BackgroundThe Mini-Mental State Examination (MMSE) is widely used in older adults, but its numerical score is sometimes overinterpreted in dementia diagnosis and capacity assessment.This review examined the hypothesis that the MMSE provides screening information but cannot diagnose dementia or determine decision-specific capacity.MethodsThis narrative review synthesized PubMed-indexed evidence concerning diagnostic accuracy, dementia criteria, alternative screens, and cultural, literacy, sensory, and capacity-related influences.ResultsMMSE performance modifies diagnostic probability but does not establish a diagnosis of dementia. Accuracy varies with threshold, setting, education, language, culture, clinical stage, sensory status, and prevalence. Alternative screens sample cognition differently but require contextual interpretation. Patient agreement, voluntary participation, and standardized administration are necessary; sensory barriers or incomplete testing may render a score uninterpretable. Capacity assessment requires evaluation of understanding, appreciation, reasoning, choice, consequences, and context.ConclusionsMMSE findings should be integrated with clinical, functional, sensory, collateral, and decision-specific evidence, not used alone.
ObjectivesMemory Clinics (MCs) have a central role in multidisciplinary diagnostics and care of cognitive disorders and dementia. This study describes current clinical practice and developments of Dutch MCs since their start in 1986.MethodsA survey was sent to all Dutch hospital-based MCs in 1998, 2004, 2009, 2017 and 2023. Topics included: organization, patient characteristics, scales and questionnaires, neuropsychological assessment, additional assessments, novel biomarkers, disclosure of diagnosis and treatment. 74 out of the total of 89 MCs completely or partially filled out the questionnaire.ResultsThe number of MCs increased to 89. The number of patients seen increased substantially (per MC/year: 1998: 130; 2023: 324; total: 1998: 1560; 2023: 28,848). The proportion of patients diagnosed with dementia decreased from 80% in 1998 to 47% in 2023. Most commonly available assessments were neuroimaging (100%), routine laboratory testing of blood (98%) and neuropsychological assessment (NPA; 98%). Thirty-one percent indicated infrastructure needed to be changed before prescribing monoclonal antibody treatments for Alzheimer's disease.ConclusionsMCs showed substantial development in number, number of patients and geographical distribution within the country. Nowadays, MCs are central care facilities for the timely and multidisciplinary diagnosis and treatment of people with cognitive disorders and dementia.
BackgroundMild Cognitive Impairment (MCI) and Mild Behavioral Impairment (MBI) can be prodromal stages of neurodegenerative disease associated with plasma biomarkers of tau pathology and neuroaxonal damage. However, in psychiatric populations, the relationship between MCI, MBI and these plasma biomarkers remains unclear.ObjectiveThis study examined the association of MCI with plasma biomarkers of neurodegeneration (phosphorylated tau217 [p-tau217] and neurofilament light chain [NfL]), metabolic alterations, psychiatric disorder features, and MBI in older adults receiving psychiatric treatment.MethodsFifty-one non-demented patients ≥60 years, referred for mood or anxiety disorders, were enrolled and classified based on cognitive performance as MCI (n = 20) or non-MCI (n = 31). Assessments included psychiatric, cognitive, functional, and plasma biomarker measures.ResultsMCI patients exhibited higher p-tau217 (P = .003) and NfL (P = .042) levels, lower cognitive scores (P < .001), and a trend toward reduced functioning (P = .074). MCI was also associated with later onset of psychiatric symptoms (P = .033) and greater prevalence of MBI (P < .001). Logistic regression identified plasma NfL as a marker of MCI (P < .05) in this sample.ConclusionOur findings suggest that integrating cognitive, psychiatric, and biomarker assessments may improve early detection of dementia risk.
BackgroundAlzheimer's Disease (AD) is characterised by progressive cognitive decline. Cholinesterase inhibitors (ChEI) (donepezil, rivastigmine and galantamine) and memantine have been the mainstay treatment and have showed their effectiveness on total cognitive scores, but their effects on individual cognitive domains remain unclear. This systematic review examined their impact on individual cognitive domains.MethodPubMed, Cochrane, MEDLINE, Web of Science and PsycINFO were searched (1st January 1999 - 31st March 2025) for studies evaluating the effects of ChEI and memantine on cognitive domains using standardised cognitive scales in individuals with AD. The review followed PRISMA guidelines. Risk of bias was assessed using the Cochrane ROB1 tool and a narrative synthesis was used to report the main findings.ResultsSixteen studies were included. Rivastigmine demonstrated dose-dependent benefits across memory, language, and praxis domains, with higher-doses generally producing less cognitive decline and greater improvements than lower-dose patches or capsules. Donepezil yielded benefits in language, praxis, and visuospatial abilities. Galantamine showed significant improvements in memory, praxis, visuospatial function, and language, and was superior to donepezil in language in one comparative study. Memantine demonstrated benefits across memory, language, praxis, attention, and visuospatial domains, both as monotherapy and as an adjunct to donepezil, with adjunct therapy producing sustained improvements in language and praxis. Overall, higher treatment doses were consistently associated with greater preservation of cognitive function across domains.DiscussionChEIs and memantine provide domain-specific cognitive benefits beyond global cognitive improvement. Future studies should examine whether treatment tailored to domain-specific deficits improves patient outcome.PROSPEROCRD42024493998.
IntroductionWe compared responses of people with Alzheimer's disease (PwAD) on the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia and an adapted figurative language version. We hypothesize that figurative language improves acknowledgment of difficulties, varying by awareness object.Methods27 mild to moderate PwAD completed measures of cognition, depression and self-reported impairments. Caregivers informed about functionality, apathy and neuropsychiatric symptoms.ResultsAcknowledgment of difficulties in activities of daily living was higher in the figurative version, while acknowledgment in the emotional domain was higher in the regular version, in both cases with medium effect sizes. No significant differences emerged for total scores, acknowledgement of cognitive deficits, or changes in social relationships, all with small effect sizes.DiscussionLanguage modulation altered acknowledgment by awareness object. Findings support clear, not complex language in assessments. Future studies should define strategies to improve awareness and its predictors across clinical groups.
BackgroundDementia is increasingly recognised as a condition that can be prevented or delayed through modifiable lifestyle risk factors. Despite promising research into dementia risk prediction algorithms based on these risk factors, existing tools are not being integrated into UK clinical practice and policy.MethodsThis UK wide study involved 15 semi-structured interviews with GPs, dementia specialists, and policy professionals. Interviews utilised a SWOT analysis to unpick the barriers and facilitators to implementing dementia risk predictions tools.FindingsFive main themes emerged: perceptions around risk score performance; clinician acceptability; fear of dementia; clinical impact; and system integration. Overall, there was clear support for implementation, with areas of cross over and differentiation between stakeholder groups' perspectives.ConclusionsA coordinated change programme is needed which: prioritises building confidence in tool performance, secures clinician buy-in, creates a more positive narrative, shifts the focus from individual responsibility, and aligns system priorities and readiness.
Purpose of ResearchLucidity is the transient recovery of abilities and communication that were seemingly lost among people living with dementia (PLWD). This study describes lucid episodes reported by Alzheimer's dementia (AD) and Lewy Body Dementias (LBD) caregivers. We analyzed survey data from 212 current AD (n = 191) and LBD caregivers who reported the frequency, duration, and characteristics of 653 lucid episodes witnessed in the past month.Major FindingsMost AD caregivers (67%) and LBD caregivers (81%) witnessed a lucid episode within the past month. LBD caregivers reported lucid episodes with greater changes in awareness and communication, compared to AD caregivers. LBD caregivers reported longer lucid episodes and that the PLWD knew about their change in lucidity, compared to AD caregivers.ConclusionsFindings suggest that differences in lucid episode intensity, timing, and meta-awareness between AD and LBD are possible and may inform care strategies for PLWD.
Introduction Cognitive rehabilitation (CR) enhances the autonomy of patients with Alzheimer’s disease. Their daily activities are likely dependent on attention networks. Method This pilot resting-state fMRI study investigated the cerebral correlates of CR in participants with mild Alzheimer disease (n = 22), compared to a control intervention in patients (n = 21) and in healthy participants (n = 27). Connectivity changes between dorsal and ventral attention networks were expected after 3 months of rehabilitation. Results A mixed ANOVA comparing pre- and post-intervention data across groups revealed increased connectivity between the dorsal and the ventral attention network following CR (FDR-corrected P = .0072). A post hoc correlation analysis of post-intervention data in the CR group showed that greater autonomy in daily activities was associated with stronger functional relationship between the two attention networks (FDR-corrected P = .0001). Conclusion Enhanced connectivity between attention networks may be a characteristic of CR benefits in individuals with mild Alzheimer disease.
ObjectivesTo examine associations between immigration-related factors and mild cognitive impairment (MCI) or dementia among Hispanics; and associations between immigration-related factors and cognitive performance among cognitively unimpaired Hispanics.MethodsData from the Health & Aging Brain Study-Health Disparities study were used. 1231 Hispanic participants were included. Six indicators, including time living in the US, nativity, age of migration, primary language, bilingualism, and acculturation level, were considered immigration-related factors. Both the three-category (dementia, MCI, and cognitively unimpaired) and binary (cognitively impaired and cognitively unimpaired) outcomes were used. The cognitive performance was evaluated by the Mini-Mental State Examination (MMSE). Multiple logistic, multinomial logistic, and linear regression models adjusted for age, sex, and education were applied.ResultsThe likelihood of cognitive impairment did not differ significantly between native-born and foreign-born Hispanics, whereas foreign-born cognitively unimpaired Hispanics had significantly lower global cognition than their native-born counterparts. When stratifying by age of migration, a significant association between time living in the US and cognitive impairment was observed among early-life immigrants. A higher acculturation level was associated with lower odds of both dementia and MCI among native-born Hispanics, but was insignificant in foreign-born Hispanics. Bilingualism was significantly associated with dementia or MCI in foreign-born Hispanics. Monolingual foreign-born cognitively unimpaired Hispanics had significantly lower MMSE scores than bilingual foreign-born Hispanics.ConclusionsForeign-born Hispanics might be more vulnerable to cognitive aging. Bilingualism may play a more important role in cognitive health in foreign-born Hispanics than in native-born Hispanics. Acculturation may have distinct effects on foreign-born and native-born Hispanics.
BackgroundRecognizing early clinical signs of dementia is key to optimizing emerging therapies, including monoclonal antibodies. Mild behavioural impairment (MBI) characterizes later-life emergent and persistent nropsychiatric symptoms linked to greater dementia risk, representing a behavioural manifestation of the underlying neurodegenerative disease for some. The association of MBI with functional ability may therefore reveal subtle functional decline as an additional early risk marker in cognitively unimpaired (CU) older adults.MethodsBaseline data from 1714 CU participants from the CAN-PROTECT study were analyzed. MBI was assessed using the MBI Checklist (MBI-C) (continuous and dichotomized, MBI+ ≥8). Functional ability was assessed using the SAGEA scale capturing instrumental and basic activities. Negative binomial models examined associations between MBI and function, adjusting for demographics, cognition, and physical/sensory limitations.ResultsHigher MBI-C scores (count ratio [CR] = 1.07; 95%CI: 1.06-1.07) and MBI+ status (CR = 2.64; 95%CI: 2.36-2.95) were associated with greater global and domain-specific functional impairments.ConclusionFindings highlight the importance of assessing both behavioural and functional changes in CU adults to identify at-risk individuals for timely interventions.
BackgroundAggressive behavior affects 30-50% of patients with dementia, yet agitation and aggression are frequently conflated despite distinct etiologies and treatment implications.ObjectivesTo examine how many recent studies define and distinguish agitation from aggression in adults with dementia or related disorders.MethodsA systematic review was conducted following a PROSPERO-registered protocol (CRD420251141548) and PRISMA guidelines. PubMed, Scopus, and Web of Science were searched for original studies published between 1st January 2017 and 28th February 2026. Definitions, assessment tools, and correlates were extracted. Study quality was appraised using CASP checklist.ResultsOf 236 identified studies, after deduplication 19 studies were reviewed in full. Only 5 studies distinguished agitation from aggression, all using the Cohen-Mansfield Agitation Inventory.ConclusionsFailure to distinguish agitation from aggression remains common and likely contributes to suboptimal management and overuse of antipsychotic medications in neurocognitive disorders.
In Greek mythology, Tithonus was the husband of Eos, the goddess of dawn. Granted immortality without the gift of eternal youth, Tithonus became an illustration of senescence without physical or cognitive wellbeing, characterised by not only physical but also cognitive decline - this is one of the earliest literary representations of dementia in Western civilisation. As myths mirror the values and concerns of a society, the depictions of Tithonus across the eras are an interesting window into how the Ancient Greek society dealt with the process of ageing and cognitive decline. In this paper, we discuss what the myth of Tithonus reveals about senescence and its challenges in the classical world. Remarkably, we conclude that many of the contemporary views and burdens of old age and dementia date from Antiquity, suggesting that ageing and its burdens are inherent human concerns, not merely products of the modern context.
Geriatric depression presents distinct clinical challenges, often manifesting atypically through cognitive decline, somatic symptoms, and apathy rather than classic mood disturbances. This review synthesizes current understanding of its unique pathophysiology - including vascular contributions and frontostriatal dysfunction - and presents evidence to argue the diagnostic pitfalls in applying youth-centric criteria to elderly populations. We examine epidemiological trends, evidence-based treatment considerations, and emerging research directions, emphasizing the urgent need for age-specific diagnostic frameworks and personalized therapeutic approaches to address this underrecognized yet debilitating condition in aging populations.
BackgroundDriving promotes independence in older adults, yet age-related changes in cognition and sleepiness may reduce driver safety. We examined associations between sleepiness and driving in older adults with subjective cognitive decline (SCD) and mild cognitive impairment (MCI).MethodsA cross-sectional/observational study of older drivers (60-80 years), classified as cognitively healthy (n = 21), SCD (n = 26), or MCI (n = 13), completing the Manchester Driver Behaviour Questionnaire (DBQ), and a 2-week driving diary including the Sleepiness Symptoms Questionnaire (SSQ).ResultsFor DBQ, MCI drivers reported 2.26x more driving lapses (eg, memory/attention failures) than healthy, while SCD reported 2.54x more driving violations than MCI. For diaries, SCD drivers reported 7.51x more inattention events than healthy, and higher SSQ (P = .002). Higher SSQ was associated with increased inattention events for SCD and MCI groups (P ≤ .018).ConclusionSleepiness impacts poorer driving outcomes in SCD and MCI, providing an intervention opportunity to support continued driving.
ObjectiveTo measure awareness of memory impairment (MI) among individuals with MI, the prevalence of MI among those with memory complaints (MC), and to identify associated factors to both in a nationally representative sample of Brazilians aged ≥50.MethodsMI was defined as a z-score ≤ -1.5 derived from immediate and delayed recall tests, adjusted for demographics. MC were identified by self-report. Logistic regression models examined sociodemographic and health-related factors associated with awareness of MI and with MI among individuals reporting MC.ResultsOf 7831 participants, 739 (9.3%) had MI, of whom 52% were aware of their impairment. Greater awareness was associated with a higher number of chronic illnesses, disability in instrumental activities of daily living (i-ADL), and more depressive symptoms. Among 3402 (41.7%) participants with MC, 11.5% had objective MI. In this group, higher education, lower income, fewer chronic illnesses, disability in i-ADL and advanced ADL (a-ADL), and more depressive symptoms were associated with MI.ConclusionHalf of individuals with objective MI demonstrated awareness of their impairment, and one in ten individuals with MC showed objective cognitive decline. These findings emphasize the need for cognitive screening in middle aged and older adults and for clinical evaluation of other causes of memory complaints, particularly mood and functional factors.
BackgroundAdvances in biomarker research allow precise diagnosis of Alzheimer's disease (AD) in patients with Mild Cognitive Impairment (MCI). Communicating this diagnosis may reduce uncertainty and aid care planning but can also increase anxiety, distress, or anticipatory burden among care partners.ObjectiveTo characterise coping strategies used by caregivers of patients recently diagnosed with MCI due to AD and examine their evolution.MethodsThirty caregivers of patients with MCI due to AD were recruited from a memory clinic, assessed at baseline, and followed over 18 months. Caregiver personality, burden, depressive and anxiety symptoms, perceived relationship closeness, and distress related to patient neuropsychiatric symptoms were also assessed at baseline. Coping was assessed longitudinally using the Brief COPE, grouping its 14 subscales into problem-focused, emotion-focused, and dysfunctional coping.ResultsCaregivers used problem-focused (3.37 ± 1.02) and emotion-focused (2.91 ± 0.86) more often than dysfunctional coping (1.13 ± 0.56). Dysfunctional coping was associated with lower perceived relationship closeness, higher burden, and greater distress related to neuropsychiatric symptoms, while emotion-focused coping was inversely associated with anxiety and depression. Trends suggested associations between emotion-focused coping and extraversion, and between problem-focused coping and conscientiousness. Coping patterns remained stable over time. Caregivers reported elevated psychological distress.ConclusionCaregivers of patients with MCI due to AD experience considerable psychological distress but appear to rely primarily on adaptive coping strategies. The stability of coping patterns suggests that coping responses may begin to consolidate early in the caregiving trajectory. Given the exploratory nature of our study, further longitudinal research is needed.
BackgroundDementia is a growing global health concern, particularly among individuals with Posttraumatic Stress Disorder (PTSD), which may be a potential risk factor. However, the effects of moderating factors remain unclear.PurposeThis study aims to assess the relationship between PTSD and dementia risk, including potential moderators. Research designA systematic literature review and meta-analysis were conducted in PubMed, CINAHL, PsycINFO, The Cochrane Library, and Scopus.Data analysisRandom-effects meta-analyses were performed separately for unadjusted risk ratios (RRs) calculated from raw data and adjusted hazard ratios (HRs) reported from survival analyses. Subgroup and moderator analyses examined effects of population type, study quality, demographics, health and lifestyle factors on the PTSD-dementia association.Study sampleEighteen studies were included after screening 30,203 abstracts and 621 full-text articles.ResultsPTSD was associated with a 43% (unadjusted pooled RR = 1.43, 95% CI:1.09-1.89, I2 = 99.22%, P = 0.011) and 56% (adjusted pooled HR = 1.56, 95% CI:1.27-1.91, I2 = 95.50%, P < 0.001) increased dementia risk. Diabetes and hypertension strengthened the association, whereas depression, traumatic brain injury, and drinking alcohol might weaken it. However, post hoc analyses indicated that the moderation effects of depression and alcohol use were not significant after excluding one influential study. No moderating effects were found for age, gender, population type or race, and no evidence of publication bias was detected.ConclusionsThese findings confirm PTSD as a significant risk factor for dementia, with diabetes and hypertension potentially increasing vulnerability. Depression and alcohol use initially appeared to attenuate the association, but these effects were not robust in post-hoc analyses. Further research is needed to identify potential moderators and develop targeted interventions.
ObjectiveThis systematic review aims to evaluate recent evidence on interventions for sleep disturbances in dementia, a major clinical concern, with limited pharmacological and non-pharmacological strategies examined in controlled trials.MethodsWe included eight RCTs (N = 666 participants; 2020 - January 2025) in people with dementia and sleep disturbances. Records were identified via MEDLINE, screened using PRISMA-guidelines, and non-randomized or non-intervention studies were excluded. Risk-of-bias was assessed with Cochrane RoB2, and effect sizes (Cohen's d) were calculated in R.ResultsZ-drugs indicated small-large benefits, with eszopiclone significantly improving sleep efficiency and latency. Orexin receptor antagonists indicated mixed evidence, with low-dose lemborexant (2.5 mg) most favorable, meeting benchmarks for nocturnal awakenings. Circadian modulation light therapy was associated with reduced nocturnal awakenings in small trials, while relaxation-based music therapy indicated little to no effect. Social stimulation with PARO indicated increased sleep time and large positive effects on sleep efficiency, despite missing clinical benchmarks.ConclusionsEvidence is limited by sparse reporting and few trials per intervention. Z-drug eszopiclone, low-dose ORA lemborexant, and social stimulation PARO show the most favorable profile across outcomes and benchmarks, but pharmacological options require careful risk-benefit consideration. Non-pharmacological approaches appear safer but under-researched. Future trials should standardize outcomes and tailor strategies to patient needs. No external funding. The review was registered in INPLASY: https://doi.org/10.37766/inplasy2025.1.0097.
IntroductionNeuropsychiatric symptoms are often considered late manifestations of dementia and can be neglected during early clinical assessments. Besides visual hallucinations, less is known about other neuropsychiatric symptoms in mild dementia with Lewy bodies (DLB). We aimed to 1) describe neuropsychiatric symptoms and associated caregiver distress in mild DLB; 2) describe neuropsychiatric symptoms stratified by dementia stage within the included participants.MethodsIndividuals with probable DLB and their caregivers underwent clinical and neuropsychiatric assessments. Clinical Dementia Rating Global Score (CDR-G) of 0.5 (denoting "very mild dementia") was used to stratify the participants into earlier and later stage subgroups. The Neuropsychiatric Inventory (NPI) was used to assess neuropsychiatric symptoms. Median regression was used to estimate the difference in symptom severity and caregiver distress between the subgroups.ResultsFifty participants (age 73.5 ± 5.7 years, 43 males, median mini mental state exam (MMSE) 26 [IQR 23 - 27], median CDR 0.5 [IQR 0.5 - 1]) were enrolled. Twenty-six had earlier and 24, later stage dementia. Neuropsychiatric symptoms were common across both subgroups (96.2% and 95.8% prevalence respectively), with apathy, anxiety and depression being most prevalent (≥50% prevalence). Overall symptom severity was similar between the subgroups, although caregivers of the later stage subgroup reported more distress.ConclusionNeuropsychiatric symptom, especially apathy, anxiety and depression, are extremely common in mild DLB. Assessment of neuropsychiatric symptoms is therefore an essential part of clinical care in DLB, starting from initial presentation. Future studies should consider factors other than symptom severity that contribute to caregiver distress.
BackgroundThis study evaluated the diagnostic value and factorial structure of the Subjective Cognitive Decline Questionnaire (SCD-Q) and the Cognitive Failures Questionnaire (CFQ) in the context of early detection of cognitive decline in a memory clinic setting.MethodsA total of 128 patients were included (AD/MCI: n = 50; non-AD dementia: n = 10; mixed dementia: n = 16; subjective cognitive decline [SCD]: n = 21). Participants completed the modified SCD-Q17 and CFQ and underwent standardized cognitive assessment. Principal component and cluster analyses, regression models, and ROC analyses were used to examine psychometric properties and diagnostic performance.ResultsThe SCD-Q17 correlated with objective cognition (CERAD: r = -0.29 to -0.35, P = 0.023-0.005) and differentiated SCD from mixed dementia (AUC = 0.71). The CFQ primarily reflected executive and attentional failures and showed moderate discrimination for non-AD dementia (SCD vs NADD: AUC = 0.67). Cluster analyses identified 2 profiles (impaired vs unimpaired) for both instruments (κ = 0.47). PCA indicated a more redundant structure for the SCD-Q17, whereas the CFQ showed a broader multidimensional structure.ConclusionsRelative to CERAD performance, both questionnaires distinguished cognitively impaired from unimpaired individuals, but neither provided sufficient precision to classify specific clinical entities.
