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55 Dementia Dissertation Topics

Published by Owen Ingram at January 2nd, 2023 , Revised On August 16, 2023

The term dementia refers to a collection of symptoms and disorders, rather than a single disease. As a result, dementia has a wide range of dissertation topics. Finding a dissertation subject related to dementia sufferers might be advantageous. You may be attempting to make a difference in the lives of dementia sufferers. You must investigate some previously unknown features to assist them! For those hoping to use their dissertation to help people with dementia, this is the right place. Our team has compiled a list of dissertation topics for your consideration. Picking dementia research subjects that haven’t received as much attention as others can add something new to the table.

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List Of Dementia Dissertation Topics For All Academic Levels

• An in-depth investigation of dementia in men and women – a case study
• An examination of the ways advocated by experts for dealing with dementia sufferers
• Highlighting the genetic and environmental risk factors for dementia development in the elderly in the United Kingdom
• The study of senior dementia patients and how they react to definite and uncertain conditions
• A comprehensive analysis of the connection between risks and smog and an increase in dementia in European industrial towns
• Experts studied a cognitive test for diagnosing mild dementia diseases in male patients.
• Use educational expert dementia strategies and how they might help treat and care for dementia sufferers.
• How much nursing assistance is required to care for dementia patients?
• Investigating the significance of the care policy for senior dementia patients in the United States of America
• The nursing qualification and certifications necessary for the care of senior dementia patients in the United Kingdom are highlighted.
• Recognizing the patient’s quality of life. A patient with dementia is the subject of this case study
• What are the most effective ways for early dementia identification in the United Kingdom? A thorough investigation
• A study of dementia patients receiving home care and how it has aided in reducing the symptoms
• Do dementia caregivers experience stress? – an examination of survey results.
• Non-pharmacological therapies for aggressiveness and stress in dementia patients
• What is the pain treatment procedure for dementia patients?
• The dementia nurses training program in the United Kingdom and how it has improved dementia patient care
• A comparison study evaluated the relationship between dementia patients’ longevity and the point at which their therapy began
• Investigating the link between memory loss and the early stages of dementia
• Investigating the cognitive tests nurses use to detect minor cognitive impairments that can progress to dementia in male patients
• Problem behaviour in dementia and the production of informal caregiving services
• Investigating the use of educational strategies by nursing staff in overcoming communication challenges in dementia patients
• Patient-centred pain control in elderly people with dementia equality, diversity, and inclusion in dementia care practice
• Can cognitive training slow the progression of dementia?
• What function does physical activity increase mobility and stamina in vascular dementia patients? An in-depth examination
• The importance of contemporary technology in the care of patients suffering from dementia. A thorough examination of dementia sufferers in the United Kingdom
• Examine the factors that increase the likelihood of developing dementia at a young age in the United Kingdom
• The ability of nursing staff to determine the requirements of dementia patients by interpreting behavioural displays and emotional responses of patients
• Making end-of-life decisions for nursing home residents with dementia
• Autism and dementia are both diagnosed and treated in the same way
• Identifying modifiable dementia risk factors pathways connecting late-life depression and dementia
• Is there communication between dementia doctors and patients?
• What are the global trends in dementia? – case studies from various nations
• Dementia research by UK ethnic minorities and how it has affected individuals
• Mild cognitive impairment and dementia in Parkinson’s disease imaging
• Improving cognitive function before clinical dementia symptoms
• Longitudinal relationships between serum cytokine levels and dementia
• Dementia and the affected parts of the brain
• Examine doll therapy treatment and how it has progressed and improved the medical sector
• Observational pain assessment scales for dementia patients
• The treatment of dementia patients and its beneficial impact on their lives.
• Deficits in exploration under ecological conditions as a marker of apathy in frontotemporal dementia
• What are the three behavioural issues related to dementia?
• What are some common behaviours observed in dementia patients?
• When do dementia patients forget about family members?
• What is the life expectancy of someone suffering from Parkinson’s disease and dementia?
• How can you tell if someone has dementia is near death?
• An overview of the literature on medical ideas and notions about dementia.
• A study on a cognitive test for diagnosing mild dementia diseases in male patients.
• What effect does dementia have on a person’s care needs?
• Why is early retirement associated with an increased risk of dementia?
• Do retirees with dementia require financial assistance?
• What are dementia pharmacological interventions?

If you have chosen one of the above dementia dissertation topics, you can start working on your dissertation . You might also want to review our list of nursing dissertation topics for extensive research because they are correlated with the field of medical science.

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Final Words

There is no doubt that your dissertation is the most important document of your academic career. A dissertation on dementia is another matter altogether. Your dissertation topic should entice your readers to read it by piquing their interest.

Above, we have provided the most comprehensive dementia research topics. The topic of your dissertation can be anything you wish. Ensure that your final dissertation topic meets the criteria for your dissertation. Dissertations that fail to meet the approval standards will almost certainly be rejected. We offer customised dementia dissertation topic s with research aims and objectives if you are still looking for suggestions.

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• Explore interdisciplinary angles.
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• Consult experts or professors.
• Choose a meaningful and feasible topic for in-depth study.

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• Correspondence
• Published: 26 May 2023

In global approaches to dementia research, do not forget care

• Fanny Monnet   ORCID: orcid.org/0000-0002-4983-9486 1 ,
• Charlèss Dupont 1 &
• Lara Pivodic   ORCID: orcid.org/0000-0002-8825-3699 1  

Nature Medicine volume  29 ,  page 1595 ( 2023 ) Cite this article

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• Alzheimer's disease
• Palliative care

We read with great interest the editorial on the importance of a global approach to dementia research 1 . We agree that a global approach to research into the mechanisms, prevalence, risk factors and prevention of dementia is needed. We would like to highlight an additional and crucial aspect of dementia research that was not mentioned in the editorial but also requires a global approach: care for people with dementia throughout the illness trajectory, including at the end of life.

Dementia is the seventh leading cause of death worldwide and the fourth among individuals 70 and older, representing 3% of total deaths in 2019 2 . As the global population ages, the prevalence of dementia is likely to continue rising, with the largest percentage increases occurring in regions such as North Africa and the Eastern Mediterranean (367%) and eastern sub-Saharan Africa (357%) 3 . Therefore, while working toward effective prevention and treatment approaches, there is also a need for research aiming to optimize care and maintain quality of life for those who will live with dementia and who will die with or from this disease 4 . Care is also highlighted as a key research theme in the World Health Organization (WHO) dementia research blueprint, to which your editorial refers 5 .

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Anonymous Nat. Med. 29 , 279 (2023).

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World Health Organization. https://go.nature.com/43nNG0w (2020).

Nichols, E. et al. Lancet Public Health 7 , e105–e125 (2022).

Alzheimer’s Disease International. https://www.alzint.org/what-we-do/research/world-alzheimer-report/ (2022).

World Health Organization. https://www.who.int/publications/i/item/9789240058248 (2022).

Miranda, R. et al. Palliat. Med. 35 , 1701–1712 (2021).

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Miranda, R. et al. Palliat. Med. 33 , 726–742 (2019).

Article   PubMed   PubMed Central   Google Scholar  

Van der Steen, J. T. et al. Palliat. Med. 28 , 197–209 (2014).

World Health Organization. https://www.who.int/publications/i/item/9789240033245 (2021).

Alzheimer’s Disease International. https://go.nature.com/3BSqEn0 ( 2022).

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End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium

Fanny Monnet, Charlèss Dupont & Lara Pivodic

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Monnet, F., Dupont, C. & Pivodic, L. In global approaches to dementia research, do not forget care. Nat Med 29 , 1595 (2023). https://doi.org/10.1038/s41591-023-02356-x

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DOI : https://doi.org/10.1038/s41591-023-02356-x

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147 Dementia Essay Topics

🏆 best essay topics on dementia, ✍️ dementia essay topics for college, 👍 good dementia research topics & essay examples, 🎓 most interesting dementia research titles, 💡 simple dementia essay ideas, ❓ research questions about dementia.

• Pain Management in Patients With Dementia
• Alzheimer and Dementia Patients Nursing Care
• Participatory Horticultural Therapy for Dementia
• Dementia: Treatment and Management
• Diagnosis and Management of Dementia
• Dementia – Health Issues and Caregiver Burden
• Care Services for Elderly People with Dementia in China
• Lewy Body Dementia: Diagnosis/Condition LBD is a condition that leads to the development of dementia and which predominantly affects people over the age of 50.
• Dementia: Ertha Williams’ Case Analysis Dementia is one of the most common brain dysfunctions that predominantly occur in older adults by diminishing their quality of life and chances for independent functioning.
• Dementia – The Disease of the Older Generation The research paper explores the ways in which the quality of life of patients with dementia could be improved.
• Alzheimer’s Disease and Dementia Description As time goes by, people are more likely to encounter memory problems. This can be both a natural sign of aging or illness.
• Falls in Patients with Dementia and Alzheimer’s In their study, Velayutham et al. consider the opportunities for reducing the threat of falls among patients with Alzheimer’s disease.
• Dementia: Dangers and Complications Memory lapses, lack of control over one’s actions, and decreased brain function do not let one underestimate the dangers of dementia.
• Dementia and Alzheimer’s Disease While Alzheimer’s disease can be found in every state, Texas’ statistics indicate the special prevalence of the condition, making dementia a permeating public health issue.
• Feeding Patients With Dementia or Alzheimer’s Disease The effectiveness of probes in feeding persons with dementia/Alzheimer’s disease remains high. However, because of the risks, other less invasive methods are recommended.
• Care for Dementia Patients in Nursing Homes Unlike pharmacological dementia management, the non-pharmacological approach help reduces pain without risks associated with drug administration.
• Healthcare Program: Informational Campaign on Dementia The role of nurses shall not be underestimated when it comes to designing and implementing healthcare programs aimed to improve the well-being of the general population.
• Cognitive-Behavioral Therapy: Dementia and Geriatric Cognitive Disorders Group therapy is an evidence-based psychotherapy method that helps solve many problems, including relationship issues and personal difficulties.
• Patient-Centered Care in a Dementia Unit Patient-centered care implies the consideration of the individual needs, preferences, and abilities of each individual who seeks assistance.
• Dementia-Associated Pain Management Guidelines People suffering from dementia experience physical pain; however, they may not be able to communicate this due to their declining brain functionalities.
• Communication Challenges in Vascular Dementia and Dysphagia When residents do not understand me, I can become more creative by limiting potential distractions to them from my response concerning a given issue.
• Preparing a Podcast on Dementia and Alzheimer Alzheimer’s disease (AD) and dementia is the podcast’s topic, and the objective is to inform the aged group, which is the target group, about the disease.
• Lewy Body Disease in Aging Patients With Dementia By using extensive professional support, as well as active education of family members, one can improve the quality of Lewi Body Disease patients’ lives significantly.
• Dementia Disease and Its Physiological Effects The rarest manifestations for people with dementia are euphoria and hallucinations. The significant clinical presentations of this condition are depression, apathy, and anxiety.
• Dementia, Bladder Infection and Other Nursing Issues This paper discusses five major issues for nurses, which are dementia, bladder infection, immobility, anxiety, blindness, and discusses a nursing process for each.
• Therapeutic Interventions for the Older Adult With Depression and Dementia The paper researches the therapeutic interventions which relevant for the older people with depression and dementia nowadays.
• Dementia and Its Controversial Treatment Dementia is a progressive decline in cognitive ability, an ailment commonly thought to be inseparable from the concept of the elderly.
• Alzheimer’s Disease and Dementia Dementia is considered a general term for impairments in remembering, moving, and thinking that serve as obstacles in a person’s everyday activity.
• Effects of Music Therapy on the Behavioral and Psychological Symptoms of Dementia This paper explores the clinical effectiveness of music therapy in mitigating the behavioral and psychological effects of dementia on patients and caregivers.
• Mindfulness Interventions for Dementia Patients Mindfulness-based interventions for patients with dementia are expected to develop their flexibility and broaden their attention, leading to positive emotions and stress reduction.
• Dementia of Alzheimer’s Type and Diagnostic Criteria Alzheimer’s disease is one of the major debilitating brain diseases whose effects are loss of memory and important mental functions among patients.
• Behavioral Disturbances in Dementia Delirium and agitated depression can occur with dementia. Delirium and dementia have similar symptoms; however, delirium is a confusion that occurs and goes away rather quickly.
• Dementia of Alzheimer’s Type: 10 Warning Signs Dementia is a protracted deterioration in memory, thinking, and reasoning competence. Alzheimer’s disease usually manifests in patients after the age of 60.
• Dementia of Alzheimer’s Type: Signs and Symptoms This paper seeks to analyze dementia that comes about as a result of Alzheimer’s disease. The signs and symptoms of the disease will also be discussed, as well as its stages.
• The Case of Dementia of the Vascular Type The paper submits a brief review of needs and rationales for each of the patterns for this case of dementia of the vascular type.
• Donepezil for Dementia Due to Alzheimer’s Disease by Govind The article ‘Donepezil for Dementia Due to Alzheimer’s Disease’ discusses the implementation of donepezil for the treatment of Alzheimer’s disease and dementia in general.
• Mother-Adult Daughter Relationships Within Dementia Care The research is devoted to the mother-daughter relationships and the perspectives of women who receive care from their adult daughters.
• Women With Dementia Receiving Their Daughters’ Care The article is devoted to the necessity of home care for people with dementia and provides interviews of people who have to live with relatives suffering from dementia.
• Diagnosing Dementia in Older Patients Many older people of various occupations receive the ‘dementia’ diagnosis. The patient has trouble recalling the names of his family members, remembering his room number, etc.
• Frontotemporal Dementia and Alzheimer Diseases The study measured and compared the balance and gait characteristics of patients with possible FTD and AD to those of a control group.
• Falls in Alzheimer’s and Dementia Older Patients The authors introduced new methods to prevent falls among older patients with Alzheimer’s disease and frontotemporal dementia.
• Patients with Frontotemporal Dementia and Alzheimer Diseases The article discusses the research study aimed at the identification of the influence of gait and balance parameters on the condition of people with Alzheimer’s disease and frontotemporal dementia.
• Balance and Gait in Dementia and Alzheimer’s Patients The study by Velayutham et al. aims to investigate how Alzheimer’s disease (AD) and Frontotemporal dementia (FTD) affect elderly patients’ gait and balance.
• Dementia: Evaluation of an Epidemiological Problem Individuals with dementia experience memory loss and the reduction of cognitive abilities caused by their brain’s degenerative processes.
• Dementia Patients: Communication Strategy and Techniques The specialists advise using slow and simple gestures not to produce the feeling of agitation in a person with dementia.
• Dementia Symptoms and Awareness in Nurses The present paper discusses a study that intends to improve the awareness of the Behavioral and Psychological Symptoms of Dementia (BPSD) in nurses.
• Patients with Dementia: Communication Techniques Dementia is a difficult condition and can complicate the process of receiving care. The techniques provided in the article appear to be effective.
• Falls Prevention in Patients With Dementia in Nursing Homes The problem of falls in the older adults with dementia remains the complicated issue despite considerable efforts aiming to improve the situation.
• Hospital Staff-Dementia Patients Interactions Some healthcare providers do not use effective approaches to communicate with patients who have dementia. To improve communication, one can use a range of techniques.
• Communication with Patients with Dementia In their article “Pilot testing an educational intervention to improve communication with patients with dementia,” the authors suggest certain communication techniques.
• Communication Strategies in Dementia Patients The study on communication strategies to tailor the needs of dementia patients is proposed for submission to the International Journal of Nursing Studies.
• Lewy Body Dementia, Its Symptoms and Treatment LBD occurs as the so-called Lewi bodies, i.e. alpha-synuclein aggregates of protein, start developing in nerve cells in the substantia nigra or cortex of the brain.
• Diabetes and Dementia Relationships and Nursing The article discusses the possible links between the two illnesses, as well as the risk of developing one of the conditions when already having the other.
• Client-Oriented Approach in Dementia Diagnosis The cultural and demographic backgrounds affect the diagnostic procedures. It takes a different amount of time to diagnose dementia in different patients.
• Health and Social Care for Older People Suffer From Dementia in the UK This paper analyzes the impacts of the reduction of the fund on older people and the unmet social care services, particularly the nursing home services in the UK.
• Dementia with Lewy Bodies and Its Treatment This paper is devoted to dementias and the ways of treating them. Particular attention is paid to dementia with Lewy bodies (DLB).
• Dementia of the Alzheimer’s Type This essay explores the Dementia of the Alzheimer’s type by providing an insight into aspects such as age of disease onset, warning signs, disease stages.
• Falls Among Older Persons With Dementia
• Dementia: Alzheimer’s Disease and Brain Changes
• Comparison Between Dementia and Delirium
• Alzheimer’s Disease and Its Relation With Dementia
• Blood Sugar Levels and Dementia
• Gibbs Reflective Cycle Dementia Care
• Equality Diversity and Inclusion in Dementia Care Practice
• Patient-Centered Pain Control of Elderly People With Dementia
• Can Cognitive Training Slow Down the Progression of Dementia?
• Risk Factors for Incident Dementia Among Older Cubans
• Dementia Problem Behavior and the Production of Informal Caregiving Services
• Dementia and Its Effects on Mental Health
• Physical Restraints for Dementia Patients
• Challenges for Professional Care of Advanced Dementia
• Bilingualism Delays the Onset of Dementia
• Dementia vs. Alzheimer’s Disease
• Anger Management Therapy for Dementia Patients
• Can Medication Alter the Course of Dementia?
• Patients With Dementia and Cognitive Impairment
• Dementia and Its Effect on the Function of the Brain
• Children With Dementia and Parkinson‘s Disease
• Dementia and the Ageing Population
• Indicated Causes and Symptoms of Senile Dementia
• Music and Dementia and Alzheimer‘s Disease
• Mindfulness Training for Carers of People With Dementia
• End-Of-Life Decision Making for Nursing Home Residents With Dementia
• Dementia, Help With Financial Management, and Well-Being
• Person-Centered Care For Dementia Patients
• Dementia Patients and Sexual Compulsion
• Dementia Effects on the Elderly and Their Caregivers
• Both Autism and Dementia in Terms of Diagnosis and Treatment
• The Alzheimer’s Disease and the Frontotemporal Dementia
• Determining Modifiable Risk Factors of Dementia
• Communication With Individuals Who Have Dementia
• Dementia: Brain and Self-Care Activities
• Pathways Connecting Late-Life Depression and Dementia
• Imaging Mild Cognitive Impairment and Dementia in Parkinson’s Disease
• Dementia Care Aging Innovation
• Enhancing Cognition Before Clinical Symptoms of Dementia
• Caring for Patients With Dementia
• Biomarkers for Early Diagnosis of Dementia
• Alzheimer’s Disease and Relate Dementia Reform Health Care
• Health Organisations for Dementia in New Zealand
• Dementia and Its Connection With Memory Loss
• Biomarkers for Dementia, Fatigue, and Depression in Parkinson’s Disease
• Alzheimer’s Dementia Posterior Cortical Atrophy
• Behavioral and Psychological Symptoms of Dementia
• Longitudinal Associations Between Serum Cytokine Levels and Dementia
• Neuro Protective Effect and Attenuation of Dementia
• Dementia and the Different Parts of the Brain Affected
• Observational Pain Assessment Scales for People With Dementia
• The Care for Dementia Patients and Its Positive Impact on Their Lives
• Genetic Dementia Alzheimer’s Disease Gene
• Technology for the Elderly With Dementia
• Cerebrum and Dementia Care
• Exploration Deficits Under Ecological Conditions as a Marker of Apathy in Frontotemporal Dementia
• Dementia Care Pathway-People With Learning Disability
• Environmental Factors That Affect the Risk of Developing Dementia
• Dementia: Alzheimer’s Disease and Loved Ones
• Brain Injury and Dementia in Pakistan: Current Perspectives
• Are Many Retirees With Dementia Lacking Help?
• What Autoimmune Diseases Cause Dementia?
• Why Does Early Retirement Increase the Risk of Dementia?
• Do Retirees With Dementia Need Financial Assistance?
• What Are Pharmacological Interventions for Dementia?
• Why Is Early Diagnosis for Dementia Important?
• Can Dementia Be Cured if Caught Early?
• What Is an Early Indicator of Dementia?
• Does a Brain Scan Show Dementia?
• What Is the Most Important Thing in Caring for Dementia Patients?
• Why Does a Head Injury Cause Dementia?
• How Does Medication Affect Dementia?
• What Medication Worsens the Symptoms of Dementia?
• Can Dementia Be Brought on by Medication?
• What Are the Social Needs of a Dementia Patient?
• Is There a Link Between Mental Health and Dementia?
• What Are the Three Behavioral Problems Associated With Dementia?
• Is Dementia a Psychiatric or Neurological Disorder?
• What Does a Psychiatrist Do for Dementia?
• Can Dementia Cause Nasty Behavior?
• What Are Signs That Dementia Is Getting Worse?
• How Do Dementia Patients Deal With Inappropriate Behavior?
• At What Stage of Dementia Does Aggression Occur?
• What Are Some Common Behaviors Seen in a Person With Dementia?
• Should a Dementia Patient See a Psychiatrist?
• At What Stage Do Dementia Patients Forget Family Members?
• What Is the Life Expectancy of Someone With Parkinson’s and Dementia?
• How Do You Know When Someone With Dementia Is Close to Death?
• Is There a Link Between Parkinson’s Disease and Dementia?
• How Does Dementia Influence a Person’s Care Needs?

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These essay examples and topics on Dementia were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

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We are now in the third decade of the 21st Century, and, especially in the last years, the achievements made by scientists have been exceptional, leading to major advancements in the fast-growing field of dementia. Frontiers has organized a series of Research Topics to highlight the latest advancements in research across the field of dementia, with articles from important researchers in dementia research. This editorial initiative of particular relevance is led by Prof. Zoe Arvanitakis and Prof. Charbel Moussa, Specialty Chief Editors of the “Aging and Risk Factors for Dementia” section and the "Translational Research in Dementia" section, respectively, together with Prof. Kejal Kantarci and Prof. Brendan McCormack, and it is focused on new insights, novel developments, current challenges, latest discoveries, recent advances, and future perspectives in the field of dementia. The Research Topic solicits forward-looking contributions from the invited contributors that describe the state-of-the-art research, outlining recent developments and major accomplishments that have been achieved and that need to occur to move the field forward, as well as ongoing research that will help shed light on key questions in the field. Authors are encouraged to identify the greatest challenges in the sub-disciplines, and how to address those challenges. The goal of this Research Topic special edition is to shed light on the progress made in the past decade in the dementia field, on current research and its future challenges to provide a thorough overview of the field. This article collection will inspire, inform, and provide direction and guidance to researchers in the field. This collection is on invitation only and will contain original research and review articles. Articles accepted after peer review will be published and appear online as soon as accepted for publication. Dr. Charbel Moussa has received research funding from SUN Pharma Advanced Research Company and KeifeRX for research on drug development in dementia. Dr. Moussa also received research funding from SKybio and NIA for research on drug development in dementia and is co-inventor of several Georgetown University patents related to dementia treatment. Dr. Zoe Arvanitakis has received funds in the last year for consulting from the following for-profit entities: Eisai, and Summus Global. The other Topic Editors declare no competing interests with regard to the Research Topic subject.

Keywords : dementia, dementia care, genetics, molecular, cellular, Alzheimer's, biomarkers, risk factors, imaging

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NIA supports and conducts research to better understand the aging process, as well as the diseases, conditions, and needs associated with growing older. The Institute is also the primary federal agency supporting and conducting Alzheimer’s disease and related dementias research. Since its inception in 1974, NIA has conducted and supported research designed to improve quality of life for aging Americans and identify strategies and treatments to effectively prevent, delay, or slow age-related diseases, including dementia.

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Scientists reverse age-related vision loss, eye damage from glaucoma in mice 

First tau biomarker approved as alzheimer’s disease diagnostic tool, combination of healthy lifestyle traits may substantially reduce alzheimer’s disease risk, blood test method may predict alzheimer's protein deposits in brain, blood test shows promise in predicting pre-symptomatic disease progression in people at risk of familial alzheimer's, lower blood pressure target greatly reduces cardiovascular complications and deaths in older adults, intensive lowering of blood pressure reduces the risk of mild cognitive impairment (mci) and may slow age-related brain damage , daily low-dose aspirin found to have no effect on healthy lifespan in older people.

Summary: Identifying new therapeutics that slow or reverse damage to tissue may help researchers prevent or treat certain diseases like glaucoma. Researchers have shown that it’s possible to restore youthful function in many tissues by reversing age-related epigenetic factors . This process, known as cellular reprogramming, involves changing mature cells into immature cells that can regenerate. However, there are risks to cellular reprogramming, which can be associated with the formation of cancer when new, immature cells grow aggressively. Recently, NIA-supported researchers were able to extend the long-term safety of cell reprogramming while reversing glaucoma-induced eye damage and restoring age-related vision loss in aged mice. The researchers modified a previous approach to remove epigenetic markers in cells which allowed them to successfully reverse cellular aging without fueling tumor growth in aged mice and mouse models of glaucoma. The research team cautions that these findings remain to be replicated in further studies, including in different animal models, before studies can begin in humans.

If replicated through further studies, this approach could pave the way for therapies to promote tissue repair across various organs and biological systems and reverse aging and age-related diseases in humans.

Summary : Before biomarker tests were developed in the early 2000s, the only sure way to know whether a person had Alzheimer’s was via autopsy. Thanks to multiple, recent scientific advances, researchers can now use brain imaging methods or lab tests to diagnose people living with the disease. In May 2020, the U.S. Food and Drug Administration approved flortaucipir as the first radioactive tracer to show the presence of tau protein tangles, one of the hallmarks of Alzheimer’s disease. According to the key study, supported in part by NIA, it can be safely used with positron emission tomography (PET) imaging to help doctors identify the presence of tau tangles and diagnose late-stage Alzheimer’s with a high level of accuracy.

Biomarkers allow for a more accurate diagnosis by helping to discern between the different diseases that cause dementia, but their use has been limited in clinical settings. With FDA approval of flortaucipir, doctors may be able to diagnose Alzheimer’s earlier and inform treatment.

Summary: Researchers are investigating behavioral patterns and other lifestyle choices that may prevent dementia or slow the progression from mild cognitive impairment to dementia. An NIA-supported study found that individuals who made multiple healthy lifestyle choices may have a much lower risk for Alzheimer’s disease. Using two NIA-funded longitudinal studies, the Chicago Health and Aging Project (CHAP) and the Memory and Aging Project (MAP) , researchers identified and scored 2,765 participants with available data on both healthy lifestyle factors and clinical assessments for Alzheimer’s disease. Factors included physical activity, not smoking, light-to-moderate alcohol consumption, a high-quality diet, and cognitive activities. The study found the risk of Alzheimer’s among participants was 37% lower with two to three healthy lifestyle factors and 60% lower with four to five factors compared to participants without any healthy lifestyle factors or just one.

This population-based study suggests that multiple factors may play a role in Alzheimer’s disease risk. While these reported associations do not establish cause and effect, they do suggest possible interventions that may help identify effective strategies for preventing Alzheimer’s and related dementias.

Summary: Evidence suggests that biomarkers are not only present in the brain and spinal fluid, but also circulate in the bloodstream. Researchers, funded in part by NIA, recently reported an advance in the development of a blood test that could help detect pathological Alzheimer’s disease in people who are showing signs of dementia. The blood test detects the abnormal accumulation of a form of tau protein known as phosphorylated-tau-181 (ptau181), which is a biomarker that suggests brain changes from Alzheimer’s . Similar tests to detect amyloid protein in blood were developed in 2019 and are currently available for research use.

Blood tests could prove a less invasive, less costly, and more rapid diagnostic tool for Alzheimer’s disease in research settings and eventually in clinical settings. By reducing the time and resources needed, blood tests may help accelerate dementia research by enabling researchers to rapidly screen larger and more diverse groups of volunteers for clinical studies.

Summary: Finding early-stage biological markers of Alzheimer’s disease to predict who will develop dementia is an evolving area of research. An NIA-funded study found that a blood test of the protein neurofilament light chain (NfL) predicted disease progression and loss of nerve cell function in the brain among cognitively normal people at risk for familial Alzheimer’s disease (FAD). FAD is a rare, early onset form of Alzheimer’s caused by genetic mutations. Researchers found that among mutation carriers, NfL levels in blood began to rise up to 16 years before the estimated age of onset of Alzheimer’s symptoms. Researchers also found that the more NfL levels changed in the blood, the closer an individual was to symptom onset. The increase in NfL changes was also linked to other Alzheimer’s-related brain changes seen in cerebrospinal fluid, magnetic resonance imaging, and memory tests which suggests that NfL changes in blood reflect NfL changes in the brain.

Current procedures for measuring changes in the brain and cerebrospinal fluid are relatively invasive and expensive and the few experimental blood tests most often measure amyloid protein — and are almost exclusively available in research settings. These results show that blood tests may be able to measure additional biological markers used for predicting an individual’s risk for familial Alzheimer’s disease beyond amyloid.

Summary: Heart disease is a leading cause of death among older adults as well as a major cause of disability, limiting the activity and eroding the quality of life of millions of older people. An NIH-funded study, with support from NIA, called Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive management of high blood pressure significantly reduced rates of cardiovascular disease and lowered the risk of death in a study group of adults 50 years and older with high blood pressure. The intervention adjusted the amount or type of blood pressure medication to achieve a target that is lower than commonly recommended. This change was linked to reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by almost a third and the risk of death by almost a quarter compared to the recommended blood pressure target.

In 2017, the American Heart Association and the American College of Cardiology updated the definition of hypertension for adults and cited these findings in the evidence review.

Summary: High blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and a growing body of research suggests that it may increase risk for dementia later in life. In a randomized clinical trial called SPRINT Memory and Cognition in Decreased Hypertension (MIND), researchers found that intensively controlling a person’s blood pressure was more effective at slowing the buildup of white matter lesions than standard treatment for high blood pressure. White matter lesions may reflect damage — including stroke — in the brain. The research group, supported in part by NIA, also found that intensive lowering of blood pressure did not significantly reduce dementia risk, but did have a measurable impact on mild cognitive impairment (MCI), which is often a precursor of dementia.

These results suggest that intensive high blood pressure control may significantly reduce the buildup of white matter lesions and the occurrence of MCI. The findings support a growing body of evidence on the link between high blood pressure and age-related cognitive loss that may help researchers better understand how to protect the brain throughout a person’s life.

Summary: Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes among people with vascular conditions such as coronary artery disease. However, it had been uncertain whether aspirin is beneficial for healthy older people without those conditions. A large NIA-funded clinical trial examined the risks and benefits of daily low-dose aspirin in healthy older adults aged 65 and older without previous heart or blood vessel problems. The study found that aspirin did not prolong healthy, independent living (defined as life free of dementia or ongoing physical disability). Healthy adults in the study taking aspirin had an increased risk of death compared to those who had not taken aspirin. In addition, further analyses of the trial data showed that healthy adults taking aspirin in the study were no more likely to be diagnosed with cancer than those who did not take aspirin. However, those taking aspirin were more likely to be diagnosed with an advanced cancer and die from cancer.

In 2019, based in part by these findings, the American Heart Association and the American College of Cardiology changed their guidelines to recommend against the routine use of low-dose aspirin in older adults who do not have existing heart disease and haven't had a stroke.

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129 Alzheimer’s Disease Essay Topics & Examples

If you’re writing about patients with memory loss or dementia care and treatment, this article will be of use. Our team has prepared Alzheimer’s disease essay examples and topics below.

🏆 Best Alzheimer’s Disease Essay Examples & Topics

💡 most interesting alzheimer’s disease topics to write about, 📌 simple & easy alzheimer’s disease research topics, 👍 good research topics about alzheimer’s disease, ❓ research questions about alzheimer’s disease.

• The Case Study of Patient With Late-Stage Alzheimer’s Disease In the majority of cases of Alzheimer’s, it has been shown that patients are unable to make decisions on their own and are also unable to communicate their assent verbally.
• Therapeutic Dogs, Dementia, Alzheimer’s and Fluid Intelligence It is worth noting that with dementia, the patient has a speech disorder and a personality change in the early stages of the pathology.
• The Alzheimer’s Association Dementia Care Practice Therefore, achieving the philosophy and recommendations of the association is a shared responsibility between doctors, patients, and caregivers. Ultimately, CAPD tests the functionalities of the patient ranging from the psychomotor activities, perceptions, awareness, and orientations, […]
• Dementia, Alzheimer, and Delirium in an Elderly Woman Additionally, she struggles with identifying the appropriate words to use in dialogue and changes the topic. Timing: While in the middle of conversations and public places like supermarkets.
• Alzheimer’s Disease Diagnosis and Intervention The accumulation of plaques and tangles in the brain is a hallmark of the disease, resulting in the death of neurons and a decline in mental capacity.
• Alzheimer’s Disease: Assessment and Intervention The caregiver is recommended to install safety locks and alarms on all doors and windows to prevent the patient from leaving the apartment without supervision.
• Diagnosis of Alzheimer’s or Mild Cognitive Impairment Additionally, it could be mild cognitive impairment as the state shares symptoms with early-onset Alzheimer’s, and if there would be a decline of the signs in the future.
• Management of a Patient With Alzheimer’s: Case Study The correlation between this issue and the probability of the emergence of AD in elderly citizens is proved by the scholars who examined the impact of the quality of air on a person’s health.
• Bilinguals’ Cognitive-Linguistic Abilities and Alzheimer’s Disease This irregularity is reflected in the preserved linguistic abilities, including code-switching and semantic fluency, and the declined functions in translation, picture naming, and phonemic fluency, calling for improved therapy and testing practices.
• Managing Dementia and Alzheimer’s Disease The PICOT question is “In the care of Alzheimer’s and dementia patients, does integrated community-based care as compared to being in a long-term care facility improve outcome throughout the remainder of their lives”.
• Pathophysiology of Alzheimer’s Disease The study will discuss the pathophysiology of Alzheimer’s disease, such as risk factors, cellular involvement, genetic influences, and the interventions of the available therapy’s pharmacological Interventions.
• Alzheimer’s Disease: Definition, Stages, Diagnosis Alzheimer’s disease is the most common type of dementia, and it is a condition in which the brain stops appropriately performing its functions.
• Fall Risk Assessment of Alzheimer’s Patient The nurse answers questions about the old lady helps fill the Stay Independent brochure and assists the observing physician in carrying the various clinical tests on the patient.
• Alzheimer’s Disease in an Iranian Patient The patient in the company of his son returns to the clinic after four weeks. Since the patient shows no side effects of the disease and an increase in Exelon to 6 mg orally BID […]
• Mr. Akkad and Alzheimer’s Disease: Case Study The onset of the symptoms is reported to have been within the past two years, but the situation has begun to deteriorate, prompting Mr.
• Alzheimer’s Disease: History, Mechanisms and Treatment Nevertheless, researchers state that the development of Alzheimer’s is impacted by the formation of protein plaques and tangles in the brain.
• Alzheimer’s Disease: Causes and Treatment AD is associated with different changes, both cognitive and behavioral. A patient can observe some or all of them depending on the development of the disease.
• Frontotemporal Dementia vs. Alzheimer’s Disease in a Patient Moreover, Alzheimer’s disease affects hypertrophies in the hippocampus as the initial part is involved in the brain’s memory areas and spatial orientation.
• Alzheimer’s Disease: Diagnostic and Treatment Alzheimer’s disease is a progressive degenerative disorder that causes a deterioration of mental and cognitive abilities.
• The Effect of Music on People With Alzheimer’s Disease The evidence suggests that one of the most prominent effects of music on patients with Alzheimer’s disease is autobiographical memory preservation alongside the stimulation of both sympathetic and parasympathetic nervous systems.
• Community Health: Alzheimer’s Disease The community nurse’s role is to develop and participate in primary, secondary, and tertiary preventive strategies and to provide a wide range of nursing care services while maintaining the health and wellbeing of individuals with […]
• Challenges of Living With Alzheimer Disease The medications make the condition of the patient better during the first stages of the disease. During the middle stage of the disease, the symptoms worsen.
• The Burden of Alzheimer’s Disease Assessing the appropriateness and effectiveness of reducing the cost of providing care for patients with Alzheimer remains a major issue that needs to be addressed.
• Chronic Care For Alzheimer’s Disease The application of the Chronic Care Model, in its turn, will serve as the foundation for building the patient’s awareness about their condition, thus, improving the patient’s quality of life and creating the environment, in […]
• Synopsis of Research Studies of Individuals Afflicted by Mild Alzheimer’s Disease The research questions in the articles were tailored along the various physical activities that can assist patients affected by Alzheimer Disease.
• Alzheimer’s Disease and Naturopathic Medicine The main feature of AD is the aggregation of -amyloid. However, application of natural therapies to prohibit the process of the pathways can slow the progress of AD.
• Brain Reduction and Presence of Alzheimer’s Disease The purpose of the study was to examine the correlation between brain reduction and the presence of Alzheimer’s disease. The researchers wanted to examine the nature of such changes in elderly individuals at low risk […]
• Alzheimer Related Morbidity and Death Among New Yorkers Generally, Alzheimer disease is a form of dementia, which inflicts a loss of memory, thinking and behavior. The proportion of ethnic and racial diversity in the US is increasing.
• Human Disorders: Alzheimer’s Disease and Dementia The brain shows notable changes in Alzheimer’s disease notably, development of tangles in deep areas of the brain and also formation of plagues in other areas.
• Environmental Interview on a Patient With Alzheimer Disease In the 1980s, delusions and hallucinations were added as signs of the disease. Researches in the 1960’s show a link between cognitive reduction and the number of ailments in the brain.
• Alzheimer’s Disease Article and Clinical Trial This study shows that environmental hazards, in this case lead, increase the risk of developing Alzheimer’s disease and that the development period is crucial for determining future vulnerability to neurodegeneration and Alzheimer’s disease.
• Alzheimer’s Disease: Regarding Physiology However, one clear aspect of the development of this disease arises from a very complex chain of activities taking place in the brain over a long period of time.
• Mapping the Neurofibrillary Degeneration From Alzheimer’s Disease Patient This is an analytic review of the studies elaborating on the relationship of hyperphosphorylated tau proteins to the development of Alzheimer’s disease and focusing on the antigen capture ELISA specific for p-tau proteins.
• Alzheimer’s Disease: Key Aspects This event constitutes part of a broader campaign, which includes fundraising, information support, and promotion of specialized care for everybody suffering from the disease.
• Role of Alzheimer’s Disease Advanced in Our Understanding of the Aging Process Aging on the hand can be defined as the accumulation of different harmful changes in the tissues and cells that raises the possibility of disease and death.
• Depression and Alzheimer’s Disease Moretti et al have studied the relationship between depression and Alzheimer’s disease and explored whether depression is a symptom of AD or comorbidity.
• Alzheimer’s Disease: Medical Analysis Such gene-associated markers have been characterized, in particular the apolipoprotein E gene, which was linked to chromosome# 19, and was responsible for accumulation of A by way of binding to this protein.
• Diabetic Teaching Plan for Alzheimer’s Patient He knows the purposes and some of the steps and needs to be taught again to regain his independence in monitoring his blood glucose level.
• Comparing Alzheimer’s Disease and Parkinson’s Disease There are many superficial similarities between Alzheimer’s disease and Parkinson’s disease primarily in some symptoms and age-group of persons afflicted by these two diseases.
• Alzheimer’s Disease and Long Term Care Alzheimer’s disease is a progressive disease in which memory impairment and disturbances in reasoning and perception are the primary symptoms. Also, well-known skills and recognition of objects and person is diminished in this stage of […]
• The Effects of Alzheimer’s Disease on Family Members The disease develops gradually and is said to be a disease of the old because it relates to the inability to remember.
• Alzheimer’s Disease in Science Daily News Article The news article accurately reports the focus of the study in the diagnosis of AD. Hence, the news article accurately presents that the diagnostic method is important in the diagnosis and prognosis of AD among […]
• Dancing and Risk of Alzheimer’s Disease Despite the fact that there is no effective treatment for Alzheimer’s disease, scientists discovered that dancing could help reduce the severity of the disorder as this activity involves simultaneous brain functioning, which helps to affect […]
• Alzheimer’s Disease Prevalence and Prevention The estimated global prevalence of Alzheimer’s disease is 50 million and is projected to triple by 2050 due to growth in the older generation. According to Alzheimer’s Association, AD is the fifth-ranking killer of persons […]
• Alzheimer’s Disease: Managing Cognitive Dysfunction In the majority of cases, Alzheimer’s disease turns out to be the cause of this problem. Alzheimer’s disease can be caused by different risk factors, but in the majority of cases, it is associated with […]
• Alzheimer’s Disease in Newspaper Articles The number of patients diagnosed with Alzheimer’s and diabetes in the United States, and indeed globally, has increased significantly in the last few years. This means that the main interest of such collaboration is to […]
• Alzheimer’s and Cardiovascular Diseases Progress While the design of the study involves a review of the existing papers and a compilation of their key results, the information provided by the authors is nonetheless crucial to the understanding of the issue.
• Heart Disease and Alzheimer’s in Adult Women Education and Employment History: The patient reported she is a college graduate and has a master’s degree in Victorian Literature. The patient is currently working full-time as a Literature professor at UC Berkeley, in a […]
• The Alzheimer’s Disease Concept In simple words, it is the condition caused by the negative changes in the human brain that, as the end result, leads to memory loss and some behavioral issues that worsen the quality of patient’s […]
• Alzheimer’s Disease, Its Nature and Diagnostics According to the Alzheimer’s Association, this condition is the sixth leading cause of lethal outcomes in the United States. The most frequent symptoms of Alzheimer’s disease include problems with memory, reasoning, thinking processes, perception, and […]
• Alzheimer’s Disease in Medical Research The existing data proposes that if the illness is distinguished before the commencement of evident warning signs, it is probable that the treatments founded on the facts of fundamental pathogenesis will be of assistance in […]
• Alzheimer’s Disease and Antisocial Personality Disorder Since there is currently no cure for Alzheimer’s disease, the future of the nursing care for the people that have the identified disorder concerns mostly maintaining the patient’s quality of life.
• Plasma Amyloid-Beta and Alzheimer’s Disease The impact of AD on public health includes increased rates of informal care and the direct charges of communal care. The aim of this study is to find the precise relationship between plasma amyloid beta […]
• Age Ailment: Dementia and Alzheimer’s Disease It is a time for one to clean the mind and take time to do what matters most in life. With an increased level of technological advancements, a digital sabbatical is mandatory to lower the […]
• Psychology Issues: Alzheimer’s Disease Alzheimer’s disease is a psychological disorder that involves the progressive destruction of brain cells and reduction in the proper functioning of the brain.
• Importance of Drug Therapy in Management of Alzheimer’s Disease The effects of Alzheimer’s disease can be controlled by early detection. Most studies are based on the effects of drug therapy mild Alzheimer’s patients.
• The Development of Alzheimer’s Disease and It’s Effect on the Brain Research studies have revealed that prevalence of the Alzheimer’s disease is increasing exponentially due to change in lifestyles and the incurable nature of the disease.
• Treatment of Alzheimer’s Disease According to documented research, Alzheimer’s disease is the primary cause of dementia affecting close to half a million people in the United Kingdom and five million in the United States.
• Health Care for Elderly People With Alzheimer’s Disease C’s condition is not likely to affect the relationship between her and her relatives if they are sensible toward her. C is to take her to a nursing home for the elderly.
• Diagnosis of Alzheimer’s Disease The most remarkable feature of the disease is the loss of ability to remember events in an individual’s life. According to the latter hypothetical medical study, it has been exemplified that the presence of deposits […]
• Concept and Treatment of the Alzheimer Disorder This implies that cognitive and natural therapies are highly perceived to be effective as opposed to pharmacological treatments. One cannot ignore the fact that both cognitive and natural therapies have become widely accepted in treating […]
• Understanding Alzheimer’s Disease Among Older Population After the 65 years, it has been found that the probability of developing Alzheimer’s disease doubles after every 5 years and as a result, by the age of 85 years, the risk of acquiring the […]
• Concepts of Alzheimer’s Disease The brain changes are the same in both men and women suffering from Alzheimer’s disease. There is also a significant increase in the death of the neurons leading to the shrinking of the affected regions.
• Alzheimer’s Association Of Neurological Disorders And Stroke
• The Potential Treatment of Alzheimer’s Disease: Through CRISPR-Cas9 Genome Editing
• Alzheimer’s Condition as an Enemy of Mental Health
• Vitamin A as a Potential Therapy to Prevent Alzheimer’s Disease
• The Relationship Between Gender And Alzheimer’s Disease
• The Stages and Treatments of Alzheimer’s Disease
• The Clinical Description of the Causes, Symptoms and Treatment of Alzheimer’s Disease
• The Description of Alzheimer’s Disease and Its Statistics in America
• The Psychological Symptoms Of Alzheimer’s The Cognitive Symptoms
• Varying Aspects of Alzheimer’s Disease and Implementations
• The Effects Of Alzheimer’s And Dementia Among Elderly
• The Early Symptoms and Progression of Alzheimer’s Disease
• Watching a Loved One Slip Away from Alzheimer’s Disease
• The Differences Between Dementia And Alzheimer’s Dementia
• A History of Alzheimer’s Disease and Why it is Still One of the Most Researched Diseases Today
• A Healthy Lifestyle Might Help Combat Parkinson’s Disease And Alzheimer’s Disease
• The Studies Of Music And How It May Not Help The Alzheimer’s Disease
• The Trials of Caring For A Loved One With Alzheimer’s Disease
• Alzheimer’s Disease A Progressive And Fatal Disease Of The Brain
• The Effects of Dementia and Alzheimer’s Disease on Caregivers and the Care Needed for Suffering Patients
• The Psychologist’s Role in Addressing Family and Community Problems for Families with Alzheimer’s Disease
• Alzheimer’s Disease and Its Effect on the Patient and Care Giver
• The Statistics of Prevalence of Alzheimer’s Disease in the 21st Century
• The Link Between Down Syndrome and Alzheimer’s Disease
• The Pathophysiology Of Alzheimer’s Disease
• The Causes, Symptoms and Treatment of Alzheimer’s Disease
• The Focus on Alzheimer’s Disease in the Documentary Black Daises for the Bride
• The Physiology and Genetics Behind Alzheimer’s Disease
• The Early Manifestations of Alzheimer’s Disease
• The Role Of Gamma Secretase In Alzheimer’s Disease
• The Lack Of Early Detection Of Alzheimer’s Disease
• The Representation of Alzheimer’s Disease and Its Impact in the Film Still Alice
• The Possible Link of the Human Immune System to Alzheimer’s Disease
• The Study of Alzheimer’s Disease and Its Affect on the Elderly
• The Characteristics, History, Symptoms, Statistics, and Treatment of Alzheimer’s Disease, a Degenerative Brain Disease
• The Triggers, Progression, and Treatment of Alzheimer’s Disease
• Traumatic Brain Injury and Alzheimer’s Disease
• The Positive Impact of Exercise in Protecting the Brain from Alzheimer’s Disease
• Three Primary Types of Dementia: Alzheimer’s Disease, Vascular Dementia
• The Causes, Risks, Factors, and Stages of Alzheimer’s Disease
• The Contingent Valuation Method in Health Care: An Economic Evaluation of Alzheimer’s Disease
• What Is the Difference Between Dementia and Alzheimer’s Disease?
• What Is the Main Cause of Alzheimer’s Disease?
• How Do You Prevent Alzheimer’s Disease?
• Who Is at High Risk for Alzheimer’s Disease?
• What Foods Cause Alzheimer’s Disease?
• Do Alzheimer’s Disease Patients Sleep a Lot?
• Do Alzheimer’s Disease Patients Know They Have It?
• Do Alzheimer’s Disease Patients Feel Pain?
• What Is the Best Treatment for Alzheimer’s Disease?
• How Long Do Alzheimer’s Disease Patients Live?
• What Do Alzheimer’s Disease Patients Think?
• Do People with Alzheimer’s Disease Have Trouble Walking?
• Is End Stage Alzheimer’s Disease Painful?
• What Are the Final Stages of Alzheimer’s Disease Before Death?
• Does Alzheimer’s Disease Run in Families?
• Should You Tell Alzheimer’s Disease Patients the Truth?
• Why Do Alzheimer’s Disease Patients Stop Talking?
• How Do You Know When an Alzheimer’s Disease Patient Is Dying?
• Which Is Worse: Dementia or Alzheimer’s Disease?
• What to Say to Someone Who Has Alzheimer’s Disease?
• How Does Alzheimer’s Disease Affect Eyes?
• Are Alzheimer’s Disease Patients Happy?
• What Are the Warning Signs of Alzheimer’s Disease?
• What Is the Best Way to Help Someone with Alzheimer’s Disease?
• What Are Good Activities for Alzheimer’s Disease Patients?
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March 23, 2024

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Research highlights importance of support reciprocity during early-stage dementia care

by Tiffany Dobbyn, UC Davis

In cases of Alzheimer's disease, it's common for a spouse to take on the role of caregiver. Research led by the University of California, Davis, suggests that patients can also support their caretakers, and that reciprocated care has mutual benefits.

A new paper published in the journal Aging and Mental Health highlights that couples coping with dementia can navigate the challenges with greater resilience and well-being by working together and supporting each other.

"We know that dementia is degenerative, there's no way back, and spousal caregivers typically face substantial burden," said Meng Huo, assistant professor with the Department of Human Ecology and lead author of the study. "But having a mutually beneficial relationship in early stages may help reduce caregiver burden and even slow the progression of dementia symptoms."

Nearly 7 million people aged 65 and older in the United States have Alzheimer's disease. In this study, researchers surveyed 72 couples from Northern California and Nevada in which one person was living with early-stage Alzheimer's disease and their spouse was the primary caregiver. They assessed the support that spouses provided to each other and found that people with dementia assisted their spousal caregivers often.

"Debunking the myth that dementia patients are only recipients of care is crucial," Huo said. "Recognizing their potential to help will encourage them to be able to maintain their personal dignity. Dementia patients know they're declining, but it's important for them to also know that they can still do a lot of things."

Practical and emotional support

Huo said the positive effects of empathy and support on emotional well-being, stress levels, communication and illness management can contribute to better overall health outcomes for individuals with dementia and their caregivers.

Researchers found that the support given by patients occurred in various ways, like practical help such as folding the laundry, dishwashing and cooking. Huo said the most common type of support was emotional, including showing appreciation and care.

"In one example, the caregiver had surgery and the dementia patient talked about how she brought flowers and food when she went to the hospital to see the caregiver, and she encouraged the caregiver to stay socially connected to make sure there's companionship," Huo said.

Caregiver, patient empathy

Researchers hope the findings can improve existing interventions that mostly target caregivers by including the dementia patients too.

"Dementia caregivers need support," Huo said. "Support can occur within this ongoing relationship between dementia patients and caregivers. By maintaining the support reciprocity, we may be able promote effective illness management in the long run."

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Alzheimer’s ‘breakthrough’ stalls: why a much-hyped drug is facing approval delays

The benefits of drugs such as donanemab, aducanumab and lecanemab are proving harder to quantify than potential harms, experts say

I t was heralded in news articles as a “breakthrough”, a “turning point” and a “gamechanger” for Alzheimer’s disease. Some experts went so far as to call the drug, donanemab, the “beginning of the end” for the debilitating condition.

Pharmaceutical company Eli Lilly in May 2023 released data from a clinical trial they said showed donanemab slowed cognitive and functional decline in people with early symptomatic Alzheimer’s disease by 35% over 18 months.

The findings saw the head of Alzheimer’s Research UK and other experts call on drugs regulators to rapidly approve the treatment for use in patients.

But despite reports the US drugs regulator was set to approve donanemab “any day” , the Food and Drug Administration (FDA) instead announced on 8 March that it had delayed its decision.

The FDA said it wants an independent panel to further scrutinise data on the safety and efficacy of donanemab, with a decision now expected later in 2024. UK, European and Australian regulators are also still assessing the drug.

In a statement, the executive vice-president of Eli Lilly, Anne White, said: “We are confident in donanemab’s potential to offer very meaningful benefits to people with early symptomatic Alzheimer’s disease”.

“It was unexpected to learn the FDA will convene an advisory committee at this stage in the review process, but we look forward to the opportunity to further present the [trial] results and put donanemab’s strong efficacy in the context of safety,” she said. “We will work with the FDA and the stakeholders in the community to make that presentation and answer all questions.”

Dr Timothy Daly, a dementia researcher with Sorbonne University in Paris, says this delay comes as no surprise to him.

He says the benefits of donanemab, and similar, much-hyped drugs, including aducanumab and lecanemab, have proved harder to quantify than their potential harms.

“Under this narrative of drug success, there are some really strong side-effects,” Daly told Guardian Australia.

These are a type of drug known as novel monoclonal antibodies, and they target amyloid proteins in the brain. Many researchers believe the buildup of these proteins contributes to Alzheimer’s disease.

The drugs have been shown to reduce amyloid levels in the brain. But around three-in-10 people taking lecanemab or donanemab in clinical trials developed a condition known as amyloid-related imaging abnormalities, abbreviated to ARIA, a condition which can cause brain swelling or haemorrhaging.

“Mostly these seem to be minor, not come with any symptoms, and follow-up scans show they appear to have resolved,” Dr Sebastian Walsh, a public health doctor researching dementia risk reduction with the University of Cambridge in the UK, says.

“In a small percentage of participants it does seem to be much more serious, and there have been some deaths – particularly for those on blood-thinning-type medications.”

Some trial participants also experienced brain shrinkage – and the long-term effects of that are unknown.

‘It’s pure speculation’

In the donanemab trial, patients receiving the drug declined on average by 10 points on a 144-point scale that combined cognitive and functional scores. The placebo group who were not receiving the drug declined by 13 points.

This data was used by researchers to state that the drug slowed cognitive and functional decline by “more than one-third”, and offered people “extra months” or “up to one year of life” without further disease progression.

Walsh says efforts to translate clinical data into terms more meaningful for people to understand means the effects of the drug have been overblown in media reports.

“Whilst it is understandable that people want to think of other ways to present these numbers, it still needs to be scientifically valid,” he says.

“Those who have reported it being ‘an extra six months at higher function’ are on shaky ground scientifically I think. The trials didn’t measure recognition of a loved one, ability to drive, any of these things – extrapolating in this way is not really justified by the evidence we have. It’s pure speculation.”

A professor of neurology at Radboud University Medical Centre in the Netherlands, Edo Richard, told news channel Al Jazeera the drugs “clearly remove” amyloid proteins from the brain “very successfully”.

But a reduction in amyloid proteins does not necessarily lead to a slowing of cognitive decline, he said.

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Research into the disease dating back more than 25 years has found that amyloid proteins are present in the brains of people with dementia. But they are also found in people who don’t have dementia, and who never go on to develop it, Richard told Al Jazeera.

While many drugs trialled in the past have reduced amyloid levels, donanemab, aducanumab and lecanemab appear to be the first to have also led to a change in cognitive decline. But Richard claimed that change was “statistically significant, but clinically irrelevant”.

When the FDA approved aducanumab in 2021, three FDA advisory committee members who advised against its approval because of what they believed was a lack of efficacy data resigned. One of the people who resigned described it as “probably the worst drug approval decision in recent US history”.

When it came to implementation, the US health insurance program Medicare said it would not cover it, and clinicians have also been cautious, with little use of the drug.

The Australian regulator, the Therapeutic Goods Administration, in June found “there is no evidence of clinically meaningful efficacy” of aducanumab.

A ‘collective desperation’

As well as minimal meaningful clinical benefits from donanemab, patients also need to receive the drugs via an intravenous infusion at a medical clinic or hospital once every two to four weeks at a cost of about US$26,500, or A$40,500, a year plus undergo regular testing. It is a lot to ask of vulnerable people and their families.

Those who participate in clinical trials are also a highly selective group. In the donanemab trial, 1,320 participants with amyloid and early disease symptoms completed it. For every 10 people screened for eligibility for the trials, about eight were found to be ineligible.

In a commentary written for the Conversation , Walsh said if, when prescribed in the real world, “the drug eligibility is restricted to match the trial eligibility, then very few people will be eligible. If eligibility is broader, then already small effects are likely to be even smaller and side-effects more pronounced”.

The director of internal medicine and clinical epidemiology at the Princess Alexandra hospital in Queensland, Australia, Prof Ian Scott, published a paper in the February edition of the journal Age and Ageing with similar concerns. He wrote trials of amyloid-targeting monoclonal antibodies to date “do not provide high-quality evidence of clinically meaningful impacts at an affordable cost”.

Daly believes that significant focus on the potential of drugs that target amyloid buildup despite a lack of efficacy has been reductive , as it has seen less attention being paid to alternative hypotheses of what is causing the disease, and ways to tackle it.

A 2020 report from the Lancet commission on dementia estimated 40% of cases of age-related dementia are associated with 12 potentially modifiable risk factors across the lifetime, including air pollution, obesity, depression, and less education.

Daly says while such findings make it tempting to list lifestyle changes people can make to reduce dementia risk, this is also too simplistic, as it puts the onus on individuals rather than governments.

“Working conditions, forms of oppression and things that can’t as easily be seen as a dementia risk are just as important in preventing disease ,” Daly says.

“There is an iceberg here – don’t just look at the surface at drugs and lifestyle. There are living conditions and social structures that represent deeper contributions to risk in the population, and interventions targeting these are needed by governments to make our society fairer and more dementia-resilient.”

Walsh says there is understandably “a collective desperation” among scientists and patients for better treatments and preventive options for Alzheimer’s disease, which is the most common cause of dementia in western societies and which has no cure.

“But this cannot cloud objectiveness when we look at the evidence,” he says.

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6.9 million Americans have Alzheimer's disease: How to reduce your risk

A new report estimates 6.9 million older Americans are living with Alzheimer’s disease in 2024, an increase of about 200,000 cases of the mind-robbing disease from 2023 and "a significant public health crisis," according to an expert.

Another 5 million to 7 million adults have mild cognitive impairment, a set of early changes to memory and thinking linked to Alzheimer's, according to an Alzheimer's Association's annual facts and figures report released Wednesday.

The report also highlights good news. Other studies indicate that dementia rates have declined over the past 25 years as more adults are achieving higher levels of education, staying active and exercising, reducing their blood pressure, avoiding cigarettes and staying socially engaged.

Adults face a higher risk of Alzheimer's and other types of dementia as they age, and the number of Americans 65 and older is projected to swell from 58 million in 2022 to 82 million in 2050. In just six years, the youngest baby boomers will be 65.

The nation's aging population will create profound economic and social challenges. The annual cost of caring for people with Alzheimer’s or other types of dementia will be $360 billion in 2024, up $15 billion from a year ago, the report said.

Medicare and Medicaid will cover the bulk of that, spending $231 billion this year to care for people with Alzheimer’s and dementia. Public and private spending to take care of Alzheimer's and dementia patients will skyrocket to nearly $1 trillion in 2050, the report projects.

"Our population is aging, so we really need to address these issues," said Sam Fazio, the Alzheimer Association's senior director of quality care and psychosocial research. "Alzheimer's disease remains a significant public health crisis."

Lifestyle changes reduce risk

Other Alzheimer's experts not involved with the report said more Americans are taking steps to reduce their risk for Alzheimer's or dementia.

Research suggests up to 40% of dementia cases can be prevented through lifestyle changes, said Dr. Keith Vossel, a neurologist and director of the Mary S. Easton Center for Alzheimer’s Research and Care at the University of California, Los Angeles.

Vossel said people who exercise regularly, do not smoke and achieve higher levels of education tend to have lower risk. Reducing blood pressure in midlife, in particular, is linked to lower risk, he said.

Paying close attention to elevated blood pressure is especially important, Vossel said. "We know that lowering blood pressure among people with elevated blood pressure in middle life can lower risk of dementia or (mild cognitive impairment) later on."

Caregivers spend 31 hours a week on Alzheimer's, dementia patients

Families and other caregivers take on an array of tasks, scheduling appointments and feeding and caring for people with Alzheimer's or dementia. The report said 11.5 million relatives and caregivers provided more than 18 million hours of unpaid care last year.

That amounted to a full-time job for caregivers who spent an average of nearly 31 hours a week caring for a person with Alzheimer's or dementia.

In July, the Centers for Medicare & Medicaid Services will launch an initiative to improve the quality of life for people with dementia, allowing them to remain at home and reduce the strain on unpaid caregivers. The model, called Guiding an Improved Dementia Experience , will coordinate care and provide a 24/7 support line. Families also can access care navigators who can connect patients and caregivers to services and support. Doctors and clinics who participate will receive a monthly per-patient fee from Medicare.

Fazio said access to navigators is crucial because the report showed that families live through a great deal of stress and that workers in the field believe the health care system is not equipped to help people living with dementia. President Joe Biden recently expanded a similar navigator plan for cancer patients in which private health insurers will cover such services.

Families "really want help and need help to navigate the system," Fazio said.

New drugs, old target

Of the eight drugs approved for Alzheimer's patients, only two attempt to attack the disease and slow memory and cognitive decline. Biogen has discontinued one of those drugs, aducanumab, sold under the brand Aduhelm. The Food and Drug Administration approved the drug despite mixed clinical trial results . Biogen also faced withering criticism when it launched Aduhelm, initially priced at $56,000 a year.

In January 2023, Eisai won FDA approval for its amyloid beta-busting drug , lecanemab. Sold under the brand name Leqembi, the drug is intended for patients in the early stages of the disease, the population studied in clinical trials.

The Alzheimer's Association report notes that the benefits of lecanemab "in the short term may be imperceptible" because it's designed to slow the disease, not reverse cognitive decline. The report said the long-term results of the drug are not clear.

Earlier this month, the FDA delayed action for Eli Lilly's drug  donanemab , the drug manufacturer said. The FDA expects to convene an advisory committee to discuss the treatment.

Clinical trials of all three amyloid-removing drugs have side effects visible on brain scans, such as brain swelling and bleeding. Some patients don't notice symptoms. Others have experienced headaches, dizziness, nausea, confusion and vision changes.

Though drugmakers largely have focused on drugs to target and clear amyloid from the brains of Alzheimer's patients, the report says, other studies are examining different methods of attacking the disease. Other potential drugs are being studied to limit the accumulation of tau protein, inflammation, altered cell metabolism and damage from toxic oxygen molecules, the report said.

Ken Alltucker is on Twitter at @kalltucker, or can be emailed at [email protected].

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First-ever transplant of pig kidney to patient a success

Parkinson’s warning in skin biopsy.

Medical office procedure identifies key biomarker that may lead to more reliable diagnosis of neurodegenerative disorders

Jacqueline Mitchell

BIDMC Communications

Illustration shows neurons containing deposits of biomarker alpha-synuclein (indicated with small red spheres) that have accumulated in brain cells.

A simple skin biopsy test has shown a high accuracy rate in detecting an abnormal form of alpha-synuclein , the pathological hallmark of Parkinson’s disease, according to neurologists at Harvard-affiliated Beth Israel Deaconess Medical Center.

In a paper published in the Journal of the American Medical Association, results from the landmark study, sponsored by the National Institutes of Health, validate this cutaneous method as a reliable and convenient tool to help physicians make more accurate diagnoses of Parkinson’s and the subgroup of neurodegenerative disorders known as synucleinopathies.

“While we have been aware of the presence of alpha-synuclein in cutaneous nerves for many years, we were thrilled with the accuracy of this diagnostic test.” Roy Freeman, professor of neurology

“Each year, there are nearly 200,000 people in the U.S. who face a diagnosis of Parkinson’s disease, dementia with Lewy bodies, and related disorders,” said lead author Christopher Gibbons, a professor of neurology at Harvard Medical School and a neurologist at BIDMC. “Too often patients experience delays in diagnosis or are misdiagnosed due to the complexity of these diseases. With a simple, minimally-invasive skin biopsy test, this blinded multicenter study demonstrated how we can more objectively identify the underlying pathology of synucleinopathies and offer better diagnostic answers and care for patients.”

Affecting an estimated 2.5 million people in the United States, the synucleinopathies include Parkinson’s disease, dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and pure autonomic failure (PAF). While the four progressive neurodegenerative diseases have varying prognoses and do not respond to the same therapies, they do share some overlapping clinical features such as tremors and cognitive changes. Additionally, all are characterized by the presence of an abnormal protein present in the nerve fibers in the skin called phosphorylated α-synuclein (P-SYN).

In this investigation, titled the Synuclein-One Study, Gibbons and colleagues at 30 academic and community-based neurology practices enrolled 428 people, ages 40-99 years, with a clinical diagnosis of one of the four synucleinopathies based on clinical criteria and confirmed by an expert panel or were healthy control subjects with no history of neurodegenerative disease. Participants underwent three 3-millimeter skin punch biopsies taken from the neck, the knee, and the ankle.

“These are systemic disorders that impact the peripheral and central nervous systems in profound ways,” said senior author Roy Freeman, director of the Center for Autonomic and Peripheral Nerve Disorders at BIDMC and professor of neurology at HMS. “While we have been aware of the presence of alpha-synuclein in cutaneous nerves for many years, we were thrilled with the accuracy of this diagnostic test.”

Among the participants with clinically confirmed Parkinson’s disease, 93 percent demonstrated a positive skin biopsy for P-SYN. Participants with DLB and MSA tested 96 percent and 98 percent positive, respectively. One hundred percent of participants with PAF were positive for the abnormal protein. Among the controls, just over 3 percent tested positive for P-SYN — an error rate the authors suspect may indicate some of the healthy controls are at risk for a synucleinopathy.

“Parkinson’s disease and its subgroup of progressive neurodegenerative diseases show gradual progression, but alpha-synuclein is present in the skin even at the earliest stages,” noted Freeman.

The team’s findings are built on earlier work by Freeman and Gibbons. The pair, together with immunohistochemist, Ningshan Wang, a research scientist at BIDMC and an assistant professor of neurology at HMS, have been focused on finding a reliable biomarker for synucleinopathies since 2009. Developing the research around alpha-synuclein in the skin is part of a licensing collaboration with CND Life Sciences , a neurodiagnostics company.

In 2023, the BIDMC researchers demonstrated and published in the journal Neurology that this technique could reliably distinguish between Parkinson’s and MSA, a differentiation that is critical to properly managing the diseases that appear clinically similar but have very different prognoses.

The authors anticipate that this research will play a role in accelerating drug development for synucleinopathies.

“Enrolling the right patients in clinical trials for these complex diseases is of utmost importance,” said Freeman. “Identifying the relevant biomarker in a patient and tracking it over the course of a clinical trial is an essential component of drug development in the neurodegeneration field.”

This work is supported by the National Institutes of Health (grants NIH R44NS117214) and sponsored by CND Life Sciences.

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• v.84(2); 2015 May

EL Cunningham

1 Centre for Public Health, Queen's University Belfast

B McGuinness

2 Belfast Health and Social Care Trust

AP Passmore

Dementia is a clinical diagnosis requiring new functional dependence on the basis of progressive cognitive decline. It is estimated that 1.3% of the entire UK population, or 7.1% of those aged 65 or over, have dementia. Applying these to 2013 population estimates gives an estimated number of 19,765 people living with dementia in Northern Ireland. The clinical syndrome of dementia can be due to a variety of underlying pathophysiological processes. The most common of these is Alzheimer's disease (50-75%) followed by vascular dementia (20%), dementia with Lewy bodies (5%) and frontotemporal lobar dementia (5%). The clinical symptoms and pathophysiological processes of these diseases overlap significantly. Biomarkers to aid diagnosis and prognosis are emerging. Acetylcholinesterase inhibitors and memantine are the only medications currently licensed for the treatment of dementia. The nature of symptoms mean people with dementia are more dependent and vulnerable, both socially and in terms of physical and mental health, presenting evolving challenges to society and to our healthcare systems.

INTRODUCTION

Dementia is a clinical diagnosis requiring new functional dependence on the basis of progressive cognitive decline and representing, as its Latin origins suggest, a departure from previous mental functioning.

The incidence of dementia rises with age making it an increasingly common phenomenon within our aging population. The nature of symptoms mean people with dementia are more dependent and vulnerable, both socially and in terms of physical and mental health, presenting evolving challenges to society and to our healthcare systems. Despite the seemingly simple premise, the clinical diagnosis of dementia can be difficult with de novo functional impairment often obscured by physical frailty, comorbid psychiatric symptoms such as depression and a subtle but steady assuming of household responsibilities by spouses and family. Clinical and pathological criteria for the main dementia-causing diseases overlap significantly. The emergence of symptoms decades into the pathophysiological process hamper targeted disease therapy. A great number of research initiatives are underway to identify potential biomarkers of disease processes earlier. The association of both overt cognitive decline and underlying pathophysiological processes with normal aging complicate the process of identifying disease processes early within the spectrum of normal aging.

Once the diagnosis is established, prognostic measures are required, and are still lacking, as disease trajectories between individuals can vary greatly. Globally, governments are recognising these challenges. Investment and research infrastructure are beginning to reflect the scale of the need. Drugs conferring symptomatic benefit are available and memory service structures exist to diagnose dementias and guide management. The personal impact of dementia on patients and families is also being increasingly recognised, with discussion in the media surrounding famous sufferers and dramatisations in literature and film. Herein we attempt to describe the current landscape of dementia.

EPIDEMIOLOGY AND SOCIO-ECONOMIC IMPLICATIONS

Dementia is often arbitrarily considered early (< 65yrs) or late-onset (> 65yrs), with the vast majority (>97%) of cases being of late-onset 1 . Table 1 shows the most recent age-related prevalence estimates for dementia in the UK, which equate to 1.3% of the entire UK population or 7.1% of those aged 65 or over 2 . Applying these to 2013 population estimates gives an estimated number of 19,765 people living with dementia in Northern Ireland 2 . This compares to the 12,811 people registered with the Quality and Outcomes Framework for Northern Ireland (NI) with a diagnosis of dementia in 2013-2014 ( http://www.dhsspsni.gov.uk/index/statistics/qof/qof-achievement/qof-lcg-13-14.htm ).

Gender specific age-related prevalence (%) of dementia in the UK (estimates from Dementia UK 2014)

The age-related incidence of dementia in the UK is falling, presumably as a result of better public health measures 3 , meaning the increasing absolute numbers of people with dementia are based on the shifting population demographic, the aging population. Global estimates of a doubling in the dementia population every 20 years giving an estimated 115 million people with dementia by 2050 were revised further upwards in 2013, to take account of the likely further increases in lower and middle income countries 4 .

Prognosis at the time of dementia diagnosis varies, with evidence that age at diagnosis, gender, comorbidities and disease severity can all affect life expectancy 5 . Whilst methodological variations limit the usefulness of the data available, median life expectancy from the time of diagnosis has been shown to range from 3.2 to 6.6 years, and from 3.3 to 11.7 years from dementia onset 5. Local research has suggested a median survival of 5.9 years from diagnosis (unpublished data).

Transition into residential care as a result of the functional impairments of dementia is a prospect that worries many patients and a reality that many families face. It was estimated last year that 69% of all those living in residential care within the UK suffer from dementia 2 .

It is perhaps no surprise then that dementia is expensive. The updated estimated cost to the UK economy of £26.3 billion per year published last year 2 took account of the role played by unpaid carers (£11.6 billion), social care costs were estimated at £10.3 billion and healthcare costs at £4.3 billion in comparison.

CLINICAL DIAGNOSIS

The clinical syndrome of dementia, characterised by new functional dependence on the basis of progressive cognitive decline, can be due to a variety of underlying pathophysiological processes. The most common of these is Alzheimer's disease (AD; 50-75%) followed by vascular dementia (VaD; 20%), dementia with Lewy bodies (DLB; 5%) and frontotemporal lobar dementia (FTLD; 5%) ( Figure 1 ). The significant clinical and pathological overlap between these processes mean their relative frequencies are estimates at best 1 , 6 . Less common causes (3%) include Huntingdon's disease, Creutzfeldt-Jakob disease, HIV/AIDS and multiple sclerosis. We will first consider the clinical and then the pathological properties of these diseases.

Pie chart showing estimated frequencies of dementiacausing disease processes

Cognitive impairments central to the diagnosis of dementia can be categorised into five main domains: memory; executive function; language; visuospatial abilities; personality and behaviour. As dementia, of any cause, progresses, cognitive impairments will broaden, involving more domains, and deepen, causing increased functional impairment. It can thus be difficult to distinguish dementias of different aetiologies in the later stages. In the early stages however the pattern of prominent symptoms can help identify the most likely underlying disease process. Clinical criteria exist for all the main dementia sub-types, the main features of which are outlined in Table 2 7 – 11 . All criteria require a diagnosis of dementia and include the caveats that there should not be a symptom pattern more in keeping with another of the dementias and that cognitive impairments should not be better explained by a psychiatric illness. Neuropsychiatric symptoms should be sought. Depression can be a cause or effect of cognitive impairments and often features such as hallucinations and delusions will not be volunteered unless specific enquiries are made.

Clinical diagnostic criteria for dementias

AD, the most common cause of dementia, typically presents with short-term memory deficits, manifesting for example as repetitive questioning. Impairment in at least one other cognitive domain is required for a diagnosis of probable dementia due to AD (ADD). Atypical presentations of ADD include behavioural or language deficits suggesting frontal variants or prominent early visuospatial problems suggesting posterior cortical atrophy. The most relevant feature of a presentation of VaD is the temporal association of cognitive deficits with stroke and evidence of cerebrovascular disease on examination and imaging. The Lewy body diseases comprise DLB and Parkinson's disease (PD). Patients with DLB may go on to develop Parkinsonism. As a rule of thumb, if the emergence of dementia and physical PD symptoms are within one year the diagnosis is PD dementia (PDD), if cognitive symptoms predate physical symptoms and signs by more than one year the diagnosis is considered to be DLB. Early language or behavioural symptoms raise the prospect of FTLD. In the younger age groups, ie less than 65, the incidence of FTLD and ADD are almost equal, in contrast to the vastly lower incidence of FTLD in older age groups. The early symptoms of behavioural variant FTLD often raise the possibility of primary functional psychiatric diagnosis, complicating diagnosis.

It is relatively common to be presented with clinical scenarios that do not wholly and exclusively fulfil a single diagnostic criteria. Reflecting the concurrent accumulation of pathophysiological processes within the brain, symptoms can represent overlapping disease processes and mixed pictures can be said to occur, this is most commonly the case with ADD and VaD.

Many people present with objective cognitive symptoms that fall short of the requirements for a diagnosis of dementia. Criteria exist then for the diagnosis of mild cognitive impairment (MCI) 12 , 13 . Creation of this diagnostic category has facilitated focused follow up demonstrating that 5-10% per year of those with MCI will progress to fulfill the diagnostic requirements of a dementia 14 . Such symptoms can also be due to psychiatric illness, drugs known to be deleterious to cognition or may be transient and regress spontaneously. As the use of biomarkers, outlined below, evolves, identification of those more likely to be in the prodromal stages of a dementia is improving, with some arguing that patients should be identified at the MCI stage as either prodromal dementia or not 15 . For now the diagnostic bracket of MCI, whilst disputed, remains.

Other diagnostic criteria exist. In addition to the criteria set out by McKhann et al in 2011 7 an International Working Group has proposed diagnostic criteria for ADD intended for use primarily in research 15 . The older Hachinski 16 and NINDS-AIREN 17 scales are still used to define VaD. The 5 th edition of the Diagnostic and Statistical Manual of Mental Disorders published in 2013 by the American Psychiatric Association 18 has introduced the terms major and mild neurocognitive disorders, which equate to dementia and MCI. Their criteria for the various subtypes equate broadly with the pre-existing clinical criteria.

Diagnosis and differentiation of dementias requires careful history taking and examination. Both patient and collateral histories are needed to establish a new functional dependence and to explore the progressive cognitive impairments as well as neuropsychiatric symptoms. Physical examination is required to examine for focal neurological or extrapyramidal signs. Cognition will be assessed informally during the course of the consultation but formal testing is required, and facilitates longitudinal monitoring. A suggested framework for assessment of patients presenting with cognitive complaints is outlined in Table 3 .

Suggested foci of assessment of patients with cognitive symptoms

Probably the most widely recognised formal cognitive test is the Mini Mental State Examination (MMSE), first proposed in 1975 19 . Whilst assertions of copyright have impacted on its use in recent years the MMSE has become well and widely established, and provides a common language for those fluent in its use. The Montreal Cognitive Assessment, originally developed as a test for MCI, and also marked out of 30, has expanded into the space created by MMSE apprehension ( www.mocatest.org ). The Addenbrooke's Cognitive Examination-III (ACE-III) provides a more thorough assessment and marks are calculated for each domain, then tallied to give a total, out of 100 ( http://www.neura.edu.au/frontier/research/test-downloads/ ). A growing variety of scales exist, none of which is perfect. Inter and intra-rater reliability can limit use and all scales are reliant on premorbid educational abilities. The important thing is to become familiar with a scale, ensure its consistent use within a service, and use it to monitor progression.

PATHOPHYSIOLOGY/PATHOLOGICAL FEATURES

The disease processes underlying dementia are yet to be fully understood. With the (probable) exception of VaD, all involve a pathological accumulation of a native protein: in the case of AD it is the extracellular plaques of amyloid and the intracellular tangles of hyperphosphorylated tau; in DLB it is alpha-synuclein in the form of Lewy bodes; in FTLD several culprits have been identified including TDP-43 and the hallmark proteins of AD and DLB in a frontotemporal distribution. Examples of these lesions can be seen in Figures 2 – 5 . It is important to remember that evidence of these processes is also found post-mortem in people who did not exhibit cognitive impairments prior to death, and that these patterns are not mutually exclusive, existing concurrently as they often do 20 .

An immunohistochemical section taken through the cortex in a case of ADD. An antibody to Beta A4 amyloid is applied to the tissue and detects this antigen which in turn stains the antigen brown. This shows a dense deposition of amyloid throughout the cortex as dense core (DC) and diffuse (D) plaques.

A section from the hippocampal dentate fascia showing dot like deposition of ubiquitin. This is characteristic of Frontotemporal Lobar Dementia with Ubiquitinised inclusions (now called TDP).

Neuronal tangles stained with an antibody to Tau (T)

A pigmented neuron from the substantia nigra. A single Lewy Body is present. This patient also had diffuse cortical Lewy bodies characteristic of Pure Lewy Body Dementia

These pathological accumulations are associated with synapse and neuronal loss and atrophy which also demonstrate patterns in terms of distribution. Hippocampal atrophy within the medial temporal lobe for instance is associated with AD, in keeping with the early amnestic symptoms 21

Genetic studies have contributed greatly to our knowledge of these disease processes. The observation that people with Down's syndrome (trisomy 21) almost invariably develop AD, led to the discovery of the first of three autosomal dominant genes associated with early-onset ADD 22 . Study of these genes, responsible for amyloid cleavage, have been integral to the understanding of pathological amyloid production. In contrast to the aberrant production of amyloid proteins implicated in early onset ADD, late-onset ADD (LOAD) is thought to be more to do with faulty clearance of amyloid from the brain. Apolipoprotein E 23 and, more recently, TREM-2 24 , 25 alleles have been identified as risk factors for LOAD. Their pathophysiological roles remain unclear: they are implicated in amyloid processing and neuroinflammation amongst other pathways. Neither are sufficient or requisite for LOAD and are therefore not tested for in routine clinical practice. Genome wide association studies in recent years have consistently identified several genes with significant but modest associations with LOAD 26 and examination of their relevant pathways, including immune response and inflammation, cell migration and lipid transport, have enhanced the evolving understanding of the ADD disease process.

These methods are being applied across the dementia spectrum and similar pathways are implicated in DLB, FTLD and VaD 27 , 28 . FTLD in particular has myriad of increasingly recognized heritable components.

Animal models, often based on these predisposing genetic mutations, continue to provide basic science research opportunities. Improving chemistry techniques, such as proteomics and metabolomics are also being used to study the disease using human-derived samples such as blood and cerebrospinal fluids.

The search for biomarkers further informs our understanding of these disease processes and offers the opportunity to identify them prior to symptom emergence. A biomarker has been defined as a ‘characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention 29 . Research into ADD is currently the main focus and biomarkers are generally considered as representing the underlying AD process (evidence of amyloid and tau accumulation) or neurodegeneration (markers of synapse/neuronal loss or atrophy) 7 , 15 .

Low amyloid beta and high tau in cerebrospinal fluid (CSF) and high levels of intracerebral amyloid as measured by positron emission tomography (PET) scanning predict the subsequent development of ADD 30 . The downstream markers of neurodegeneration - hippocampal atrophy on MRI and decreased uptake of a radiolabelled glucose tracer (18-fluorodeoxyglucose, FDG) as measured using PET scanning (FDG-PET) have also been shown to increase diagnostic accuracy when used to supplement clinical measures 30 .

The occurrence of these pathophysiological processes in cognitively normal people, especially with increasing age, complicates the interpretation of these biomarkers. Several studies of cognitively normal patients are ongoing and a recently published cross sectional study of 985 participants showed that over the age of 85 more people had biomarker changes in keeping with ADD than did not 31 . There are significant variations in neuroimaging techniques across centres and also in the sampling, handling and analysis of CSF 21 , 32 , 33 . Worldwide research collaborations, such as the Alzheimer's Disease Neuroimaging Initiative (ADNI), are in place to try and accelerate our understanding of the pathophysiological processes underlying dementia, and hence the interpretation of biomarker findings, in both cognitively normal and impaired participants. Global standardisation initiatives are also ongoing with regard to MRI and PET imaging and CSF amyloid and tau. Biomarkers are beginning to be used in clinical practice 34 but the likelihood, and benefit, of more widespread adoption is dependent on these issues being resolved.

INVESTIGATION

Initial investigation of patients presenting with cognitive impairment centres on the exclusion of reversible causes of cognitive impairment. The National Institute of Clinical Excellence (NICE) recommends blood tests (full blood picture, urea and electrolytes, calcium, glucose, liver function tests, thyroid function tests and vitamin B12 and folate) and structural brain imaging (preferably MRI but CT will suffice) 35 . In addition to ruling out tumours, subdural haematomas, stroke and normal pressure hydrocephalus, CT, and to a greater extent MRI, can also provide information regarding chronic ischaemia, infarcts and focal atrophy. Functional imaging, such as single-photon emission computed tomography (SPECT) and FDG-PET are recommended to help differentiate between the dementia sub-types where appropriate. Figure 6 & 7 show normal compared to reduced uptake in keeping with ADD on FDG-PET. Dopamine transporter (DAT) scanning has shown high sensitivity and specificity for DLB and is the investigation of choice when trying to differentiate between DLB and other dementias 36 .

Figures 6 and ​ and7 7 show normal and reduced uptake on FDG-PET scanning respectively. The decreased uptake in the temporoparietal and precuneus (arrow) regions, typical of ADD, can be seen.

RISK FACTORS

In tandem with the laboratory science methods outlined above, observational studies have informed our understanding of the risk factors for dementia, as well as the natural history and prognosis of the diseases. Age is the main risk factor for dementia. Established modifiable risk factors for dementia include: depression, diabetes, (midlife) hypertension, (midlife) obesity, smoking, alcohol abuse, high cholesterol, coronary heart disease, renal dysfunction, low unsaturated fat intake and inflammation 37 . It has been argued that the decrease in age-related dementia incidence seen in the UK is due to better public health measures and thus amelioration of these factors 3 . There is in addition increased focus on recognised protective factors such as: cognitive activity, physical activity, healthy dietary pattern and low/moderate alcohol intake 37 .

MANAGEMENT – NON-PHARMACOLOGICAL

Management will be guided by the nature and severity of the symptoms and any safety concerns. Vascular risk factors should be addressed. Patients and relatives should be offered information and explanations. The Public Health Agency ( www.publichealth.hscni.net ) have developed a booklet ‘Communicating effectively with a person living with dementia’ available via their website. The Alzheimer's Society have local offices and provide information and support ( www.alzheimers.org.uk ). Patients and carers should be referred to a social worker if a carer's assessment is felt appropriate and to facilitate access to services such as Day Centres and social services care provision. As a result of the NI Dementia Strategy a navigation service for all those diagnosed with dementia is being established in all Trusts; this will ensure patients and carers have a consistent contact point throughout their journey. Moderate physical exercise should be encouraged where possible. No formal cognitive training services are currently being offered consistently though supportive evidence is emerging and may translate into service provision. Where appropriate patients can be referred to community mental health teams. Transition into residential care is influenced by social circumstances, dementia severity and the behavioural and psychological symptoms of dementia (BPSD) eg aggression. Non-pharmacological measures are recommended as first line therapy for BPSD but there is as yet no consensus regarding the most effective measures. All patients should be advised to inform the Driver & Vehicle Agency and their insurer of a diagnosis of dementia. If there are concerns regarding a patient's ability to drive they should be advised to stop driving. Where patients lack capacity to manage their own affairs and assets a referral to the Office of Care and Protection ( www.courtsni.govuk/en-GB/Services/OCP/ ) may be warranted. A draft Mental Capacity Bill (NI) (working title) is due to be introduced to the NI Assembly this year having already been consulted upon. It is likely this will have significant impact on how healthcare decisions are made for people who lack capacity.

People with dementia are frequently admitted acutely to hospital, most commonly following a fall, and it is estimated that up to one quarter of in patients in UK hospitals, at any one time, have dementia 38 . This is important as caring for patients with dementia requires modification of communication, diagnostic and, at times, management approaches. Patients may have difficulties articulating symptoms. Constipation and acute urinary retention for example should be actively sought out. Disorientation and agitation may develop and both environmental (eg clear signage and clocks) and attitudinal (eg repeated reassurance, clear explanations, good lighting, involvement of families) approaches can ameliorate this. Dysphagia is a common occurrence as dementia progresses and patients may require dietary modification and assistance at meal times. Dyspraxia can hinder personal care, with considerate assistance required. Patients with dementia are more likely to develop delirium which can further complicate care needs 39 . Rehabilitation attempts can be hampered by cognitive impairments but dementia should not be a contraindication to rehabilitation as evidence for benefit exists. Discharge planning is required, often with inclusion of families. More than one third of patients with dementia admitted to hospital from their own homes will be discharged to an institutional setting 38 . A scheme has been introduced to increase the understanding, and identification, of dementia within hospital settings ( http://butterflyscheme.org.uk ).

MANAGEMENT – PHARMACOLOGICAL

Offending medications, in particular those with anticholinergic properties should be reconsidered and stopped where possible. It is important to note that even over the counter medications can affect cognition 40 . An association with benzodiazepines has been suggested by observational work and these too should be reconsidered 41 .

Acetylcholinesterase inhibitors and memantine, an NMDA receptor antagonist, ( Table 4 ) are the only medications currently licensed for the treatment of dementia. All three acetylcholinesterase inhibitors (AChEi) have a license and are recommended by NICE for the treatment of ADD with rivastigmine additionally approved for the treatment of PDD 42 , 43 . Memantine is approved for the treatment of moderate ADD where AChEi are contraindicated or not tolerated and as an adjunct to AChEi therapy in severe disease 43 . Evidence exists to suggest a moderate improvement in cognitive function with these drugs 44 , 45 . These drugs are not licensed for use in VaD. In clinical practice it can be difficult to distinguish whether there is an ADD component and these medications are often offered as a therapeutic trial. There is no evidence to support the use of AChEi or memantine in FTLD; 46 , 47 AChEi usually make symptoms of FTLD worse as the underlying pathological process is different to that of ADD.

Acetylcholinesterase inhibitors and memantine

Mild, moderate and severe disease severity categories are often used but are arbitrary by nature. As a rule of thumb NICE considers corresponding cut-offs by MMSE of 21-26, 10-20 and less than 10 35 but in practice this is only a single facet of the assessment outlined in Table 3 .

AChEi therapy exerts its benefit by raising pathologically low levels of the neurotransmitter acetylcholine. Potential adverse events include risk of bradycardia and syncope, potential worsening of obstructive airways disease and gastrointestinal disturbance. Assessment should therefore include an ECG and chest auscultation, with severe sinus bradycardia or evidence of a significant cardiac conduction defect or significant audible wheeze all contraindications to AChEi therapy. The possibility of reduction in the dose of beta-blocker or ratelimiting calcium channel blocker could be considered prior to initiation of an AChEi. An anti-emetic, usually domperidone, can be prescribed on an as required basis for the first few weeks to alleviate nausea. The British National Formulary recommends nocte administration of donepezil but it is acceptable to take it in the morning. The decision to continue or terminate drug therapy, in the setting of inevitable cognitive decline, can be difficult. The DOMINO-AD 48 study showed that continuation of donepezil therapy, even in severe disease, was associated with significant cognitive benefit.

Souvenaid is a food for special medical purposes with evidence for improved memory function in early ADD 49 . It is not available on prescription and requires a recommendation from a healthcare professional.

BPSD is an umbrella term for a variety of symptoms including apathy, agitation, disinhibition and sleep disturbance. These can be particularly distressing for carers and often precipitate admission to institutional care. Atypical antipsychotics are sometimes employed to combat BPSD but are associated with significant side effects including an increase in mortality and so should be carefully considered 50 . Only risperidone has a license for the treatment of BPSD and short-term treatment (<6 weeks) is recommended 42 . Depression is a common symptom (see the upcoming review in this Journal regarding diagnosis and treatment of depression).

Many pharmacological avenues are being explored in an effort to find new effective, safe drugs for dementia. Efforts are hampered by the as yet incomplete understanding of the pathophysiological processes being targeted. Drugs targeting amyloid production and amyloid plaque clearance have failed on safety and efficacy grounds. Anti-tau agents are currently being studied. Apart from Souvenaid the much vaunted dietary supplements have yet to be supported by consistent evidence. Safety concerns are being addressed, and emerging pathophysiological insights exploited, by attempts to reposition existing drugs within the dementia field, for example metformin 51 .

Significant advances have been made in our understanding of dementia in recent decades. Dementia presents laboratory, clinical, societal and economic challenges. Diagnosis remains clinical, supplemented by improving biomarkers. Dementia causing diseases overlap in their pathophysiology and phenotypes. The only licensed drugs to date provide symptomatic benefit. Disease-modifying drug development is reliant on early identification of disease processes prior to symptom emergence, where it is currently felt best therapeutic window exists. Both biomarker and drug development depend on better understanding of underlying pathophysiological processes. The wide-reaching benefits of improved public health measures have yielded a decrease in age-related incidence but the ongoing demographic shift means efforts on all fronts must be redoubled if we are to diagnose, treat, understand and care for those of us who develop dementia. The importance of dementia as a global priority is recognised in the declarations of the G8 Dementia Summit in 2013, committing the G8 nations to the improvement in the quality of life for people with dementia and their carers and identification of disease-modifying therapies by way of a co-ordinated and funded international research framework.

ACKNOWLEDGEMENTS

Dr William Murphy, Consultant Radiologist, provided the FDGPETCT images. Drs Shane Gallagher and Brenda Campbell, General Practitioners, reviewed the article and provided advice. Patients and relatives have donated tissue over the years to further the study and understanding of dementia.

CONFLICTS OF INTEREST

ELC has received a contribution towards conference fees from Lundbeck

BMcG has received honoraria and assistance with travel from Nutricia

BH has nothing to declare

APP has received honoraria and assistance with travel from Pfizer/Eisai, Shire, J&J, Novartis, Lundbeck and Nutricia