Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care

Borson, S. et al. | Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care: a systematic review and practical considerations for the clinician | BMC Primary. Care . 24, 233 | https://doi.org/10.1186/s12875-023-02185-4

Primary care clinicians (PCCs) are typically the first practitioners to detect cognitive impairment in their patients, including those with Alzheimer’s disease or related dementias (ADRD). However, conversations around cognitive changes can be challenging for patients, family members, and clinicians to initiate, with all groups reporting barriers to open dialogue. . This systematic review looks to identify barriers to and facilitators of brain health conversations in primary care settings.

The authors identified four main themes: (1) PCCs are hesitant to discuss brain health and cognitive concerns; (2) patients are hesitant to raise cognitive concerns; (3) evidence to guide clinicians in developing treatment plans that address cognitive decline is often poorly communicated; and (4) social and cultural context influence perceptions of brain health and cognition, and therefore affect clinical engagement.

The paper concludes that early conversations about brain health between PCCs and their patients are rare, and effective tools, processes, and strategies are needed to make these vital conversations routine.

Full paper: Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care: a systematic review and practical considerations for the clinician.

Raising the barriers: An action plan to tackle regional variation in dementia diagnosis in England

All-Party Parliamentary Group on Dementia

A dementia diagnosis is a fundamental first stage of the dementia pathway. Missing out on an early and accurate diagnosis can have a significant negative impact, for example limiting access to symptom management interventions, ultimately leading to poorer outcomes and increased health and social care costs. At present there is a difference of over twenty percentage points in the dementia diagnosis rates between the highest and lowest performing Integrated Care Systems (ICSs) in England.

This is a report of an inquiry that examined how the most deprived and rural communities are particularly adversely affected by this regional disparity. The inquiry’s findings show a complex picture in which issues ranging from variation in population health risk and dementia public health understanding, to the geographical spread of brain scans and transport networks all play a part in regional dementia related health disparities.

The report sets out a number of recommendations across the core themes of dementia diagnosis, data, workforce and public health messaging. Collectively these recommendations outline how dementia pathways can be strengthened to enable access and quality care across all settings, communities and regions in England so that all who need it can receive a timely and accurate dementia diagnosis.

Full report: Raising the barriers: An action plan to tackle regional variation in dementia diagnosis in England

UK on verge of new dawn for dementia treatments, says taskforce chair

via The Guardian

Today’s generation of elderly people could be the last to face the spectre of untreatable Alzheimer’s disease, according to the co-chair of the government’s new dementia mission. Hilary Evans, the chief executive of Alzheimer’s Research UK, appointed by ministers last month, said the world was “on the cusp of a new dawn” for dementia treatments that meant devastating neurodegenerative illness would no longer be regarded as an inevitable part of old age.

However, she warned that an overhaul of NHS dementia care was required to ensure that patients could access the first effective Alzheimer’s drugs, which could be approved in the UK as soon as next year.

Full article: UK on verge of new dawn for dementia treatments, says taskforce chair

Supporting people living with Dementia: Evidence from research

Institute of Public Care

What good commissioning of support for people living with dementia and for their carers should look like is multi-layered and complex. It requires a long-term strategic commitment and ensuring wherever possible that support is evidence-based and informed. In addition to the central importance of health and care support, there are implications for wider commissioning and services including the built environment and transport for example. Commissioners and providers should consider how well their current service offer enables people living with dementia to participate in their communities as fully as possible, for as long as possible.

Our review explores a range of evidence on what can enable people to maintain independence and wellbeing, and how best to support people living with dementia to have a quality of life grounded on what matters to them, and to their carers and family members.

Full briefing paper: Supporting people living with Dementia: Evidence from research

Mediterranean diet associated with lower dementia risk

Shannon, O.M., Ranson, J.M., Gregory, S. et al. | Mediterranean diet adherence is associated with lower dementia risk, independent of genetic predisposition: findings from the UK Biobank prospective cohort study | BMC Medicine 21, 81 (2023). https://doi.org/10.1186/s12916-023-02772-3

The identification of effective dementia prevention strategies is a major public health priority, due to the enormous and growing societal cost of this condition. Consumption of a Mediterranean diet (MedDiet) has been proposed to reduce dementia risk. However, current evidence is inconclusive and is typically derived from small cohorts with limited dementia cases. Additionally, few studies have explored the interaction between diet and genetic risk of dementia.

This study concludes that higher adherence to a Mediterranean diet was associated with lower dementia risk, independent of genetic risk, underlining the importance of diet in dementia prevention interventions.

Full paper: Mediterranean diet adherence is associated with lower dementia risk, independent of genetic predisposition: findings from the UK Biobank prospective cohort study

Dementia: Brain check-up tool aims to cut risk at any age

A new brain check-up tool from Alzheimer’s Research UK offers tips on staying sharp, keeping active and connecting with others | via BBC News

People of all ages are being encouraged to do more to look after their brains to try to reduce their dementia risk. Research suggests there are 12 risk factors for dementia which, if modified, could stop 4 in 10 people developing memory loss, confusion and communication problems.

Advice based on these risk factors is to stop smoking, do regular exercise, cut back on alcohol and challenge your brain – and it is never to early or too late to start doing it, experts say. Anyone can take the brain check, which has been based on the latest research, to find out how to lower their individual chances of dementia, but it is particularly aimed at adults aged 40-50 because this is seen to be an important window for taking action to look after brain health.

Full detail: Dementia: Brain check-up tool aims to cut risk at any age

See also: Think Brain Health Check-in | Alzheimer’s Research UK

Related research: Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Dementia Diagnoses data collection

To ensure that dementia diagnosis rates are accurately reflected regionally and nationally across ICBs, GP practices are invited to sign up to the new Calculating Quality Reporting Service (CQRS) service/extract, an approval, reporting and payments calculation system for GP practices.

GP practices who have not already signed up to the new service/extract are encouraged to do so by the end of December 2022 to ensure dementia diagnosis data is accurately reflected in the next publication of the Primary Care Dementia Data collection in January 2023.

• Calculating Quality Reporting Service (CQRS)
• Primary Care Dementia Data | NHS Digital

Appropriate prescribing of antipsychotic medication in dementia

NHS England – October 2022

Intended audience: To support Integrated Care Systems working with providers: GPs, GP practice pharmacists, Primary Care Network (PCN) pharmacists, Trust clinicians, staff in care homes, acute hospitals, Memory Assessment Services (MAS) and Community Mental Health Teams (CMHTs). It may also be a useful source of information and support for people living with dementia and carers.

There is concern over the high rates of antipsychotic prescribing in people with dementia due to the associated risks often outweighing the benefits. As such, antipsychotics should only be considered as a last resort in dementia.
This toolkit provides expert, evidence-based practical advice and guidance on risk reduction when using these agents and support with deprescribing where appropriate.

The aim of the resource is to provide guidance and information to address:
• uses, risks and alternatives to antipsychotic medication
• risk reduction in antipsychotic prescribing
• support for local systems to deliver best practice in antipsychotic prescribing and de-prescribing where appropriate.

Full Resource – Appropriate prescribing of antipsychotic medication in dementia

Health Secretary announces 10-year plan for dementia

Health and Social Care Secretary announces a new 10-year plan to tackle dementia and boost funding into research to better understand neurodegenerative diseases | Department of Health and Social Care

• Health and Social Care Secretary Sajid Javid announces plans to work across government to boost the £375 million already committed for research into neurodegenerative diseases.
• Actions will reduce the up to 40% of dementia considered to be potentially preventable and explore how new technology, science and medicine can help reduce the numbers and severity of dementia.
• Record NHS funding to reduce the coronavirus (COVID-19) backlog will help ensure more timely dementia diagnosis.

A new 10-year plan to tackle dementia will be published later this year, Health and Social Care Secretary Sajid Javid confirmed.

Full detail: Health Secretary announces 10-year plan for dementia

Levelling up dementia diagnosis: Tackling variations in diagnosis rates in England

This research report from Future Health has been commissioned and funded by Roche Products Ltd to further the understanding of care for people with Alzheimer’s disease and other forms of dementia.

Future Health has published research which shows that over 300,000 people living with dementia in England go undiagnosed. The report finds:

• A postcode lottery for dementia diagnosis, with large variations across England, including between neighbouring healthcare authorities
• The pandemic has seen a reduction in the proportion of patients receiving a diagnosis, with the number falling below 60% – missing the Government target of two thirds
• £3billion could be saved with better diagnosis rates of dementia, as report calls for pandemic recovery investment and an urgent public health campaign to encourage people to visit their GPs if they have concerns

Full report: Levelling up dementia diagnosis: Tackling variations in diagnosis rates in England

Press release: New report reveals pandemic impact on dementia diagnosis