with some additional components, to increase appropriate activity engagement among 5 residents (aged 77 to 83 years) with severe dementia. Evaluated in a concurrent multiple baseline design across participants that incorporated partial withdrawal phases, activity engagement increased for 3 participants, with modest improvement for 1 other participant. The 4 responders all engaged in a wider variety of activities during intervention. © Society for the Experimental Analysis of Behavior. Title: Working memory binding and episodic memory formation in aging, mild cognitive impairment, and Alzheimer's dementia. Citation: Journal of clinical and experimental neuropsychology, Jun 2015, vol. 37, no. 5, p. 538-548 (June 2015) Author(s): van Geldorp, Bonnie, Heringa, Sophie M, van den Berg, Esther, Olde Rikkert, Marcel G M, Biessels, Geert Jan, Kessels, Roy P C Abstract: Recent studies indicate that in both normal and pathological aging working memory (WM) performance deteriorates, especially when associations have to be maintained. However, most studies typically do not assess the relationship between WM and episodic memory formation. In the present study, we examined WM and episodic memory formation in normal aging and in patients with early Alzheimer's disease (mild cognitive impairment, MCI; and Alzheimer's dementia, AD). In the first study, 26 young adults (mean age 29.6 years) were compared to 18 middle-aged adults (mean age 52.2 years) and 25 older adults (mean age 72.8 years). We used an associative delayedmatch-to-sample WM task, which requires participants to maintain two pairs of faces and houses presented on a computer screen for short (3 s) or long (6 s) maintenance intervals. After the WM task, an unexpected subsequent associative memory task was administered (two-alternative forced choice). In the second study, 27 patients with AD and 19 patients with MCI were compared to 25 older controls, using the same paradigm as that in Experiment 1. Older adults performed worse than both middle-aged and young adults. No effect of delay was observed in the healthy adults, and pairs that were processed during long maintenance intervals were not better remembered in the subsequent memory task. In the MCI and AD patients, longer maintenance intervals hampered the task performance. Also, both patient groups performed significantly worse than controls on the episodic memory task as well as the associative WM task. Aging and AD present with a decline in WM binding, a finding that extends similar results in episodic memory. Longer delays in the WM task did not affect episodic memory formation. We conclude that WM deficits are found when WM capacity is exceeded, which may occur during associative processing 79 Title: 'There's a letter called ef' on Challenges and Repair in Interpreter-Mediated Tests of Cognitive Functioning in Dementia Evaluations: A Case Study. Citation: Journal of cross-cultural gerontology, Jun 2015, vol. 30, no. 2, p. 163-187 (June 2015) Author(s): Plejert, Charlotta, Antelius, Eleonor, Yazdanpanah, Maziar, Nielsen, T Rune Abstract: In the Scandinavian countries Sweden, Denmark, Norway, and Finland, the number of first generation migrants reaching an old age, who will be in need of age-related health-care, is rapidly increasing. This situation poses new demands on health-care facilities, such as memory clinics, where patients with memory problems and other dementia symptoms are referred for examination and evaluation. Very many elderly people with a foreign background require the assistance of an interpreter in their encounter with health-care facilities. The use of, and work by an interpreter is crucial in facilitating a smooth assessment. However, interpreters, clinicians, as well as patients and their companions, may be faced with many challenges during the evaluation procedure. The aim of this case-study is to highlight some of the challenges that occur in relation to a specific activity within the dementia evaluation, namely the test of cognitive functioning. Special attention will be paid to the phenomenon 'repair', i.e., participants' joint attempts to solve upcoming difficulties during the course of interaction. Results show that sources of trouble may be related to the lack of cultural, linguistic, and educational adaptation of the test to the patient, and to interpreter and clinician practises. Findings will be discussed in terms of test-validity, clinician and interpreter training, and the institutional goals and constraints of the dementia evaluation. The methodology Conversation Analysis has been used to conduct a highly detailed analysis of participants' practices and actions during the administration of the test. Title: Cognitive impairment and its consequences in everyday life: experiences of people with mild cognitive impairment or mild dementia and their relatives. Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 949-958 (June 2015) Author(s): Johansson, Maria M, Marcusson, Jan, Wressle, Ewa Abstract: The aim of this study was to explore experiences of cognitive impairment, its consequences in everyday life and need for support in people with mild cognitive impairment (MCI) or mild dementia and their relatives. A qualitative approach with an explorative design with interviews was chosen. The participants included five people with MCI and eight people with mild dementia and their relatives. All participants were recruited at a geriatric memory clinic in Sweden. The Grounded Theory method was used. The following categories emerged: noticing cognitive changes; changed activity patterns; coping strategies; uncertainty about own ability and environmental reactions; support in everyday life; support from the healthcare system; consequences in everyday life for relatives; and support for relatives. The main findings were that people with MCI and dementia experienced cognitive changes that could be burdensome and changed activity patterns. Most of them, however, considered themselves capable of coping on their own. The relatives noticed cognitive changes and activity disruptions to a greater extent and tried to 80 be supportive in everyday life. Degree of awareness varied and lack of awareness could lead to many problems in everyday life. Perceived cognitive impairment and its consequences in everyday life were individual and differed among people with MCI or dementia and their relatives. Thus, healthcare professionals must listen to both people with cognitive impairment and their relatives for optimal individual care planning. Support such as education groups and day care could be more tailored towards the early stages of dementia. Title: Development of an exercise intervention to improve cognition in people with mild to moderate dementia: Dementia And Physical Activity (DAPA) Trial, registration ISRCTN32612072. Citation: Physiotherapy, Jun 2015, vol. 101, no. 2, p. 126-134 (June 2015) Author(s): Brown, Deborah, Spanjers, Katie, Atherton, Nicky, Lowe, Janet, Stonehewer, Louisa, Bridle, Chris, Sheehan, Bart, Lamb, Sarah E Abstract: More than 800000 people in the UK have dementia, and it is a government priority to improve dementia care. Drug treatment options are relatively limited. The Dementia And Physical Activity (DAPA) study is a randomised trial which targets cognition in people with dementia, using an exercise programme. There is evidence to suggest that both aerobic and resistance exercise may be useful in improving cognition. Hence the intervention comprises a supervised part of twice-weekly exercise classes of one hour duration for 4 months, including aerobic exercise at moderate intensity on static bicycles, and resistance (weight training) exercise using weight vests, weight belts and dumbbells. Thereafter participants progress to unsupervised, independent exercise. Aids to behaviour modification have been incorporated into the intervention. The DAPA intervention has been designed to maximise likelihood of effectiveness and cost-effectiveness, and for delivery in the UK National Health Service. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved. Title: Cognitive-behavioural therapy for anxiety in dementia: pilot randomised controlled trial. Citation: The British journal of psychiatry : the journal of mental science, Jun 2015, vol. 206, no. 6, p. 509-516 Author(s): Spector, Aimee, Charlesworth, Georgina, King, Michael, Lattimer, Miles, Sadek, Susan, Marston, Louise, Rehill, Amritpal, Hoe, Juanita, Qazi, Afifa, Knapp, Martin, Orrell, Martin Abstract: Background Anxiety is common and problematic in dementia, yet there is a lack of effective treatments. Aims To develop a cognitive-behavioural therapy (CBT) manual for anxiety in dementia and determine its feasibility through a randomised controlled trial. Method A ten-session CBT manual was developed. Participants with dementia and anxiety (and their carers) were randomly allocated to CBT plus treatment as usual (TAU) (n = 25) or TAU (n = 25). Outcome and cost measures were administered at baseline, 15 weeks and 6 months. Results At 15 weeks, there was an adjusted difference in anxiety (using the Rating Anxiety in Dementia scale) of (-3.10, 95% CI -6.55 to 0.34) for CBT compared with TAU, which just fell short of statistical significance. There were significant improvements in depression at 15 weeks after adjustment (-5.37, 95% CI -9.50 to -1.25). 81 Improvements remained significant at 6 months. CBT was cost neutral. Conclusions CBT was feasible (in terms of recruitment, acceptability and attrition) and effective. A fully powered RCT is now required. © The Royal College of Psychiatrists 2015. Title: Computer Activities for Persons With Dementia. Citation: The Gerontologist, Jun 2015, vol. 55 Suppl 1, p. S40. (June 2015) Author(s): Tak, Sunghee H, Zhang, Hongmei, Patel, Hetal, Hong, Song Hee Abstract: The study examined participant's experience and individual characteristics during a 7-week computer activity program for persons with dementia. The descriptive study with mixed methods design collected 612 observational logs of computer sessions from 27 study participants, including individual interviews before and after the program. Quantitative data analysis included descriptive statistics, correlational coefficients, t-test, and chi-square. Content analysis was used to analyze qualitative data. Each participant averaged 23 sessions and 591min for 7 weeks. Computer activities included slide shows with music, games, internet use, and emailing. On average, they had a high score of intensity in engagement per session. Women attended significantly more sessions than men. Higher education level was associated with a higher number of different activities used per session and more time spent on online games. Older participants felt more tired. Feeling tired was significantly correlated with a higher number of weeks with only one session attendance per week. More anticholinergic medications taken by participants were significantly associated with a higher percentage of sessions with disengagement. The findings were significant at p < .05. Qualitative content analysis indicated tailoring computer activities appropriate to individual's needs and functioning is critical. All participants needed technical assistance. A framework for tailoring computer activities may provide guidance on developing and maintaining treatment fidelity of tailored computer activity interventions among persons with dementia. Practice guidelines and education protocols may assist caregivers and service providers to integrate computer activities into homes and aging services settings. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Title: Therapeutic drug monitoring for patients with Alzheimer dementia to improve treatment with donepezil. Citation: Therapeutic drug monitoring, Jun 2015, vol. 37, no. 3, p. 353-361 (June 2015) Author(s): Hefner, Gudrun, Brueckner, Anne, Hiemke, Christoph, Fellgiebel, Andreas Abstract: Aiming to verify that therapeutic drug monitoring has the potential to optimize treatment with acetylcholine esterase inhibitors of patients with Alzheimer dementia, this study investigated whether serum concentrations of donepezil are associated with clinical improvement. Clinical improvement was measured using the clinical global impression (CGI) scale, and donepezil concentrations were measured in serum by a high-performance liquid chromatographic method 82 with spectrophotometric detection. In total, 206 serum samples from 106 patients (49.5% female) were retrospectively available for analysis. Patients included were treated under everyday conditions. Their mean ± SD age was 72 ± 9 years, daily doses of donepezil were 5 and 10 mg, and their mean ± SD serum concentrations were 23 ± 9 and 47 ± 18 ng/mL, respectively. Serum concentrations correlated significantly (P < 0.001) with CGI scores (Pearson's correlation coefficient r = 0.511, P < 0.01). In patients who were "very much improved," according to their CGI score, the mean serum concentration was 66 ± 20 ng/mL and thus significantly higher (P < 0.01) than in patients with "minimal improvement" (29 ± 12 ng/mL). Receiver operating characteristics analysis suggests that donepezil serum concentrations of at least 50 ng/mL may be recommended for maximal clinical benefit. Because donepezil serum concentrations were highly variable between individual patients and the majority of patients exhibited concentrations that were below 50 ng/mL at therapeutic doses of 5 and 10 mg/d, it can be concluded that therapeutic drug monitoring may be used to enhance the effectiveness of donepezil treatment. Title: Cognitive–Behavioral Therapy (CBT) Versus Acceptance and Commitment Therapy (ACT) for Dementia Family Caregivers With Significant Depressive Symptoms: Results of a Randomized Clinical Trial. Citation: Journal of Consulting and Clinical Psychology, Jun 2015, Author(s): Losada, Andrés, Márquez-González, María, Romero-Moreno, Rosa, Mausbach, Brent T., López, Javier, Fernández-Fernández, Virginia, Nogales-González, Celia Abstract: Objective: The differential efficacy of acceptance and commitment therapy (ACT) and cognitive–behavioral therapy (CBT) for dementia family caregivers’ is analyzed through a randomized controlled trial. Method: Participants were 135 caregivers with high depressive symptomatology who were randomly allocated to the intervention conditions or a control group (CG). Pre-, postintervention, and follow-up measurements assessed depressive symptomatology, anxiety, leisure, dysfunctional thoughts, and experiential avoidance. Results: Depression: Significant effects of interventions compared with CG were found for CBT (p < .001, d = 0.98, number needed to treat [NNT] = 3.61) and ACT (p < .001, d = 1.17, NNT = 3.53) at postintervention, but were maintained only at follow-up for CBT (p = .02, d = 0.74, NNT = 9.71). Clinically significant change was observed in 26.7% participants in CBT, 24.2% in ACT, and 0% in CG. At follow-up, 10.53% in CBT and 4% in ACT were recovered (0% CG). Anxiety: At postintervention, ACT participants showed lower anxiety than CBT participants (p < .05, d = 0.50) and CG participants (p < .01, d = 0.79, NNT = 3.86), with no effects at follow-up. At postintervention, 23.33% in CBT, 36.36% in ACT, and 6.45% in CG showed clinically significant change. At follow-up, 26.32% in CBT, 36% in ACT, and 13.64% in CG were recovered. Significant changes at postintervention were found in leisure and dysfunctional thoughts in both ACT and CBT, with changes in experiential avoidance only for ACT. Conclusion: Similar results were obtained for ACT and CBT. ACT seems to be a viable and effective treatment for dementia caregivers. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) 83 Title: Implementing living room theatre activities for people with dementia on nursing home wards: A process evaluation sudy. Citation: Aging & Mental Health, Jun 2015, vol. 19, no. 6, p. 536-547, 1360-7863 (Jun 2015) Author(s): van Haeften-van Dijk, A. Marijke, van Weert, Julia C. M., Dröes, Rose-Marie Abstract: Objectives: A new communication method, the ‘Veder Method’, was implemented in the Netherlands. This method uses theatrical stimuli in combination with proven person-centred communication methods. Care staff was trained to apply the Veder Method in a ‘living room theatre activity’ for people with dementia. This study evaluates the implementation of the Veder Method on psychogeriatric nursing home wards. Methods: Facilitators and barriers to train staff and implement the Veder Method in psychogeriatric nursing homes were identified by conducting semi-structured interviews with 12 stakeholders who were involved in the implementation, and five focus groups with 35 trained care staff. The interviews and focus groups were transcribed verbatim, and two independent researchers analysed the content of the transcripts. The Implementation Process Evaluation (IPE) Framework was used to categorize the data and the 7s-model to contextualize the qualitative findings. Results: A structured overview of facilitators and barriers in different stages of the implementation process is presented. Positive reactions in residents and more reciprocity in caregiver-resident contact motivated trained care staff to work with the Veder Method. An action plan, executive support, the visibility of the method in the organization and a pioneer group that initiated implementation were essential for successful implementation. High work pressure for the care staff was a hindering factor. Conclusion: Respondents experienced the added value of the Veder Method. The facilitators and barriers to implementation we identified in this study can help to implement and disseminate the successful Veder Method and other person-centred communication methods in psychogeriatric nursing homes effectively. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Other Title: Suicidal ideation and related factors among dementia patients. Citation: Journal of affective disorders, Jun 2015, vol. 178, p. 66-70 (June 1, 2015) Author(s): Koyama, Asuka, Fujise, Noboru, Matsushita, Masateru, Ishikawa, Tomohisa, Hashimoto, Mamoru, Ikeda, Manabu Abstract: It is generally thought that people with dementia are not able to attempt suicide because of impaired executive function. Little research is available about suicidal ideation among dementia patients. The present study examines 1) the sociodemographic and clinical features of dementia patients with suicidal ideation and 2) the effect of suicidal ideation on caregiver burden. A total of 634 dementia outpatients and their family caregivers participated in this study. Comparisons of variables were made among three groups: patients with suicidal ideation, patients with depression without suicidal ideation, and patients with neither suicidal ideation nor depression. Data were collected between April 2007 and July 2013. Suicidal ideation was seen in 64 patients (10.1%). Patients with suicidal ideation had a significantly higher rate of behavioural and psychological 84 symptoms of dementia (BPSD) (P<0.001). Caregivers of patients with suicidal ideation felt a higher caregiver burden, even after adjusting for BPSD score (P<0.01). Suicidal ideation was assessed by interview with caregivers, so we may have overlooked people who had suicidal ideation but did not express it to their caregivers. Suicidal ideation among dementia patients should receive greater attention. Adequate assessment of suicidal ideation and psychological support for both patients with suicidal ideation and their caregivers are needed. Copyright © 2015 Elsevier B.V. All rights reserved. Title: Driving safely with dementia. Citation: Journal of neurology, neurosurgery, and psychiatry, Jun 2015, vol. 86, no. 6, p. 593-594 Author(s): Warlow, Charles Title: The neural correlates of road sign knowledge and route learning in semantic dementia and Alzheimer's disease. Citation: Journal of neurology, neurosurgery, and psychiatry, Jun 2015, vol. 86, no. 6, p. 595-602 Author(s): Luzzi, S, Cafazzo, V, Damora, A, Fabi, K, Fringuelli, F M, Ascoli, G, Silvestrini, M, Provinciali, L, Reverberi, C Abstract: Although there is a growing body of research on driving and Alzheimer's disease (AD), focal dementias have been understudied. Moreover, driving has never been explored in semantic dementia (SD). An experimental battery exploring road sign knowledge and route learning was applied to patients with SD and AD selected in the early-moderate stage of disease and to a group of healthy participants. Neuropsychological data were correlated to cerebral hypometabolism distribution, investigated by means of positron emission tomography. The two dementias showed opposite profiles. Patients with SD showed poor road sign knowledge and normal performance in route learning. By contrast, patients with AD showed low performance in route learning test with preservation of semantic knowledge of road signs. In SD, there was a correlation of semantic knowledge impairment with hypometabolism in the left temporolateral cortex. No correlation between the AD region of interests (ROIs) and the relevant behavioural indices was found, while in the whole-brain analysis there was a significant correlation between route learning and the superior frontal gyrus. For the first time, driving skills were explored in SD, and it is showed a differential profile from the one detected in AD. We demonstrate that the left anterior temporal cortex is implicated in road sign knowledge, while a distributed cortical network, including the frontal cortex, is likely to process route learning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rightslicensing/permissions. Title: Dementia education in Higher Education Institutions. Citation: Nurse education today, Jun 2015, vol. 35, no. 6, p. 731-732 (June 2015) 85 Author(s): Collier, Elizabeth, Knifton, Chris, Surr, Claire Abstract: This article is a contemporary issues piece which discusses the challenges in providing dementia education in Higher Education Institutions. Copyright © 2015 Elsevier Ltd. All rights reserved. Title: An investigation of nursing students' knowledge of dementia: A questionnaire study. Citation: Nurse education today, Jun 2015, vol. 35, no. 6, p. 800-805 (June 2015) Author(s): Eccleston, Claire E A, Lea, Emma J, McInerney, Fran, Crisp, Elaine, Marlow, Annette, Robinson, Andrew L Abstract: Globally, rising rates of dementia indicate the need for more nurses skilled in caring for people with this condition. However nursing students may not acquire the requisite knowledge from existing undergraduate curricula. To investigate the dementia knowledge of second-year nursing students before and after a supported placement in a residential aged care facility. Assessment of the level of knowledge of dementia is important to provide evidence of the need to enhance dementia learning in the nursing curriculum. A pre-post control-intervention questionnaire study. 16 Tasmanian residential aged care facilities (RACFs). 99 Tasmanian second-year nursing undergraduate students (52 intervention, 47 control). Second year nursing students were engaged in a three week RACF clinical placement at one of the 14 control facilities or one of the 2 involved in the development of teaching aged care facilities. Pre/post data were collected using the 21-item 'Dementia Knowledge Assessment Tool 2.0' and demographic survey questions, and analysed using descriptive analyses and nonparametric significance tests. The data showed that these nursing students had a poor knowledge of dementia, with limited understanding of key items relevant to their clinical practice. Knowledge of dementia was significantly improved after students' participation in supported clinical placements at an intervention residential aged care facility. This knowledge improvement was significantly higher than that of students who attended clinical placements at control facilities. A well-supported clinical placement at a residential aged care facility can improve nursing students' knowledge of dementia, in particular in relation to aspects directly relevant to their clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved. Title: A review of contemporary work on the ethics of ambient assisted living technologies for people with dementia. Citation: Science and engineering ethics, Jun 2015, vol. 21, no. 3, p. 707-765 (June 2015) Author(s): Novitzky, Peter, Smeaton, Alan F, Chen, Cynthia, Irving, Kate, Jacquemard, Tim, O'Brolcháin, Fiachra, O'Mathúna, Dónal, Gordijn, Bert Abstract: Ambient assisted living (AAL) technologies can provide assistance and support to persons with dementia. They might allow them the possibility of living at home for longer whilst maintaining their comfort and security as well as offering a way towards reducing the huge economic and personal costs forecast as the incidence of dementia increases worldwide over coming decades. 86 However, the development, introduction and use of AAL technologies also trigger serious ethical issues. This paper is a systematic literature review of the on-going scholarly debate about these issues. More specifically, we look at the ethical issues involved in research and development, clinical experimentation, and clinical application of AAL technologies for people with dementia and related stakeholders. In the discussion we focus on: (1) the value of the goals of AAL technologies, (2) the special vulnerability of persons with dementia in their private homes, (3) the complex question of informed consent for the usage of AAL technologies. Title: Folk and biological perceptions of dementia among Asian ethnic minorities in Hawaii. Citation: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jun 2015, vol. 23, no. 6, p. 589-595 (June 2015) Author(s): Suzuki, Rika, Goebert, Deborah, Ahmed, Iqbal, Lu, Brett Abstract: To study if Asian ethnic groups in Hawaii today maintain folk-based beliefs about dementia, have inadequate biomedical understanding of dementia, and differ among each other regarding perceptions of dementia. The study adapts and expands a 2004 survey of ethnic groups on perceptions of Alzheimer disease demonstrating that ethnic minority groups hold more folk perceptions and less biomedical perceptions of dementia than Caucasians. This study surveys particular ethnic minority family members of elders admitted to four long-term care and inpatient facilities in Hawaii. Seventy-one family members completed surveys, including 23 Chinese, 18 Filipino, and 30 Japanese participants. Elders may or may not have had the diagnosis of dementia, though an estimated half of elders in all four facilities already held the diagnosis of dementia. Findings indicated that Japanese and Chinese respondents in this study held perceptions about dementia that were more consistent with current biomedical understanding compared with their Filipino counterparts (mean differences/percent correct for Japanese: 57%, Chinese: 56% versus Filipino: 38%; F = 6.39, df = 2,55, p = 0.003). Filipino respondents were less likely than Japanese and Chinese respondents to report that persons with dementia can develop physical and mental problems-97% of Japanese participants and 82% of Chinese participants responded correctly compared with 63% of Filipino participants (Fisher's Exact test p = 0.009). With regard to folk beliefs about dementia, variation occurred with no consistent trend among the groups. Low levels of biomedical understanding of dementia were reflected by all three subgroups of Asians living in Hawaii with less prominence of folk beliefs compared with prior studies of ethnic minority perceptions. Education did not predict variability in dementia perceptions among the groups. Lower levels of acculturation, suggested by primary home language other than English, may correlate with a perception of dementia that is less consistent with current biomedical understanding of dementia. Persisting folk beliefs about dementia and the evident lack of biomedical understanding, particularly the belief that dementia is a normal part of aging, emphasizes the need for more culturally tailored strategies in patient education about dementia and the importance of early intervention. Copyright © 2015 American Association for Geriatric Psychiatry. All rights reserved. 87 Title: Sleep Quality and Risk of Dementia Among Older Male Veterans. Citation: The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jun 2015, vol. 23, no. 6, p. 651-654 (June 2015) Author(s): Yaffe, Kristine, Nettiksimmons, Jasmine, Yesavage, Jerome, Byers, Amy Abstract: To determine whether a diagnosis of sleep disturbance is associated with dementia in older veterans. For this retrospective cohort study, we obtained medical record data from the Department of Veterans Affairs National Patient Care Database for 200,000 randomly selected veterans aged 55 years and older. Prevalent cases of dementia from the baseline period (2000-2003) were excluded, leaving an analytic sample of 179,738 male veterans. Follow-up took place from 2004 to 2011. The primary outcome was all-cause dementia, ascertained using International Classification of Disease, Ninth Revision codes. Sleep disturbance, the primary predictor, was also ascertained using these codes. After adjusting for potential confounders, those with sleep disturbance had a 27% increased risk of dementia (hazard ratio: 1.27; 95% confidence interval: 1.201.34). Sleep disturbance was associated with increased risk of dementia among a large cohort of older, primarily male veterans. Copyright © 2015. Published by Elsevier Inc. Title: Clinical features of delusional jealousy in elderly patients with dementia. Citation: The Journal of clinical psychiatry, Jun 2015, vol. 76, no. 6, p. 691-695 (June 2015) Author(s): Hashimoto, Mamoru, Sakamoto, Shinichi, Ikeda, Manabu Abstract: Delusional jealousy is a psychotic syndrome characterized by a belief in the infidelity of one's spouse that reaches delusional intensity. Although delusional jealousy has been described in relation to organic psychosis, little is known concerning the actual role of delusional jealousy in dementia. The aim of the present study was to investigate the clinical features of delusional jealousy and possible mechanisms whereby delusional jealousy arises in patients with dementia. We studied 208 consecutive outpatients with dementia (diagnosis based on DSM-III-R criteria; mean [SD] age of 77.0 [8.0] years; study period: September 2011-August 2012). Delusional jealousy was defined as a false belief derived from a pathological jealousy that makes the patient believe that his or her spouse is unfaithful. The prevalence of delusional jealousy was compared between Alzheimer's disease, dementia with Lewy bodies, and vascular dementia. Patients with and without delusional jealousy were compared in terms of general characteristics. In addition, each patient with delusional jealousy and their primary caregivers were interviewed about the clinical features of the syndrome. Of the 208 patients with dementia, 18 (8.7%) showed delusional jealousy. The prevalence of delusional jealousy in patients who had dementia with Lewy bodies (26.3%) was significantly higher than that in patients with Alzheimer's disease (5.5%) (P < .01). There were no significant differences between patients with and without delusional jealousy in regard to gender (P = 1.00), age (P = .81), educational attainment (P = .29), presence of other persons living with the couple (P = .22), and Mini-Mental State Examination score (P = .47). On the other hand, delusional jealousy was preceded by the onset of serious physical diseases in nearly half of the patients. Delusional jealousy resolved within 12 months after treatment in 15 of 18 patients (83%). Although delusional jealousy is a considerable problem in dementia, the prognosis of delusional jealousy in demented patients 88 appears to be relatively benign. In dementia, delusional jealousy may develop more easily in patients who have dementia with Lewy bodies and those with coexisting serious physical disorders. © Copyright 2015 Physicians Postgraduate Press, Inc. Title: BMI and dementia: feast or famine for the brain? Citation: The lancet. Diabetes & endocrinology, Jun 2015, vol. 3, no. 6, p. 397-398 (June 2015) Author(s): Gustafson, Deborah Title: BMI and risk of dementia in two million people over two decades: a retrospective cohort study. Citation: The lancet. Diabetes & endocrinology, Jun 2015, vol. 3, no. 6, p. 431-436 (June 2015) Author(s): Qizilbash, Nawab, Gregson, John, Johnson, Michelle E, Pearce, Neil, Douglas, Ian, Wing, Kevin, Evans, Stephen J W, Pocock, Stuart J Abstract: Dementia and obesity are increasingly important public health issues. Obesity in middle age has been proposed to lead to dementia in old age. We investigated the association between BMI and risk of dementia. For this retrospective cohort study, we used a cohort of 1 958 191 individuals derived from the United Kingdom Clinical Practice Research Datalink (CPRD) which included people aged 40 years or older in whom BMI was recorded between 1992 and 2007. Follow-up was until the practice's final data collection date, patient death or transfer out of practice, or first record of dementia (whichever occurred first). People with a previous record of dementia were excluded. We used Poisson regression to calculate incidence rates of dementia for each BMI category. Our cohort of 1 958 191 people from UK general practices had a median age at baseline of 55 years (IQR 45-66) and a median follow-up of 9·1 years (IQR 6·3-12·6). Dementia occurred in 45 507 people, at a rate of 2·4 cases per 1000 person-years. Compared with people of a healthy weight, underweight people (BMI <20 kg/m(2)) had a 34% higher (95% CI 29-38) risk of dementia. Furthermore, the incidence of dementia continued to fall for every increasing BMI category, with very obese people (BMI >40 kg/m(2)) having a 29% lower (95% CI 22-36) dementia risk than people of a healthy weight. These patterns persisted throughout two decades of follow-up, after adjustment for potential confounders and allowance for the J-shape association of BMI with mortality. Being underweight in middle age and old age carries an increased risk of dementia over two decades. Our results contradict the hypothesis that obesity in middle age could increase the risk of dementia in old age. The reasons for and public health consequences of these findings need further investigation. None. Copyright © 2015 Elsevier Ltd. All rights reserved. Title: Mobility and safety issues in drivers with dementia. Citation: International Psychogeriatrics, Jun 2015, (Jun 26, 2015), 1041-6102 (Jun 26, 2015) 89 Author(s): Carr, David B., O’Neill, Desmond Abstract: Although automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients’ fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients’ social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: A review of ethical issues in dementia. Citation: International Psychogeriatrics, Jun 2015, (Jun 10, 2015), 1041-6102 (Jun 10, 2015) Author(s): Johnson, Rebecca A., Karlawish, Jason Abstract: ABSTRACT Dementia raises many ethical issues. The present review, taking note of the fact that the stages of dementia raise distinct ethical issues, focuses on three issues associated with stages of dementia's progression: (1) how the emergence of preclinical and asymptomatic but at-risk categories for dementia creates complex questions about preventive measures, risk disclosure, and protection from stigma and discrimination; (2) how despite efforts at dementia prevention, important research continues to investigate ways to alleviate clinical dementia's symptoms, and requires additional human subjects protections to ethically enroll persons with dementia; and (3) how in spite of research and prevention efforts, persons continue to need to live with dementia. This review highlights two major themes. First is how expanding the boundaries of dementias such as Alzheimer's to include asymptomatic but at-risk persons generate new ethical questions. One promising way to address these questions is to take an integrated approach to dementia ethics, which can include incorporating ethics-related data collection into the design of a dementia research study itself. Second is the interdisciplinary nature of ethical questions related to dementia, from health policy questions about insurance coverage for long-term care to political questions about voting, driving, and other civic rights and privileges to economic questions about balancing an employer's right to a safe and productive workforce with an employee's rights to avoid discrimination on the basis of their dementia risk. The review highlights these themes and emerging 90 ethical issues in dementia. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Napping in older people ‘at risk’ of dementia: Relationships with depression, cognition, medical burden and sleep quality. Citation: Journal of Sleep Research, Jun 2015, (Jun 21, 2015), 0962-1105 (Jun 21, 2015) Author(s): Cross, Nathan, Terpening, Zoe, Rogers, Naomi L., Duffy, Shantel L., Hickie, Ian B., Lewis, Simon J.G., Naismith, Sharon L. Abstract: Summary Sleep disturbance is prevalent in older adults, particularly so in those at a greater risk of dementia. However, so far the clinical, medical and neuropsychological correlates of daytime sleep have not been examined. The aims of this study were to investigate the characteristics and effects of napping using actigraphy in older people, particularly in those ‘at risk’ of dementia. The study used actigraphy and sleep diaries to measure napping habits in 133 older adults ‘at risk’ of dementia (mean age = 65.5 years, SD = 8.4 years), who also underwent comprehensive medical, psychiatric and neuropsychological assessment. When defined by actigraphy, napping was present in 83.5% (111/133) of participants; however, duration and timing varied significantly among subjects. Nappers had significantly greater medical burden and body mass index, and higher rates of mild cognitive impairment. Longer and more frequent naps were associated with poorer cognitive functioning, as well as higher levels of depressive symptoms, while the timing of naps was associated with poorer nocturnal sleep quality (i.e. sleep latency and wake after sleep onset). This study highlights that in older adults ‘at risk’ of dementia, napping is associated with underlying neurobiological changes such as depression and cognition. Napping characteristics should be more routinely monitored in older individuals to elucidate their relationship with psychological and cognitive outcomes. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Optimizing eating performance for older adults with dementia living in long‐term care: A systematic review. Citation: Worldviews on Evidence-Based Nursing, Jun 2015, (Jun 29, 2015), 1545-102X (Jun 29, 2015) Author(s): Liu, Wen, Galik, Elizabeth, Boltz, Marie, Nahm, Eun‐Shim, Resnick, Barbara Abstract: ABSTRACT Background Review of research to date has been focusing on maintaining weight and nutrition with little attention on optimizing eating performance. Objective To evaluate the effectiveness of interventions on eating performance for older adults with dementia in long‐ term care (LTC). Methods A systematic review was performed. Five databases including Pubmed, Medline (OVID), EBM Reviews (OVID), PsychINFO (OVID), and CINAHL (EBSCOHost) were searched between January 1980 and June 2014. Keywords included dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, autonomy, intervention. Intervention studies that optimize eating performance and evaluate change of self‐feeding or eating performance among older adults (≥65 years) with dementia in LTC were eligible. Studies were screened by title and abstract, and full‐texts 91 were reviewed for eligibility. Eligible studies were classified by intervention type. Study quality was accessed using the Quality Assessment Tool for Quantitative Studies, and level of evidence using the 2011 Oxford Centre for Evidence‐Based Medicine (OCEBM) Levels of Evidence. Results Eleven intervention studies (five randomized controlled trials; RCTs) were identified, and classified into four types: Training program, mealtime assistance, environmental modification, and multicomponent intervention. The quality of the 11 studies was generally moderate, with the main threats as weak designs, lack of blinding and control for confounders, and inadequate psychometric evidence for measures. Training programs targeting older adults (Montessori methods and spaced retrieval) demonstrated good evidence in decreasing feeding difficulty. Mealtime assistance offered by nursing staff (e.g., verbal prompts and cues, positive reinforcement, appropriate praise and encouragement) also showed effectiveness in improving eating performance. Linking evidence to action This review provided preliminary support for using training and mealtime assistance to optimize eating performance for older adults with dementia in LTC. Future effectiveness studies may focus on training nursing caregivers as interventionists, lengthening intervention duration, and including residents with varying levels of cognitive impairment in diverse cultures. The effectiveness of training combined with mealtime assistance may also be tested to achieve better resident outcomes in eating performance. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics. Citation: Patient Education and Counseling, Jun 2015, (Jun 11, 2015), 0738-3991 (Jun 11, 2015) Author(s): Elsey, Christopher, Drew, Paul, Jones, Danielle, Blackburn, Daniel, Wakefield, Sarah, Harkness, Kirsty, Venneri, Annalena, Reuber, Marku Abstract: OBJECTIVE: This study explores whether the profile of patients’ interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases. METHODS: Conversation Analysis of video recordings of neurologists’ interactions with patients attending a specialist memory clinic. “Gold standard” diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging. RESULTS: Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients’ responses to neurologists’ questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent “I don’t know” responses. CONCLUSION: Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD. PRACTICAL IMPLICATIONS: Our findings demonstrate that conversational profiles based on patients’ contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) 92 Title: A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the gap between scientific evidence and clinical practice. Citation: International Psychogeriatrics, Jun 2015, (Jun 10, 2015), 1041-6102 (Jun 10, 2015) Author(s): Zuidema, Sytse U., Johansson, Alice, Selbaek, Geir, Murray, Matt, Burns, Alistair, Ballard, Clive, Koopmans, Raymond T. C. M. Abstract: ABSTRACT Background: To produce a practice guideline that includes a set of detailed consensus principles regarding the prescription of antipsychotics (APs) amongst people with dementia living in care homes. Methods: We used a modified Delphi consensus procedure with three rounds, where we actively specified and optimized statements throughout the process, utilizing input from four focus groups, carried out in UK, Norway, and the Netherlands. This was done to identify relevant themes and a set of statement that experts agreed upon using the Research and Development/University of California at Los Angeles (RAND/UCLA) methodology. Results: A total of 72 scientific and clinical experts and 14 consumer experts reached consensus upon 150 statements covering five themes: (1) General prescription stipulations, (2) assessments prior to prescription, (3) care and treatment plan, (4) discontinuation, and (5) long-term treatment. Conclusions: In this practice guideline, novel information was provided about detailed indication and thresholds of symptoms, risk factors, circumstances at which APs should be stopped or tapered, specific criteria for justifying long-term treatment, involvement of the multidisciplinary team, and family caregiver in the process of prescription. The practice guideline is based on formal consensus of clinicians and consumer experts and provides clinicians relevant practical information that is lacking in current guidelines. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Achieving consensus and controversy around applicability of palliative care to dementia. Citation: International Psychogeriatrics, Jun 2015, (Jun 10, 2015), 1041-6102 (Jun 10, 2015) Author(s): van der Steen, Jenny T., Radbruch, Lukas, de Boer, Marike E., Jünger, Saskia, Hughes, Julian C., Larkin, Phil, Gove, Dianne, Francke, Anneke L., Koopmans, Raymond T.C.M., Firth, Pam, Volicer, Ladislav, Hertogh, Cees M.P.M. Abstract: ABSTRACT Background: People with dementia may benefit from palliative care which specifically addresses the needs of patients and families affected by this life-limiting disease. On behalf of the European Association for Palliative Care (EAPC), we recently performed a Delphi study to define domains for palliative care in dementia and to provide recommendations for optimal care. An international panel of experts in palliative care, dementia care or both, achieved consensus on almost all domains and recommendations, but the domain concerning the applicability of palliative care to dementia required revision. Methods: To examine in detail, the opinions of the international panel of 64 experts around the applicability of palliative care, we explored feedback they provided in the Delphi process. To examine which experts found it less important or less applicable, ordinal regression analyses related characteristics of the panelists to ratings of overall importance of the 93 applicability domain, and to agreement with the domain's four recommendations. Results: Some experts expressed concerns about bringing up end-of-life issues prematurely and about relabeling dementia care as palliative care. Multivariable analyses with the two outcomes of importance and agreement with applicability indicated that younger or less experienced experts and those whose expertise was predominantly in dementia care found palliative care in dementia less important and less applicable. Conclusions: Benefits of palliative care in dementia are acknowledged by experts worldwide, but there is some controversy around its early introduction. Further studies should weigh concerns expressed around care receiving a “palliative” label versus the benefits of applying palliative care early. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Religiosity and quality of life: A dyadic perspective of individuals with dementia and their caregivers. Citation: Aging & Mental Health, Jun 2015, vol. 19, no. 6, p. 500-506, 1360-7863 (Jun 2015) Author(s): Nagpal, Neha, Heid, Allison R., Zarit, Steven H., Whitlatch, Carol J. Abstract: Objectives: Dyadic coping theory purports the benefit of joint coping strategies within a couple, or dyad, when one dyad member is faced with illness or stress. We examine the effect of religiosity on well-being for individuals with dementia (IWDs). In particular, we look at the effect of both dyad members’ religiosity on perceptions of IWDs’ quality of life (QoL). Neither of these issues has been extensively explored. Method: One hundred eleven individuals with mild-to-moderate dementia and their family caregivers were interviewed to evaluate IWDs’ everyday-care values and preferences, including religious preferences. Using an actor–partner multi-level model to account for the interdependent relationship of dyads, we examined how IWD and caregiver ratings of religiosity (attendance, prayer, and subjective ratings of religiosity) influence perceptions of IWDs’ QoL. Results: After accounting for care-related stress, one's own religiosity is not significantly related to IWDs’ or caregivers’ perceptions of IWD QoL. However, when modeling both actor and partner effects of religiosity on perceptions of IWDs’ QoL, caregivers’ religiosity is positively related to IWDs’ self-reports of QoL, and IWDs’ religiosity is negatively associated with caregivers’ perceptions of IWDs’ QoL. Conclusion: These findings suggest that religiosity of both the caregiver and the IWD affect perception of the IWD's QoL. It is important that caregivers understand IWDs’ values concerning religion as it may serve as a coping mechanism for dealing with dementia. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Preventing aggression and other secondary features of dementia in elderly persons: Three case studies. Citation: Bulletin of the Menninger Clinic, Jun 2015, vol. 79, no. 2, p. 95-115, 0025-9284 (Jun 2015) Author(s): Fowler, Jane H., Dannecker, Kerry, Stanley, Melinda, Wilson, Nancy, Snow, A. Lynn, Kunik, Mark E. 94 Abstract: Dementia and Alzheimer’s disease are associated with behavioral symptoms that can be costly and troublesome to caregivers. Behavioral strategies to prevent aggression in people with dementia (PWDs) are necessary to decrease caregiver burden and relieve other behavioral disturbances in PWDs, such as depression. On the basis of their previous study that identified pain as a possible cause of aggression, the authors developed a behavioral in-home intervention designed to teach caregiver(s) how to recognize signs of pain and distress in PWDs. The authors present a description of the Preventing Aggression in Veterans with Dementia (PAVeD) intervention and illustrate its use and results with three case studies. Results indicate that this intervention may help prevent the development of aggression and pain in PWDs, reduce caregiver burden, and help manage other behavioral symptoms associated with dementia. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract) Title: Nutrition in dementia Citation: Nursing Standard, Jun 2015, vol. 29, no. 42, p. 61., 0029-6570 (June 17, 2015) Author(s): O'Reilly-Foley, Georgina Abstract: A CPD article prompted Georgina O'Reilly-Foley to consider ways of improving mealtimes for patients with dementia[Reflection on Continuing Professional Development, NS784 on managing malnutrition in patients with dementia] [PUBLICATION] 1 reference Title: Oral and enteral nutrition in dementia: an overview. Citation: British journal of nursing (Mark Allen Publishing), Jun 2015, vol. 24, no. 12, p. 624-628, Author(s): Brooke, Joanne, Ojo, Omorogieva Abstract: The number of people currently living with dementia in the UK is estimated to be 850 000 and this is expected to rise to over 1 million by the year 2025. Dementia is a progressive terminal disease and the rate of decline is unique to each person; however, cognitive deterioration can be accelerated by undernutrition. This article discusses evidence-based approaches in the use of oral and enteral nutrition interventions for people living with dementia and ways to support their caregivers. The discussion of interventions to improve oral nutrition includes changes to the environment, support with feeding difficulties, nutritional supplements and education and training for caregivers. Title: Promoting collaborative dementia care via online interprofessional education. Citation: Australasian journal on ageing, Jun 2015, vol. 34, no. 2, p. 88-94 (June 2015) Author(s): Cartwright, Jade, Franklin, Diane, Forman, Dawn, Freegard, Heather 95 Abstract: This study aimed to develop, implement and evaluate an online interprofessional education (IPE) dementia case study for health science students. The IPE initiative aimed to develop collaborative interprofessional capabilities and client-centred mindsets that underpin high-quality dementia care. A mixed methods research design was used to assess students' values, attitudes and learning outcomes using an interprofessional socialization and valuing scale (ISVS) completed pre and post the online case study and via thematic analysis of free text responses. Students' ISVS scores improved significantly following online participation, and the qualitative results support a shift towards interprofessional collaboration and client-centred care. This online IPE case study was successful in developing the collaborative mindsets and interprofessional capabilities required by a future workforce to meet the complex, client-centred needs of people living with dementia. © 2013 ACOTA 96 Journal Tables of Contents The most recent issues of the following journals: Alzheimer’s and Dementia Dementia: The International Journal of Social Research and Practice Age and Ageing Journal of the American Geriatrics Society Click on the covers for the most recent tables of contents. If you would like any of the papers from these journals in full text then get in touch: bennet.jones@uhbristol.nhs.uk Alzheimer’s and Dementia Vol.11, iss. 6, June 2015 Dementia: The International Journal of Social Research and Practice Vol. 14, iss. 3, May 2015 Age and Ageing Vol.44, iss. 4, July 2015 Journal of the American Geriatrics Society Vol. 63, iss. 6, June 2015 97 Library Opening Times Staffed hours: 8am-5pm, Mon-Fri Swipe-card access: 7am-11pm 7 days a week Level 5, Education and Research Centre University Hospitals Bristol Contact your outreach librarian: Jo Hooper, outreach librarian joanna.hooper@uhbristol.nhs.uk Ext. 20103