Ilianna Lourida

Mediterranean Diet, Cognitive Function, and Dementia A Systematic Review

Background: Adherence to a Mediterranean diet has been associated with lower risk of various age-related diseases including dementia. Although narrative reviews have been published, no systematic review has synthesized studies on the association between Mediterranean diet adherence and cognitive function or dementia. Methods: We conducted a systematic review of 11 electronic databases (including Medline) of published articles up to January 2012. Reference lists, selected journal contents, and relevant websites were also searched. Study selection, data extraction, and quality assessment were performed independently by two reviewers using predefined criteria. Studies were included if they examined the association between a Mediterranean diet adherence score and cognitive function or dementia. Results: Twelve eligible papers (11 observational studies and one randomized controlled trial) were identified, describing seven unique cohorts. Despite methodological heterogeneity and limited statistical power in some studies, there was a reasonably consistent pattern of associations. Higher adherence to Mediterranean diet was associated with better cognitive function, lower rates of cognitive decline, and reduced risk of Alzheimer disease in nine out of 12 studies, whereas results for mild cognitive impairment were inconsistent. Conclusions: Published studies suggest that greater adherence to Mediterranean diet is associated with slower cognitive decline and lower risk of developing Alzheimer disease. Further studies would be useful to clarify the association with mild cognitive impairment and vascular dementia. Long-term randomized controlled trials promoting a Mediterranean diet may help establish whether improved adherence helps to prevent or delay the onset of Alzheimer disease and dementia.

Parathyroid Hormone, Cognitive Function and Dementia: A Systematic Review

Background Metabolic factors are increasingly recognized to play an important role in the pathogenesis of Alzheimer’s disease and dementia. Abnormal parathyroid hormone (PTH) levels play a role in neuronal calcium dysregulation, hypoperfusion and disrupted neuronal signaling. Some studies support a significant link between PTH levels and dementia whereas others do not. Methods We conducted a systematic review through January 2014 to evaluate the association between PTH and parathyroid conditions, cognitive function and dementia. Eleven electronic databases and citation indexes were searched including Medline, Embase and the Cochrane Library. Hand searches of selected journals, reference lists of primary studies and reviews were also conducted along with websites of key organizations. Two reviewers independently screened titles and abstracts of identified studies. Data extraction and study quality were performed by one and checked by a second reviewer using predefined criteria. A narrative synthesis was performed due to the heterogeneity of included studies. Results The twenty-seven studies identified were of low and moderate quality, and challenging to synthesize due to inadequate reporting. Findings from six observational studies were mixed but suggest a link between higher serum PTH levels and increased odds of poor cognition or dementia. Two case-control studies of hypoparathyroidism provide limited evidence for a link with poorer cognitive function. Thirteen pre-post surgery studies for primary hyperparathyroidism show mixed evidence for improvements in memory though limited agreement in other cognitive domains. There was some degree of cognitive impairment and improvement postoperatively in observational studies of secondary hyperparathyroidism but no evident pattern of associations with specific cognitive domains. Conclusions Mixed evidence offers weak support for a link between PTH, cognition and dementia due to the paucity of high quality research in this area.

Stroke and dementia risk: A systematic review and meta-analysis

Stroke is an established risk factor for all‐cause dementia, though meta‐analyses are needed to quantify this risk.

Dissemination and implementation research in dementia care: a systematic scoping review and evidence map

BackgroundThe need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review was to give an overview of the state of the evidence on implementation and dissemination of dementia care, and create a systematic evidence map.MethodsWe sought studies that addressed dissemination and implementation strategies or described barriers and facilitators to implementation across dementia stages and care settings. Twelve databases were searched from inception to October 2015 followed by forward citation and grey literature searches. Quantitative studies with a comparative research design and qualitative studies with recognised methods of data collection were included. Titles, abstracts and full texts were screened independently by two reviewers with discrepancies resolved by a third where necessary. Data extraction was performed by one reviewer and checked by a second. Strategies were mapped according to the ERIC compilation.ResultsEighty-eight studies were included (30 quantitative, 34 qualitative and 24 mixed-methods studies). Approximately 60% of studies reported implementation strategies to improve practice: training and education of professionals (94%), promotion of stakeholder interrelationships (69%) and evaluative strategies (46%) were common; financial strategies were rare (15%). Nearly 70% of studies reported barriers or facilitators of care practices primarily within residential care settings. Organisational factors, including time constraints and increased workload, were recurrent barriers, whereas leadership and managerial support were often reported to promote implementation. Less is known about implementation activities in primary care and hospital settings, or the views and experiences of people with dementia and their family caregivers.ConclusionThis scoping review and mapping of the evidence reveals a paucity of robust evidence to inform the successful dissemination and implementation of evidence-based dementia care. Further exploration of the most appropriate methods to evaluate and report initiatives to bring about change and of the effectiveness of implementation strategies is necessary if we are to make changes in practice that improve dementia care.

Coronary Artery Bypass Graft Surgery and Dementia Risk in the Cardiovascular Health Study

Introduction: The association between history of coronary artery bypass graft surgery (CABG) and dementia risk remains unclear. Methods: We conducted a prospective cohort analysis using data on 3155 elderly adults free from prevalent dementia from the US population-based Cardiovascular Health Study (CHS) with adjudicated incident all-cause dementia, Alzheimer disease (AD), vascular dementia (VaD), and mixed dementia. Results: In the CHS, the hazard ratio (HR) for all-cause dementia was 1.93 [95% confidence interval (CI), 1.36-2.74] for those with CABG history compared with those with no CABG history after adjustment for potential confounders. Similar HRs were observed for AD (HR=1.71; 95% CI, 0.98-2.98), VaD (HR=1.42; 95% CI, 0.56-3.65), and mixed dementia (HR=2.73; 95% CI, 1.55-4.80). The same pattern of results was observed when these CHS findings were pooled with a prior prospective study, the pooled HRs were 1.96 (95% CI, 1.42-2.69) for all-cause dementia, 1.71 (95% CI, 1.04-2.79) for AD and 2.20 (95% CI, 0.78-6.19) for VaD. Discussion: Our results suggest CABG history is associated with long-term dementia risk. Further investigation is warranted to examine the causal mechanisms which may explain this relationship or whether the association reflects differences in coronary artery disease severity.

A SYSTEMATIC REVIEW OF MENDELIAN RANDOMIZATION STUDIES INVESTIGATING CAUSAL ASSOCIATIONS BETWEEN RISK FACTORS AND DEMENTIA

Related factors of cognitive decline in community-dwelling elderly people are gender (male), alcohol consumption, smoking and employment (past). Thus, it is important that related factors open to change such as alcohol consumption, and smoking are more important factors to consider in cognitive decline. In conclusion, changing the above related factors that are closely related to lifestyle is very important in preventing cognitive decline in community-dwelling elderly people. Consequently, we must provide assistance and education to the elderly which will help them make changes in such related factors.

STRATEGIES, FACILITATORS AND BARRIERS TO CHANGE: A SYSTEMATIC REVIEW OF IMPLEMENTATION RESEARCH WITHIN DEMENTIA CARE

Background:There is no standardised instrument for assessing social functioning in dementia despite decline in social functioning being one of the diagnostic criteria for dementia and important to patients and their families. We aimed to develop a valid, reliable, acceptable instrument for assessing social function in people with dementia. Methods:We conducted qualitative interviews with 18 dyads of people with dementia and their family carers, a literature review, and focus groups with expert health-care professionals to develop the patient-rated and carer-rated versions of the Social Functioning in Dementia (SF-DEM) instrument. We tested the acceptability and psychometric properties of these measures in structured interviews at baseline and at 4 weeks’ and 6–8 months’ follow-up in a cohort of 30 dyads of people with mild dementia and their carers, recruited from London memory services. Results:SFDEM had content validity. The instrument was acceptable to both patients and carers, who all rated it as acceptable or very acceptable. Inter-rater agreement was good or very good for all questions. Test–retest reliability was very strong (Intraclass correlation coefficient (ICC)1⁄40

OP27 Dissemination and implementation in dementia care practice: a systematic scoping review

89, 95% CI [0.73, 0.96]) for the carer-rated SFDEM and (ICC1⁄40

OP68 Implementing and disseminating best practice in the care home setting: A systematic scoping review

80, 95% CI [0.54, 0.92]) patient-rated version, and both versions had internal consistency (Cronbach’s a1⁄40

DISSEMINATION AND IMPLEMENTATION IN DEMENTIA CARE: A MIXED-METHODS SYSTEMATIC REVIEW

71 for carer-rated SF-DEM and a1⁄40