Last reviewed 16 September 2020

The coronavirus has had a huge impact on those suffering from dementia, with over one in four deaths being those of people with a dementia diagnosis. Deborah Bellamy looks at how this can be addressed, as well as recent developments regarding dementia prevention.

Introduction

The number of people diagnosed with dementia continues to rise, so it is increasingly important to address modifiable risk factors which can delay or slow onset or progression. Recently published developments from the Lancet Commission have identified three further modifiable risk factors and it is urging countries to be ambitious about dementia prevention.

People with dementia have been impacted greatly by coronavirus in the UK, with over one in four deaths being those of people with a dementia diagnosis as well as increasing evidence of more rapid deterioration of the disease. Alzheimer’s Disease International (ADI) is calling on world governments to ensure dementia remains a priority during and after the Covid-19 pandemic.

Despite there being no new drugs for dementia in 15 years, other progress is being made with new blood tests to help diagnose the disease, further research into gene therapy and other breakthroughs with existing drugs.

Lancet Commission on dementia prevention, intervention and care — three new risk factors

The understanding around causes of dementia is changing. In July 2020, the Lancet Commission updated evidence of modifiable risk factors in prevention of dementia and the “life-course model of dementia prevention”.

In addition to the 2017 intervention and care life-course model of nine factors, namely: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes and infrequent social contact, three new modifiable risk factors have been added:

  • excessive alcohol consumption

  • head injury

  • air pollution.

These 12 risk factors are considered responsible for around 40% of dementias worldwide, which theoretically may be preventable or delayed.

Wellbeing is central to dementia care and those with dementia have complex issues and symptoms. Evidence is accruing for the effectiveness, in the short term, of psychosocial interventions modified to individual needs, to manage symptoms. Evidence-based interventions for carers can reduce depressive and anxiety symptoms and be cost-effective.

Maintaining physical health is important for cognition and those with dementia have more physical health problems than others of the same age, and comparatively more hospital admissions, including for illnesses that are potentially manageable in home/care settings.

Delirium is common in people with dementia and contributes to cognitive decline. It has been suggested that in hospital, care including appropriate sensory stimulation, ensuring fluid intake and avoiding infections might reduce delirium, but this would also be transferable for care home service users.

As with Covid-19, many dementia risk factors gather around inequalities, which occur particularly in black, Asian, and minority ethnic groups and vulnerable populations. Addressing such will need societal action as well as health promotion.

More information can be found at: https://www.thelancet.com/commissions/dementia2020.

Alzheimer’s and Covid-19

In our 2018 feature on Ensuring good healthcare for people with dementia, Jef Smith discussed Alzheimer’s being “so disrupting of personal communication that it can easily lead others to miss what the person is wanting to say and allow them to attribute everything that happens to the disease”.

During the pandemic, in-depth knowledge of the person with dementia, maintaining effective communication and the ability to read non-verbal cues remain key, partly because identifying coronavirus symptoms may be more problematic with individuals who have a reduced ability to articulate such. Use of personal protective equipment, hand hygiene practices, social distancing and visiting restrictions will all have added to the challenges faced daily.

While evidence is being examined to ascertain if dementia increases the risk of contracting Covid-19, dementia-related behaviors, increased age/frailty, and common health conditions that accompany dementia are likely to increase risk.

Those with dementia, living in both residential care and at home, have declined significantly faster than expected over the past months, with social isolation a major factor.

The ADI report (2020) states that Covid-19 has highlighted the scale of the challenges faced by the global dementia community, intensifying individual challenges of the millions of people living with dementia. It is lobbying governments for a minimum of 1% of the societal cost of dementia to be donated to research. See more on the Alzheimer’s Disease International website.

World Alzheimer’s day

Every year, 21 September is World Alzheimer's Day, dedicated to raising awareness about Alzheimer’s and dementia, and is part of World Alzheimer's Month. It aims to raise awareness, highlight issues faced by people affected by dementia and demonstrate how these may be overcome to support people to live well with dementia. This year's focus is stigma.

More information can be found at: www.alzheimers.org.uk.

Dementia Action Week to return in 2021

With continued social distancing, restrictions on public events and uncertainty about what the rest of the year may hold, the Alzheimer’s Society has decided not to run a postponed Dementia Action Week later this year.

Alzheimer’s Society study 2020

Two studies funded by the Alzheimer’s Society revealed around a third of people with dementia and two-thirds of carers of people with dementia experience loneliness, and this is expected to increase. There have been few studies to explore the effect of loneliness on people living with dementia.

The Alzheimer’s Society is concerned that rates of loneliness will rise as a consequence of coronavirus, as those affected by dementia deal with limited or suspended face-to-face services, reduction in care workers and the impact of isolation.

Common physical illness

Former research into the use of diabetes drugs and dementia show studies evaluating the effect of metformin, a drug used to treat type 2 diabetes on the risk of dementia remain rare.

However, further research has been conducted and a new study published in the Journal of Alzheimer’s Disease providing insight into the association of blood markers of diabetes amongst older people at risk of dementia. Results suggest a link between Alzheimer’s pathology, lower levels of insulin and lower insulin resistance. This adds to data on associations of insulin resistance and diabetes with Alzheimer’s disease pathology.

Further studies are still required to clarify the relationship between methotrexate (a drug used to treat rheumatoid arthritis) as well as biological treatments with protection against dementia risk.

New scientific developments

New blood test to diagnose Alzheimer’s disease

Researchers have developed a new blood test indicated to be 94% accurate in detecting Alzheimer’s disease, prior to brain scans being able to detect the condition. While this requires further testing to confirm accuracy, it could be another step forward identifying those at risk of the disease enabling early treatment.

A new gene therapy to tackle inherited forms of dementia

Some types of dementia are known to be caused by inherited gene mutations. New gene therapy initiatives based at University College London are being funded to investigate how these genes can be prevented from causing the disease.

Commitment to care of people living with dementia — SPACE principles

Royal College of Nursing (RCN) guidance (2019) comprises five principles, forming a shared commitment to improving care for people living with dementia and their families. It is designed to be used in health and social care settings by nurses and other staff, as well as by senior managers and directors.

The aim is to support the implementation of the SPACE principles, namely:

  • staff who are skilled and have time to care

  • partnership working — effective care requires a relationship-centred approach

  • assessment, early identification of dementia and post-diagnostic support (assessment should be informed by NICE guidance)

  • care and support plans which are person centred and individual

  • environments that are dementia friendly.

While some generic statements can be made about dementia, everyone will be affected differently, altering how a person may function. Rather than seeing “someone with dementia”, it is essential to:

  • seek to understand the individual

  • value individuals with dementia and those who care for them, and recognise their rights

  • treat people as individuals, understanding unique history and personality

  • contemplate the world from the perspective of the person and listen to their voice

  • recognise that human life is grounded in relationships and individuals need to live in a social environment, supporting wellbeing

  • understand alterations to behaviour and mood and enable the opportunity for new and life-affirming experiences.

These resources can be used along with other initiatives that support innovation and improvement.

The guidance can be accessed at: https://www.rcn.org.uk/professional-development/publications/pub-007827.