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    Diagnostic, management and nursing challenges of less common dementias: Frontotemporal dementia, alcohol-related dementia, HIV dementia and prion diseases

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    Author
    Davis, Laura
    Dening, Tom
    Keyword
    Dementia
    Patient care planning
    Nursing
    Date
    2022
    
    Metadata
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    DOI
    10.12968/bjnn.2022.18.1.26
    Publisher's URL
    https://www.magonlinelibrary.com/doi/abs/10.12968/bjnn.2022.18.1.26
    Abstract
    Background: Most cases of dementia are due to Alzheimer's disease or vascular dementia, but attention on these disorders means that other important causes of dementia may be relatively neglected. About 10?15% of people with dementia have other diagnoses, and there are numerous causes of the less common types of dementia. Aims: This paper provides information about the causes, symptoms, diagnosis and nursing management of some of the different types of less common dementias, with the aim of helping nurses to provide better care to patients and families affected. Methods: This is one of two connected papers and provides a narrative review of the literature on the clinical presentation of frontotemporal dementia, HIV dementia, prion dementias and alcohol-related dementia. Findings: Frontotemporal dementia has important clinical subtypes with distinct different presentations; for example, predominantly behavioural symptoms or progressive language dysfunction. Alcohol-related dementia is one of several types of alcohol-related brain damage. This is important as, with abstinence, its progression may be halted or even to some extent improved. HIV dementia has become less common since the introduction of effective antiretroviral therapy, but, nonetheless, the less severe picture of HIV-associated cognitive dysfunction remains prevalent despite treatment. Prion dementias encompass sporadic, familial and acquired Creutzfeldt-Jakob disease and are incurable, therefore requiring extensive palliative care. Conclusions: These forms of dementia all have different symptoms and courses from common types of dementia, such as Alzheimer's disease. It is important for nurses to be aware that dementia may have several causes and that people with different dementias will have different needs. Nonetheless, the general skills of nurses in supporting patients and families remain essential in order to develop appropriate care plans and to provide individualised, person-centred care.
    Citation
    Davis, L., Karim, Z. & Dening, T. (2022). Diagnostic, management and nursing challenges of less common dementias: Frontotemporal dementia, alcohol-related dementia, HIV dementia and prion diseases. British Journal of Neuroscience Nursing, 18(1), pp.26-37.
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/15317
    Collections
    Dementia

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      Risk of conversion from mild cognitive impairment to dementia in low- and middle-income countries: A systematic review and meta-analysis

      Yates, Jennifer A.; Stephan, Blossom C. M. (2022)
      IntroductionWith no treatment for dementia, there is a need to identify high risk cases to focus preventive strategies, particularly in low- and middle-income countries (LMICs) where the burden of dementia is greatest. We evaluated the risk of conversion from mild cognitive ompairment (MCI) to dementia in LMICs.MethodsMedline, Embase, PsycINFO, and Scopus were searched from inception until June 30, 2020. The search was restricted to observational studies, conducted in population-based samples, with at least 1 year follow-up. There was no restriction on the definition of MCI used as long as it was clearly defined. PROSPERO registration: CRD42019130958.ResultsTen thousand six hundred forty-seven articles were screened; n = 11 retained. Of the 11 studies, most were conducted in China (n = 7 studies), with only two studies from countries classified as low income. A qualitative analysis of n = 11 studies showed that similar to high-income countries the conversion rate to dementia from MCI was variable (range 6 . 0%-44 . 8%; average follow-up 3 . 7 years [standard deviation = 1 . 2]). A meta-analysis of studies using Petersen criteria (n = 6 studies), found a pooled conversion rate to Alzheimer's disease (AD) of 23 . 8% (95% confidence interval = 15 . 4%-33.4%); approximately one in four people with MCI were at risk of AD in LMICs (over 3 . 0-5 . 8 years follow-up). Risk factors for conversion from MCI to dementia included demographic (e.g., age) and health (e.g., cardio-metabolic disease) variables.ConclusionsMCI is associated with high, but variable, conversion to dementia in LMICs and may be influenced by demographic and health factors. There is a notable absence of data from low-income settings and countries outside of China. This highlights the urgent need for research investment into aging and dementia in LMIC settings. Being able to identify those individuals with cognitive impairment who are at highest risk of dementia in LMICs is necessary for the development of risk reduction strategies that are contextualized to these unique settings.
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      An individual cognitive stimulation therapy app for people with dementia and carers: Results from a fesibility randomized controlled trial (RCT)

      Schneider, Justine; Orrell, Martin (2021)
      Background: There is a lack of digital resources that support the cognition and quality of life (QoL) of people with dementia. The individual cognitive stimulation therapy application (iCST app) aims to provide cognitive stimulation and social interaction to people with dementia and carers through interactive touch-screen technology. This study set out to determine the feasibility of conducting a full-scale, randomized controlled trial (RCT) with the iCST app. Methods: This was a single blind, feasibility RCT including people with mild to moderate dementia and their carers. Multiple trial components were assessed including recruitment and retention rates, intervention fidelity and usability, and acceptability of the outcome assessments which included measures of cognition and QoL. A sample of the intervention group was invited to a semi-structured post-trial interview to examine the experience of using the iCST app. Results: Sixty-one dyads were randomised to the iCST app (n = 31) or treatment-as-usual (TAU) control group (n = 30) for 11 weeks. In the iCST app group, 77% used the intervention for 20 minutes or more each week. Carers using the iCST app rated their QoL better at follow-up 2 compared to the TAU control group (EQ-5D, MD = 7.69, 95% CI = 2.32– 13.06, p = 0.006). No significant differences were found on the other outcome measures. Conclusion: The iCST app was deemed usable and enjoyable. Most participants completed the activities more quickly than anticipated and did not have enough activities to continue using the app frequently. Expansion of the iCST app is needed to maintain engagement for longer. Findings indicate that computerised cognitive stimulation can be beneficial, and a large-scale RCT is feasible with modifications to trial components. The results are relevant to researchers, software developers, policy-makers, people with dementia and carers who are looking to be involved in such interventions.
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      Systematic review of pharmacological interventions for people with Lewy body dementia

      Watts, Katrina E.; Storr, Nicholas J.; Barr, Phoebe G.; Rajkumar, Anto P. (2022)
      OBJECTIVELewy body dementia (LBD) is the second most common neurodegenerative dementia, and it causes earlier mortality and more morbidity than Alzheimer's disease. Reviewing current evidence on its pharmacological management is essential for developing evidence-based clinical guidelines, and for improving the quality of its clinical care. Hence, we systematically reviewed all studies that investigated the efficacy of any medication for managing various symptoms of LBD.METHODWe identified eligible studies by searching 15 databases comprehensively. We completed quality assessment, extracted relevant data, and performed GRADE assessment of available evidence. We conducted meta-analyses when appropriate (PROSPERO:CRD42020182166).RESULTSWe screened 18,884 papers and included 135 studies. Our meta-analyses confirmed level-1 evidence for Donepezil's efficacy of managing cognitive symptoms of dementia with Lewy bodies (DLB) (SMD = 0.63; p < 0.001) and Parkinson's Disease Dementia (PDD) (SMD = 0.43; p < 0.01), and managing hallucinations in DLB (SMD=-0.52; p = 0.02). Rivastigmine and Memantine have level-2 evidence for managing cognitive and neuropsychiatric symptoms of DLB. Olanzapine and Yokukansan have similar evidence for managing DLB neuropsychiatric symptoms. Level-2 evidence support the efficacy of Rivastigmine and Galantamine for managing cognitive and neuropsychiatric symptoms of PDD.CONCLUSIONWe list evidence-based recommendations for the pharmacological management of DLB and PDD, and propose specific clinical guidelines for improving their clinical management.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2022.2032601 .
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