Dementia prevention, intervention, and care

Abstract

People with dementia are usually older, often have co-morbidities and may need help in coping with these illnesses. A third of older people now die with dementia and all professionals working in endof-life care need to make this a central part of their planning and communication. In this commission, we have detailed evidence-based approaches to dementia and its symptoms. Services should be available, scalable and give value. As there are limited resources, professionals and services need to use what works, not use what is ineffective, and be aware of the difference. Overall, there is good potential for prevention and, once someone develops dementia, for care to be high-quality, accessible, and give value to an under-served, growing population. Effective dementia prevention and care could transform the future for society and vastly improve living and dying for individuals with dementia and their families. Acting now on what we already know can make this difference happen. Key Messages 1 There are increasing numbers of people with dementia globally although incidence in some countries has decreased. 2 Be ambitious about prevention: We recommend energetically treating hypertension in middle aged and older people without dementia to reduce dementia incidence. Interventions for other risk factors, including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes and obesity; may have the potential of delaying or preventing a third of dementias. 3 Treat cognitive symptoms: To maximise cognition, people with Alzheimer's dementia or Dementia with Lewy Bodies should be offered Cholinesterase Inhibitors (ChEIs)at all stages, or memantine for severe dementia. ChEIs are not effective in Mild Cognitive Impairment. 4 Individualise dementia care: Good dementia care spans medical, social and supportive care, should be tailored to unique individual and cultural needs, preferences, priorities, and should incorporate support for the family carers 5 Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, include START (Strategies for Relatives) or REACH (Resources for Enhancing Alzheimer's Caregiver Health intervention) and should be made available. 6 Plan for the future. People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis. 7 Protect people with dementia. People with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability including to exploitation, managing money, driving or using weapons. Risk assessment and management at all stages of the disease is essential but it should be balanced against the persons' right to autonomy. 8 Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia including agitation, low mood or psyc...

Demenz als interdisziplinäres Thema von Alter(n)swissenschaft und Alter(n)smedizin

“…Seit 1995, dem Beginn der Erfassung in PubMed, wurden 1801 Beiträge aus unserer Zeitschrift in dieser Datenbank gelistet, 314 davon, also 17,4 %, sind mit dem Schlagwort "dementia" verknüpft (Stand 12.08.2017 Vor dem Hintergrund neuerer Erkenntnisse, wonach etwa ein Drittel der für Demenz relevanten Risikofaktoren potenziell modifizierbar ist, nähren epidemiologische Daten die Erwartung, dass sich die Kurve der altersbezogenen Erkrankungsrate abflachen könnte [4]. Weiterhin besteht die begründete Hoffnung, dass weltweite neurobiologische und klinische Forschung zukünftig Früchte trägt und krankheitsmodifizierende Therapien entwickelt werden.…”

“…Exemplarisch sei an präventive und therapeutische Maßnahmen in Bezug auf die Demenzen häufig begleitenden psychischen und Verhaltensstörungen erinnert, die eine personalintensive und fachlich qualifizierte Betreuung gleichermaßen erfordern [4]. Auch wenn sich bisher längst nicht alle Hoffnungen, die in neue Therapien gesetzt wurden, erfüllt haben, so ist doch hervorzuheben, dass die wachsenden Erkenntnisse zu präven-tiven Strategien und die Möglichkeiten, vorhandenes Wissen zu fachübergreifen-den und multiprofessionellen Interventionen umzusetzen, einer immer noch verbreiteten resignativen Einstellung zu Demezerkrankungen entgegen stehen [4,6].…”

The IDEMCare Study—Improving Dementia Care in Black African and Caribbean Groups: A feasibility cluster randomised controlled trial

“…National and international strategies prioritise early detection of dementia,1 which have led to a significant increase in investment, research, training, and the number of people being diagnosed 2. However, Black and Minority Ethnic (BME) populations access dementia services later in their illness,3, 4, 5, 6, 7 despite being at higher risk of dementia than their White counterparts 8.…”

Successful institutional care for behavioral and psychological symptoms of dementia in a repopulated area after the 2011 Fukushima disaster: A case report

“…The prevalence of BPSD is an impending issue because of the increasing number of dementia patients worldwide 2, 3. There were about 47 million people with dementia worldwide in 2015.…”

“…More than 50% of dementia patients develop BPSD in their lifetime, cumulatively imposing a marked burden on an aging society 2, 4. BPSD impair the dementia patients’ daily lives2 and can impose a significant caregiver burden 5. It is therefore important for BPSD patients to receive formal long‐term care.…”