The effect of match location and travel modality on physical performance in A-League association football matches.

This study investigated the impact of match location and travel modality on physical performance of an Australian A-League association football team. Match location comprised of a home vs away comparison; while travel modality compared home matches, road travel, short-flight travel, and long-flight travel. Both models accounted for match result, opposition quality and total distance covered. Physical performance was defined as average running intensity (m.min-1), low-speed activity (LSA), high-speed activity (HSA), very high-speed activity (VHSA), high-intensity efforts (HIE) and sprint efforts. Statistical significance was accepted at p < 0.05. Match location results demonstrated significantly greater average running intensity and LSA for away matches and significantly greater HSA for home matches. Travel modality results demonstrated significantly greater LSA for road travel compared to home matches and long-flight travel, while HSA was significantly greater for home matches and long-flight travel than for road travel. Additionally, home matches demonstrated significantly greater VHSA than road travel. Assessing the impact of travel modality on physical performance provides more contextual information than solely home vs away. Coaches may use this information to plan travel to mitigate detrimental effects on physical performance, particularly concerning road travel on matchdays.

Epidemiology of time-loss injuries within an Australian male professional football club: A 5-year prospective observational study of 21,343 player hours.

This study aimed to establish injury incidence rates (IIRs) and burden within an Australian male professional football club (n = 73) and to investigate longitudinal trends across five consecutive seasons (2016/17-2020/21). There was an overall IIR of 9.18 injuries per 1000 hours (h) (95% CI [7.89, 10.47]). The IIR was approximately seven times greater (rate ratio (RR): 6.85; 95% CI [5.13, 9.19]; p < 0.01) in matches (31.29 injuries per 1000 h; 95% CI [25.25, 37.33]) compared to training (4.49 injuries per 1000 h; 95% CI [3.51, 5.47]). The overall injury burden was 254.1 days lost per 1000 h (95% CI [220.9, 292.3]). Compared with the reference 2016/17 season, there were significant increases in minimal (RR: 6.94; 95% CI [1.27, 128.73]) and mild injuries (RR: 3.76; 95% CI [1.21, 16.39]) in season 2017/18 and decreases in moderate (RR: 0.40; 95% CI [0.19, 0.80]) and contact injuries (RR: 0.35; 95% CI [0.12, 0.90]) in season 2019/2020. Time-loss injury is common and represents a major burden in Australian male professional football, with injuries more frequently sustained during matches. Injury prevention practices should specifically be directed towards muscle/tendon and ligament injuries of the lower limb, particularly anterior cruciate ligament, ankle sprain and hamstring strain injuries.

Subscapularis tendinopathy is highly prevalent in elite swimmer's shoulders: an MRI study.

OBJECTIVES: The aim of this study is to determine the prevalence of abnormal anatomical change present on MRI in elite swimmers' shoulders compared to age-matched controls. DESIGN: Descriptive epidemiological study. METHODS: Sixty (aged 16-36 years) elite Australian swimmers and 22 healthy active, age and gender matched controls (aged 16-34 years). All participants completed a demographic, and training load and shoulder pain questionnaire and underwent shoulder MRI. Tests for differences in the population proportion was used for comparison between swimmers dominant and non-dominant shoulders and those of the controls. RESULTS: Subscapularis and supraspinatus tendinopathy was the most common tendon abnormality identified in swimming participants, being reported in at least one shoulder in 48/60 (73 %) and 46/60 (70 %) swimmers, respectively. There was no significant difference between dominant and non-dominant shoulders for either tendinopathy, however, grade 3 tendinopathy was significantly more prevalent in subscapularis than in supraspinatus (P < 0.01). Compared with controls, significantly more abnormalities were reported in swimmers' shoulders in both subscapularis and supraspinatus tendons along with the labrum and acromioclavicular joint. Pathology was not a predictor of current pain. CONCLUSIONS: This data confirms that tendon abnormality is the most common finding in elite swimmers' shoulders. Furthermore, that subscapularis tendinopathy is not only as common as supraspinatus but has a greater prevalence of grade 3 tendinopathy. With significant varied abnormalities including tendinopathy being so common in both symptomatic and asymptomatic shoulders of swimming athletes', clinicians should consider imaging findings alongside patient history, symptom presentation and clinical examination in determining their relevance in the presenting condition.

Comparing proxy rated quality of life of people living with dementia in care homes.

BACKGROUND: Improving quality of life (QOL) for people with dementia is a priority. In care homes, we often rely on proxy ratings from staff and family but we do not know if, or how, they differ in care homes. METHODS: We compared 1056 pairs of staff and family DEMQOL-Proxy ratings from 86 care homes across England. We explored factors associated with ratings quantitatively using multilevel modelling and, qualitatively, through thematic analysis of 12 staff and 12 relative interviews. RESULTS: Staff and family ratings were weakly correlated (ρs = 0.35). Median staff scores were higher than family's (104 v. 101; p < 0.001). Family were more likely than staff to rate resident QOL as 'Poor' (χ2 = 55.91, p < 0.001). Staff and family rated QOL higher when residents had fewer neuropsychiatric symptoms and severe dementia. Staff rated QOL higher in homes with lower staff:resident ratios and when staff were native English speakers. Family rated QOL higher when the resident had spent longer living in the care home and was a native English. Spouses rated residents' QOL higher than other relatives. Qualitative results suggest differences arise because staff felt good care provided high QOL but families compared the present to the past. Family judgements centre on loss and are complicated by decisions about care home placement and their understandings of dementia. CONCLUSION: Proxy reports differ systematically between staff and family. Reports are influenced by the rater:staff and family may conceptualise QOL differently.

The Lancet Commission on Dementia Prevention, Intervention, and Care: a call for action.

The purpose of this Editorial is to summarise the key recommendations of the Lancet Commission on Dementia Prevention, Intervention, and Care, reporting on the best available evidence to date on what we can do to prevent and intervene for dementia. We briefly describe the new life-course model of dementia prevention incorporating nine modifiable risk factors and their potential effect in reducing individuals' risk of dementia. We also summarise the recommendations of the report about which pharmacological, psychological, and social interventions are effective, and improve outcomes for people with dementia and their families. Recent developments highlight that there is good potential for the prevention of dementia. Progress in evidence-based approaches indicate the potential for dementia care to be of high-quality and widely accessible. Acting upon this knowledge now will reduce the global burden of dementia and improve the lives of people living with dementia and their families.

Relationship between speaking English as a second language and agitation in people with dementia living in care homes: Results from the MARQUE (Managing Agitation and Raising Quality of life) English national care home survey.

OBJECTIVE: As not speaking English as a first language may lead to increased difficulties in communication with staff and other residents, we (1) tested our primary hypotheses that care home residents with dementia speaking English as a second language experience more agitation and overall neuropsychiatric symptoms, and (2) explored qualitatively how staff consider that residents' language, ethnicity, and culture might impact on how they manage agitation. METHODS: We interviewed staff, residents with dementia, and their family carers from 86 care homes (2014-2015) about resident's neuropsychiatric symptoms, agitation, life quality, and dementia severity. We qualitatively interviewed 25 staff. RESULTS: Seventy-one out of 1420 (5%) of care home residents with dementia interviewed spoke English as a second language. After controlling for dementia severity, age, and sex, and accounting for care home and staff proxy clustering, speaking English as a second language compared with as a first language was associated with significantly higher Cohen-Mansfield Agitation Inventory (adjusted difference in means 8.3, 95% confidence interval 4.1 to 12.5) and Neuropsychiatric inventory scores (4.1, 0.65 to 7.5). Staff narratives described how linguistic and culturally isolating being in a care home where no residents or staff share your culture or language could be for people with dementia, and how this sometimes caused or worsened agitation. CONCLUSIONS: Considering a person with dementia's need to be understood when selecting a care home and developing technology resources to enable dementia-friendly translation services could be important strategies for reducing distress of people with dementia from minority ethnic groups who live in care homes.

The Internet's role in a biodosimetric response to a radiation mass casualty event.

Response to a large-scale radiological incident could require timely medical interventions to minimize radiation casualties. Proper medical care requires knowing the victim's radiation dose. When physical dosimetry is absent, radiation-specific chromosome aberration analysis can serve to estimate the absorbed dose in order to assist physicians in the medical management of radiation injuries. A mock exercise scenario was presented to six participating biodosimetry laboratories as one individual acutely exposed to Co under conditions suggesting whole-body exposure. The individual was not wearing a dosimeter and within 2-3 h of the incident began vomiting. The individual also had other medical symptoms indicating likelihood of a significant dose. Physicians managing the patient requested a dose estimate in order to develop a treatment plan. Participating laboratories in North and South America, Europe, and Asia were asked to evaluate more than 800 electronic images of metaphase cells from the patient to determine the dicentric yield and calculate a dose estimate with 95% confidence limits. All participants were blind to the physical dose until after submitting their estimates based on the dicentric chromosome assay (DCA). The exercise was successful since the mean biological dose estimate was 1.89 Gy whereas the actual physical dose was 2 Gy. This is well within the requirements for guidance of medical management. The exercise demonstrated that the most labor-intensive step in the entire process (visual evaluation of images) can be accelerated by taking advantage of world-wide expertise available on the Internet.

Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine.

OBJECTIVE: Depression is common in dementia, causing considerable distress and other negative impacts. Treating it is a clinical priority, but the evidence base is sparse and equivocal. This trial aimed to determine clinical effectiveness of sertraline and mirtazapine in reducing depression 13 weeks post randomisation compared with placebo. DESIGN: Multicentre, parallel-group, double-blind placebo-controlled randomised controlled trial of the clinical effectiveness of sertraline and mirtazapine with 13- and 39-week follow-up. SETTING: Nine English old-age psychiatry services. PARTICIPANTS: A pragmatic trial. Eligibility: probable or possible Alzheimer's disease (AD), depression (4+ weeks) and Cornell Scale for Depression in Dementia (CSDD) score of 8+. EXCLUSIONS: clinically too critical (e.g. suicide risk); contraindication to medication; taking antidepressants; in another trial; and having no carer. INTERVENTIONS: (1) Sertraline; (2) mirtazapine; and (3) placebo, all with normal care. Target doses: 150 mg of sertraline or 45 mg of mirtazapine daily. OUTCOME: CSDD score. Randomisation: Allocated 1 : 1 : 1 through Trials Unit, independently of trial team. Stratified block randomisation by centre, with randomly varying block sizes; computer-generated randomisation. Blinding: Double blind: medication and placebo identical for each antidepressant. Referring clinicians, research workers, participants and pharmacies were blind. Statisticians blind until analyses completed. RESULTS: Numbers randomised: 326 participants randomised (111 placebo, 107 sertraline and 108 mirtazapine). OUTCOME: Differences in CSDD at 13 weeks from an adjusted linear-mixed model: mean difference (95% CI) placebo-sertraline 1.17 (-0.23 to 2.78; p = 0.102); placebo-mirtazapine 0.01 (-1.37 to 1.38; p = 0.991); and mirtazapine-sertraline 1.16 (-0.27 to 2.60; p = 0.112). HARMS: Placebo group had fewer adverse reactions (29/111, 26%) than sertraline (46/107, 43%) or mirtazapine (44/108, 41%; p = 0.017); 39-week mortality equal, five deaths in each group. CONCLUSIONS: This is a trial with negative findings but important clinical implications. The data suggest that the antidepressants tested, given with normal care, are not clinically effective (compared with placebo) for clinically significant depression in AD. This implies a need to change current practice of antidepressants being the first-line treatment of depression in AD. From the data generated we formulated the following recommendations for future work. (1) The secondary analyses presented here suggest that there would be value in carrying out a placebo-controlled trial of the clinical effectiveness and cost-effectiveness of mirtazapine in the management of Behavioural and Psychological Symptoms of Dementia. (2) A conclusion from this study is that it remains both ethical and essential for trials of new medication for depression in dementia to have a placebo arm. (3) Further research is required to evaluate the impact that treatments for depression in people with dementia can have on their carers not only in terms of any impacts on their quality of life, but also the time they spend care-giving. (4) There is a need for research into alternative biological and psychological therapies for depression in dementia. These could include evaluations of new classes of antidepressants (such as venlafaxine) or antidementia medication (e.g. cholinesterase inhibitors). (5) Research is needed to investigate the natural history of depression in dementia in the community when patients are not referred to secondary care services. (6) Further work is needed to investigate the cost modelling results in this rich data set, investigating carer burden and possible moderators to the treatment effects. (7) There is scope for reanalysis of the primary outcome in terms of carer and participant CSDD results.

The potential of case management for people with dementia: a commentary.

BACKGROUND: A recent review of studies of case management in dementia argues that lack of evidence of cost-effectiveness should discourage the use of this approach to care. We argue that that this is too conservative a stance, given the urgent need throughout the world to improve the quality of care for people with dementia and their caregivers. We propose a research agenda on case management for people with dementia. METHOD: A critical comparison was made of the studies identified in two systematic reviews of trials of case management for dementia, with selective inclusion of non-trial studies and economic evaluations. RESULTS: Our interpretation of the literature leads us to four provisional conclusions. First, studies with long follow-up periods tend to show delayed relocation of people with dementia to care homes. Second, the quality of life of people with dementia and their caregivers may also influence the likelihood of relocation. Third, different understandings of what constitutes case management make interpretation of studies difficult. Fourth, we agree that the population most likely to benefit from case management needs to be characterised. Earlier intervention may be more beneficial than intervening when the condition has progressed and the individual's situation is highly complex. However, this runs counter to some definitions of case management as an administrative, professional, and systemic focus on people with high needs and where expensive support is accessed or in prospect. CONCLUSIONS: More work needs to be carried out in a more focused way in order to establish the value of case management for people with dementia. Since care home residence is such a sizeable contributor to the costs of dementia care, studies need to be long enough to capture possible postponed relocation. However, case management studies with shorter follow-up periods can still contribute to our understanding, since they can demonstrate improved quality of life. Future research should be built around a common, agreed definition of types of case management.

Genome-wide association study of Alzheimer's disease with psychotic symptoms.

Psychotic symptoms occur in ~40% of subjects with Alzheimer's disease (AD) and are associated with more rapid cognitive decline and increased functional deficits. They show heritability up to 61% and have been proposed as a marker for a disease subtype suitable for gene mapping efforts. We undertook a combined analysis of three genome-wide association studies (GWASs) to identify loci that (1) increase susceptibility to an AD and subsequent psychotic symptoms; or (2) modify risk of psychotic symptoms in the presence of neurodegeneration caused by AD. In all, 1299 AD cases with psychosis (AD+P), 735 AD cases without psychosis (AD-P) and 5659 controls were drawn from Genetic and Environmental Risk in AD Consortium 1 (GERAD1), the National Institute on Aging Late-Onset Alzheimer's Disease (NIA-LOAD) family study and the University of Pittsburgh Alzheimer Disease Research Center (ADRC) GWASs. Unobserved genotypes were imputed to provide data on >1.8 million single-nucleotide polymorphisms (SNPs). Analyses in each data set were completed comparing (1) AD+P to AD-P cases, and (2) AD+P cases with controls (GERAD1, ADRC only). Aside from the apolipoprotein E (APOE) locus, the strongest evidence for association was observed in an intergenic region on chromosome 4 (rs753129; 'AD+PvAD-P' P=2.85 × 10(-7); 'AD+PvControls' P=1.11 × 10(-4)). SNPs upstream of SLC2A9 (rs6834555, P=3.0 × 10(-7)) and within VSNL1 (rs4038131, P=5.9 × 10(-7)) showed strongest evidence for association with AD+P when compared with controls. These findings warrant further investigation in larger, appropriately powered samples in which the presence of psychotic symptoms in AD has been well characterized.

Happiness across age groups: results from the 2007 National Psychiatric Morbidity Survey.

OBJECTIVE: To test our hypotheses that happiness declines with age, and that age moderates the relationship of other influences on happiness, so that they vary in different age groups. METHODS: We analysed data from adults interviewed for the 2007 English National Psychiatric Morbidity Survey, representative of people living in private homes. 7399 (57%) of people approached completed information about our main outcome measure, a single item measure of happiness. We compared happiness between younger adults (aged 16-59) and those aged 60-69, 70-79 and 80+. RESULTS: 2746 (39.6%) of people said that they were currently 'very happy', 3956 (52.4%) were 'fairly happy' and 697 (8.0%) were 'not too happy'. Levels of happiness did not vary with age. Social capital and participation predicted happiness across the age span. However, the impact of several variables was moderated by age. Compared with younger people, living with a partner more strongly predicted happiness in people in their 70s. Attendance at religious services or places and having qualifications were more important predictors of happiness in the oldest old, whereas having a social network of at least three people was relatively less important in this age group. CONCLUSION: Four out of 10 people reported being very happy, and five out of 10 were fairly happy. This is higher than levels reported in earlier surveys. Our findings suggest that interventions that increase social capital and participation may augment general happiness, health and recovery from illness and this would be an interesting area for future study.

Contrasting perceptions of health professionals and older people in Australia: what constitutes elder abuse?

OBJECTIVES: To explore the perceptions of family carers, older people and health professionals in Australia about what constitutes elder abuse. METHODS: The Caregiving Scenario Questionnaire (CSQ) was disseminated to health professionals from two metropolitan hospitals, older volunteers and carers of older people with dementia recruited for other studies. RESULTS: One hundred and twenty health professionals, 361 older people and 89 carers returned the surveys. χ(2) analyses indicated that significantly more health professionals than older people identified locking someone in the house alone all day (χ(2) (2) = 10.20, p = 0.006, Cramer's V = 0.14), restraining someone in a chair (χ(2) (2) = 19.984, p = 0.0005, Cramer's V = 0.19) and hiding medication in food (χ(2) (2) = 8.72, p = 0.013, Cramer's V = 0.13) as abusive. There were no significant differences between healthy volunteer older people and carers in their perceptions of elder abuse. A significant minority (40.8%) of health professionals and over 50% of carers did not identify locking the care recipient alone in the house all day as abusive. CONCLUSION: In Australia, there is limited consensus between older people, carers and health professionals regarding what constitutes elder abuse. Health professionals were more likely to identify abusive and potentially abusive strategies correctly than carers or healthy older people, but nonetheless between one quarter and two-fifths [correction made here after initial online publication] of health professionals did not identify the abusive strategies.

Cost effectiveness of memantine in Alzheimer's disease in the UK.

OBJECTIVE: This analysis assesses the cost-effectiveness of memantine for the treatment of moderate-to-severe Alzheimer's disease (AD) in the UK. METHODS: This cost-utility analysis was based on a Markov model. The model simulated 5-year progress of patients with AD until they need full-time care (FTC), defined as a patient becoming either dependent or institutionalised. Transition probabilities were based on a predictive equation, derived from the London and South-East Region epidemiological study. Resource use, utilities and mortality were obtained from the same study. Memantine efficacy was based on a meta-analysis of six large trials. The model compared memantine to its alternative in the UK, i.e. no pharmacological treatment or background therapy with acetylcholinesterase inhibitors. RESULTS: Memantine was found to delay the need to FTC by 6 weeks compared with current practice in the UK. It was associated with increased quality-adjusted life-years and cost savings to the healthcare system (probability of this outcome was 96%). The projections were made assuming that benefits from the 6-month treatment were sustained over time, which is regarded as the main limitation. The model underwent extensive sensitivity analyses, which confirmed the base-case findings. CONCLUSIONS: The model suggests that memantine delays the need for FTC and decreases cost. It can be regarded as a cost-effective choice in the management of moderate and severe AD.

Predicting time to full-time care in AD: a new model.

OBJECTIVE: To develop a model to predict the length of time before patients with Alzheimer's disease (AD) of varying severity require full-time care (FTC). METHODS: A predictive model (equation) of time to FTC (defined as being institutionalised or dependent) was developed based on the London and South-East Region (LASER-AD) epidemiological study using a discrete time representation of the Cox continuous time proportional hazards model and complementary log-log specification. RESULTS: Of the 117 pre-FTC patients, 68 (58.1%) patients progressed to FTC during the 54-month follow-up period. Analysis of potential predictors showed that baseline cognitive state, impairment of activities of daily living (ADL) and neuropsychiatric symptoms were strong predictors of time to FTC. In addition, the rate of cognitive and ADL decline predicted time to FTC. The final model predicted 88.2% of observations. CONCLUSION: The model simulates and predicts progression of pre-FTC AD patients until the need for FTC based on assessments for cognitive, functional and behavioural domains. The main application of the model is to assess the cost effectiveness of AD therapies as potential adjuncts to a background AD treatment including disease-modifying treatments. The applicability of the predictive model to a specific setting should be carefully assessed, i.e. the patient population being examined should have similar characteristics as patients in the LASER-AD cohort.

Abusive behaviour experienced by family carers from people with dementia: the CARD (caring for relatives with dementia) study.

BACKGROUND: The authors report the first study of abusive behaviour by people with dementia towards their family carers. The authors hypothesised that while abusive behaviour would be associated with the carer reporting a less rewarding relationship, this could be mediated by the carer's coping style. METHODS: The authors interviewed 220 consecutively referred family dementia carers from five UK Community Mental Health Teams, using the revised Modified Conflict Tactics Scale to measure abuse, and the Relationship Rewards Scale. RESULTS: 82 (37.3%) carers reported abuse from the care recipient 'at least sometimes' over the last 3 months. 80 (36.4%) reported psychologically, and 13 (5.9%) physically abusive behaviour. On average, current carer relationship rewards had decreased from premorbid levels (mean difference -1.5 (95% CI 1.8 to 1.2); p<0.001). The association between higher abuse score and lower current relationship rewards was mediated by dysfunctional coping use. In our final model, current relationship rewards were predicted by reporting a better past relationship (beta=0.66 (95% CI 0.55 to 0.77)), less abuse from the care recipient (beta=-0.39 (-0.65 to -0.13)) and fewer dysfunctional coping strategies (beta=-0.98 (-1.50 to-0.46)). CONCLUSION: Over a third of family carers reported significant abuse from the people they cared for. Carers who reported more abuse also reported a greater deterioration in their relationship with the person with dementia. The extent to which carers used dysfunctional coping strategies partially explained this, suggesting that interventions to change the carers' coping styles might alleviate the impact of abusive behaviour.

The determinants of family carers' abusive behaviour to people with dementia: results of the CARD study.

BACKGROUND: Although dementia and elder abuse prevention are political priorities, there are no evidence-based interventions to reduce abuse by family carers. We have limited understanding of why some family carers, but not others in similar circumstances, behave abusively. We aimed to test our hypothesis, that more anxious dementia carers report more abusive behaviours, and dysfunctional coping strategies and carer burden mediate this relationship. METHOD: We interviewed 220 family/friend dementia carers from Essex and London Community Mental Health Teams. We used the revised Modified Conflict Tactics Scale to measure abuse. RESULTS: More anxious and depressed carers reported more abuse; this relationship was mediated by using dysfunctional coping strategies and higher burden. Abuse was predicted by: spending more hours caring, experiencing more abusive behaviour from care recipients and higher burden. LIMITATIONS: This was a cross-sectional study so we cannot confirm directions of causality. While many carers were willing to report abusive actions, some may not have been and our numbers may be an underestimate. CONCLUSION: Anxious and depressed carers are particularly likely to report abusive behaviour when asked. Testing interventions directed at reducing carer anxiety, depression or changing unhelpful coping strategies, and/or reducing care recipient aggression where possible, is a logical and urgent next step.

Interlaboratory variation in scoring dicentric chromosomes in a case of partial-body x-ray exposure: implications for biodosimetry networking and cytogenetic "triage mode" scoring.

The international radiation biodosimetry community has recently been engaged in activities focused on establishing cooperative networks for biodosimetric triage for radiation emergency scenarios involving mass casualties. To this end, there have been several recent publications in the literature regarding the potential for shared scoring in such an accident or incident. We present details from a medical irradiation case where two independently validated laboratories found very different yields of dicentric chromosome aberrations. The potential reasons for this disparity are discussed, and the actual reason is identified as being the partial-body nature of the radiation exposure combined with differing criteria for metaphase selection. In the context of the recent networking activity, this report is intended to highlight the fact that shared scoring may produce inconsistencies and that further validation of the scoring protocols and experimental techniques may be required before the networks are prepared to deal satisfactorily with a radiological or nuclear emergency. Also, the findings presented here clearly demonstrate the limitations of the dicentric assay for estimating radiation doses after partial-body exposures and bring into question the usefulness of rapid "triage mode" scoring in such exposure scenarios.

Alcohol in moderation, premorbid intelligence and cognition in older adults: results from the Psychiatric Morbidity Survey.

AIMS: To test the hypothesis that the association previously reported between moderate alcohol use and better cognition is an artefact of confounding by (a) higher premorbid education and socioeconomic status; (b) a lifestyle of moderation (using smoking as a risk marker); and (c) decreased alcohol consumption in people with physical illnesses. METHOD: Data were analysed from people aged 60-74 years interviewed for the 2000 British National Psychiatric Morbidity Survey, representative of people living in private homes. Alcohol use information was available for 1985 (98.9%) of the eligible participants, of whom 1735 (87.4%) who drank moderately or abstained were included in the analyses. Our main outcome measures were the Alcohol Use Disorders Identification Test (AUDIT), the Telephone Interview for Cognitive Status Screen for Cognitive Impairment and the National Adult Reading Test to measure crystallised (premorbid) intelligence. Our physical health measures were the number of prescribed medications and physical illness reported, and the 12 item Short Form Health Survey's Physical Component Score. RESULTS: The relationship between current cognition and alcohol use was reduced and no longer significant after considering premorbid intelligence or physical health. In our final model, the significant predictors of current cognition among non-problem drinkers were: age (B = -0.13, -0.18 to -0.08; p<0.001) and crystallised intelligence (B = 0.14, 0.12 to 0.17; p<0.001). Smoking was not associated with cognition. CONCLUSIONS: In people who were not problem drinkers, higher alcohol intake was not associated with improved current cognition after controlling for premorbid intelligence and physical health. Our findings suggest that, despite previous suggestions, moderate alcohol consumption does not protect older people from cognitive decline.

The relationship of dementia prevalence in older adults with intellectual disability (ID) to age and severity of ID.

BACKGROUND: Previous research has shown that adults with intellectual disability (ID) may be more at risk of developing dementia in old age than expected. However, the effect of age and ID severity on dementia prevalence rates has never been reported. We investigated the predictions that older adults with ID should have high prevalence rates of dementia that differ between ID severity groups and that the age-associated risk should be shifted to a younger age relative to the general population. METHOD: A two-staged epidemiological survey of 281 adults with ID without Down syndrome (DS) aged 60 years; participants who screened positive with a memory task, informant-reported change in function or with the Dementia Questionnaire for Persons with Mental Retardation (DMR) underwent a detailed assessment. Diagnoses were made by psychiatrists according to international criteria. Prevalence rates were compared with UK prevalence and European consensus rates using standardized morbidity ratios (SMRs). RESULTS: Dementia was more common in this population (prevalence of 18.3%, SMR 2.77 in those aged 65 years). Prevalence rates did not differ between mild, moderate and severe ID groups. Age was a strong risk factor and was not influenced by sex or ID severity. As predicted, SMRs were higher for younger age groups compared to older age groups, indicating a relative shift in age-associated risk. CONCLUSIONS: Criteria-defined dementia is 2-3 times more common in the ID population, with a shift in risk to younger age groups compared to the general population.

Successful ageing in adversity: the LASER-AD longitudinal study.

BACKGROUND: Most models of successful ageing do not allow for the possibility of living "successfully," despite some degree of cognitive or physical impairment. We reviewed the successful ageing and related quality of life literature to identify their potential predictors. We then tested our hypotheses that wellbeing in adversity would be predicted by mental health (anxiety and depression) and social factors rather than physical health and that it would be stable over time. METHOD: We interviewed 224 people with Alzheimer's disease (AD) and their family carers, recruited to be representative of those living with AD in the community. We re-interviewed 122 (73.1% of eligible) participants 18 months later. Our main outcome measure was the perception of the person with AD on their life as a whole. RESULTS: Mean "wellbeing in adversity" scores did not change significantly over time (t = 0.23). Social relationships, subjective mental health, health perception, activities of daily living and baseline wellbeing in adversity were the significant correlates of wellbeing in adversity on univariate analysis. Only baseline wellbeing in adversity and mental health score were significant predictors in our regression analysis. In a well fitting structural equation model, less severe dementia and better health perception predicted fewer mental health problems and social relationships, but were not direct predictors of wellbeing in adversity at 18 months. CONCLUSION: Successful ageing was common among a cohort of people with dementia. The most important predictors of this were mental health and social relationships, which fully mediated the relationship we found between health perception and wellbeing 18 months later.