How football is helping unlock dementia patients' memories

Images of footballers can serve as a trigger for conversation and reminisence among male dementia patients. Photograph: Scott Heppell/AP

A dementia care unit is being built close to Sunderland football club's Stadium of Light. The Roker ward – named after the club's former ground Roker Park – at Monkwearmouth hospital, will provide 14 beds for men aged over 65.

The new unit will replace a ward in Cherry Knowle hospital in Ryhope, which has passed its sell-by date. The ward at Cherry Knowle has been trialling sport as a focus for reminiscence therapy and the results were good enough to convince the ward managers that this was something that should be adopted in the new building.

Finding meaningful ways to connect and engage with dementia patients is always challenging. Football provides an alternative focus for men who are reluctant to join in other group and reminiscence based activities. Memories of players, matches and sports events from 30, 50 or 60 years ago can remain clear when prompted. The Sporting Memories Network travelled to Ryhope and worked with ward staff, giving them ideas about how they could use images of famous footballers and sports stars from days gone by as a trigger for conversation, debate and reminiscence. Those debates and discussions often focus on recalling favourite players, great victories, away trips and the inevitable defeats.

"It's often difficult to engage older men in meaningful activities," says ward manager Geoff Willis. "But using sporting memories as a framework has worked for us, most clients are keen to share their memories about football. They become animated and passionate and have so much to tell you.

"We held themed events over the summer; we had a Royal Ascot afternoon with form guides, betting slips and refreshments which saw patients placing fun bets for chocolates. And we also hosted a Wimbledon-themed day to coincide with the men's singles finals with all the trimmings including strawberries and cream.

"Events like this have impressed relatives. They have commented on how animated their loved ones became on these special afternoons."   

The Sporting Memories Network ensures that new materials are made available on a regular basis to keep the sessions and conversations fresh. That's where we hit on the idea of publishing a weekly reminiscence newspaper.

A couple of weeks ago one of the very last Saturday night sports papers published its final printed version in Sheffield before moving to a digital platform. Going out to buy the Pink'un or Green'un on a Saturday evening was a tradition for sports fans across the country for many years. So we supply dementia wards with (our version of) the Sporting Pink, which is filled with archive sporting images and match reports for the staff to use for reminiscence.

Dr Michael Clark from the Personal Social Services Research Unit at LSE evaluated a pilot project the Sporting Memories Network ran across care homes in Leeds. His report noted a positive impact not only on the wellbeing of residents but also on the staff, as they too enjoyed hearing about great football games of the past. The pilot was funded by a Skills for Care workforce development innovation fund grant and attracted the support of local clubs and organisations but also came to the attention of the government. The network's work with football and sports clubs was mentioned in the first annual report on the prime minister's dementia challenge.

Sports stars including Chris Kamara, Robbie Savage, David Coulthard and Ross Brawn have shared some of their own favourite memories and have been joined by celebrities, fans and professional bodies such as the Professional Footballers' Association and British Racing Drivers' Club in supporting the network. The bank of memories shared is then used by staff facilitating sports reminiscence activities.

Tony Jameson-Allen is a director of the Sporting Memories Network, a community interest company established to develop reminiscence activities that improve the wellbeing of older people and those living with dementia through tapping into the passion, knowledge and love of sport.

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Is Dudley council setting out a new model for dementia care?

Dudley's initiative aims to help people with dementia stay independent for as long as possible. Photograph: David Levene for the Guardian

One of the most pressing problems for local authorities and the new clinical commissioning groups (CCGs) is how to provide services to people in their areas diagnosed with dementia. As the ageing population imposes even greater demands on health and social care services, a local authority in the Midlands has developed its own strategy for dementia that brings services together to support people at home.

The dementia gateway service developed by Dudley metropolitan borough council (DMBC) has been operating since November 2011 and aims to integrate early diagnosis and medical intervention for people with dementia with social care to keep the person independent and in their own home for as long as possible.

The care pathway is based on a multidisciplinary team approach, involving initial assessment by dementia nurses, with input from old age psychiatrists, mental health specialists, and dementia advisers, all of whom were part of the steering group that devised the pathway.

Matt Bowsher, assistant director, quality and commissioning at DMBC, says: "We wanted to develop a person-centred approach to dementia care based on listening to our clients and responding to their needs, and to help people avoid having premature links with 'serviceland' for as long as possible. We needed to adapt services to the needs of clients and their families rather than have a rigid system which delivered the same service to all clients."

The council estimates that it will have around 4,365 people diagnosed with dementia by 2015, but this is predicted to rise by 50% to 6,435 by 2030. There are currently around 58,200 people aged over 65 in its population of 312,000.

The government's strategy for personalisation of social care, "Making it Real", launched in 2009, prompted the council to review the way it provided dementia care and led to the setting of the steering group. Last year, prime minister David Cameron set a Dementia Challenge for councils to improve their services to local people.

"We now support high numbers of people, including some of working age, to live well with dementia at home by providing information and advice and making links to universal services so that people can still pursue their personal interests and hobbies through our adult community enablement team," says Bowsher.

The council has a dementia adviser linked into acute hospital services, who liaises with the early supported discharge team. The adviser links with the person and their relatives within a day or two of their admission to hospital, liaises with ward staff and supports an inpatient clinic. This setup enables the NHS to achieve its CQUIN targets.

The gateway offers therapeutic and creative activities to clients, and short and long-term respite to carers, as well as interventions to people living with dementia, which maintain or build on their skill levels while also reducing the need for drug therapy or early admission to residential or nursing home care. The council also works in an integrated way with its own adult social commissioners and the CCG commissioners to ensure that services are co-ordinated.

"We originally had only one dementia nurse specialist, but we now have three," says Annette Darby, dementia services manager at DMBC. "There are now three ways that clients can be progressed through the system: through GP referral to our nurse specialists, through community mental health nurses and through social workers. Our dementia advisors are also being trained to undertake the assessment of need – technically known as an MAF1/MAF2/Support Plan – to deal with presenting issues."

The CCG was involved in the service from the outset (formerly as the PCT) and believes the pathway has been very successful. Paul Maubach, the CCG's chief accountable officer, says: "We think the service is a really good example of collaboration between local authority and CCG. Dudley was in the bottom third of detection and diagnosis rates for England, and there was actually a reluctance for some GPs to diagnosis patients with dementia, because they did not feel there were adequate support services in place. Now that's changed and the gateway service has diagnosed around 400 cases in the last two years. We have a much higher rate of referral to services now and a clear pathway for patients."

He also says that the three dementia centres run by the service provide a valuable focal point for treatment and support for clients and their families. Both the council and the CCG acknowledge the crucial role played by the voluntary sector in supporting people who have been diagnosed and their families.

Janice Connolly, the Midlands locality manager for the Alzheimer's Society, says that it offers a range of services in the Dudley area and across the Midlands. "We run around 18 dementia cafes across the Midlands region and four of these are in the Dudley area.

These are monthly sessions where the person diagnosed and their family can meet others in the same situation, and this can help greatly with information-sharing and mutual support. We also run a helpline for crisis support and give advice on accessing social and domiciliary care."

The service has now gained national recognition, winning praise from health minister Norman Lamb at a recent conference and even from health secretary Jeremy Hunt. The NHS director general of social care has also paid a visit to Dudley in recent weeks to see first-hand how the service works.

As councils struggle to find resources for improving dementia care, the Dudley model could prove to be a blueprint for the future around the country.

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Dementia risk score for people with diabetes

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Main Category: Alzheimer's / Dementia
Also Included In: Diabetes;  Neurology / Neuroscience;  Seniors / Aging
Article Date: 20 Aug 2013 - 0:00 PDT Current ratings for:
Dementia risk score for people with diabetes

Scientists have created a simple scoring system that will allow clinicians to predict whether older people with type 2 diabetes are at risk of developing dementia, according to a study published in The Lancet Diabetes and Endocrinology.

Researchers from the Kaiser Permanente Division of Research in California say the new system, called the "diabetes-specific dementia risk score" (DSDRS), will mean doctors can closely monitor patients with type 2 diabetes who are at highest risk of dementia and enable early treatment to be given.

For the study, the research team analyzed medical records of 29,961 Kaiser Permanente patients over the age of 60 who had type 2 diabetes.

The researchers looked at whether the patients were diagnosed with dementia within the 10-year follow-up period. The analysis revealed that 17% of patients developed dementia during this time.

They built the DSDRS model with 45 candidate risk factors for dementia. Using "sophisticated statistical methods," the researchers looked at patients' medical records to determine the risk factors that most strongly predicted the onset of dementia within 10 years.

The following were identified as the most important predictive factors:

The scoring system can divide patients into one of 14 categories. The lowest score is -1, which indicates the lowest risk of dementia, while the highest scores are between 12 and 19.

By using the diabetes-specific dementia risk score, results showed that, compared with those who had the lowest scores, patients with the highest were 37 times more likely to develop dementia within 10 years.

Additionally, patients with the highest scores developed dementia faster than those with the lowest.

The researchers tested the scoring system against a large group of people with type 2 diabetes who were unrelated to the study and found that it accurately predicted their risk of developing dementia.

Dr. Rachel Whitmer from Kaiser Permenante says:

"Unfortunately, there is an epidemic of both type 2 diabetes and dementia, and the link between these two illnesses portends a possible public health crisis."

"Our model shows that in two large populations of patients with type 2 diabetes a combination of diabetes-associated complications, education, and age is highly predictive of the likelihood of dementia within the next decade."

The study authors say that this is the first time scoring systems have been used to specifically predict dementia in patients with type 2 diabetes.

They add that the scoring system would prove beneficial to doctors in predicting the onset of dementia in type 2 diabetes patients, as it does not rely on expensive, complicated brain imaging or cognitive testing.

"Early detection of patients with type 2 diabetes who are at increased risk of dementia could help to develop and target preventive treatment," says Dr. Whitmer.

"Our scoring system has the potential to change clinical care by giving clinicians a simple and accurate way of predicting the risk of dementia in older people with type 2 diabetes."

But the study authors note that there are plans to conduct a second stage into the scoring system, which may involve some use of cognitive testing in order to improve accuracy.

In a comment piece following the study, Dr. Anna-Maija Tolppanen of the Center for Comparative Effectiveness and Patient Safety in Finland, says that although the diabetes-specific dementia risk score (DSDRS) could be beneficial for clinicians in determining dementia risk, the system may not be so useful in selecting patients for drug trials.

"Clinical trial data on effective preventive interventions for dementia are currently lacking," says Dr. Tolppanen.

"Although [the researchers] state that DSDRS could be used to select candidates for trials, it should be noted that diabetes and many of the components of the score are often exclusion criteria for medication trials."

Written by Honor Whiteman

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Copper build up in brain 'could explain Alzheimer's dementia'

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Main Category: Alzheimer's / Dementia
Also Included In: Neurology / Neuroscience;  Water - Air Quality / Agriculture
Article Date: 20 Aug 2013 - 3:00 PDT Current ratings for:
Copper build up in brain 'could explain Alzheimer's dementia'

New research suggests copper that enters the body at levels encountered in the average modern diet may be leading, eventually, to Alzheimer's disease - by reducing the body's ability to clear away toxic proteins in the brain, and also by encouraging the clumping of those proteins.

Copper is an essential trace element in the diet. With iron, it helps make red blood cells, and it is also essential for the health of the immune system, blood vessels, nerves, and bones.

Copper enters the body via many sources, including drinking water carried in copper pipes, and from foods such as shellfish, nuts, red meat and many fruits and vegetables, and also via food supplements.

But now a study that used cells from both mice and humans, led by Rashid Deane, a research professor in the University of Rochester Medical Center (URMC) in the US, shows that copper can also build up in the brain and disrupt the body's ability to clear away amyloid beta proteins before they form the plaques that are the hallmark Alzheimer's disease.

Prof Deane says:

"It is clear that, over time, copper's cumulative effect is to impair the systems by which amyloid beta is removed from the brain."

He and his co-authors, all with URMC, write about their findings in Monday's online issue of the Proceedings of the National Academy of Sciences.

Normally, the body removes amyloid beta from the brain with the help of a protein called LRP1, short for lipoprotein receptor-related protein 1. This protein, which lines blood vessels in the brain, binds with amyloid beta and escorts it out of the brain.

For their study, the team gave mice trace levels of copper for three months.

They found the metal collected in the cells walls of the fine vessels that feed blood to the brain.

The cells the copper collected in are an important part of the brain's defence mechanism, the so-called blood/brain barrier, which controls the substances that can pass in and out of brain tissue.

By collecting copper in their membranes, the cells were just doing their job.

But the researchers found that with time, through the process of oxidation, the copper build up in the cell walls started to affect the ability of LRP1 to escort amyloid beta proteins out of the brain. They saw this happen in both mouse and human brain cells.

In a further experiment, they then examined the process in live mice bred to develop Alzheimer's disease. They found the cells responsible for maintaining the blood/brain barrier could not cope: they became leaky, probably with age and repeated damage from toxins.

Had they not been leaky, the cells would have trapped the copper in their cell walls, but in the Alzheimer's mice, the blood-borne metal was able to pass unhindered through the blood/brain barrier.

As it met with brain tissue, the leaked copper stimulated brain cells to increase their production of amyloid beta.

The copper also had a direct effect on the toxic protein itself: it encouraged it to clump together and form the characteristic plaques of Alzheimer's disease.

Once amyloid beta forms these large clumps inside brain cells, the body's natural ways of eliminating it are overwhelmed and cannot cope: scientists believe this is how Alzheimer's starts and progresses.

In a final experiment, the team also found that copper led to inflammation of brain tissue, which may also speed up the breakdown of the blood/brain barrier and the subsequent build up of Alzheimer's toxins.

The levels of copper the researchers used in their experiments were trace amounts, about one-tenth of that set by standards for water quality from the US Environmental Protection Agency.

Prof Deane says:

"These are very low levels of copper, equivalent to what people would consume in a normal diet."

But neither he nor his colleagues are suggesting people change their diets or intakes of copper on the basis of these findings, which they say should be interpreted with caution.

The body needs copper, it is an essential metal. The effects shown in this study are due to exposure over a long period, and the key is getting the balance between too much and too little.

"Right now we cannot say what the right level will be, but diet may ultimately play an important role in regulating this process," Prof. Deane says.

Help with finding for the study came from The Alzheimer's Association, the National Institute on Aging, and a pilot grant from the National Institute of Environmental Health Sciences.

This is not the first study to implicate copper in a neurodegenerative disease. In 2011, another group of US researchers reported how copper affected a protein associated with Parkinson's disease.

Written by Catharine Paddock PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our alzheimer's / dementia section for the latest news on this subject.

Low levels of copper disrupt brain amyloid-ß homeostasis by altering its production and clearance Itender Singh, Abhay Sagare, Mireia Coma and others, PNAS. Published online 19 August 2013 (DOI: 10.1073/pnas.1302212110).

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New Risk Score Predicts 10-Year Dementia Risk for Type 2 Diabetes Patients

Main Category: Diabetes
Also Included In: Alzheimer's / Dementia
Article Date: 20 Aug 2013 - 0:00 PDT Current ratings for:
New Risk Score Predicts 10-Year Dementia Risk for Type 2 Diabetes Patients

Researchers at Kaiser Permanente and the University Medical Centre Utrecht in the Netherlands have created the first risk score that predicts the 10-year individualized dementia risk for patients with type 2 diabetes, as reported in the inaugural issue of Lancet Diabetes & Endocrinology.

The researchers developed and validated the Diabetes-Specific Dementia Risk Score by examining data from nearly 30,000 patients with type 2 diabetes aged 60 and older over a 10-year period. They found eight factors that were most predictive of dementia - including microvascular disease, diabetic foot and cerebrovascular disease - and assigned each a value related to their association with dementia to create an overall score for patients. The researchers found that individuals in the lowest category of the 20-point risk score had a 5.3 percent chance of developing dementia over the next 10 years, while those in the highest category had a 73 percent chance. Compared with those in the lowest category, those in the highest were 37 times more likely to get dementia, according to the study.

"Patients with type 2 diabetes are twice as likely to develop dementia as those without the disease, but predicting who has the highest future risk is difficult," said Rachel Whitmer, PhD, an epidemiologist at the Kaiser Permanente Division of Research in Oakland, California, who led the study. "While a few dementia risk scores exist, this is the first one that has been developed specifically for individuals with type 2 diabetes and encompasses diabetes-specific characteristics."

All predictors included in the Diabetes-Specific Dementia Risk Score are easy to obtain and based primarily on medical history, so the risk score can be calculated during a routine medical visit or with electronic health records. No labor-intensive or expensive tests, such as cognitive function or brain imaging, are required.

"This risk score is crucial for the care of patients with diabetes since they are particularly susceptible to dementia. It provides clinicians with an easy and efficient tool to assess their patients' chances of developing dementia over the next 10 years," Whitmer said. "Early detection of diabetes patients who are at increased future risk of dementia could help to develop and target preventive treatment."

According to the Centers for Disease Control and Prevention, more than 25 million children and adults in the United States have diabetes with type 2 diabetes in particular accounting for more than 90 percent of these cases. In addition to being a risk factor for dementia, diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputations and new cases of blindness among adults in the United States.

"The risk score could be useful in the selection of high-risk patients for early intervention studies and for many applications of personalized medicine," said Geert Jan Biessels, MD, professor of neurology at the University Medical Centre Utrecht and co-author of the study. "Clinicians can use it to guide their decisions in terms of clinical attention to incipient cognitive impairment which makes people vulnerable to dangerous side-effects of diabetes treatment. The risk score will also help us to understand the causes of diabetes associated increased dementia risk, because we can examine those at high risk in early stages of the dementia process."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The study is reported in Lancet Diabetes & Endocrinology

Additional authors on the study include Lieza G. Exalto, MD, of the Department of Neurology, University Medical Centre Utrecht, the Netherlands; Andrew J. Karter, PhD, of the Kaiser Permanente Division of Research, Oakland, Calif.; Elbert S. Huang, MD, of the Department of Internal Medicine, University of Chicago; Wayne J. Katon, MD, of the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine; and Jerome R. Minkoff, MD, of the Kaiser Permanente Department of Endocrinology, Santa Rosa, Calif.

Research reported in this press release was supported by Kaiser Permanente Community Benefit, and by the National Institute of Diabetes and Digestive and Kidney Disorders of the National Institutes of Health under award number DK081796.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Kaiser Permanente

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'New Risk Score Predicts 10-Year Dementia Risk for Type 2 Diabetes Patients'

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Ethical issues are often not addressed in national clinical practice guidelines for dementia

Main Category: Alzheimer's / Dementia
Article Date: 13 Aug 2013 - 14:00 PDT Current ratings for:
Ethical issues are often not addressed in national clinical practice guidelines for dementia

Twelve national dementia clinical practice guidelines included only half of 31 ethical issues the authors had identified as important in patient care, finds a study by Daniel Strech, of Hannover Medical School, Hannover, Germany, and colleagues, published in this week's issue of PLOS Medicine.

The authors identified current national clinical practice guidelines for dementia care published in English or German. They had previously systematically reviewed ethical issues in dementia care and they used thematic text analysis to assess whether and how the ethical issues were addressed in the guidelines. In the 12 national practice guidelines identified, an average of 49.5% of the 31 ethical issues were addressed (range, 22% to 77%). National guidelines differed substantially with respect to which ethical issues were represented, whether ethical recommendations were included, whether justifications or citations were provided to support recommendations, and to what extent the ethical issues were explained.

The clinical practice guidelines were published by a central governmental institution in 6 countries (Australia, France, Malaysia, New Zealand, Singapore, United Kingdom), by a medical association in 4 countries (Canada, Germany, Scotland, United States of America), one by a statutory health insurance body (Austria), and by an expert panel in one country (Switzerland). The authors state, "All guidelines explicitly acknowledged the involvement of experts from different specialties (most often from psychiatry, neurology, gerontology, and family medicine)."

Four (13%) ethical issues were not addressed in at least 11 out of 12 CPGs: "Adequate consideration of existing advance directives in medical decision making.", "Usage of GPS and other monitoring techniques ", "Covert medication" and "Dealing with suicidality."

The authors conclude, "Ethical issues and how to deal with them are important for guidelines to address, for the medical profession to understand how to approach care of patients with dementia, and for patients, their relatives, and the general public, all of whom might seek information and advice in national guidelines."

Furthermore, although clinical practice guidelines are "meant to improve standards of clinical competence and professionalism by referring explicitly to evidence-based information on benefits and harms", the authors state that clinical practice guideline development manuals worldwide fail to address how to include disease-specific ethical issues.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alzheimer's / dementia section for the latest news on this subject.

This work has been funded by the German Research Foundation (DFG) through the research project Ethics Guide (STR 1070/2-1). The article processing charge was funded by means of the DFG-Project ‘‘Open Access Publishing’’ by the German Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Inclusion of Ethical Issues in Dementia Guidelines: A Thematic Text Analysis

PLoS Med 10(8): e1001498. doi:10.1371/journal.pmed.1001498

Knüppel H, Mertz M, Schmidhuber M, Neitzke G, Strech D (2013)

PLOS Medicine

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In China over 90 percent of dementia cases go undetected

Main Category: Alzheimer's / Dementia
Also Included In: Psychology / Psychiatry;  Mental Health
Article Date: 28 Jul 2013 - 0:00 PDT Current ratings for:
In China over 90 percent of dementia cases go undetected

An international team of researchers has found that over 90 percent of dementia cases in China go undetected, with a high level of undiagnosed dementia in rural areas. The team of public health experts led by Dr Ruoling Chen at King's College London argues that more mental health education targeting high-risk populations is now needed to improve diagnosis rates, and increase support for sufferers and their families.

Dementia affects 10 million in China and up to 50 million worldwide, of which around 35 million sufferers are undiagnosed. Dementia causes deterioration in memory, thinking, behaviour and the ability to perform everyday activities. Although the condition mainly affects older people, it is not a normal part of ageing. Dementia is one of the major causes of disability and dependency among older people worldwide. Early diagnosis is crucial to alleviating the significant physical, psychological, social and economical impact the condition has on caregivers, families and society.

The new study, led by Dr Chen, a research leader in global health in the School of Medicine at King's, found that in China 93 percent of dementia cases in people aged 60 and over went undetected. The level of undetected dementia is much higher than has been seen in studies undertaken in high income countries, where about 60 percent of older adults with dementia are not diagnosed.

Published in the British Journal of Psychiatry and funded by Alzheimer's Research UK and the BUPA Foundation, the large population based study is a collaboration between scientists at King's College London and other universities in the UK, and Anhui Medical University and five other medical universities in China. The study is the first to examine factors influencing the poor diagnosis of dementia in older people in low-income countries, where there are more dementia sufferers than in high-income countries.

Dr Chen and his team interviewed a random sample of 7,072 older adults in six provinces across China, with one rural and one urban community in each province. They identified 359 older adults with dementia and 328 with depression. There were only 26 participants who had doctor-diagnosed dementia reported and 26 who had doctor-diagnosed depression. Overall, 93 percent of dementia cases and 93 percent of depression was not detected.

The team found that, in China, undetected dementia among older adults is strongly associated with low socioeconomic status such as a low educational and occupational class, and living in a rural area.

In rural China, the average annual income is two to five times lower than in urban areas and about 90 percent of older people are illiterate. Medical coverage and health services are often insufficient in rural areas, with primary care clinics mainly staffed by health-workers with limited training. In high-income countries most studies have not shown a strong association between low socioeconomic status and undetected dementia, which could be due to better access to healthcare.

The research team also identified that Chinese cultural factors may play a role in poor detection rates of dementia. Unlike in high-income countries, most of older Chinese people live with their families. A surprising, important finding was that undetected dementia is related to strong social support. Such 'help available when needed' may mask the disease and hinder detection. In addition, Chinese may interpret dementia symptoms in older people as being an acceptable part of the ageing process rather than as an illness.

Dr Ruoling Chen said: 'Dementia is increasingly a major global health challenge given that the world's population is ageing. China has the most dementia sufferers of any country in the world, but at the same time it is a poorly recognised condition.

Mental health services need to be prioritised as economic development extends throughout China. Mental health campaigns will ensure that health workers and the general population are able to recognise the condition, so that sufferers receive the support they need.

Our hope is that by looking at the rate of undetected dementia in China we can offer globally applicable insights into the common risk factors, aid earlier diagnosis, ultimately improve prognosis for sufferers and maintain caregivers' health and wellbeing .'

Professor Martin Prince, global mental health expert from the Institute of Psychiatry at King's College London, who was not involved in the research, commented: 'This is an important study, highlighting the very low detection rate by Chinese health services of dementia among older people.

Large treatment gaps for mental and neurological disorders have been observed in low income countries, but this is the first study to focus on older adults, among whom dementia is a major concern.

Detection is the first step in accessing evidence-based treatment and care. Limited knowledge, skills and confidence among health care workers, and a lack of understanding of the benefits that may stem from diagnosis and intervention are all likely to contribute.'

In a related recent commentary in the Lancet, Professor Prince argued: '... the Chinese Government faces a daunting task in addressing future needs for long-term care. Previously, these needs have been met by families, consistent with traditional values and enforced through the Elderly Rights and Protection Law of 1996. However, central government policy is shifting towards new social care initiatives and increased investment in social protection, as outlined in a radically amended version of the 1996 law which will take force from July, 2013.'

Dr Simon Ridley, Head of Research at Alzheimer's Research UK, said: 'We know that dementia is a global problem and it is important to understand more about the risk factors and barriers to diagnosis across different countries. Investigating the social, economic and cultural factors influencing attitudes and access to dementia diagnosis can help shape strategies that could benefit multiple countries across the world.

We must ensure long-term investment for dementia research if we are to improve the lives of millions living with this condition worldwide.'

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alzheimer's / dementia section for the latest news on this subject.

'Determinants for undetected dementia and late-life depression' is published in the British Journal of Psychiatry doi: 10.1192/bjp/bp.112.119354

'Dementia in China: east-west collaboration bears fruit' is published in the Lancet doi:10.1016/S0140-6736(13)60770-9

King's College London

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'Promising' blood test discovered for Alzheimer's dementia

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Main Category: Alzheimer's / Dementia
Also Included In: Neurology / Neuroscience;  Mental Health;  Psychology / Psychiatry
Article Date: 29 Jul 2013 - 0:00 PDT Current ratings for:
'Promising' blood test discovered for Alzheimer's dementia

Researchers in Germany have identified a new blood test that may in future provide much earlier diagnosis of Alzheimer's disease and other degenerative disorders.

The team, from Saarland University and Siemens Healthcare, describe their test in the open access journal Genome Biology. They found it could be used to discriminate between people with Alzheimer's from healthy people without the dementia.

Alzheimer's disease, the most common form of dementia, can currently only be diagnosed with certainty at autopsy, so there is considerable interest in finding reliable, non-invasive biomarkers for diagnosis in living people.

Andreas Keller focused on microRNAs (miRNAs), working with colleagues from Siemens Healthcare, Saarland University at Homburg, and three other German universities, as well as The Scripps Research Institute, of La Jolla, California. The small non-coding RNA molecules are known to influence the way genes are expressed, and miRNAs can be found circulating in bodily fluids, including blood. ?

The team highlighted and tested a 'signature' panel of 12 miRNAs among 48 people with Alzheimer's and 22 healthy controls and discovered different levels in the people with the dementia.

They then developed the tests in a larger cohort of 202 people, comprising not only people with Alzheimer's disease alongside healthy controls, but also patients with other neurological and neurodegenerative disorders.

Here, the new test not only reliably distinguished people with Alzheimer's from the controls with normal health but was also able to identify other conditions.

Useful biomarkers need to be accurate, sensitive (correctly identifying people with the disease) and specific (correctly filtering out people without the disease).

The new test scored highly on all three measures. It was:

93% accurate95% sensitive92% specific.

However, the authors caution that while their blood test shows obvious promise, it still needs to be validated for clinical use, and may eventually work best when combined with other standard diagnostic tools, such as imaging.

Since people with other brain disorders can sometimes show Alzheimer's-like symptoms, the team also looked for the miRNA signature in other patient groups. Interestingly, while the 12 miRNAs were chosen for their potential to separate Alzheimer's disease from controls, the same signature was more than 95% accurate in distinguishing controls from people with various psychiatric disorders, such as schizophrenia, depression and bipolar conditions.

It was less accurate (around 82%) in distinguishing patients with other neurodegenerative disorders, such as mild cognitive impairment, Parkinson's disease and multiple sclerosis, from controls.

The test was also able to discriminate between Alzheimer's patients and those with other neurodegenerative disorders, with an accuracy of around 75%.

The authors believe accuracy in distinguishing Alzheimer's disease from the wider range of neurodegenerative conditions might be improved by tweaking the miRNAs used in the test. They explained:

"Since the 12-miRNA signature has been tailored to differentiate between Alzheimer's disease and controls, other miRNAs may likely contribute to a signature that permits also a better differentiation between the other tested diseases and Alzheimer's disease."

The work at Saarland builds on previous studies highlighting the potential of miRNAs as blood-based biomarkers for many diseases, including numerous cancers. It also suggests that miRNAs could yield useful biomarkers for various brain disorders and sheds further light on the mechanisms underpinning Alzheimer's disease.

Two of the miRNAs are known to be involved in amyloid precursor protein processing, which itself is involved in the formation of plaques, a classic hallmark of Alzheimer's disease. Further, many of the miRNAs are believed to influence the growth and shape of neurons in the developing brain. ?

Written by Nick Valentine

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our alzheimer's / dementia section for the latest news on this subject. Genome Biology 2013, 14: R78. DOI: 10.1186/gb-2013-14-7-r78. Published online 29 July 2013. Please use one of the following formats to cite this article in your essay, paper or report:

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''Promising' blood test discovered for Alzheimer's dementia'

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Radix Achyranthis Bidentatae to potentially treat senile dementia

Main Category: Alzheimer's / Dementia
Article Date: 29 Jul 2013 - 0:00 PDT Current ratings for:
Radix Achyranthis Bidentatae to potentially treat senile dementia

A research team from the School of Basic Medical Sciences, Beijing University of Chinese Medicine reports that Radix Achyranthis Bidentatae can inhibit advanced glycation end product formation, reduce their levels in the frontal cortex, and improve learning and memory capabilities in ovariectomized rats.

The Radix Achyranthis Bidentatae inhibitory effect on advanced glycation end product accumulation is associated with an antioxidative effect.

These novel findings, published in Neural Regeneration Research (Vol. 8, No. 18, 2013), provide insight into the mechanisms of action of Radix Achyranthis Bidentatae.

Article: "Radix Achyranthis Bidentatae improves learning and memory capabilities in ovariectomized rats" by Yuefen Wang, Ya Xu, Yanshu Pan, Weihong Li, Wei Zhang, Yang Liu, Jing Jia, Pengtao Li

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alzheimer's / dementia section for the latest news on this subject.

Wang YF, Xu Y, Pan YS, Li WH, Zhang W, Liu Y, Jia J, Li PT. Radix Achyranthis Bidentatae improves learning and memory capabilities in ovariectomized rats. Neural Regen Res. 2013;8(18):1644-1654.

Neural Regeneration Research http://www.nrronline.org/

Neural Regeneration Research

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New idea and approach in the treatment of vascular dementia

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alzheimer's / dementia section for the latest news on this subject.

Article: " A ginkgo biloba extract promotes proliferation of endogenous neural stem cells in vascular dementia rats " by Jiwei Wang2, Wen Chen1, Yuliang Wang1 (1 Department of Physiology, Weifang Medical University, Weifang 261042, Shandong Province, China; 2 School of Medicine, Shandong University, Jinan 250012, Shandong Province, China).

Wang JW, Chen W, Wang YL. A ginkgo biloba extract promotes proliferation of endogenous neural stem cells in vascular dementia rats. Neural Regen Res. 2013;8(18):1655-1662.

Full text: http://www.sjzsyj.org:8080/Jweb_sjzs/CN/article/downloadArticleFile.do?attachType=PDF&id=634

Neural Regeneration Research

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