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Dementia
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Kelly J. Freeman, D. Nicole Paddock, Cristina H. Davis
Dementia is not a normal part of aging, and older age alone is not sufficient to cause Alzheimer’s disease and other forms of dementia. The greatest risk factors for Alzheimer’s dementia are older age, genetics, and family history.3–6 Experts believe that Alzheimer’s disease, like other common chronic diseases, develops as a result of multiple factors. It is important to note that, while it is beyond the scope of this chapter, when a woman does have symptoms that align with a potential dementia diagnosis, it is imperative to first rule out potential causes of pseudodementia (i.e., “reversible dementias”) such as depression, hypothyroidism, and vitamin deficiencies.7 Rarely, there are genetic factors that may influence the development of early-onset dementia.8
Young onset dementia − challenges in nomenclature and clinical definitions
Published in Marjolein de Vugt, Janet Carter, Understanding Young Onset Dementia, 2021
Dennis van de Veen, Christian Bakker, Tor Rosness, Raymond Koopmans
A PubMed search with the term early onset dementia shows that this term has been applicable for approximately two decades. Early onset dementia includes the more common aetiologies that have their onset at a younger age, as well as the typical old-age aetiologies such as Alzheimer's disease and vascular dementia (Miyoshi, 2009). Furthermore, the clinical manifestation of Alzheimer's disease can often show atypical symptoms when occurring at a young age, such as the absence of episodic memory dysfunction and the presence of apraxic or aphasic symptoms (Balasa et al., 2011). A short-coming of the term early onset dementia is that it may be easily confused with the term early-stage dementia, used to refer to the stage or phase of the dementia.
Contexts
Published in Emmanuel Tsekleves, John Keady, Design for People Living with Dementia, 2021
Emmanuel Tsekleves, John Keady
Age poses an additional challenge in reaching a diagnosis of dementia. This is because the oldest-old are the fastest growing segment of the population and have the highest rates of dementia. However, the diagnosis of dementia in this age group is further complicated by naturally occurring age-related phenomena such as sensory losses, medical co-morbidities, over-medication use and frailty (Brumback-Peltz et al., 2011). On the other hand, diagnosis of dementia in younger age groups – also known as ‘early onset dementia’ – is equally challenging as its symptoms are not easily associated with the condition (Rossor et al., 2010). The challenges faced by individuals living with early onset dementia and by those who support and care for them are different due to the stage of life that is interrupted by the diagnosis and the duration of the disease course (Lambert et al., 2014). For this group of younger people living with dementia, employability, current family dynamics and presentation of dementia symptoms can intensify experiences and increase stress for them and their families (Roach et al., 2016). Indeed, it can take over one and a half years longer to be diagnosed for people living with early onset dementia as compared to people over the age of 65 (Greenwood and Smith, 2016). This questions whether the same clinical and neuropathological criteria used for the diagnosis of dementia on older populations can be applied for on the oldest-old populations as well as in younger populations (Slavin et al., 2013).
Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration
Published in Clinical Gerontologist, 2022
Claire Quinlan, Christine McKibbin, Cari Cuffney, Ross Brownson, Carol Brownson, Jeff Clark, Lisa Osvold
Improvements may also acknowledge the present focus identified in this population. Forty-three states have adopted an Aging and Disability Resource Center, in order to promote the “no wrong door” approach to helping older adults and their caregivers navigate the world of social services (NCSL, n.d.). Evidence-based programs such as the SHARE program support aging in place by facilitating value-based care-plans between caregivers and care receivers with early-onset dementia, effectively identifying services to fill future needs and successfully keeping people in their homes (Orsulic-Jeras, Whitlatch, Szabo, Shelton, & Johnson, 2019). The Iowa Department of Health and others have adopted a mandatory options counseling policy which counsels older adults considering discharge from a hospital or SNF through a person-centered plan to successfully live at home. Other states have also urged Medicare regulations requiring more thorough discharge planning in regards to caregiver needs (Henning-Smith & Lahr, 2018). These services acknowledge that successful aging in place requires both timely and appropriate care which takes into account the burdens of informal family support.
The prevention of urinary tract infections in aged care residents through the use of cranberry products: a critical analysis of the literature
Published in Contemporary Nurse, 2022
Jane E. Bartlett, Anita De Bellis
Bacteriuria and UTIs in aged care residents are often misinterpreted and mishandled. There are challenges and controversies in the diagnosis of UTIs, for instance, pyuria could be evident in an estimated 90% of aged care residents, despite the absence of a UTI. Therefore, antimicrobial treatment could be prescribed inappropriately (Detweiler et al., 2015). Older people presenting with unexplained changes in behaviour and symptoms of confusion, agitation and withdrawal are commonly diagnosed with early onset dementia and Alzheimer’s disease. However, these symptoms could be potentially related to a UTI causing delirium. Therefore, UTIs are often underdiagnosed (Alzheimer’s Society, n.d.). Importantly, UTIs could potentially have a detrimental effect on an older person's quality of life. Emotional problems, such as anxiety and depression, may develop, along with social and functional decline (Renard et al., 2014). Recent results suggest the utilisation of cranberry proanthocyanidins-chitosan hybrid nanoparticles as a potential inhibitor of extra-intestinal pathogenic Escherichia coli invasion of gut epithelial cells and may prevent E-Coli UTIs (Alfaro-Viquez et al., 2018).
Recent developments in geriatric psychopharmacology
Published in Expert Review of Clinical Pharmacology, 2021
Awais Aftab, Jeffrey A. Lam, Fred Liu, Anjan Ghosh, Martha Sajatovic
Diagnostic radiotracers that detect the presence of Aβ neuritic plaques and aggregated tau NFT represent a productive intersection of psychopharmacology with diagnostic imaging. There is convincing and high-quality evidence to support their use as aids in the diagnostic process; however, their clinical use is significantly constrained by limited insurance coverage. The clinical utility of amyloid PET scan in cases of early onset dementia appears to be in confirming the diagnosis by demonstrating the presence of amyloid in the cortex while the clinical utility in late-onset cases appears to be greater in detecting amyloid-negative cases and thereby reducing the probability of AD. A positive tau PET scan is associated with advanced stage of tau pathology where NFTs have spread throughout the neocortex. Tau PET is unable to detect earlier stages of tau pathology in AD in which NFTs are only present in deeper brain regions. Tau PET scan is thereby likely to offer more clinical utility in cases of AD in which activities of daily living have been significantly affected. Appropriate use recommendations regarding tau PET and recommendations regarding selecting between amyloid and tau PET imaging are currently pending.