dementia

Correlates of frailty In Alzheimer’s Disease and Mild Cognitive Impairment

NI MHAOLAIN, A., GALLAGHER, D., CROSBY, L., RYAN, D., LACEY, L., COEN, R., BRUCE, I., WALSH, J.B., CUNNINGHAM, C., LAWLOR, B.A.
Age and Ageing, 40(5)
2011

Ni Mhaolain et al. (2011) examine the relationship between frailty and a range of domains including age, comorbidity, course of illness, cognitive impairment, functional limitations and abnormalities of behaviour in a group of patients with AD and MCI.

The study found that 51% of the patients were robust or not-frail, with 49% at an intermediate or complete stage of frailty.  It suggests that escalating frailty is positively associated with increasing number of medical comorbidities and advancing age rather than being a marker of cognitive decline and severity of illness. The study suggests that optimising the management of co-morbid illness in people with dementia may play a role in minimizing the health impact of frailty in this group. 

Cost-effectiveness of prion filtration of red blood cells to reduce the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease in the Republic of Ireland

TELJEUR, C., FLATTERY, M., HARRINGTON, P., O’NEILL, M., MORAN, P.S., MURPHY, L., RYAN, M.
Transfusion, 52(November)
2012

This study by Telijeur et al.

(2012) evaluated the cost-effectiveness of implementing a policy of prion filtration of red blood cells in ROI, based on a literature review on efficacy and safety of prion filters, a cost effectiveness analysis and analysis of two models of prion filtration. It concluded that the introduction of prion filtration for all transfusion recipients was not cost-effective by traditional standards of cost-effectiveness, whilst acknowledging that factors other than cost-effectiveness may influence the decision on whether or not to implement a policy of prion filtration of red blood cells in ROI.  

Lithium and prevention of cognitive impairment

ABIDAN, Z., COONEY, C., JACKSON, D., FREYNE, A.
Irish Journal of Psychological Medicine
2014

A retrospective study by Abidan et al. (2014) was undertaken in the context of increased interest in the neuro-protective effects of lithium and studies suggesting lithium may have a protective role in dementia.

Covering the period 1998 to 2007, it involved 29 patients attending a lithium treatment clinic who had been commenced on lithium treatment for affective disorders such as depression, bipolar disorder and schizoaffective disorder. The study reported that no new cases of dementia developed over a mean follow-up period of 38 months. Given the limitations, the authors tentatively suggest that lithium may have a protective effect against cognitive decline in people with affective disorder and in those with concurrent affective disorder and cognitive impairment.

Very rare and unusual causes account for about 5% of cases of dementia.  Variant CJD, a human prion disease, is one of the rarer causes of dementia, caused when meat from cattle infected with bovine spongiform encephalopathy (BSE) is eaten. It typically affects younger adults. ROI has the second highest rate of vCJD in the world, with four cases reported to date. To complement existing measures adopted to contain the risk of vCJD transmission from transfusion of blood or blood products originating from subclinical carriers of the disease, prion-removing filters have been developed to reduce the risk of vCJD transmission. 

Education, occupation and retirement age effects on the age of onset of Alzheimer’s disease

LUPTON, M.K., STAHL., D., ARCHER, N., FOY, C., POPPE, M., LOVESTONE, S., HOLLINGSWORTH, P., WILLIAMS, J., OWEN, M.J., DOWZELL, K., ABRAHAM., R., SIMS, R., BRAYNE, C., RUBINSZTEIN, D., GILL., M., LAWLOR, B.A., LYNCH, A., POWELL., J.F
International journal of geriatric psychiatry
2010

This study by Lupton et al. (2010) is based on data from a sample of 1,320 people with probably Alzheimer’s disease from the UK and the ROI, who were primarily recruited to investigate candidate genes that may increase susceptibility to Alzheimer’s disease.

Data was analysed (using multiple regression analysis) to determine the effects of early life education, midlife employment and later life age of retirement on the age of onset of Alzheimer’s disease. This study found no effect of education or employment on the age of onset of Alzheimer’s disease, but found a significant effect of a later retirement age in delaying the onset of Alzheimer’s disease.   

The Irish National Dementia Strategy

Department of Health
2014

The Irish National Dementia Strategy, led by the Department of Health, was launched on 17 December 2014. The ROI Government made a commitment in The Programme for Government 2011-2016 to develop a National Dementia Strategy for Ireland by 2013.

The development of the strategy was informed by a research review, a review of international dementia policies/plans/strategies, review of Irish policy contexts, public consultation process, clinicians’ roundtable (2) on the national dementia strategy, workshops (2) with people with dementia and carers, and National Dementia Strategy Advisory Group. The aim of the Strategy is to improve dementia care so that people with dementia can live well for as long as possible, can ultimately die with comfort and dignity, and can have services and supports delivered in the best way possible. The Strategy identifies key principles to underpin and inform the full range of health and social care services provided to people with dementia, their families and carers. Six Priority Areas for Action have been identified in the Strategy, as follows:

  • Better awareness and understanding

  • Timely diagnosis and intervention

  • Integrated services, supports and care for people with dementia and their carers

  • Training and education

  • Research and information systems

  • Leadership

For each of the Priority Action Areas, considered key to the implementation of the Strategy, objectives are outlined, the area is discussed and Additional Actions are also identified. In the context of resource constraints, some of the actions will be implemented based on a review and reconfiguration of existing resources, whilst others will be progressed as resources become available in the future. The Department of Health and the Health Service Executive have agreed a joint initiative with The Atlantic Philanthropies with initial funding of €27.5m, with The Atlantic Philanthropies contributing €12m, and the HSE contributing €15.5m, to be used to implement the Strategy over the period 2014-2017. The National Dementia Implementation Programme aims to promote a greater focus on timely diagnosis of dementia and on the value of early intervention, along with the long-term objective of making people in ROI generally more aware and understanding of the needs of people with dementia, and of the contribution that those with dementia continue to make to our society.

Improving Dementia Services in Northern Ireland: A Regional Strategy

Dept. of Health, Social Services and Public Safety
2011

The Bamford Action Plan 2009-2011 (DHSSPS, 2009) included a commitment by government to develop a regional dementia services strategy.

The Bamford Action Plan 2009-2011 (DHSSPS, 2009) included a commitment by government to develop a regional dementia services strategy.  A consultation process was carried out in 2010 to inform the development of the strategy.  This included consultation with a wide group of stakeholders and a targeted consultation for people living with dementia and their carers.  The strategy was formally launched in 2011 and aims to:

  • Promote a greater understanding of how dementia impacts on the lives of individuals, and how people can be supported to live well, with dignity and as valued members of our society.

  • Raise public awareness of dementia and how people can take some measures to reduce the risk of developing dementia or potentially delay its onset.

  • Encourage sharing of information on dementia to allow individuals, families and carers to make informed decisions.

  • Maximise independence and enhance daily living.

  • Respond to the voice of people with dementia and their carers, and promote access to earlier diagnosis and multidisciplinary assessment and support through further development of health and social care commissioning, thus placing the person with dementia, their families and carers at the centre of the care planning process.

  • Promote partnership working that recognises the pivotal role of carers and integrates the activity and skills of those who work in the statutory, community, voluntary and independent sectors.

The values underpinning the strategy are identified as dignity and respect; autonomy; justice and equality; safe, effective person-centred care; care for carers; and skills for staff.  A series of actions linked to one or more of these values were proposed.  These were reducing the risk or delaying the onset of dementia, raising awareness, promoting early assessment and diagnosis, supporting people with dementia, supporting carers, legislation and research.  The Department of Health, Social Services and Public Safety anticipated that the key actions required to improve services would be likely to cost an additional £6-8m per year. With additional support from The Atlantic Philanthropies, in September 2014 £11 million was allocated within the Delivering Social Change Initiative, targeting Raising Awareness; Information and Support for people living with dementia; Training and Development for those in the caring professions, both formally and informally; and Respite, Short Breaks & Support for Carers.   

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