Dementia Futures Conference 2015

Society’s response to dementia must be multi-faceted and at the University of Sheffield we have an impressive track record contributing to this response. Building on this and thinking ahead we have currently a range of cutting-edge postgraduate research studies being undertaken across different disciplinary areas within the university. David Reid, organiser of the Dementia Futures Conference describes what makes this event unique.

Economic evaluation of healthcare interventions follows the guideline produced by the National Institute for Health and Care Excellence (NICE). NICE recommends a Cost Utility Analysis (CUA) approach where outcomes are health effects on patients (and carers where relevant) expressed in terms of Quality Adjusted Life Years (QALYs), and costs are restricted to only those falling on the budgets of the NHS and Social Services. An individual-level simulation is developed to estimate all costs and consequences of several healthcare interventions for dementia. Then, two different decision making approaches are applied to determine which option has the best value for money. These approaches account for a broad range of costs and consequences for both the NHS, people with dementia, and informal caregivers. The research will contribute to the development of a new decision making framework at national level to approve health care interventions for people with dementia.

Hearing loss is generally underdiagnosed in the population but it is estimated to affect 1 in 6 people, and 2/3 of these will be over 65. One of the most common causes for hearing loss is presbycusis (age related hearing loss) which is progressive, and tends to affect both ears symmetrically and typically starts to occur over the 4th decade. Ageing in general is accompanied by a decline in memory and attention, but current research has shown that there may be more than just the age of a person linking hearing loss and loss of mental abilities. This research aims to investigate the prevalence of hearing loss and decline in mental abilities in the ageing population to identify possible links between hearing status and changes in memory and attention. We can use this information to ascertain whether hearing loss may be a marker for cognitive decline and whether cognitive impairment may be more severe in people with a hearing loss. We can then raise awareness for the need for hearing tests in people with cognitive decline and dementia.

Older adults with late stage dementia are likely to lack the capacity to make decisions regarding care and treatment on their own, and subsequently these decisions may rely on a proxy decision-maker. In most cases, a carer will assume the role of decision maker, and this will involve navigating which services and treatments are most appropriate for women with a breast cancer diagnosis. The Mental Capacity Act (2005) sets out the guidelines for safeguarding individuals who are unable to make an informed decision, and this act is underpinned by the principle that any decision should be made in their best interests. Little is currently known about how treatment decisions are made for older women with breast cancer, and there are limited treatment recommendations tailored specifically towards older women with dementia and a breast cancer diagnosis. This research will reflect on the needs of caregivers involved in making proxy treatment decisions in breast cancer care.

It is believed that in many amyloid diseases, including Alzheimer’s, the primary toxic species responsible for neurodegeneration are small oligomers of the causative protein, rather than the fibres that often define the disease. I have, therefore, isolated oligomers of our model protein Cystatin B and those of Amyloid β in order to further characterise them.

The availability of touchscreen tablet devices on the market has led to an increased interest in their potential usefulness for people with dementia, particularly for providing meaningful and enjoyable activities. The challenge is to identify off-the-shelf applications (apps) that are suitable for people living with dementia. The InTouch project attempted to find out what features games need to make them engaging to people with dementia and how to identify apps that are suitable for people with dementia.

Amyloid beta deposition in the brain is the hallmark of Alzheimers disease. Co-deposition of other amyloidogenic proteins like transthyretin, human cystatin C have been found in the plaques along with A beta. Revealing the details of the interaction between these proteins with A beta peptide in vitro is able to provide insight into finding new therapies for the disease.

Why do most of us only get dementia when we grow old? One suggestion is that in the young, some proteins interact with the species known to be involved in dementia preventing them from becoming toxic. This talk is interested in the behaviour of the cystatin C (HCC) protein, which normally has a useful but unrelated function, and it’s interaction with the amyloid beta peptide (Aβ) which is thought to cause Alzheimer’s disease.