METHODS: The visuals were analyzed by employing the Visual Discourses of Disability (ViDD) framework that juxtaposes the "perspectivizing-personizing" cline with the "enabling-disabling" continuum. The data studied comprise a total of 432 images sourced from three domains, namely (1) The Star, a Malaysian mainstream English newspaper (2012-2021); (2) Alzheimer's Disease Foundation Malaysia (ADFM) website (2019-2021); and (3) the Ministry of Health Malaysia (2019-2021) website. Findings from the visual analyses were corroborated by four representatives of ADFM in a group interview.
RESULTS: There is a predominance of stigmatized images, constructing dementia as a loss and deficit, thus depicting individuals in distanced suffering. Generic representations of people through stock images, a unique focus on the hands, representations of brain degeneration through abstractions and missing puzzle pieces are also prevalent. Despite these, the interview data confirmed that the perspectivizing aspect may be necessary to educate the public on what dementia entails. While personizing images that depict personhood and actual persons living with dementia are ideal, the use of stock images may be necessary if there is a need to maintain confidentiality and observe sensitivities. Similarly, images with positive emotions are encouraged but disabling ones are equally important to reflect reality and inculcate empathy.
CONCLUSION: When capturing, selecting and publishing images of dementia, organizations should deliberate on different visual elements which evoke empowerment, advocacy, handicapping and othering implications as outlined in the ViDD framework. Any decision should only be made after considering the purposes of publications and implications such images have on the intended audiences.
METHODS: A comprehensive search was done on 3 databases, namely PubMed, ScienceDirect, and Web of Science, to identify original cost-of-illness studies that only evaluate the economic burden of AD up to August 2022. The risk of bias in the studies was assessed using Consolidated Health Economic Evaluation Reporting Standards 2022 criteria. Cost articles without specifying etiology of AD or those in non-English were excluded.
RESULTS: Twelve of 5536 studies met the inclusion criteria. The total annual cost of AD per capita ranged from US $468.28 in mild AD to US $171 283.80 in severe AD. The cost of care raised nonlinearly with disease severity. Indirect caregiving cost represented the main contributor to societal cost in community-dwelling patients. When special caregiving accommodation was opted in daily care, it results in cost shifting from indirect cost to direct nonmedical cost. Formal caregiving accommodation caused increase in direct cost up to 67.3% of overall economic burden of the disease.
CONCLUSIONS: AD exerts a huge economic burden on patients and caregivers. Overall rise of each cost component could be anticipated with disease deterioration. Choice of special caregiving accommodation could reduce caregiver's productivity loss but increase the direct nonmedical expenditure of the disease from societal perspective.
METHODS: Medline, Embase, Google Scholar, and Cochrane Library were searched from their inception until August 2023 to identify studies using VCAT to diagnose MCI/mild dementia. The primary outcome was to assess the diagnostic accuracy of the VCAT for detecting MCI/mild dementia through area under the receiver operating characteristic curve (AU-ROC) analysis. The secondary outcome was to explore the correlation between VCAT scores and MCI/mild dementia presence by comparing scores among patients with and without MCI/mild dementia. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated.
RESULTS: Five studies with 1,446 older adults (mean age 64-68.3 years) were included. The percentage of participants with MCI/mild dementia versus controls ranged from 16.5% to 87% across studies. All studies were conducted in Asian populations, mostly Chinese, in Singapore and Malaysia. The pooled sensitivity was 80% [95% confidence interval (CI) 68%-88%] and the specificity was 75% (95% CI 68%-80%). The AU-ROCC was 0.77 (95% CI 0.73-0.81). Patients with MCI/mild dementia had lower VCAT scores than the controls (mean difference -6.85 points, p