How are people with a cognitive impairment investigated, to understand the underlying cause of impairment?
Award Number
NIHR133541Status / Stage
CompletedDates
1 November 2020 -1 May 2021
Duration (calculated)
00 years 06 monthsFunder(s)
NIHRFunding Amount
£0.00Funder/Grant study page
NIHRContracted Centre
The University of SheffieldPrincipal Investigator
Dr Andrew BoothPI Contact
a.booth@sheffield.ac.ukPI ORCID
0000-0003-4808-3880WHO Catergories
Methodologies and approaches for risk reduction researchUnderstanding Underlying Disease
Disease Type
Dementia (Unspecified)CPEC Review Info
| Reference ID | 141 |
|---|---|
| Researcher | Reside Team |
| Published | 12/06/2023 |
Data
| Award Number | NIHR133541 |
|---|---|
| Status / Stage | Completed |
| Start Date | 20201101 |
| End Date | 20210501 |
| Duration (calculated) | 00 years 06 months |
| Funder/Grant study page | NIHR |
| Contracted Centre | The University of Sheffield |
| Funding Amount | £0.00 |
Abstract
We will aim to address the following questions: What is the evidence base around the assessment and management pathway of older adults with mild cognitive impairment in acute hospital wards, community/primary care and residential settings? In particular: o How are older adults presenting with memory problems investigated to understand the underlying cause of impairment? o What are the advantages and disadvantages of a ‘diagnosis’ of mild cognitive impairment? We will aim to address both patient and health/social care provider perspectives o What is known about the experience of health and care services from the perspective of people with memory problems and their support networks (e.g. family, friends and other carers)?
Plain English Summary
Cognitive impairment is an overarching term referring to deficits in one or more of the areas of memory, problems with communication, attention, thinking and judgment. Impairment can range from mild to severe. Mild cognitive impairment (MCI) is defined as objective cognitive symptoms (e.g. memory problems) in the absence of dementia[1]. MCI is common in older people, affecting 20% of those aged over 65[1]. Subjective cognitive decline (SCD), where people report problems but perform normally on cognitive tests, affects half of over-65s. Although most people with MCI do not go on to develop dementia, the condition is associated with increased dementia risk and this may lead people with MCI (or SCD) to seek help from health services. People with MCI may also be identified as a result of treatment for other conditions in a range of settings. Access to services for people with MCI is a complex issue. Lifestyle changes can reduce modifiable risk factors for dementia, including cardio-metabolic dysfunction (diabetes and cardiovascular risks), physical inactivity, social isolation, hearing loss, mental illness, alcohol and smoking[1]. While there are numerous interventions aimed at modifying lifestyle there appear to be no evidence-based interventions aimed specifically at preventing dementia and suitable for delivery on a large scale. Responsibility for preventing dementia also falls into a grey area between public health (the responsibility of local authorities) and the NHS. A review of policies and strategies for dementia prevention in England found limited evidence for their implementation at the clinical level[2]. NHS memory services are limited to people with a diagnosis of dementia and are unable to help those with MCI beyond ‘signposting’ to other services[1]. The current configuration of services leads some health professionals to question the value of identifying people with MCI. They argue that a ‘label’ of MCI may worsen anxiety or other mental health problems without offering access to effective treatments not otherwise available. On the other hand, prevention of dementia is a high priority for those directly affected and society as a whole. In 2017, the NIHR HS&DR programme issued a call for research into cognitive impairment (17/107: Organisation of services and workforce interventions for the assessment and management of older adults with cognitive impairments in generalist health and care services). The response to this call was limited. The HS&DR programme team have requested the Sheffield HS&DR Evidence Synthesis Centre to review the current evidence base, taking different perspectives into account, to identify key implications for research and service delivery. An initial scoping search of the MEDLINE database (November 2020) identified some potentially relevant papers. In particular, a consensus meeting held in Manchester in 2019 led to the publication of a clinical guideline on MCI in November 2020[3]. The authors stated that the guideline covers ‘the use of neuroimaging, fluid biomarkers, cognitive testing, follow-up and diagnostic terminology’ in MCI. While clearly important for UK practice, this guideline does not cover the full range of topics of interest to the HS&DR programme. Indeed, one of the authors’ key recommendations is that the National Institute for Health and Care Excellence (NICE) should produce guidance on MCI. In the absence of such guidance, a targeted evidence review may be of value for both research commissioners and decision-makers in health and social care.