Background Type 2 diabetes (T2D) is associated with increased risk of dementia. The prospective longitudinal Israel Diabetes and Cognitive Decline study aims at identifying T2D-related characteristics associated with cognitive decline. Methods Subjects are population-based T2D 65+, initially cognitively intact. Medical conditions, blood examinations, and medication use data are since 1998; cognitive, functional, demographic, psychiatric, DNA, and inflammatory marker study assessments were conducted every 18 months. Because the duration of T2D reflects its chronicity and implications, we compared short (0–4.99 years), moderate (5–9.99), and long (10+) duration for the first 897 subjects. Results The long duration group used more T2D medications, had higher glucose, lower glomerular filtration rate, slower walking speed, and poorer cognitive functioning. Duration was not associated with most medical, blood, urine, and vital characteristics. Conclusions Tracking cognition, with face-to-face evaluations, exploiting 15 years of historical detailed computerized, easily accessible, and validated T2D-related characteristics may provide novel insights into T2D-related dementia.

price rs & keady j (2010)  Journal of Nursing and Healthcare of Chronic Illness 2, 88–101
Systematic review: role of health promotion in vascular dementia Aims.  This narrative synthesis of the literature investigates the areas of vascular dementia and modifiable risk factors in order to identify the evidence base and opportunities for specific health promotion work and nursing involvement. Background.  Strategies for well‐being, prevention and health promotion are becoming increasingly important determinants of a quality dementia care service. In England, this emphasis is manifest in the recently launched National Dementia Strategy (February 2009) and areas that address modifiable vascular risk factors are helpful starting points for the enactment of such goals. Design and methods.  A comprehensive search strategy identified primary and secondary search terms that were used systematically in order to search for relevant information and literature; 128 articles were finally included in the overall design and these were broken down into 116 articles obtained through the formal search process using the online databases and 12 articles from the ‘grey literature’. Results.  A narrative synthesis of the included material generated a thematic framework that revealed four discrete but overlapping themes: vascular risk factors (1); prevention and reduction of vascular risk factors (2); treatment and intervention in vascular dementia (3); and vascular health promotion (4). Relevance to clinical practice.  Nursing is in a prime position to undertake health promotion initiatives in modifiable risk behaviours in vascular dementia, an approach that should be commenced for the general population in mid‐life (50 years and over).

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A systematic review conducted by Price and Keady (Journal of Nursing and Healthcare of Chronic Illness, 2, 88 and 2010) demonstrated that there was a dearth of health‐promoting literature available for people diagnosed with vascular dementia. The correlation between health behavior and the onset of cardiovascular change that can lead to vascular dementia had demonstrated a need for health education and health‐promoting information to be made accessible to vulnerable populations to ameliorate the risk of cognitive decline because of cardiovascular disease. Dementia is a progressive and life‐limiting condition and with limited treatment options and a lack of progress in identifying a way to delay onset or even cure the condition. Focus must be targeted towards risk reduction strategies that serve to reduce onset and decline and limit the global burden on not only the individual with the condition and their carers but also to the health and social care economy. To identify the progress that has been made in developing health‐promoting literature and patient education guidance since 2010 a systematic literature review was undertaken. Using thematic analysis, CINAHL, MEDLINE, and psych INFO databases were accessed and following PRISMA guidelines an inclusion and exclusion criteria was developed in order to locate peer‐reviewed articles. Titles and abstracts were reviewed to identify a match with key terms, and from 133 screened abstracts eight studies met the inclusion requirements. From the eight studies, thematic analysis was implemented to identify shared understanding of experiences relating to health promotion in vascular dementia. The methodology for the study was replicated from the authors’ previous systematic review in 2010. Five key themes were identified in the literature (Healthy heart healthy brain; Risk factors; Risk reduction/modification; Interventions; Absence of targeted health promotion). From what little evidence was available to review the thematic analysis has demonstrated developments in knowledge into the link between the onset of cognitive impairment and vascular dementia because of compromised cardiovascular health. Modifying health behavior has become essential in ameliorating the risk of vascular cognitive decline. With these developments the synthesis of the literature demonstrates that even with these insights there continues to be a lack of targeted material that individuals can access to understand the link between cardiovascular health and cognitive decline. It is recognized that maximizing cardiovascular health has the potential to lessen the risk of vascular cognitive impairment and vascular dementia developing and progressing yet targeted health promoting material remains lacking. With the developments in understanding the causal links between poor cardiovascular health, vascular cognitive impairment, and vascular dementia progress now needs to be made in developing targeted health promotion material for individuals to access to share this knowledge to reduce the potential ...