Making Alzheimer's and dementia research fit for populations

Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
The Lancet (Impact Factor: 45.22). 10/2012; 380(9851):1441-3. DOI: 10.1016/S0140-6736(12)61803-0
Source: PubMed
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Available from: Carol Brayne,
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    • "Delirium, as defined in this study, is associated with increased dementia, strengthening the argument that interventions for delirium may have an impact on the burden of cognitive impairment. Nonetheless, the core elements of the delirium-dementia relationship still require further exploration (e.g. if the key factors responsible for this association relate to etiology, duration, severity or some combination), particularly in the general population and in other cohort studies [18]. At the least, these findings indicate that it is possible to identify population samples with delirium and subsyndromal delirium at higher risk for dementia. "
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    ABSTRACT: Background In the general population, the epidemiological relationships between delirium and adverse outcomes are not well defined. The aims of this study were to: (1) construct an algorithm for the diagnosis of delirium using the Geriatric Mental State (GMS) examination; (2) test the criterion validity of this algorithm against mortality and dementia risk; (3) report the age-specific prevalence of delirium as determined by this algorithm. Methods Participant and informant data in a randomly weighted subsample of the Cognitive Function and Ageing Study were taken from a standardized assessment battery. The algorithmic definition of delirium was based on the DSM-IV classification. Outcomes were: proportional hazard ratios for death; odds ratios of dementia at 2-year follow-up. Results Data from 2197 persons (representative of 13,004) were used, median age 77 years, 64% women. Study-defined delirium was associated with a new dementia diagnosis at two years (OR 8.82, 95% CI 2.76 to 28.2) and death (HR 1.28, 95% CI 1.03 to 1.60), even after adjustment for acute illness severity. Similar associations were seen for study-defined subsyndromal delirium. Age-specific prevalence as determined by the algorithm increased with age from 1.8% in the 65-69 year age group to 10.1% in the ≥85 age group (p < 0.01 for trend). For study-defined subsyndromal delirium, age-specific period prevalence ranged from 8.2% (65-69 years) to 36.1% (≥85 years). Conclusions These results demonstrate the possibility of constructing an algorithmic diagnosis for study-defined delirium using data from the GMS schedule, with predictive criterion validity for mortality and dementia risk. These are the first population-based analyses able to account prospectively for both illness severity and an earlier study diagnosis of dementia.
    BMC Geriatrics 07/2014; 14(1):87. DOI:10.1186/1471-2318-14-87 · 1.68 Impact Factor
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    • "" While depression is less frequent in late life than in mid-life, it is more frequent in the oldest old than in the younger old, possibly because of the higher proportion of women, disability, and cognitive impairment in this group (Blazer, 2003; Luppa et al., 2010). The age distribution of a study population differs by setting (Brayne and Davis, 2012) and often an age cut-off is used as an inclusion criterion (e.g. recruitment of those aged 55+, 65+, or 75+ years). "
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    ABSTRACT: Terms to describe the behavioral and psychological symptoms commonly seen in dementia, including "Behavioral and Psychological Symptoms of Dementia" (BPSD), "non-cognitive symptoms," and "neuropsychiatric symptoms," were introduced in the 1980s and 1990s to draw attention to the heterogeneous group of symptoms that, distinct from cognitive deficits, are commonly seen in dementia and cause significant distress to patients and carers (Reisberg et al., 1987; Cummings et al., 1994; Allen and Burns, 1995; Finkel et al., 1996). BPSD include a wide range of affective, psychotic, and hyperactivity symptoms, and studies include different combinations of symptoms. These symptoms are also often studied individually outside the context of BPSD in the older population with or without cognitive impairment. Depression is most frequently studied, particularly in the older population without dementia. The relationship between dementia and depression in older people and the courses of the two disorders have been an important research topic for around 70 years (Roth, 1955).
    International Psychogeriatrics 10/2013; 26(2):1-7. DOI:10.1017/S1041610213001592 · 1.93 Impact Factor
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    ABSTRACT: Research that follows people over a period of time (longitudinal or panel studies) is increasingly recognised as of great importance in helping us to understand the ageing process and changes over time in the lives of older people. If people drop out of studies - which older people are more likely to do - the value of the study diminishes. This research draws on evidence from ongoing and previous longitudinal studies of people aged 55 and over to examine what factors encourage the retention of participants and what causes them to drop out. The research is synthesising existing evidence, drawing together the experiences of researchers involved in longitudinal studies, and collecting some new evidence about the views of survey participants. This article reports on the first part of the research by drawing together evidence from other studies. These show that there are some factors that are related to attrition whereas for others the evidence is mixed. Methods employed by these studies to reduce attrition and retain participants are examined. It must be noted that apart from the consistent finding that attrition is associated with age, education, socio-economic status and cognitive impairment, not all studies examined the same variables; some only being explored by one study. This makes it difficult to draw any further conclusions and indicates that attrition needs to be addressed in a uniform manner by more studies. This article identifies some implications for policy-makers and practitioners.
    Quality in ageing: policy, practice and research 12/2008; 9(4). DOI:10.1108/14717794200800025
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