November dementia current awareness by Musgrove Park Hospital Library

Library Services Musgrove Park and Somerset Partnership

Current Awareness Dementia This monthly Current Awareness Bulletin is produced by the Library, Musgrove Park Academy to provide staff with a range of dementia-related resources to support practice. It includes recently published guidelines and research articles, news and policy items.

This guide provides a selection of resources relevant to the subject area and is not intended to be a comprehensive list. All websites have been evaluated and details are correct at the time of publications. Details correct at time of going to print. Please note that resources are continuously updated. For further help or guidance, please contact a member of library staff.

This guide has been compiled by: Jess Pawley Senior Library Assistant Musgrove Park Hospital Library Service jessica.pawley@tst.nhs.uk

Issue 6 November 2015

Contents Click on a section title to navigate contents Page Recent journal articles

Books

Cochrane Systematic Reviews

Guidelines

UpToDate & DynaMed

Dementia in the News

Reports, publications and resources

Topic Alerts and Updates

Twitter

Training & Networking Opportunities, Conferences, Events

Literature search service

Training and Athens

Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Tel: 01823 34 (2433) Fax: 01823 34 (2434) Email: library@tst.nhs.uk Blog: http://librarymph.wordpress.com @musgrovesompar

RECENT JOURNAL ARTICLES BACK TO TOP This is a list of journal articles on the topic of dementia. Some articles are available in the library or on-line via an OpenAthens password by following the full-text link. If you would like an article which is not available as full-text then please contact library staff. Please note that abstracts are not always available for all articles. Title: Neuropsychological predictors of rapidly progressive Alzheimer's disease Citation: Acta Neurologica Scandinavica, December 2015, vol./is. 132/6(417-422), 0001-6314;16000404 (December 2015) Author(s): Tosto G., Gasparini M., Brickman A.M., Letteri F., Renie' R., Piscopo P., Talarico G., Canevelli M., Confaloni A., Bruno G. Abstract: Objective: Alzheimer's disease (AD), the most common cause of dementia, typically shows a slow clinical progression over time. 'Rapidly progressive' AD, a variant of the disease characterized by an aggressive course, exhibits distinct clinical, biological, and neuropathological features. Here, we investigate neuropsychological predictors of rapid decline in a group of mild patients with AD. Methods: One hundred fifty-three mild patients with AD admitted to a memory disorder clinic and followed for up to 3 years were included in this study. A comprehensive neuropsychological (NP) battery was performed at the time of enrollment. Patients were defined as 'rapidly progressive' if they exhibited a drop of 6 or more points on the Mini Mental State Examination (MMSE) between two consecutive annual visits. This event defined the main outcome in multiple analyses of variance and Cox proportional hazards models that investigated the impact of NP predictors. Categorical principal component analysis (CATPCA) was also employed in order to delineate clusters of NP tests and to test their effect on the outcome. Results: Of 153 subjects, thirty-seven (24%) were classified as 'rapidly progressive'; those subjects showed younger age of symptoms onset compared to slow decliners (68 vs 71.5 years old). Baseline lower performance on a neuropsychological test of naming predicted a rapid decline over the follow-up (P = 0.001). Three clusters of NP were defined by CATPCA: (i) executive/language, (ii) visuospatial memory, and (iii) verbal memory. The executive/language component predicted a rapid decline over the follow-up (P = 0.016). Conclusion: Early executive/language impairment is highly predictive of a rapid progression of AD. ________________________________________________________________________________ Title: Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition. Citation: Age and ageing, Nov 2015, vol. 44, no. 6, p. 993-999 (November 2015) Author(s): Timmons, Suzanne, Manning, Edmund, Barrett, Aoife, Brady, Noeleen M, Browne, Vanessa, O'Shea, Emma, Molloy, David William, O'Regan, Niamh A, Trawley, Steven, Cahill, Suzanne, O'Sullivan, Kathleen, Woods, Noel, Meagher, David, Ni Chorcorain, Aoife M, Linehan, John G Abstract: previous studies have indicated a prevalence of dementia in older admissions of â&#x2C6;ź42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. to determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. six hundred and six patients aged â&#x2030;Ľ70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for

delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. Full text: Available Ovid online collection at Age & Ageing ________________________________________________________________________________ Title: Community environment, cognitive impairment and dementia in later life: results from the Cognitive Function and Ageing Study. Citation: Age and ageing, Nov 2015, vol. 44, no. 6, p. 1005-1011 (November 2015) Author(s): Wu, Yu-Tzu, Prina, A Matthew, Jones, Andrew P, Barnes, Linda E, Matthews, Fiona E, Brayne, Carol, Medical Research Council Cognitive Function and Ageing Study Abstract: few studies have investigated the impact of the community environment, as distinct from area deprivation, on cognition in later life. This study explores cross-sectional associations between cognitive impairment and dementia and environmental features at the community level in older people. the postcodes of the 2,424 participants in the year-10 interview of the Cognitive Function and Ageing Study in England were mapped into small area level geographical units (Lower-layer Super Output Areas) and linked to environmental data in government statistics. Multilevel logistic regression was conducted to investigate associations between cognitive impairment (defined as MMSE ≤ 25), dementia (organicity level ≥3 in GMS-AGECAT) and community level measurements including area deprivation, natural environment, land use mix and crime. Sensitivity analyses tested the impact of people moving residence within the last two years. higher levels of area deprivation and crime were not significantly associated with cognitive impairment and dementia after accounting for individual level factors. Living in areas with high land use mix was significantly associated with a nearly 60% reduced odds of dementia (OR: 0.4; 95% CI: 0.2, 0.8) after adjusting for individual level factors and area deprivation, but there was no linear trend for cognitive impairment. Increased odds of dementia (OR: 2.2, 95% CI: 1.2, 4.2) and cognitive impairment (OR: 1.4, 95% CI: 1.0, 2.0) were found in the highest quartile of natural environment availability. Findings were robust to exclusion of the recently relocated. features of land use have complex associations with cognitive impairment and dementia. Further investigations should focus on environmental influences on cognition to inform health and social policies. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. Full text: Available Ovid online collection at Age & Ageing ________________________________________________________________________________ Title: Uptake of a newly implemented advance care planning program in a dementia diagnostic service. Citation: Age and ageing, Nov 2015, vol. 44, no. 6, p. 1045-1049 (November 2015) Author(s): Lewis, Matthew, Rand, Elizabeth, Mullaly, Elizabeth, Mellor, David, Macfarlane, Stephen Abstract: advance care planning (ACP) provides a framework for discussion and documentation of future care preferences when a person loses cognitive capacity. It can assist people in the early stages of dementia to document their preferences for care at later stages of the illness. a three-stage project introduced ACP to clients with mild cognitive impairment (MCI) or recently diagnosed

dementia and their families through a specialist memory clinic. Over 8 months, all English-speaking clients (n = 97) and carers (n = 92) were mailed a survey assessing completed documentation for future care; understanding of the principles of ACP and willingness to get further information about ACP (Stage 1). Participants wanting more information were invited to a seminar introducing the ACP program and service (Stage 2). Participants wanting to complete ACP documentation could make an appointment with the ACP clinicians (Stage 3). forty-eight (52.2%) carers and 34 clients (35.1%) responded to the survey. Most clients (62.1%) and carers (79.1%) expressed interest in ACP, and 78.6% of clients and 63.6% of carers believed that clients should be involved in their future medical decisions. Nine clients (26.5%; diagnoses: MCI = 5; AD = 3; mixed dementia = 1) and 9 carers (18.8%) attended the seminars, and 2/48 (4%) carers and 3/34 (8.8%) clients (diagnoses: MCI = 2; AD = 1) completed ACP. despite initial interest, ACP completion was low. The reasons for this need to be determined. Approaches that may better meet the needs of people newly diagnosed with MCI and dementia are discussed. ÂŠ The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com. Full text: Available Ovid online collection at Age & Ageing ________________________________________________________________________________ Title: Coping Strategy and Caregiver Burden Among Caregivers of Patients With Dementia. Citation: American journal of Alzheimer's disease and other dementias, Nov 2015, vol. 30, no. 7, p. 694-698 (November 2015) Author(s): Huang, Mei-Feng, Huang, Wen-Hui, Su, Yi-Ching, Hou, Shu-Ying, Chen, Hui-Mei, Yeh, YiChun, Chen, Cheng-Sheng Abstract: This study aims to examine whether coping strategies employed by caregivers are related to distinct symptoms of patients with dementia and to investigate the associations between burden and coping among caregivers of patients with dementia. A cross-sectional study design was used. A total of 57 caregivers of patients with dementia were enrolled. Coping strategies were assessed using the Ways of Coping Checklist, and burden was assessed using the Chinese version of Caregiver Burden Inventory. Correlations between coping and patients' behavior or memory problems were examined. Severities of behavior and memory problems were adjusted to examine the correlations between caregiver burden and coping strategies. The patients' disruptive behavior problems were associated with avoidance, and depression problems were associated with avoidance and wishful thinking. After adjusting for severity of behavior problems, coping strategies using avoidance were positively correlated with caregiver burden. Emotion-focused coping strategies are a marker of caregiver burden. ÂŠ The Author(s) 2013. ________________________________________________________________________________ Title: Association between dementia and postoperative complications after hip fracture surgery in the elderly: analysis of 87,654 patients using a national administrative database. Citation: Archives of orthopaedic and trauma surgery, Nov 2015, vol. 135, no. 11, p. 1511-1517 (November 2015) Author(s): Tsuda, Yusuke, Yasunaga, Hideo, Horiguchi, Hiromasa, Ogawa, Sumito, Kawano, Hirotaka, Tanaka, Sakae Abstract: Mortality following hip fracture surgery is higher in patients with dementia than those without; however, few large-scale studies have investigated postoperative in-hospital complications in such patients. The aim of this study was to elucidate the complications that occur after hip fracture surgery in patients with and without dementia using a large national database. We retrospectively identified patients aged â&#x2030;Ľ70 years who underwent hemiarthroplasty, osteosynthesis for femoral neck fracture or osteosynthesis for intertrochanteric fracture, and compared the occurrence of

postoperative complications between patients with and without dementia. Multivariate logistic regression analysis was performed to adjust for patient characteristics and hospital factors. A total of 87,654 patients were included in this study, including 9419 with dementia. Compared with the nondementia group, the dementia group showed a higher incidence of overall postoperative complications [odds ratio (OR) 1.45; p < 0.001), surgical site infection (OR 1.58; p = 0.004), urinary tract infection (OR 1.87; p < 0.001) and respiratory complications (OR 1.49; p < 0.001). The rate of postoperative complications was higher for all types of hip fracture surgery. The occurrence of a postoperative complication was significantly higher in patients aged â&#x2030;Ľ80 years (OR 1.37; p < 0.001) and those with dementia (OR 1.45; p < 0.001), any type of malignancy (OR 1.42; p < 0.001), a history of cardiovascular disease (OR 1.33; p < 0.001), a history of cerebrovascular disease (OR 1.15; p = 0.029), chronic renal failure (OR 1.36; p < 0.001), liver cirrhosis (OR 1.41; p < 0.001) or blood transfusion after surgery (OR 1.49; p < 0.001). Our results highlight the need to pay particular attention to surgical site infection, urinary tract infection and respiratory complications in patients with preoperative dementia after hip fracture surgery. These results provide additional useful evidence to inform the management of these patients. ________________________________________________________________________________ Title: Pain and temperature processing in dementia: a clinical and neuroanatomical analysis. Citation: Brain : a journal of neurology, Nov 2015, vol. 138, p. 3360-3372 (November 2015) Author(s): Fletcher, Phillip D, Downey, Laura E, Golden, Hannah L, Clark, Camilla N, Slattery, Catherine F, Paterson, Ross W, Rohrer, Jonathan D, Schott, Jonathan M, Rossor, Martin N, Warren, Jason D Abstract: Symptoms suggesting altered processing of pain and temperature have been described in dementia diseases and may contribute importantly to clinical phenotypes, particularly in the frontotemporal lobar degeneration spectrum, but the basis for these symptoms has not been characterized in detail. Here we analysed pain and temperature symptoms using a semi-structured caregiver questionnaire recording altered behavioural responsiveness to pain or temperature for a cohort of patients with frontotemporal lobar degeneration (n = 58, 25 female, aged 52-84 years, representing the major clinical syndromes and representative pathogenic mutations in the C9orf72 and MAPT genes) and a comparison cohort of patients with amnestic Alzheimer's disease (n = 20, eight female, aged 53-74 years). Neuroanatomical associations were assessed using blinded visual rating and voxel-based morphometry of patients' brain magnetic resonance images. Certain syndromic signatures were identified: pain and temperature symptoms were particularly prevalent in behavioural variant frontotemporal dementia (71% of cases) and semantic dementia (65% of cases) and in association with C9orf72 mutations (6/6 cases), but also developed in Alzheimer's disease (45% of cases) and progressive non-fluent aphasia (25% of cases). While altered temperature responsiveness was more common than altered pain responsiveness across syndromes, blunted responsiveness to pain and temperature was particularly associated with behavioural variant frontotemporal dementia (40% of symptomatic cases) and heightened responsiveness with semantic dementia (73% of symptomatic cases) and Alzheimer's disease (78% of symptomatic cases). In the voxel-based morphometry analysis of the frontotemporal lobar degeneration cohort, pain and temperature symptoms were associated with grey matter loss in a right-lateralized network including insula (P < 0.05 corrected for multiple voxel-wise comparisons within the prespecified anatomical region of interest) and anterior temporal cortex (P < 0.001 uncorrected over whole brain) previously implicated in processing homeostatic signals. Pain and temperature symptoms accompanying C9orf72 mutations were specifically associated with posterior thalamic atrophy (P < 0.05 corrected for multiple voxel-wise comparisons within the prespecified anatomical region of interest). Together the findings suggest candidate cognitive and neuroanatomical bases for these salient but underappreciated phenotypic features of the dementias, with wider implications for the homeostatic pathophysiology and clinical management of neurodegenerative diseases. ÂŠ The Author (2015).

Published by Oxford University Press on behalf of the Guarantors of Brain. ________________________________________________________________________________ Title: Development and preliminary evaluation of the anxiety in cognitive impairment and dementia (ACID) scales. Citation: International psychogeriatrics / IPA, Nov 2015, vol. 27, no. 11, p. 1825-1838 (November 2015) Author(s): Gerolimatos, Lindsay A, Ciliberti, Caroline M, Gregg, Jeffrey J, Nazem, Sarra, Bamonti, Patricia M, Cavanagh, Casey E, Edelstein, Barry A Abstract: Although rates of anxiety tend to decrease across late life, rates of anxiety increase among a subset of older adults, those with mild cognitive impairment (MCI) or dementia. Our understanding of anxiety in dementia is limited, in part, by a lack of anxiety measures designed for use with this population. This study sought to address limitations of the literature by developing a new measure of anxiety for cognitively impaired individuals, the anxiety in cognitive impairment and dementia (ACID) Scales, which includes both proxy (ACID-PR) and self-report (ACID-SR) versions. The ACID-SR and ACID-PR were administered to 45 residents, aged 60 years and older, of three long-term care (LTC) facilities, and 38 professional caregivers at these facilities. Other measures of anxiety, and measures of depression, functional ability, cognition, and general physical and mental health were also administered. Initial evaluation of its psychometric properties revealed adequate to good internal consistency for the ACID-PR and ACID-SR. Evidence for convergent validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by moderate-to-strong associations with measures of worry, depressive symptoms, and general mental health. Discriminant validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by weak correlations with measures of cognition, functional ability, and general physical well-being. The preliminary results suggest that the ACID-SR and ACID-PR can obtain reliable and valid measures of anxiety among individuals with cognitive impairment. Given the subjective nature of anxiety, it may be prudent to collect self-report of anxiety symptoms even among those with moderate cognitive impairment. ________________________________________________________________________________ Title: Impact of caregivers' behaviors on resistiveness to care and collaboration in persons with dementia in the context of hygienic care: an interactional perspective. Citation: International psychogeriatrics / IPA, Nov 2015, vol. 27, no. 11, p. 1861-1873 (November 2015) Author(s): Belzil, Guylaine, VĂŠzina, Jean Abstract: The role played by various physical and verbal behaviors of professional caregivers in the onset of resistiveness to care (RTC) and collaborative behaviors of nursing home residents with dementia was assessed in a daily hygienic care routine context. Two hundred and forty hygienic care routines, observed in eight nursing home residents, were analyzed with a video-assisted systematic observation methodology and a sequential statistical analysis strategy. Caregiver and care recipient behaviors are interdependent in the hygienic care routine context. Physical instrumental behavior, neutral, negative and positive statements, positive and negative instructions, and verbal distraction emitted by caregivers are significantly and moderately associated with the onset of RTC in persons with dementia (PWD), but the strength of relationships observed depends on the care recipient's behavior prior to the caregiver's action. Positive instructions are moderately associated with the onset of collaboration in residents with preserved language abilities. However, for residents with severe language impairment, these same instructions were linked to RTC behaviors. Although antecedents to RTC can be identified, the risk that caregiver behaviors trigger resistive responses is higher when care recipients are already exhibiting RTC, and is low when no particular behavior or collaboration is shown. Antecedents to collaboration are also identified and discussed. Although different caregiver behaviors may be more or less likely to elicit resistiveness or collaboration, it is the pre-existing state

of the care recipient that will determine its reaction to the caregiver's behavior. Clinical implications emerging from these influential findings are elaborated. ________________________________________________________________________________ Title: Enabling resources in people with dementia: a qualitative study about nurses' strategies that may support a sense of coherence in people with dementia. Citation: Journal of clinical nursing, Nov 2015, vol. 24, no. 21-22, p. 3129-3137 (November 2015) Author(s): Lillekroken, Daniela, Hauge, Solveig, SlettebĂ¸, Ă&#x2026;shild Abstract: To explore nurses' strategies that may support the sense of coherence in people with dementia. People with dementia are often described as people with no resources, people who need support from family or from healthcare personnel to function in everyday life. Despite the disease, some people still have the resources needed to cope well with parts of their lives and experience coherence. To date, no research has explored any nurses' strategies that may support the sense of coherence in people with dementia. The design of the study is qualitative and exploratory. Data were collected by participant observation and focus group interviews. Sixteen registered nurses from two different Norwegian nursing homes were recruited and participated in the study. Qualitative content analysis was used to analyse the data. The empirical material consisted of field notes from participant observation and transcripts from focus group interviews. Three generic categories were identified as strategies that may support sense of coherence in people with dementia: 'Finding and nurturing the individual's resources', 'Customising meaningful activities' and 'Finding creative solutions'. These categories were identified as strategies that may support and possibly enhance the sense of coherence in people with dementia. The findings provide an empirical base for assuming that with support and help from nurses, people with dementia may experience and strengthen their sense of coherence, therefore, the nurses need to be aware of the activities that may support and possibly enhance the sense of coherence in people with dementia. Despite the contextual limitations, this study highlights the need to identify and nurture resources in people with dementia, thus supporting their sense of coherence. The findings may contribute in enhancing the quality of care for people with dementia. ÂŠ 2015 John Wiley & Sons Ltd. ________________________________________________________________________________ Title: Using visual rating to diagnose dementia: a critical evaluation of MRI atrophy scales. Citation: Journal of neurology, neurosurgery, and psychiatry, Nov 2015, vol. 86, no. 11, p. 1225-1233 (November 2015) Author(s): Harper, Lorna, Barkhof, Frederik, Fox, Nick C, Schott, Jonathan M Abstract: Visual rating scales, developed to assess atrophy in patients with cognitive impairment, offer a cost-effective diagnostic tool that is ideally suited for implementation in clinical practice. By focusing attention on brain regions susceptible to change in dementia and enforcing structured reporting of these findings, visual rating can improve the sensitivity, reliability and diagnostic value of radiological image interpretation. Brain imaging is recommended in all current diagnostic guidelines relating to dementia, and recent guidelines have also recommended the application of medial temporal lobe atrophy rating. Despite these recommendations, and the ease with which rating scales can be applied, there is still relatively low uptake in routine clinical assessments. Careful consideration of atrophy rating scales is needed to verify their diagnostic potential and encourage uptake among clinicians. Determining the added value of combining scores from visual rating in different brain regions may also increase the diagnostic value of these tools. 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. Full text: Available Highwire Press at Journal of neurology, neurosurgery, and psychiatry

________________________________________________________________________________ Title: Impaired imitation of gestures in mild dementia: comparison of dementia with Lewy bodies, Alzheimer's disease and vascular dementia. Citation: Journal of neurology, neurosurgery, and psychiatry, Nov 2015, vol. 86, no. 11, p. 1248-1252 (November 2015) Author(s): Nagahama, Yasuhiro, Okina, Tomoko, Suzuki, Norio Abstract: To examine whether imitation of gestures provided useful information to diagnose early dementia in elderly patients. Imitation of finger and hand gestures was evaluated in patients with mild dementia; 74 patients had dementia with Lewy bodies (DLB), 100 with Alzheimer's disease (AD) and 52 with subcortical vascular dementia (SVaD). Significantly, more patients with DLB (32.4%) compared with patients with AD (5%) or SVaD (11.5%) had an impaired ability to imitate finger gestures bilaterally. Also, significantly, more patients with DLB (36.5%) compared with patients with AD (5%) or SVaD (15.4%) had lower mean scores of both hands. In contrast, impairment of the imitation of bimanual gestures was comparable among the three patient groups (DLB 50%, AD 42%, SVaD 42.3%). Our study revealed that imitation of bimanual gestures was impaired non-specifically in about half of the patients with mild dementia, whereas imitation of finger gestures was significantly more impaired in patients with early DLB than in those with AD or SVaD. Although the sensitivity was not high, the imitation tasks may provide additional information for diagnosis of mild dementia, especially for DLB. 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. Full text: Available Highwire Press at Journal of neurology, neurosurgery, and psychiatry ________________________________________________________________________________ Title: Tools to Assess Pain or Lack of Comfort in Dementia: A Content Analysis. Citation: Journal of pain and symptom management, Nov 2015, vol. 50, no. 5, p. 659 (November 2015) Author(s): van der Steen, Jenny T, Sampson, Elizabeth L, Van den Block, Lieve, Lord, Kathryn, Vankova, Hana, Pautex, Sophie, Vandervoort, An, Radbruch, Lukas, Shvartzman, Pesach, Sacchi, Valentina, de Vet, Henrica C W, Van Den Noortgate, Nele J A, EU-COST Action TD1005 Collaborators Abstract: There is need for tools to help detect pain or lack of comfort in persons unable to communicate. However, pain and (dis)comfort tools have not been compared, and it is unclear to what extent they discriminate between pain and other possible sources of discomfort, or even if items differ. To map and compare items in tools that assess pain and the broader notion of discomfort or comfort in people with severe dementia or at the end of life. Using qualitative content analysis with six classifications, we categorized each item of four thoroughly tested observational pain tools (Pain Assessment in Advanced Dementia [PAINAD], Pain Assessment Checklist for Seniors with Limited Ability to Communicate [PACSLAC], Doloplus-2, and draft Pain Assessment in Impaired Cognition [PAIC]), and four discomfort tools (including distress, comfort, and quality of life in severe dementia or at the end of life; Discomfort Scale-Dementia Alzheimer Type [DS-DAT], Disability Distress Assessment Tool [DisDAT], End-of-Life in Dementia-Comfort Assessment in Dying with Dementia [EOLD-CAD], and Quality of Life in Late-Stage Dementia [QUALID] scale). We calculated median proportions to compare distributions of categories of pain and discomfort tools. We found that, despite variable content across tools, items from pain and discomfort tools overlapped considerably. For example, positive elements such as smiling and spiritual items were more often included in discomfort tools but were not unique to these. Pain tools comprised more "mostly descriptive" (median 0.63 vs. 0.44) and fewer "highly subjective" items (0.06 vs. 0.18); some used time inconsistently, mixing present and past observations. This analysis may inform a more rigorous theoretical underpinning

and (re)development of pain and discomfort tools and calls for empirical testing of a broad item pool for sensitivity and specificity in detecting and discriminating pain from other sources of discomfort. Copyright ÂŠ 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. ________________________________________________________________________________ Title: Brain health and shared risk factors for dementia and stroke. Citation: Nature reviews. Neurology, Nov 2015, vol. 11, no. 11, p. 651-657 (November 2015) Author(s): Gardener, Hannah, Wright, Clinton B, Rundek, Tatjana, Sacco, Ralph L Abstract: Impaired brain health encompasses a range of clinical outcomes, including stroke, dementia, vascular cognitive impairment, cognitive ageing, and vascular functional impairment. Conditions associated with poor brain health represent leading causes of global morbidity and mortality, with projected increases in public health burden as the population ages. Many vascular risk factors are shared predictors for poor brain health. Moreover, subclinical brain MRI markers of vascular damage are risk factors shared between stroke and dementia, and can be used for risk stratification and early intervention. The broad concept of brain health has resulted in a conceptual shift from vascular risk factors to determinants of brain health. Global campaigns to reduce cardiovascular diseases by targeting modifiable risk factors are necessary and will have a broad impact on brain health. Research is needed on the distinct and overlapping aetiologies of brain health conditions, and to define MRI markers to help clinicians identify patients who will benefit from aggressive prevention measures. Full text: Available Nature Publishing Group at Nature Reviews Neurology ________________________________________________________________________________ Title: Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack and Stroke: (III) Applicability of Cognitive Tests. Citation: Stroke; a journal of cerebral circulation, Nov 2015, vol. 46, no. 11, p. 3067-3073 (November 2015) Author(s): Pendlebury, Sarah T, Klaus, Stephen P, Thomson, Ross J, Mehta, Ziyah, Wharton, Rose M, Rothwell, Peter M, Oxford Vascular Study Abstract: Cognitive assessment is recommended after stroke but there are few data on the applicability of short cognitive tests to the full spectrum of patients. We therefore determined the rates, causes, and associates of untestability in a population-based study of all transient ischemic attack (TIA) and stroke. Patients with TIA or stroke prospectively recruited (2002-2007) into the Oxford Vascular Study had â&#x2030;Ľ1 short cognitive test (mini-mental state examination, telephone interview of cognitive status, Montreal cognitive assessment, and abbreviated mental test score) at baseline and on follow-up to 5 years. Among 1097 consecutive assessed survivors (mean: age/SD, 74.8/12.1 years; 378 TIA), numbers testable with a short cognitive test at baseline, 1, 6, 12, and 60 months were 835/1097 (76%), 778/947 (82%), 756/857 (88%), 692/792 (87%), and 472/567 (83%). Eightyeight percent (331/378) of assessed patients with TIA were testable at baseline compared with only 46% (133/290) of major stroke (P<0.001). Untestability was also associated with older age, premorbid dependency, death on follow-up, and with both pre- and postevent dementia (all P<0.01). Untestability (and problems with testing) were commonly caused by acute stroke effects at baseline (153/262 [58%]: dysphasia/anarthria/hemiparesis=84 [32%], drowsiness=58 [22%], and acute confusion=11 [4%]), whereas sensory deficits caused relatively more problems with testing at later time points (24/63 [38%] at 5 years). Substantial numbers of patients with TIA and stroke are untestable with short cognitive tests. Future studies should report data on untestable patients and those with problems with testing in whom the likelihood of dementia is high. ÂŠ 2015 American Heart Association, Inc.

________________________________________________________________________________ Title: Improving the hospital environment for people with dementia. Citation: Nursing older people, Oct 2015, vol. 27, no. 9, p. 16-20, 1472-0795 (October 29, 2015) Author(s): Bray, Jennifer, Evans, Simon, Bruce, Mary, Carter, Christine, Brooker, Dawn, Milosevic, Sarah, Thompson, Rachel, Longden, Jane, Robinson, Jennifer Abstract: This article is the third in a series presenting examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. The hospital environment is often disorientating for people with dementia and can be particularly distressing when a patient is admitted in an emergency. Subsequent ward moves can also be disruptive and confusing, especially if they take place out of hours. Two NHS trusts aimed to improve the experience for patients with dementia by addressing the physical environment along with practical aspects of care provision at different stages in the hospital journey. The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust in Norfolk enhanced its emergency department environment by redesigning four bays and an observation area to be dementia-friendly. The hospital has supported these changes by providing dementia awareness training for all staff in these areas. Walsall Healthcare NHS Trust focused on minimising ward moves by implementing procedures to identify patients who should not be moved. Since introducing the new process, adherence has been good and there have been fewer ward moves. Full text: Available RCN Publishing at Nursing Older People Full text: Available RCN Publishing at Nursing Older People ________________________________________________________________________________ Title: Dementia Friends sessions for nursing students. Citation: Nursing older people, Oct 2015, vol. 27, no. 9, p. 34-38, 1472-0795 (October 29, 2015) Author(s): Baillie, Lesley, Beecraft, Susan, Woods, Sandie Abstract: All health and social care students must learn about dementia in the curriculum. This article explains how Dementia Friends sessions, which aim to raise awareness about dementia, were delivered in the students' induction at one university. The objective was for all new students to understand some important facts about dementia, thus addressing any misconceptions at an early stage and establishing a foundation for further learning. The sessions were evaluated through an analysis of written comments, which indicated that nursing students enjoyed the sessions and had learnt the five facts about dementia. Students intended to apply their learning through: changes in attitudes and interactions, raising awareness, volunteering, supporting people with dementia in the community, seeking further knowledge and personal support to their families. After this positive response, Dementia Friends sessions will continue to be delivered during induction for undergraduate health and social care students. Full text: Available RCN Publishing at Nursing Older People Full text: Available RCN Publishing at Nursing Older People ________________________________________________________________________________ Title: Pain management: a fundamental component of dementia care. Citation: Nursing standard (Royal College of Nursing (Great Britain) : 1987), Oct 2015, vol. 30, no. 9, p. 43-50 (October 28, 2015) Author(s): Regan, Ann, Colling, Jane, Tapley, Michael Abstract: Pain is a multifaceted experience with physical, psychological, social and spiritual components. Dementia, which is often accompanied by impaired communication, complicates the assessment and treatment of pain. Although older people with dementia share the same age-related pathology as other older people, they do not experience the same access to pain relief as their

cognitively-unimpaired counterparts. Tools have been developed to enhance self-reporting of pain by people with dementia and the objective observation of non-verbal signs of pain. The first step, however, is awareness that pain might be present and can be responsible for otherwise unexplained distress and behaviour change. Recognition of pain should trigger the appropriate and timely use of pain assessment tools. Pharmaceutical and non-pharmaceutical measures to relieve pain should be used as appropriate. Evaluation of the efficacy of these methods is needed on an ongoing basis. People living with dementia deserve to be listened to, no matter how they choose to express pain, and to have their pain minimised effectively and efficiently. ________________________________________________________________________________ Title: Eating behavior in frontotemporal dementia: Peripheral hormones vs hypothalamic pathology. Citation: Neurology, Oct 2015, vol. 85, no. 15, p. 1310-1317 (October 13, 2015) Author(s): Ahmed, Rebekah M, Latheef, Sahar, Bartley, Lauren, Irish, Muireann, Halliday, Glenda M, Kiernan, Matthew C, Hodges, John R, Piguet, Olivier Abstract: To contrast the relationships of hormonal eating peptides and hypothalamic volumes to eating behavior and metabolic changes (body mass index [BMI]) in behavioral variant frontotemporal dementia (bvFTD) and semantic variant primary progressive aphasia (svPPA). Seventy-five patients with dementia (19 bvFTD, 26 svPPA, and 30 Alzheimer disease dementia) and 23 controls underwent fasting blood analyses of leptin, ghrelin, cholecystokinin, peptide tyrosine tyrosine (PYY), and agoutirelated peptide (AgRP) levels. On brain MRI anterior, posterior, and total hypothalamic volumes were measured. Relationships between endocrine measures, hypothalamic volumes, eating behaviors, and BMI were investigated. Levels of AgRP were higher in patients with bvFTD (69 ± 89 pg/mL) and svPPA (62 ± 81 pg/mL) compared with controls (23 ± 19 pg/mL, p < 0.01). No differences were found for leptin, oxytocin, cholecystokinin, ghrelin, and PYY levels. Patients with bvFTD and svPPA had higher scores on questionnaires measuring eating behaviors. Atrophy of the posterior and total hypothalamus was observed in the bvFTD group only. Linear regression modeling revealed that leptin and AgRP levels predicted BMI. Eating abnormalities are multifactorial in FTD. In bvFTD, they are in part related to hypothalamic degeneration, with potential disintegration of the network connections between the hypothalamus and orbitofrontal cortex/reward pathways. In svPPA, although hypothalamic volumes are preserved, this group experiences elevated AgRP levels similar to bvFTD, which predicts BMI in both groups. This finding highlights the potential key role of AgRP in eating and metabolic changes and provides a potential target for treatment to modify disease progression. © 2015 American Academy of Neurology. Full text: Available Ovid online collection at Neurology ________________________________________________________________________________

BOOKS BACK TO TOP If you are unable to find a book, or require a book that is not on this list, please ask library staff who will be able to locate the book for you using interlibrary loan. Books available to borrow on the topic of pain management in dementia Aging and dementia: neuropsychology, motor skills and pain Scherder 2011

Dementia: From advanced disease to bereavement Pace 2011

From the back of the book: Drawing on the most current research, The book explains why changes in cognition, motor skills, and pain are typical for the elderly while describing the most prevalent subtypes of dementia, including Alzheimer's disease, vascular dementia, and frontotemporal dementia. Focusing on the motor skills of hand motor activity and gait, the study also illustrates changes in the various aspects of pain experience, explaining them clearly through the use of neuropathology of the medial and lateral pain systems. Updates concerning compensation and rehabilitation are also included.

From the back of the book: This book concentrates on advanced disease andaddresses issues such as pain management, decision-making, spiritual needs, communication, the Mental Health Capacity Act, dementia in the younger patient, and the carer's perspective.Written by specialists, this book will be invaluable for doctors and nurses involved in palliative medicine, geriatrics, and old-age psychiatry, and the generalist who treats the patient with dementia.

Taunton and SomPar NHS staff - Have you visited the EBL eBook catalogue? Follow the links below and login via OpenAthens to read online books free for 5-10 minutes each day, send requests for eBook loans or purchase suggestions Taunton & Somerset eBook catalogue

Somerset Partnership eBook catalogue

About OpenAthens

COCHRANE SYSTEMATIC REVIEWS BACK TO TOP Reviews from October 2015 Montreal Cognitive Assessment for the diagnosis of Alzheimerâ&#x20AC;&#x2122;s disease and other dementias

Protocols from October 2015 Information, support and training for informal caregivers of people with dementia Dietary interventions for prevention of dementia in people with mild cognitive impairment Vitamin and mineral supplementation for prevention of dementia or delaying cognitive decline in people with mild cognitive impairment

GUIDELINES BACK TO TOP NICE Guidelines NG16: Disability, dementia and frailty in later life- mid-life approaches to prevention- October 2015

UPTODATE & DYNAMED BACK TO TOP Whatâ&#x20AC;&#x2122;s new from our clinical decision-making tools on the topic of dementia. UpToDate (Access for Musgrove Park Staff only) DynaMed Please contact library staff for details on how to access these resources; you will need an Athens password.

DEMENTIA IN THE NEWS BACK TO TOP Behind the Headlines Warning about middle-aged drinking and dementia

BBC News Dementia drug ‘keeps patients out of nursing homes’

REPORTS, PUBLICATIONS AND RESOURCES BACK TO TOP NICE Pathway on Dementia NICE Pathway on Dementia, Disability and Frailty in Later Life: Mid-Life Approaches to Delay or Prevent Onset overview SCIE (Social Care Institute for Excellence) Dementia Gateway Estimation of future cases of dementia from those born in 2015 Alzheimer’s research UK Office of Health Economics Report

Improving Dementia Education and Awareness (IDEA)- Online resource created by the University of Nottingham, listing online courses, news, events and resources. User friendly medicines for Alzheimer’s disease The Medicines and Healthcare products Regulatory Agency is working with the pharmaceutical industry to optimise the way medicines for the treatment of Alzheimer’s disease are packaged. All these medicines will include the days of the week clearly on the blister packs. This change is designed to enable patients to retain independence in taking their medicines. It could have the added effect of aiding compliance with dosage regimens and ultimately maximising the efficacy of treatment for patients. The improved packaging will be introduced from June 2016. A better way to care: Safe and high-quality care for patients with cognitive impairment (dementia and delirium) in hospital The Australian Commission on Safety and Quality in Health Care has developed three resources to guide health service managers, clinicians and consumers in improving care of people with cognitive impairment. RemindMeCare Launched Trialled at Royal Bedfordshire and supported by the Royal Free, RemindMeCare addresses many

issues faced in the dementia care process, such as calming strategies based on knowledge of the person with dementia, reminiscence therapy using highly bespoke images to optimise engagement, response recording and music playlists that are automated and specific to the individual. Dementia Core Skills Education and Training Framework Health Education England has launched a new resource to support health and social care staff and educators who work with people living with dementia and their carers. The Dementia Core Skills Education and Training Framework sets out the essential skills and knowledge necessary for all staff involved in dementia care. Leading a healthier lifestyle can delay dementia, disability and frailty in later life People should be encouraged to stop smoking, be more physically active, reduce their alcohol consumption, and adopt a healthy diet to help lower the risk of developing dementia, disability and frailty in later life. Nutritional support for dementia patients Imperial College Healthcare Charity has funded a project to help with nutritional needs of dementia inpatients at the Imperial College Healthcare NHS Trust. A manual for good social work practice- supporting adults who have dementia This document aims to provide good practice guidance for adult social workers specialising in dementia. Prevalence of dementia in population groups by protected characteristics: a systematic review of the literature This systematic review from Public Health England examines evidence on how the prevalence of dementia varies with socio-economic position; race or ethnic group; religion or belief; gender; sexual orientation or disability. The review is for commissioners and providers of dementia services, PHE knowledge and intelligence team, researcher funding bodies and researchers and policy makers. Dementia day programmes: how can we tell if they are effective? Community-based dementia day programmes are designed to improve the mental and physical wellbeing of people with dementia and their carers. An additional key driver for the programmes is to keep people with dementia living at home for as long as possible.

TOPIC ALERTS AND UPDATES BACK TO TOP ABSTRACTS AVAILABLE VIA LINKS BELOW- FOR FULL-TEXT PLEASE ASK LIBRARY STAFF Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (DOMINO-AD) trial: secondary and post-hoc analyses Lancet Neurology, Published Online:26 October 2015

Elsevier Practice Updates Detailed comparison of amyloid PET and CSF biomarkers for identifying early Alzheimer disease Neurology October 6, 2015 vol. 85 no. 14 1240-1249 Spectrum of cognition short of dementia Neurology, Published online before print October 9, 2015 Medscape Topic Alerts GWAS of longitudinal amyloid accumulation on 18F-florbetapir PET in Alzheimerâ&#x20AC;&#x2122;s disease implicates microglial activation gene IL1RAP Brain. 2015;138:3076-3088 Telomere Length Shortening and Alzheimer Disease-A Mendelian Randomization Study JAMA Neurol. 2015;72(10):1202-1203 The Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life Burden of Health Care Costs for Patients With Dementia Ann Intern Med. Published online 27 October 2015 Association Between Alzheimer Dementia Mortality Rate and Altitude in California Counties JAMA Psychiatry. Published online October 21, 2015

Memory complaints and risk of cognitive impairment after nearly 2 decades among older women Neurology, Published online before print October 28, 2015 TRIP Database Raloxifene for women with Alzheimer disease: A randomized controlled pilot trial Neurology. 2015 Nov 4. Identification of the palliative phase in people with dementia: a variety of opinions between healthcare professionals BMC Palliat Care. 2015; 14: 56. FREE FULL TEXT Web-based STAR E-Learning course increases empathy and understanding in dementia caregivers: results from a randomized controlled trial in the Netherlands and the United Kingdom J Med Internet Res 2015;17(10):e241

The burden of healthcare costs for patients with dementia in the last 5 years of life Ann Intern Med. 2015 Oct 27 No Effect of Omega-3 Fatty Acid Supplementation on Cognition and Mood in Individuals with Cognitive Impairment and Probable Alzheimer's Disease: A Randomised Controlled Trial. Int J Mol Sci. 2015 Oct 16;16(10):24600-13 FREE FULL TEXT Tau PET imaging in aging and early Alzheimer's disease. Ann Neurol. 2015 Oct 27 Dementia Knowledge Assessment Scale: Development and Preliminary Psychometric Properties J Am Geriatr Soc. 2015 Oct 27

TWITTER BACK TO TOP The latest from popular Twitter pages dedicated to dementia: Dementia UK @DementiaUK Alzheimer’s Society @alzheimerssoc Dementia Today @DementiaToday Dementia Friends @DementiaFriends

TRAINING & NETWORKING OPPORTUNITIES, CONFERENCES, EVENTS BACK TO TOP

Alzheimer’s Society Training and resources Dementia training for care providers Health Education England Dementia awareness training RCN Ongoing work at the RCN on dementia care

Alzheimer’s Research UK Research Conference- 8 March 2016, Manchester th

Dementia 2020- Transforming Care, Support and Research- 12 April 2016 st

31 International Conference of Alzheimer’s Disease International- 21 -24 April 2016, Budapest

LITERATURE SEARCH SERVICE BACK TO TOP Looking for the latest evidence-based research but havenâ&#x20AC;&#x2122;t got time to trawl the databases? Do you need a literature search carried out? Do you need to find evidence to support an improvement? Do you want to know how something has been done elsewhere and whether it worked?

Library staff provide a literature search service for busy clinicians who are pressed for time.

To request a search please complete and return the appropriate form, providing as much information as possible. Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library. Musgrove staff click here to access literature search form Somerset Partnership staff click here to access literature search form

TRAINING AND ATHENS BACK TO TOP Most electronic resources are available via an Athens password. You can register for this via the Library intranet page, or from home at www.swice.nhs.uk and following the link for Athens selfregistration. Please note that registering from home will take longer as it will need to be verified that you are NHS staff/student on placement. The library offers training on how to access and use Athens resources, as well as an introductory course on critical appraisal. You can book a course through the Learning and Development intranet page, or by contacting the library directly.