Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis

Lang, Linda; Clifford, Angela; Li, Wei; Zhang, Dongmei; Leung, Daryl; Augustine, Glenda; Danat, Isaac M; Zhou, Weiping; Copeland, J. R. M.; Anstey, Kaarin J.; Chen, Ruoling

doi:10.1136/bmjopen-2016-011146

Cited by 433 publications

(362 citation statements)

References 38 publications

(91 reference statements)

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“…An important risk factor for longer hospitalization time in PWD is the higher risk of developing delirium during hospitalization among people with dementia, with several studies showing that interventions aimed to address delirium during hospitalization could also reduce the LOS . One major problem previous research has shown is that delirium and cognitive function are not always assessed, and the prevalence of undetected dementia varies between 43% and 58% in Europe and up to 70% in North America according to a recent meta‐analysis . Such factors could lead to an underestimated difference regarding LOS in PWD compared to PwoD and to an inappropriate treatment of PWD.…”

Section: Discussionmentioning

confidence: 99%

Length of hospital stay and dementia: A systematic review of observational studies

Möllers

Stocker

Wei

et al. 2018

Int J Geriat Psychiatry

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Objective Hospitalizations of people with dementia (PWD) are often accompanied by complications or functional loss and can lead to adverse outcomes. Unsystematic findings suggest an influence of comorbidities on the extent of differences in the length of hospital stay (LOS). This systematic review aimed to identify and evaluate all studies reporting LOS in PWD as compared to PwoD in general hospitals. Methods A systematic review of observational studies using PubMed and ISI Web of Knowledge. Inclusion criteria comprised original studies written in English or German, assessment of diagnosis of dementia, measurement of LOS, and comparison of people with and without dementia. Results Fifty‐two of 60 studies reported a longer hospitalization time for PWD compared to PwoD. The extent of the difference in LOS varied between and within countries as well as by type of primary morbidity (eg, injuries, cardiovascular diseases). The range of the LOS difference for studies without restriction to a primary morbidity was −2 to +22 days after matching or adjustment for a variable number and selection of potentially relevant covariates. For studies with injuries/fractures/medical procedures and infectious/vascular disease as the primary morbidity, the range was −2.9 to +12.4 and −11.2 to +21.8 days, respectively. Conclusions The majority of studies reported a longer hospitalization of PWD compared to PwoD. Length of hospital stay seems to be influenced by a variety of medical, social, organizational factors, including reasons for hospital admission, whose role should be explored in detail in further research.

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Section: Discussionmentioning

confidence: 99%

Length of hospital stay and dementia: A systematic review of observational studies

Möllers

Stocker

Wei

et al. 2018

Int J Geriat Psychiatry

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“…One alternative would have been to classify individuals based on dementia status (e.g., no dementia diagnosis throughout the observation period, incident dementia, and dementia diagnosis from the beginning). Although our study includes relatively frequent measures of the CPS score, dementia status is typically not as frequently assessed in nursing homes, leading to a considerable diagnostic gap [41][42][43]. Thus, even if a person is not diagnosed with dementia until their death, we will not know with certainty that they were indeed free of dementia symptoms.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

et al. 2018

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Background: Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. Objectives: We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents with the objective of examining whether terminal change is normative or whether one or multiple subgroup(s) with relative stability exist. Methods: We performed a longitudinal analysis based on routine assessments with the Resident Assessment Instrument – Minimal Data Set in 341 nursing homes between 1998 and 2014. In sum, we used 143,052 observations from 30,054 residents (69% women, average age at death 87 years) in the last 3 years of life. We analyzed trajectories of the Cognitive Performance Scale (CPS) score with latent class growth curve models and examined sociodemographic factors (age at death, sex, marital status, prior living situation) as well as functional and mental health (Activities of Daily Living Index and Depression Rating Scale) and dementia diagnosis as correlates of group membership. Results: We identified three distinct classes based on longitudinal trajectories of the CPS score. In the first group (transition from no to mild impairment, 27%), cognitive impairment increased with time to death (linear and quadratic), but remained at relatively mild levels at all times. The trajectories of the second group (transition from moderate to severe impairment, 43%) were characterized by linear and quadratic changes across time to death. The trajectories of the third group (severe impairment, 30%) were characterized by the lowest amount of linear increase across all groups and no quadratic increase indicating no accelerated change. Better functional health and absence of a dementia diagnosis predicted less impairment. Fewer depressive symptoms were associated with low as opposed to moderate or severe, but also severe versus moderate impairment. Conclusion: Our findings suggest that the majority of residents experience terminal change, with the exception of those at already high levels of impairment. Furthermore, late-life cognitive change is related to functional and mental health.

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“…Moreover, the rate of undetected dementia is about 61.7% [87]. Alzheimer's disease (AD) is the most common form of dementia.…”

Section: Role Of Lc/ne System In Neuropathologiesmentioning

confidence: 99%

Noradrenergic Modulation of Cognition in Health and Disease

2017

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Norepinephrine released by the locus coeruleus modulates cellular processes and synaptic transmission in the central nervous system through its actions at a number of pre- and postsynaptic receptors. This transmitter system facilitates sensory signal detection and promotes waking and arousal, processes which are necessary for navigating a complex and dynamic sensory environment. In addition to its effects on sensory processing and waking behavior, norepinephrine is now recognized as a contributor to various aspects of cognition, including attention, behavioral flexibility, working memory, and long-term mnemonic processes. Two areas of dense noradrenergic innervation, the prefrontal cortex and the hippocampus, are particularly important with regard to these functions. Due to its role in mediating normal cognitive function, it is reasonable to expect that noradrenergic transmission becomes dysfunctional in a number of neuropsychiatric and neurodegenerative diseases characterized by cognitive deficits. In this review, we summarize the unique role that norepinephrine plays in prefrontal cortical and hippocampal function and how its interaction with its various receptors contribute to cognitive behaviors. We further assess the changes that occur in the noradrenergic system in Alzheimer's disease, Parkinson's disease, attention-deficit/hyperactivity disorder, and schizophrenia and how these changes contribute to cognitive decline in these pathologies.

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Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis

Cited by 433 publications

References 38 publications

Length of hospital stay and dementia: A systematic review of observational studies

Length of hospital stay and dementia: A systematic review of observational studies

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

Noradrenergic Modulation of Cognition in Health and Disease

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