AAN recommends people 65+ be screened yearly for memory problems
September 19, 2019
Science Daily/American Academy of Neurology
To help physicians provide the highest quality patient-centered neurologic care, the American Academy of Neurology (AAN) is recommending physicians measure how frequently they complete annual assessments of people age 65 and older for thinking and memory problems.
People with mild cognitive impairment have thinking and memory problems but usually do not know it because such problems are not severe enough to affect their daily activities. Yet mild cognitive impairment can be an early sign of Alzheimer's disease or other forms of dementia. It can also be a symptom of sleep problems, medical illness, depression, or a side effect of medications.
To help physicians provide the highest quality patient-centered neurologic care, the American Academy of Neurology (AAN) is recommending physicians measure how frequently they complete annual assessments of people age 65 and older for thinking and memory problems. This metric for yearly cognitive screening tests is part of an AAN quality measurement set published in the September 18, 2019, online issue of Neurology®, the medical journal of the American Academy of Neurology.
A quality measure is a mathematical tool to help physicians and practices understand how often health care services are consistent with current best practices and are based on existing AAN guideline recommendations. Quality measures are intended to drive quality improvement in practice. Physicians are encouraged to start small using one or two quality measures in practice that are meaningful for their patient population, and measure use is voluntary.
"Since thinking skills are the most sensitive indicator of brain function and they can be tested cost-effectively, this creates an enormous opportunity to improve neurologic care," said author Norman L. Foster, MD, of the University of Utah in Salt Lake City and a Fellow of the American Academy of Neurology. "The American Academy of Neurology is recommending the measurement of annual cognitive screenings for everyone age 65 and older because age itself is a significant risk factor for cognitive decline and mild cognitive impairment is increasingly prevalent with older age. The measure complements past American Academy of Neurology quality measures released for Parkinson's disease, multiple sclerosis and stroke, and allows for a doctor to meet the measure with a recommended periodic three-minute cognitive test."
According to the 2018 AAN guideline on mild cognitive impairment, nearly 7 percent of people in their early 60s worldwide have mild cognitive impairment, while 38 percent of people age 85 and older have it.
The new AAN quality measurement set recommends doctors measure how often they conduct annual screenings to improve the recognition of mild cognitive impairment and allow for earlier intervention.
"We cannot expect people to report their own memory and thinking problems because they may not recognize that they are having problems or they may not share them with their doctors," said Foster. "Annual assessments will not only help identify mild cognitive impairment early, it will also help physicians more closely monitor possible worsening of the condition."
The new measurement set states that documenting mild cognitive impairment in a person's medical record can be invaluable in alerting other physicians and medical staff so that the best care is provided to that patient.
Early diagnosis can help identify forms of mild cognitive impairment that may be reversible, including those caused by sleep problems, depression or medications, and lead to treatments that can improve a person's quality of life such as correcting hearing loss and avoiding social isolation.
When mild cognitive impairment is not reversible and could develop into more severe forms of dementia like Alzheimer's disease, the quality measurement set recommends measuring how frequently people are given information about their condition as early as possible, so they can take steps to avoid exploitation, plan for their care and monitor their condition.
It is also important not to forget about family and caregivers. The measurement set also asks doctors to identify care partners to help describe symptoms. Doctors should quantify involvement with family and caregivers and provide them with information so that they too receive support and get access to services to help them cope if person's illness progresses and to improve their well-being.
https://www.sciencedaily.com/releases/2019/09/190919093916.htm
Feeling depressed? Mahjong might be the answer
Study shows that for older Chinese, it might boost mental health
September 17, 2019
Science Daily/University of Georgia
When it comes to boosting mental health among older Chinese, it might be as simple as a game of mahjong, according to a new study from the University of Georgia.
Regularly playing the popular tile-based strategy game was one of several types of social participation linked to reduced rates of depression among middle-aged and older adults in China in the study appearing in Social Science & Medicine.
"Global economic and epidemiologic trends have led to significant increases in the burden of mental health among older adults, especially in the low- and middle-income countries," said Adam Chen, an associate professor of health policy and management at UGA's College of Public Health and study co-author.
Poor mental health is a major issue in China, which accounts for 17% of the global disease burden of mental disorders. On top of that, mental health issues related to social isolation and loneliness are on the rise as China's number of older adults -- as in other nations -- continues to increase.
The benefits of participating in social activities to mental health have been widely acknowledged, and some work has been done in developed nations, including the U.S. and Japan, to better understand this relationship.
But little is known about the role of social interaction and mental health outside of these settings.
"Social participation manifests itself in different formats within different cultural contexts," said Chen.
"Our paper provides evidence on the association between social participation and mental health in the context of a developing country. We also examined the rural-urban difference, which has not been examined extensively in this line of literature."
Chen and collaborators from China's Huazhong University of Science and Technology analyzed survey data from nearly 11,000 residents aged 45 years and older from the nationally representative China Health and Retirement Longitudinal Study.
They looked at symptoms of depression and compared it to the type and frequency of social participation, including visiting with friends, playing mahjong, participating in a sport or social club, and volunteering in the community.
They found that, on the whole, participating in a wide variety of activities more frequently was associated with better mental health. Specifically, urban residents who played mahjong, a popular strategy game, were less likely to feel depressed.
That wasn't too surprising for Chen, as this finding was in line with other studies, but he was surprised to find that rural Chinese overall tended to report poor mental health compared to their urban counterparts.
"Traditionally, rural China featured tight-knit communities of close kinship, often with a limited number of extended large families in a village," he said. "We were expecting strong ties and communal bonds in rural China, but it appears that we were wrong."
Chen suspects that the social structures in rural China were disrupted as many able-bodied adults moved into cities to find work. While family ties remained strong, community ties weakened in rural areas.
"What is more surprising is that mahjong playing does not associate with better mental health among rural elderly respondents," added Chen. "One hypothesis is that mahjong playing tends to be more competitive and at times become a means of gambling in rural China."
The authors believe these findings may offer a guide to health practitioners designing policies and interventions to improve mental health among older Chinese.
The findings could also translate, said Chen, to Asian American communities.
"Older Asian Americans have a much higher proportion of suicidal thoughts than whites and African Americans," he said. "Improving social participation among older Asian Americans may help to address this burden to the U.S. population health that has not received due attention."
https://www.sciencedaily.com/releases/2019/09/190917115420.htm
Socially active 60-year-olds face lower dementia risk
August 2, 2019
Science Daily/University College London
Being more socially active in your 50s and 60s predicts a lower risk of developing dementia later on, finds a new UCL-led study.
The longitudinal study, published in PLOS Medicine, reports the most robust evidence to date that social contact earlier in life could play an important role in staving off dementia.
"Dementia is a major global health challenge, with one million people expected to have dementia in the UK by 2021, but we also know that one in three cases are potentially preventable," said the study's lead author, Dr Andrew Sommerlad (UCL Psychiatry).
"Here we've found that social contact, in middle age and late life, appears to lower the risk of dementia. This finding could feed into strategies to reduce everyone's risk of developing dementia, adding yet another reason to promote connected communities and find ways to reduce isolation and loneliness."
The research team used data from the Whitehall II study, tracking 10,228 participants who had been asked on six occasions between 1985 and 2013 about their frequency of social contact with friends and relatives. The same participants also completed cognitive testing from 1997 onwards, and researchers referred to the study subjects' electronic health records up until 2017 to see if they were ever diagnosed with dementia.
For the analysis, the research team focused on the relationships between social contact at age 50, 60 and 70, and subsequent incidence of dementia, and whether social contact was linked to cognitive decline, after accounting for other factors such as education, employment, marital status and socioeconomic status.
The researchers found that increased social contact at age 60 is associated with a significantly lower risk of developing dementia later in life. The analysis showed that someone who saw friends almost daily at age 60 was 12% less likely to develop dementia than someone who only saw one or two friends every few months.
They found similarly strong associations between social contact at ages 50 and 70 and subsequent dementia; while those associations did not reach statistical significance, the researchers say that social contact at any age may well have a similar impact on reducing dementia risk.
Social contact in mid to late life was similarly correlated with general cognitive measures.
Previous studies have found a link between social contact and dementia risk, but they did not have such long follow-up times, so they could not rule out the possibility that the beginnings of cognitive decline may have been causing people to see fewer people, rather than the other way around. The long follow-up in the present study strengthens the evidence that social engagement could protect people from dementia in the long run.
The researchers say there are a few explanations for how social contact could reduce dementia risk.
"People who are socially engaged are exercising cognitive skills such as memory and language, which may help them to develop cognitive reserve -- while it may not stop their brains from changing, cognitive reserve could help people cope better with the effects of age and delay any symptoms of dementia," said senior author Professor Gill Livingston (UCL Psychiatry).
"Spending more time with friends could also be good for mental wellbeing, and may correlate with being physically active, both of which can also reduce the risk of developing dementia," added Professor Livingston, who previously led a major international study outlining the lifecourse factors that affect dementia risk.
The researchers were supported by Wellcome and the National Institute for Health Research UCLH Biomedical Research Centre, while the Whitehall II study is supported by the US National Institutes of Health, UK Medical Research Council and the British Heart Foundation.
The study was conducted by researchers in UCL Psychiatry, UCL Epidemiology & Public Health, Camden & Islington NHS Foundation Trust and Inserm.
Dr Kalpa Kharicha, Head of Innovation, Policy and Research at the Campaign to End Loneliness, said: "We welcome these findings that show the benefits of frequent social contact in late/middle age on dementia risk. As we found in our Be More Us Campaign, almost half of UK adults say that their busy lives stop them from connecting with other people. It's important we make changes to our daily lives to ensure we take the time to connect with others. We need more awareness of the benefits that social wellbeing and connectedness can have to tackle social isolation, loneliness and reduce dementia risk."
Fiona Carragher, Chief Policy and Research Officer at Alzheimer's Society, said: "There are many factors to consider before we can confirm for definite whether social isolation is a risk factor or an early sign of the condition -- but this study is a step in the right direction. We are proud of supporting work which helps us understand the condition better -- it is only through research that we can understand true causes of dementia and how best to prevent it.
"As the number of people in the UK with dementia is set to rise to one million by 2021, we must do what we can to reduce our risk -- so along with reducing your alcohol intake and stopping smoking, we encourage people across the country to get out into the sunshine, and do something active with family and friends.
"The Government's recent emphasis on health prevention is a welcome opportunity to reduce the risk of dementia across society. We now need to see Ministers prioritise better support initiatives to help people reduce the risk of dementia, and look forward to seeing this when the results of the Green Paper on Prevention are published later in the year."
https://www.sciencedaily.com/releases/2019/08/190802144414.htm