DEMENTIA NEWS

EDITION 13 - AUGUST 12 , 2013

UNDERSTAND PARTICIPATE

DISCUSS

EDITORIAL

Hello Dementia News readers,

Having only been working for Alzheimer’s Australia for just a couple of weeks now, I have been constantly amazed with the amount of dementia research happening all over the world, including Australia. I receive new research updates daily and while I would love to explore all of them, in this issue I have a picked a few studies that I found interesting to focus on.

These include:•People with dementia showing improved brain functionwhenprescribedwithaspecificbloodpressure drug.

•Dog interaction improving the physical and mental health of people with mild to moderate dementia in assisted living homes.

•Dementia being linked with poor oral hygiene.

We also have an article by Dr Mary Gray, the manager of the Alzheimer’s Australia Dementia Research Foundation (AADRF), who has written about recent Australian research focusing on the declining use prescription Alzheimer’s disease drugs in Australia and the reasons for this.

The‘‘Discuss the Science’’ section focuses on Dementia carers. From our recent surveys, we know a lot of our readers are carers themselves, so I hope youfindthisarticleinformative.Researchersarenow looking into the burdens carers of people with dementia may face. Feel free to let me know your thoughts on this, as I think it brings up some interesting points.

Congratulations are in order for the following Australian dementia researcher:Dr Peng Lui – 2012 recipient of an AADRF scholarship has recently been awarded a government funded (NHMRC) early career fellowship to continue research investigating the interactions between tau and iron. Peng has previously demonstrated that the tau protein regulates iron in the brain and too much iron has been found to be neurotoxic. We wish Peng luck in his future research.

A special mention should be made that Alzheimer’s Australia CEO Glenn Rees, along with Ian Yates, CEO of COTA Australia and Carol Bennett, CEO of the Consumer Health Forum will be speaking at the National Press Club tomorrow (Tuesday 13th of August) from 11.30am to 1.30pm to discuss and highlight consumer policies on aged care and health for the federal election. Tune into ABC 1 on Wednesday the 14th of August between 12.30pm to 1.30pm to watch a live broadcast.

Finally, as I get into the swing of things, Dementia News will now be more consistent and will be delivered into your inboxes each Monday fortnight from here on in. Over the next few months you might notice some changes to the layout and guest articles by researchers themselves. I welcome your feedback and ideas, as we want to make it as readable, educational and exciting as possible.

I hope you enjoy this issue,Ian McDonald

Did you know: An estimated 1.2 million Australians are caring for someone with dementia.

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Brain function (measured in the form of a cognitive test score) was found to improve in people with dementia given centrally acting ACE Inhibitors (CACE-Is). Researchers at the University of Cork, Ireland, analysed a total of 361 individual medical records. Records were only included of people who had been pre-diagnosed with dementia from two different university hospitals in Ontario, Canada, via two separate cognitive screening tests for diagnosing mental disorders.

Of the 361 records included in the study, 85 had previously been prescribed and were receiving CACE-Is (some since 1999), 30 had just been prescribed with CACE-Is and 276 where not prescribed with CACE-Is. A few other notable facts included:

•The average age of study participants were 78 years old,

•The average time spent in education was 11 years and

•Male to female ratio was split almost 50:50.

Six months after the study began, participants were retested using the same tests as those to diagnose dementia. Results showed a small reduction in the rate of cognitive decline (i.e. brain function) in those who had previously been prescribed with CACE-Is comparedtothosewhoweren’t.Morespecifically,resultsshowedastatisticallysignificantdifferenceover six months when the Qmci test was used. However when the SMMSE test was used the resultswerenotsignificant,butsuggestedpotentially slower disease progression. Interestingly, those who had just been prescribed CACE-Is showed even better improvement over the course of thesixmonths,whichwasasignificantstudyfinding,neverseenbefore.

There are some limitations to this study, most important is that it was an ‘observational study’ – meaning data was collected from medical records only and therefore researchers had no control in the way participants received treatment or if other drugs were administered during the six months for other related illnesses. Therefore, the next step is to undertake a similar study in a more controlled setting and potentially over a longer period of time to see if similarfindingsaremade.

For more information click on the link below:Media link: Herald Sun Journal link: BMJ Open

BLOOD PRESSURE DRUGS SHOWN TO SLOW DEMENTIA SYMPTOMS

UNDERSTAND NEW RESEARCH

What are CACE-Is?

Known as a Centrally Acting Angiotensin Converting Enzyme Inhibitors, they are a group of drugs used for blood pressure control. Examples include perindopril, rampril, trandolapril and many others. Theyspecificallytargetthereninangiotensin system, which regulates bloodpressureandfluidbalanceinthe body. If this system becomes overactive – high blood pressure results.

What cognitive screening tests were used?

A Standardised Mini-Mental State Examination (SMMSE) and Quick mild cognitive impairment (Qmci) were used to diagnose people in this study. Qmci is a new cognitive test screen which has been found to be more sensitiveandspecificfordifferentiating between mild cognitive impairment from normal cognition and dementia – see paper published in Age and Ageing Journal - click here.

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POOR ORAL HYGIENE LINKED WITH DEMENTIAThe presence of a bacterium (Porphyromonas gingivalis) has been found in the brains of people with dementia. This bacterium, commonly associated with chronic periodontal (i.e. gum) disease, is now thought toalsocauseaninflammatoryroleinexistingAlzheimer’s disease pathology. Professor Stjohn Crean and researchers from the University of Central Lancashire, UK, examined twenty different donated brain samples. Ten of these brains were known to be from people with Alzheimer’s disease while ten were not. All known Alzheimer’s disease brain samples were taken at least 12 hours post mortem and all the brains were from people of similar age. The research team found the presence of the bacterium in all ten brains from people with Alzheimer’s disease.

These bacteria are generally more prominent in people with poor oral hygiene and enter the bloodstream through common activities like eating, brushing teeth and especially following invasive dental treatment. From there it is thought that they enter the brain on a regular basis. The researchers suggest that every time the bacteria enter the brain, they trigger a response which causes the release of more chemicals that kill brain cells. This could be one mechanism that triggers changes to the brain that occur in Alzheimer’s disease.

Thisfindinghasnotbeendocumentedpreviously,andadds to a growing body of evidence that suggests an association between poor oral hygiene and dementia. However, the sample of brains assessed is too small tomakeanyrealdefiningconclusions.Onelimitationto this study is that the dental records of the individuals whose brain specimens were examined were not available, so the researchers acknowledged thedifficultyinmakinganydirectrelationshipsbetween periodontal disease and Alzheimer’s disease during life and it should continued to be studied.

The researchers from this current study have since undertaken work in animal models, which have confirmedthatthebacteriainthemouthcanfinditsway to the brain once the periodontal disease becomes established. In the future they aim to discover if P. gingivalis can be used as a marker, via a simple blood test, to predict the development of Alzheimer’s disease in ‘at risk’ patients. While there are still more research outcomes to be assessed, this study does make a good point that good oral hygiene (i.e.brushingtwiceadayandflossingregularly)isessential in keeping a healthy body and mind.

For more information click on the links below:Media link: The AustralianJournal link: Journal of Alzheimer’s DiseasePhotos sourced with permission from UCLAN press

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DOGS HELPING PEOPLE WITH DEMENTIABefore you get too excited, dogs have not been trained to become dementia carers. Nevertheless, what researchers have found is that people with mild to moderate dementia symptoms show enhanced mental health and physical function when interacting with dogs.

Dr Erika Friedmann from the University of Maryland, USA presented these results at the recent triennial conference of the International Association of Human-Animal Interaction Organisations in Chicago. Her research team hypothesised that structured interaction with dogs may slow the deterioration of brain function compared with another equal attention intervention.

The study consisted of forty residents from seven aged care facilities in the USA with dementia symptoms and without dog allergies or fear. Participants were split into two groups. Each group received two 60-90 minute ‘attention intervention’ sessions each week over a 12 week period, as per below:

•Pet Assisted Living (PAL) dog intervention: participants were encouraged to perform skills with the visiting dog including: motor skills, sequencing events and social skills.

•Reminiscing intervention: participants were prompted with materials which encouraged them to reminisce about their experiences.

Participants were assessed prior to the study for physical, emotional and behavioural function and this was monitored every four weeks during the study. Dr Friedmann found that the frequency of depression wassignificantlylowerinthoseinteractingwithadograther then reminiscing. These short term results show that dog intervention or ‘Pet Assisted Living’ may be effective in preserving and enhancing the mental and physical health of people with mild to moderate dementia.

I asked Dr Friedmann what these preliminary results meant for her future research and she said ‘The next step is to conduct a more extensive study to evaluate the effectiveness of the intervention in the longer term, to broaden the type of assisted living facility and to examine different subgroups of patients to see if somepeoplebenefitmorethanothers’.Thisresearchhas not yet been published but there are plans to both publishthefindingsinapeerreviewedjournalandtoundertake more trials.

For more information click on the link below:Media link: Medical News todayConference link: IAHAIO’s International Conference

PRESCRIPTION DRUG INEQUALITY FOR ALZHEIMER’S DISEASEDr Renate Zilkens and her Perth team, recently undertook a study on the rates of prescription of cholinesterase inhibitors across Australia to determine if there were any trends in who was or was not prescribed these drugs. Cholinesterase inhibitors are a class of drugs that help treat the symptoms of mild-to-moderate Alzheimer’s disease. These drugs are one of the very limited treatment options for people with Alzheimer’s disease.

Dr Zilkens and her team used records of all Australians prescribed cholinesterase inhibitors between 2003 and 2010. They found that there was, on average, 11,909 newpeoplebeingprescribedthesedrugs,forthefirsttime, every year. This equates to about 13% of the estimated population of people with Alzheimer’s disease over 65 years of age each year. The study found that this percentage decreased in remote and social disadvantaged groups to less than 8%.

However, people in the most advantaged group had prescription rates of around 20%. Furthermore, the peak of prescribing cholinesterase inhibitors was reached in 2004 and has dropped subsequently, perhaps due to an increase in the co-payment costs for medicines in 2005 through the Pharmaceutical BenefitsScheme.

“Since 2011 access to medication to treat Alzheimer’s disease has been made easier for people with Alzheimer’s and their GPs. GPs are now allowed to prescribe cholinesterase inhibitors without the need for a specialist referral. Hopefully this will increase the number of people with Alzheimer’s disease (including those in remote and disadvantaged areas) getting access to cholinesterase inhibitors.” stated Dr Renate Zilkens.

For more information click on the link below:Journal link: Alzheimer’s and Dementia

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Guilt, frustration, embarrassment and depression are just some of the negative impacts that have come out of a study in North America looking at the various dimensions of burden from those caring for people with dementia. Many people with dementia are now being cared for by spouses and/or adult children and research has been focusing on how caring for people with dementia can impact on carers physical and mental health. A study led by Dr Beth Springate from Rhode Island Hospital, USA, was recently published in American Journal of Geriatric Psychiatry.

Dr Springate and her team interviewed 206 spousal or adult child caregivers for people with mild to moderate dementia. Carers were assessed through a variety of measures including interviews and quizzes. 84% of carersreportedclinicallysignificantburdensintheformof physical or mental health. They were shown to have an increased chance of depression and when people with dementia displayed behavioural issues, this lead to embarrassment and frustration among carers within the study.

Another interesting result was that the age of the carer was associated with an increased sense of guilt, particularly among the younger carers. The study found that spousal carers showed less reported burden then adult children carers. The authors of the study suggested that this is likely due to the fact that adult children carers are often balancing caring for parents, as well as their own children and also likely to be working–addingasignificantstresstotheirlives.

The study concluded that tailored intervention programs specifictothetypeofdifficulitesbeingfacedbycarerswould be required in order for the best support outcomes.Thereisnota‘oneapproachfitsall’solution.

Alzheimer’s Australia recommends getting support early if you are a carer of someone with Dementia – contact your state branches for the various support services on offer - click here for contact details.

Our National Dementia Helpline (1800 100 500) offers support between 9am and 5pm (AEST) or you can call the Dementia Behaviour Management Advisory Service (1800 699 799) 24 hours a day. The Fight Dementia website has an extensive section on advice for carers of people with dementia including a section on taking care of yourself - click here.

For more information click on the links belowMedia link: Lifespan newsroomJournal link: American Journal of Geriatric Psychiatry

COPING WITH THE BURDEN OF BEING A DEMENTIA CARER

DISCUSS THE SCIENCE

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FORGIVENESS – HELPING WITH THE BURDEN OF DEMENTIA CARING

Caring for people with dementia may result in negative feelings such as anger and resentment, which may lead to abusive or potentially harmful behaviours. A study of 76 Chinese family caregivers was undertaken by researchers within the Department of Psychological studies at the Hong Kong Institute of Education. All study participants were carers of people with dementia andtheyeachfilledoutaquestionnaire.

The research found that the burden of being a caregiver could potentially lead to harmful behaviours towards the people with dementia that may have included, screaming and yelling, physical force, withholding food, shaking and rough handling. Researchers undertaking this study hypothesised that forgiveness (usually in the form of an apology) would be associated with a reduction in anger, stress and resentment and encourage positive actions towards the person they are caring for. They found that forgiveness mediated the association between disruptive behaviours displayed by people with dementia and the burden felt by the carers themselves. Forgiveness is often used to deal with emotions and bring back a sense of normalcy to a relationship.

This study acknowledges some limitations within its results, including the majority of participants being female and the relatively small sample size in comparison to the amount of carers in the population.

However, it does provoke discussion around whether forgiveness may be a useful tool for incorporation in carer intervention programs and may help carers manage their feelings of anger and frustration when undertaking the responsibility of caring for a loved one. Future research hopes to look more into the emotional processes involved in forgiveness and how it can be further used as a positive method within the caring community.

Alzheimer’s Australia recommends calling our National Dementia Helpline (1800 100 500) if you ever feel you need support in this area. Also, see our section on feelings - on the Fight Dementia website.

For more information click on the link belowJournal link: Journal of Ageing and Mental Health

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PARTICIPATE TO LEARN MORE

HOW DOES STRESS AND NUTRITION AFFECT CARERS DNA?Are you a Carer, living in metropolitan Adelaide?

Dr Caroline Bull and her colleagues at CSIRO are examining the relationship between the physical and emotional health of primary carers of individuals with Alzheimer’s disease. They aim to identify practical, effective ways to prevent damage to DNA, reduce disease risk and improve the long term health and wellbeing of carers who experience high levels of stress.

The study will require a single blood sample and small saliva sample to study stress, DNA health, and nutrition factors, as well as questionnaires about participants’ regular diet, psychological wellbeing, stress burden, thinking and memory.

For further information please download the information sheet and medical screening questionnaire from the Alzheimer’s Australia website here. For further information please contact: Clinical Trial Manager, Julia Weaver Phone: (08) 8303 8876 Email: CRUstudies@csiro.au.

MAKE YOUR VOTE COUNT FOR DEMENTIA THIS FEDERAL ELECTIONTo show your support for dementia in the upcoming election, Alzheimer’s Australia has produced its own Ballot Paper.

Youcanmakeyourvotecountbyfillingouttheelectronic ballot paper via the following link - click here.

Tell us why this issue is important to you and what your priorities are in this area.

These responses will then be collated and sent to Mr RuddandMrAbbott.Themorepeoplewhofilloutthisballot, the larger our voice will be.

Dementia is the public health challenge of the 21st century and is the third leading cause of death of Australians. There are more than 321,000 Australians living with dementia today and an estimated 1.2 million Australians who support them.

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CONTACT

This newsletter was funded by the Australian Government as well as the Dementia Collaborative Research Centre: Carers and Consumers © Alzheimer’s Australia as represented by the Dementia Collaborative Research Centre: Carers and Consumers, 2011DISCLAIMER:The views expressed in this work are the views of its author/s and not necessarily those of the Australian Government.

Any questions or comments are welcome.To subscribe/unsubscribe or if you have any information you would like to see included in future editions please contact:E: ian.mcdonald@alzheimers.org.auP: (02) 6278 8916

NATIONAL DEMENTIAHELPLINE1800 100 500

EVALUATION OF THE LEAD CLINICIANS GROUP INITIATIVE

The Department of Health and Ageing has appointed Health Outcomes International to undertake an Evaluation of the Lead Clinicians Group (LCG) Initiative. The evaluation seeks the input of clinicians and other stakeholders:Survey Now Open – click here to complete

BACKGROUND

The three (3) LCG Initiative strategies are:1. The National Lead Clinicians Group, to promote improved clinical engagement. 2. A National Clinicians Network (NCN), to promote clinical leadership and engagement through forums. 3. Providing funds to the Australian Medicare Local Alliance to work with Medicare Locals to improve clinical leadership and engagement at the local level.

For further information about the LCG Initiative, click here

Surveys Close 30th August 2013