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11 - The good, the challenging and the supportive: mapping life with dementia in the community
- Edited by Richard Ward, University of Stirling, Andrew Clark, University of Salford, Lyn Phillipson, University of Wollongong, Australia
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- Book:
- Dementia and Place
- Published by:
- Bristol University Press
- Published online:
- 13 May 2022
- Print publication:
- 24 September 2021, pp 160-185
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Summary
Introduction
Developing bodies of work in interdisciplinary dementia research are engaging with concepts of place and spatiality as they relate to the everyday experience of living with dementia (Clarke and Bailey, 2016; Odzakovic et al, 2018). Rather than focus on the ‘dis-abilities’ of a person and their effect on navigation or wayfinding, these works have looked first to understand environmental barriers and to improve the enabling characteristics of environments – through features such as signage, pathways and distinctiveness (Mitchell and Burton, 2010). Building upon understanding the role of material geographies is work that engages with more progressive understandings of neighbourhoods as spaces of lived experience, belonging and relational ties (Ward et al, 2018; Clark et al, 2020). This evolving understanding of the vital importance of place and space for people with dementia is in contrast to a spatial literature where the relationship of people with dementia to space was pathologised – for example the reframing of the everyday practice of walking as a form of deviant wandering (Brittain et al, 2017). Rather than support mobility, a pathologising spatial lens problematises outdoor mobility for people with dementia as a health and safety risk and a social burden (MacAndrew et al, 2018). For those receiving a dementia diagnosis, notions like ‘prescribed dis-engagement’ (Swaffer, 2015) can foreclose possibilities for continuing involvement in the everyday spaces of community life. This prevalent narrative within the medicalised model sees dementia as a disease without a cure, with many medical practitioners accompanying diagnoses with instructions to abandon activities that are crucial to well-being and personhood and focus instead on end-of-life affairs and a potential trajectory of suffering.
People living with dementia have the right to freedom of movement and liberty and to be supported to maintain an ‘activity space’ (Hägerstrand, 1970) of regular social activities and movement within their neighbourhoods (Cahill 2018; Steele et al, 2019). These rights are being demanded through dementia activism and a closer alignment with the disability rights movement (Thomas and Milligan, 2018; Shakespeare et al, 2019). A new commitment to inclusion is also evident in some expressions of the international Dementia Friendly Communities (DFC) movement (Alzheimer's Disease International, 2017).
The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies
- Jane Walker, Katy Burke, Marta Wanat, Rebecca Fisher, Josephine Fielding, Amy Mulick, Stephen Puntis, Joseph Sharpe, Michelle Degli Esposti, Eli Harriss, Chris Frost, Michael Sharpe
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- Journal:
- Psychological Medicine / Volume 48 / Issue 14 / October 2018
- Published online by Cambridge University Press:
- 26 March 2018, pp. 2285-2298
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Background
Comorbid depression in the medically ill is clinically important. Admission to a general hospital offers an opportunity to identify and initiate treatment for depression. However, we first need to know how common depression is in general hospital inpatients. We aimed to address this question by systematically reviewing the relevant literature.
MethodsWe reviewed published prevalence studies in any language which had used diagnostic interviews of general hospital inpatients and met basic methodological quality criteria. We focussed on interview-based studies in order to estimate the proportion of patients with a diagnosis of depressive illness.
ResultsOf 158 relevant articles, 65 (41%) describing 60 separate studies met our inclusion criteria. The 31 studies that focussed on general medical and surgical inpatients reported prevalence estimates ranging from 5% to 34%. There was substantial, highly statistically significant, heterogeneity between studies which was not materially explained by the covariates we were able to consider. The average of the reported prevalences was 12% (95% CI 10–15), with a 95% prediction interval of 4–32%. The remaining 29 studies, of a variety of specific clinical populations, are described.
ConclusionsThe available evidence suggests a likely prevalence high enough to make it worthwhile screening hospital inpatients for depression and initiating treatment where appropriate. Further, higher quality, research is needed to clarify the prevalence of depression in specific settings and to further explore the reasons for the observed heterogeneity in estimates.
Visuospatial Processing Deficits Linked to Posterior Brain Regions in Premanifest and Early Stage Huntington’s Disease
- Izelle Labuschagne, Amy Mulick Cassidy, Rachael I. Scahill, Eileanoir B. Johnson, Elin Rees, Alison O’Regan, Sarah Queller, Chris Frost, Blair R. Leavitt, Alexandra Dürr, Raymond Roos, Gail Owen, Beth Borowsky, Sarah J. Tabrizi, Julie C. Stout, the TRACK-HD Investigators
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- Journal:
- Journal of the International Neuropsychological Society / Volume 22 / Issue 6 / July 2016
- Published online by Cambridge University Press:
- 23 May 2016, pp. 595-608
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Objectives: Visuospatial processing deficits have been reported in Huntington’s disease (HD). To date, no study has examined associations between visuospatial cognition and posterior brain findings in HD. Methods: We compared 119 premanifest (55> and 64<10.8 years to expected disease onset) and 104 early symptomatic (59 stage-1 and 45 stage-2) gene carriers, with 110 controls on visual search and mental rotation performance at baseline and 12 months. In the disease groups, we also examined associations between task performance and disease severity, functional capacity and structural brain measures. Results: Cross-sectionally, there were strong differences between all disease groups and controls on visual search, and between diagnosed groups and controls on mental rotation accuracy. Only the premanifest participants close to onset took longer than controls to respond correctly to mental rotation. Visual search negatively correlated with disease burden and motor symptoms in diagnosed individuals, and positively correlated with functional capacity. Mental rotation (“same”) was negatively correlated with motor symptoms in stage-2 individuals, and positively correlated with functional capacity. Visual search and mental rotation were associated with parieto-occipital (pre-/cuneus, calcarine, lingual) and temporal (posterior fusiform) volume and cortical thickness. Longitudinally, visual search deteriorated over 12 months in stage-2 individuals, with no evidence of declines in mental rotation. Conclusions: Our findings provide evidence linking early visuospatial deficits to functioning and posterior cortical dysfunction in HD. The findings are important since large research efforts have focused on fronto-striatal mediated cognitive changes, with little attention given to aspects of cognition outside of these areas. (JINS, 2016, 22, 595–608)
Contributors
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- By Douglas L. Arnold, Laura J. Balcer, Amit Bar-Or, Sergio E. Baranzini, Frederik Barkhof, Robert A. Bermel, Francois A. Bethoux, Dennis N. Bourdette, Richard K. Burt, Peter A. Calabresi, Zografos Caramanos, Tanuja Chitnis, Stacey S. Cofield, Jeffrey A. Cohen, Nadine Cohen, Alasdair J. Coles, Devon Conway, Stuart D. Cook, Gary R. Cutter, Peter J. Darlington, Ann Dodds-Frerichs, Ranjan Dutta, Gilles Edan, Michelle Fabian, Franz Fazekas, Massimo Filippi, Elizabeth Fisher, Paulo Fontoura, Corey C. Ford, Robert J. Fox, Natasha Frost, Alex Z. Fu, Siegrid Fuchs, Kazuo Fujihara, Kristin M. Galetta, Jeroen J.G. Geurts, Gavin Giovannoni, Nada Gligorov, Ralf Gold, Andrew D. Goodman, Myla D. Goldman, Jenny Guerre, Stephen L. Hauser, Peter B. Imrey, Douglas R. Jeffery, Stephen E. Jones, Adam I. Kaplin, Michael W. Kattan, B. Mark Keegan, Kyle C. Kern, Zhaleh Khaleeli, Samia J. Khoury, Joep Killestein, Soo Hyun Kim, R. Philip Kinkel, Stephen C. Krieger, Lauren B. Krupp, Emmanuelle Le Page, David Leppert, Scott Litwiller, Fred D. Lublin, Henry F. McFarland, Joseph C. McGowan, Don Mahad, Jahangir Maleki, Ruth Ann Marrie, Paul M. Matthews, Francesca Milanetti, Aaron E. Miller, Deborah M. Miller, Xavier Montalban, Charity J. Morgan, Ichiro Nakashima, Sridar Narayanan, Avindra Nath, Paul W. O’Connor, Jorge R. Oksenberg, A. John Petkau, Michael D. Phillips, J. Theodore Phillips, Tammy Phinney, Sean J. Pittock, Sarah M. Planchon, Chris H. Polman, Alexander Rae-Grant, Stephen M. Rao, Stephen C. Reingold, Maria A. Rocca, Richard A. Rudick, Amber R. Salter, Paula Sandler, Jaume Sastre-Garriga, John R. Scagnelli, Dana J. Serafin, Lynne Shinto, Nancy L. Sicotte, Jack H. Simon, Per Soelberg Sørensen, Ryan E. Stagg, James M. Stankiewicz, Lael A. Stone, Amy Sullivan, Matthew Sutliff, Jessica Szpak, Alan J. Thompson, Bruce D. Trapp, Helen Tremlett, Maria Trojano, Orla Tuohy, Rhonda R. Voskuhl, Marc K. Walton, Mike P. Wattjes, Emmanuelle Waubant, Martin S. Weber, Howard L Weiner, Brian G. Weinshenker, Bianca Weinstock-Guttman, Jeffrey L. Winters, Jerry S. Wolinsky, Vijayshree Yadav, E. Ann Yeh, Scott S. Zamvil
- Edited by Jeffrey A. Cohen, Richard A. Rudick
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- Book:
- Multiple Sclerosis Therapeutics
- Published online:
- 05 December 2011
- Print publication:
- 20 October 2011, pp viii-xii
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Do childhood growth indicators in developing countries cluster? Implications for intervention strategies
- Bridget Fenn, Saul S Morris, Chris Frost
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- Journal:
- Public Health Nutrition / Volume 7 / Issue 7 / October 2004
- Published online by Cambridge University Press:
- 02 January 2007, pp. 829-834
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- Article
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Objective:
The effectiveness of geographic targeting in nutrition programmes depends largely on the degree to which malnutrition clusters within particular areas. This study investigates the extent to which the childhood nutrition indicators, stunting (height-for-age Z-score <−2) and wasting (weight-for-height Z-score <−2), are spatially clustered; this information is used to determine the implications of spatial clustering for the effectiveness of geographic targeting.
Design:Analysis of data from Demographic and Health Survey (DHS) results. Clustering is assessed by calculating intra-cluster correlation coefficients (ICCs). Estimating the proportion of malnourished children covered by a programme successfully targeting 10% of clusters with the highest malnutrition prevalences allows an assessment of the effectiveness of geographic targeting.
Setting:Fifty-eight DHS III (1992–1997) and DHS IV (1998–2001) reports from 46 developing countries.
Subjects:Pre-school children of mothers interviewed by DHS.
Main results: The extent of clustering of nutritional status was surprisingly low (median ICC for national samples: stunting=0.054, wasting=0.032) and most countries were characterised by having an ICC <0.1 – i.e. low clustering – for childhood undernutrition (91% of countries for wasting and 78% for stunting). Our assessment of the effectiveness of geographic targeting showed that coverage was better for wasting than for stunting; for wasting, 23% of countries would achieve less than 20% coverage, compared with 76% of countries achieving less than 20% coverage for stunting. Coverage is dependent on the overall prevalence of malnutrition and the ICC.
Conclusions:Childhood nutritional status is determined at the household, or even individual, level; nutrition programmes that are geographically targeted may result in high levels of under-coverage and leakage, thereby compromising their cost-effectiveness; the lack of clustering questions the appropriateness of current nutrition interventions.