Trends in diagnosis and treatment for people with dementia in the UK from 2005 to 2015: a longitudinal retrospective cohort study

Donegan, Katherine; Fox, Nick C.; Black, Nick; Livingston, Gill; Banerjee, Sube; Burns, Alistair

doi:10.1016/s2468-2667(17)30031-2

Cited by 120 publications

(130 citation statements)

References 21 publications

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“…Furthermore, studies such as clinical practice research datalink have highlighted the need for national policies to improve the quality of dementia care (Donegan et al . ). Available biological markers of AD need to be validated and standardized for use in research and clinical practice.…”

Section: Resultsmentioning

confidence: 97%

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Dementia risk and prevention by targeting modifiable vascular risk factors

Tariq

Barber

2017

Journal of Neurochemistry

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The incidence of dementia is expected to double in the next 20 years and will contribute to heavy social and economic burden. Dementia is caused by neuronal loss that leads to brain atrophy years before symptoms manifest. Currently, no cure exists and extensive efforts are being made to mitigate cognitive impairment in late life in order to reduce the burden on patients, caregivers, and society. The most common type of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) often co-exists in the brain and shares common, modifiable risk factors, which are targeted in numerous secondary prevention trials. There is a growing need for non-pharmacological interventions and infrastructural support from governments to encourage psychosocial and behavioral interventions. Secondary prevention trials need to be redesigned based on the risk profile of individual subjects, which require the use of validated and standardized clinical, biological, and neuroimaging biomarkers. Multidomain approaches have been proposed in high-risk populations that target optimal treatment; clinical trials need to recruit individuals at the highest risk of dementia before symptoms develop, thereby identifying an enriched disease group to test preventative and disease modifying strategies. The underlying aim should be to reduce microscopic brain tissue loss by modifying vascular and lifestyle risk factors over a relatively short period of time, thus optimizing the opportunity for preventing dementia in the future. Collaboration between international research groups is of key importance to the optimal use and allocation of existing resources, and the development of new techniques in preventing dementia.

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Section: Resultsmentioning

confidence: 97%

“…(Donegan et al . ). Data from randomized controlled trials (RCTs) to support preventative strategies provide no convincing evidence that a single drug approach is effective in the prevention of dementia.…”

Section: Preventionmentioning

confidence: 97%

Dementia risk and prevention by targeting modifiable vascular risk factors

Tariq

Barber

2017

Journal of Neurochemistry

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“…A recent Canadian [8] retrospective cohort study found a simultaneous trend of decreasing incidence and increasing prevalence of dementia over a relatively short 8-year time period from 2005/06 to 2012/13, with the age-standardized prevalence increasing from 21.35% to 27.87%. Other studies also demonstrated increases in dementia prevalence in UK [9], another Canadian study [10], and pooled European data [11] (also reviewed in [12]).…”

Section: Introductionmentioning

confidence: 93%

Time Trends in the Prevalence of Neurocognitive Disorders and Cognitive Impairment in the United States: The Effects of Disease Severity and Improved Ascertainment

Akushevich

Yashkin

Kravchenko

et al. 2018

JAD

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BACKGROUND: Trends in the prevalence of cognitive impairment (CI) based on cognitive assessment instruments are often inconsistent with those of neurocognitive disorders (ND) based on Medicare claims records. OBJECTIVE: We hypothesized that improved ascertainment and resulting decrease in disease severity at the time of diagnosis are responsible for this phenomenon. METHODS: Using Medicare data linked to the Health and Retirement Study (1992–2012), we performed a joint analysis of trends in CI and ND to test our hypothesis. RESULTS: We identified two major contributors to the divergent directions in CI and ND trends: reductions in disease severity explained more than 60% of the differences between CI and ND prevalence over the study period; the remaining 40% was explained by a decrease in the fraction of undiagnosed individuals. DISCUSSION: Improvements in the diagnoses of ND diseases were a major contributor to reported trends in AD and CI. Recent forecasts of CI and ND trends in the U.S. may be overly pessimistic.

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“…Rates of dementia diagnosis are rising4; however, patients may still present without a formal dementia diagnosis. Where this is suspected, a cognitive history from the patient and collateral history from an informant will signpost towards a diagnosis.…”

Section: Diagnosing Dementiamentioning

confidence: 99%

Challenges in end-of-life dementia care

Fetherston

Rowley²,

Allan³

2018

Evid Based Mental Health

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Dementia is a chronic, progressive disease that is now much more widely recognised and treated. Patients with dementia may require palliative care when they reach the end stage of their illness, or they may have mild-moderate cognitive symptoms comorbid with a life-limiting illness. The variety of presentations necessitates a highly individual approach to care planning, and patients should be encouraged to set their own goals and contribute to advanced care planning where possible. Assessment and management of distressing symptoms at the end of life can be greatly helped by a detailed knowledge of the individuals' prior wishes, interdisciplinary communication and recognition of changes in presentation that may result from new symptoms, for example, onset of pain, nutritional deficits and infection. To navigate complexity at the end of life, open communication that involves patients and families in decisions, and is responsive to their needs is vital and can vastly improve subjective experiences. Complex ethical dilemmas may pervade both the illness of dementia and provision of palliative care; we consider how ethical issues (eg, providing care under restraint) influence complex decisions relating to resuscitation, artificial nutrition and treatment refusal in order to optimise quality of life.

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Trends in diagnosis and treatment for people with dementia in the UK from 2005 to 2015: a longitudinal retrospective cohort study

Abstract: None.

Cited by 120 publications

References 21 publications

Dementia risk and prevention by targeting modifiable vascular risk factors

Dementia risk and prevention by targeting modifiable vascular risk factors

Time Trends in the Prevalence of Neurocognitive Disorders and Cognitive Impairment in the United States: The Effects of Disease Severity and Improved Ascertainment

Challenges in end-of-life dementia care

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