Category Archives: A&A Journal

There’s an order to things: Item response theory as a way to make sense of functional decline in dementia

Sarah McGrory is a PhD Student at the Alzheimer Scotland Dementia Research Centre at the University of Edinburgh. Reblogged from the British Geriatrics Society blog.functional decline

Are some activities harder than others for people with dementia? In our research, recently reported in Age and Ageing, we looked at how people with dementia differed in their day to day activities. 202 people with mostly mild to moderate dementia in Scotland were asked about their activities

Activities (using the telephone, shopping, food preparation, housekeeping, laundry, travelling, taking medications, handling finances) can be measured using a questionnaire called the Lawton Instrumental Activities of Daily Living (IADL) scale. Usually scores on the individual tasks are added together to give a total score ranging from 0 to 8. This number can hide a lot of information about a patient’s functional ability. It assumes every functional activity is equally difficult, which is rarely the case. For example, being able to manage your finances is likely to be harder for most people than being able to eat.

Our research used a statistical technique called item response theory (IRT) to get more information from a questionnaire about function. IRT allows the different activities to be ranked according to their difficulty. This can be especially useful for assessing progression of cognitive impairment. Knowing the expected order of decline can help to monitor progression, so any changes from the usual course, or changes in rates of decline, can be identified and studied. IRT can help to identify key tasks in a scale, and can also show in what order tasks might become more difficult as dementia progresses.  To do this, though, clinicians and researchers have to record answers to every task on a scale, not just to the total number.

We found that the tasks included in the scale could be ordered by increasing difficulty from being able to use the telephone (easiest) to the ability to shop (most difficult). This means a person may be having problems shopping independently may showing the first sign of functional difficulties related to cognitive impairment. Problems with this task should alert doctors as a possible early symptom of cognitive decline. Recognising these early stages is very important and can help people live independently for as long as possible with the help of medications, family education and counselling.  Looking at the individual tasks within a scale instead of relying on the total score can help us to understand more about dementia progression and help us to identify care requirements for patients.

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The more you study, the later you drop – Education and terminal cognitive decline

Graciela Muniz-Terrera is a Senior Investigator Scientist at the MRC Lifelong Health and Ageing Unit at UCL. Reblogged from the British Geriatrics Society Blogshutterstock_21757213

The terminal decline hypothesis suggests an acceleration of rate of cognitive decline before death, although information about the onset of faster decline is inconsistent and varies by ability examined. The identification of factors that may delay such onset is crucial for policy implementation, as such delay would imply that individuals spend a shorter period of time in the fast declining stages of life. Education is a modifiable risk factor usually considered as a proxy for cognitive reserve that has been shown to be associated with cognitive function and, in a few American studies, has also been shown to be associated with a later onset of pre-clinical dementia. Continue reading

November issue of Age and Ageing journal out now

Reblogged from the BGS Blog

The November 2013 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.

full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more. Hot topics this issue include:

  • Screening for dementia
  • Cancer screening in later life
  • Diagnostic accuracy of temperature measurement
  • Dysphagia in patients with hip fracture
  • The Cochrane Collaboration and Geriatric Medicine

The Editor’s Pick can be read here.

This issue’s free access papers are:

Too old to drink? At risk drinking in over-75s

Prof Margda Waern, psychiatrist and professor at the Sahlgrenska Academy, University of Gothenburg. This has been re-blogged from the British Geriatrics Society blogdrinker

Health benefits related to mild to moderate alcohol consumption include better cardiac and cerebrovascular health, decreased risk of dementia and improved quality of life. This might help to explain why we are nowadays less likely to discontinue drinking as we age. There may, however, be a down side. Over-consumption of alcohol can increase risk of cognitive impairment, self-neglect and falls. Considering this, it is surprising that we know so little about the extent to which older people engage in potentially harmful drinking.

I was part of a group of researchers at the University of Gothenburg in Sweden who set out to study at-risk alcohol consumption in older people.  We did this using data from two long-running surveys on health and ageing: theH70 study and the Prospective Population Study of Women.  We compared at-risk drinking in two groups of 75-year-olds: 303 persons born in 1901, and 753 born three decades later in 1930. Participants were asked about their intake of beer, wine and spirits; at-risk drinking was defined as ≥ 100g/week (corresponding roughly to more than 2 drinks/day). We found at-risk drinking in 19% of men who took part in the mid-seventies study, compared with 27% of those who participated in 2005. There was a tenfold increase in at-risk drinking in women, from 0.6 % in 1976 to 10% in 2005.

We concluded that alcohol consumption has changed markedly in 75 year olds, especially in women. It is important to note that the study was set in Scandinavia, where gender differences may be less pronounced than in other parts of Europe. Studies are needed in varied settings in order to evaluate the health implications of changing trends in alcohol consumption in later life.

The full paper can be read in Age and Ageing today.

Sleep Disorders in older people

Kirstie Anderson is Project Leader at Newcastle University’s Clinical Ageing Research Unit, for the ICICLE Sleep Study. (Reblogged from the British Geriatrics Society blog).sleepy

Sleep is a biological imperative, famously described as “of the brain, by the brain and for the brain.” In young and middle aged volunteers, sleep restriction can be shown to adversely affect memory formation, consolidation and mood. Sleep disorders including insomnia, obstructive sleep apnoea and restless legs all increase in prevalence with age but the effects of disturbed sleep in the oldest age groups are still poorly understood. Sleep becomes increasingly fragmented, although total sleep time does not change significantly and there is weakening of the circadian rhythm which is likely to be both biological and environmental. Continue reading

Driving with Dementia

Professor Joseph E Ibrahim (MBBS, GradCertHE, PhD, FRACP, FAFPHM) of The Victoria and Tasmania Dementia Training Study Centre and Monash University introduces his short animation about people with dementia who want to continue to drive. (This was first blogged on the BGS Blog site).

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Assessing a patient’s fitness to continue driving a motor vehicle following a diagnosis of dementia presents an important personal, professional and community challenge. The revocation of a person’s license is a traumatic event that significantly impacts on their quality of life. This is especially so for patients who are living in regional and rural areas. This animated video addresses some of the complex issues involved in assessing whether a person with dementia is fit to drive. Continue reading