OBJECTIVES:Loneliness is a rising public health concern among older Japanese adults. We aimed to construct a predictive model for loneliness onset among older adults and evaluate its predictive performance. METHODS:A total of 4050 participants responded to our survey (mean follow-up period: 3.1 [range, 2.8-3.3] years). Of these, 1806 older adults (age ≥ 65 years) who were not lonely at baseline were included. Loneliness was assessed using the UCLA Loneliness Scale (Version 3). A score of ≥ 44 indicated the presence of loneliness at follow-up. Predictive models for the onset of loneliness were developed using 12 machine-learning algorithms. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs). Sensitivity analyses examined the contribution of baseline UCLA-LS information, model stability, and class imbalance handling. RESULTS:In total, 421 respondents (23.3%) reported loneliness at follow-up. The XGBoost model achieved the highest AUC of 0.740 (0.705-0.776), with an accuracy of 0.631, sensitivity of 0.806, and specificity of 0.577. SHAP analysis indicated that baseline UCLA-LS items were among the most influential predictors. When all baseline UCLA-LS items were excluded, the test AUC decreased to 0.635. Ten-fold cross-validation showed a mean AUC of 0.742 ± 0.065 for the full XGBoost model. CONCLUSION:XGBoost showed moderate discrimination for predicting 3-year loneliness onset. However, baseline UCLA-LS information contributed substantially to model performance, and external predictors alone showed modest discriminative ability. Further refinement and external validation are needed before implementation.
BACKGROUND AND PURPOSE:Glaucoma, a neurodegenerative optic neuropathy and leading cause of irreversible vision loss, shares vascular and neurodegenerative mechanisms with dementia. The 2024 Lancet Commission newly identified visual impairment as a modifiable dementia risk factor. As glaucoma management ranges from long-term medical therapy to laser/surgical intervention, it remains uncertain whether treatment modality influences long-term systemic outcomes such as dementia. This study compares dementia risk in patients receiving glaucoma surgery versus medical therapy. METHODS:Glaucoma patients aged ≥ 40 years and diagnosed and managed before July 2021 were identified in the TriNetX database and followed from the first definitive treatment-surgery or initiation of medical therapy-until dementia diagnosis, death, or July 2026. The primary outcome was all-cause dementia; secondary outcomes included Alzheimer's disease, vascular dementia, and visual loss. Subgroup analyses examined surgical timing, modality, age, sex, and comorbidities. RESULTS:After 1:1 propensity score matching, 51,923 patients were included in each cohort (mean age 64 years; 55.3% female). Glaucoma surgery was associated with reduced risks of all-cause dementia (HR 0.81) and vascular dementia (HR 0.53), a non-significant reduction in Alzheimer's disease (HR 0.87), and a higher risk of visual loss (HR 1.52), consistent with more advanced disease among surgical candidates. Associations were stronger with late surgery, traditional incisional procedures, younger age, and absence of comorbidities. CONCLUSIONS:Patients who underwent glaucoma surgery were associated with a lower subsequent risk of all-cause dementia and vascular dementia, with a non-significant trend for Alzheimer's disease, compared with those receiving medical therapy. These findings suggest that surgical management is associated with more favourable long-term cognitive outcomes beyond ocular benefits, which may provide additional context for treatment-escalation decisions in suitable patients.
BACKGROUND/OBJECTIVES:Older adults with musculoskeletal disorders (MSDs) are at increased risk of psychological distress and reduced quality of life, yet evidence on depressive symptoms among older Nigerians with MSDs remains limited. This study aimed to examine the prevalence and predictors of clinically significant depressive symptoms among older adults with musculoskeletal disorders (MSDs) in southeastern Nigeria, exploring both clinical and sociodemographic correlates. METHODS:A multicenter cross-sectional survey was conducted from June 2024 to August 2025 across 30 healthcare facilities in 15 Local Government Areas within five southeastern Nigerian states. Using a multistage sampling technique, 718 older adults (aged ≥ 60 years; mean age: 71.5) with confirmed MSD diagnoses were recruited. Data were collected using the culturally adapted Geriatric Depression and Musculoskeletal Disorders Assessment Questionnaire (GeDMoDAQ). Geriatric depression was measured using the GDS-15. Statistical analyses included chi-square tests and multivariate logistic regression; significance was set at p < 0.05. RESULTS:The prevalence of severe depressive symptoms was 61.3%. Statistically significant associations were found between depression and several MSDs, including polymyalgia rheumatica (χ2 = 88.21, p < 0.001), spinal stenosis (χ2 = 88.68, p < 0.001), osteoarthritis (χ2 = 120.76, p < 0.001), and rheumatoid arthritis (χ2 = 50.96, p < 0.001). Sociodemographic predictors included age ≥ 70 years (OR = 2.23, p < 0.001), female gender (OR = 3.45, p < 0.001), Christian affiliation (OR = 3.75, p < 0.001), married status (OR = 3.00, p < 0.001), and living with family (OR = 3.23, p = 0.017). Education level was not significantly associated (p = 0.292). CONCLUSION:There is a high burden of geriatric depression among older adults with MSDs in southeastern Nigeria, driven by both clinical and social factors. These findings underscore the need for integrated mental and musculoskeletal health services, especially within primary care settings in low-resource contexts.
INTRODUCTION:This study aimed to examine the patterns and predictors of health service use for people with dementia who self-harmed. METHODS:Using a retrospective linked cohort of people who accessed health services in New South Wales, Australia between 2001 and 2015, we identified 154,811 people with dementia or mild cognitive disorder (the dementia cohort), 28,972 people who self-harmed (the self-harm cohort), and 1541 who had a record of both dementia or mild cognitive disorder and self-harm (the dementia and self-harm subgroup). We examined the rates of health service use (inpatient hospital admissions, emergency department presentations, and mental health ambulatory days) for these cohorts. Using random effects Poisson regression and survival modelling, we investigated the change in and predictors of health service use following self-harm (for those with dementia) or dementia diagnosis (for those who had self-harmed). RESULTS:People with dementia who self-harmed had the highest rate of use of all health services. Ambulatory mental health service use increased after self-harm for people in the dementia cohort, while emergency department and mental health related hospital presentations decreased. Hospitalisations for non-mental health reasons increased after dementia diagnosis for those in the self-harm cohort, but use of other services decreased. Ambulatory mental health service use predicted increased time to re-presentation to hospital. DISCUSSION:Health service use changed after an episode of self-harm for people with dementia. People with dementia with poor mental health or substance use concerns may benefit from more proactive provision of mental health services.
OBJECTIVES:To compare the associations of household energy infrastructure and primary cooking fuel use with mental health among older adults in rural China. METHODS:This cross-sectional analysis included 4975 rural adults aged 60 years or older from 3291 households in the 2018 China Health and Retirement Longitudinal Study. Mental health was operationalized as depressive symptoms measured using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10); the continuous score was primary and CESD-10 ≥ 10 secondary. Exposures were Coal gas/natural gas availability, heating availability, and primary cooking fuel (solid, gaseous, or electric). Separate adjusted linear and logistic regression models used household-clustered standard errors. RESULTS:Neither Coal gas/natural gas availability (b = -0.249, 95% CI -0.850 to 0.353; p = 0.418) nor heating availability (b = 0.104, 95% CI -0.811 to 1.018; p = 0.824) was clearly associated with CESD-10 scores. Compared with solid fuel, gaseous fuel (b = -1.422, 95% CI -1.889 to -0.956; p < 0.001; OR = 0.663, 95% CI 0.569-0.771) and electricity (b = -0.631, 95% CI -1.150 to -0.113; p = 0.017; OR = 0.851, 95% CI 0.727-0.996) were associated with lower scores and lower odds of probable depressive symptoms. Findings were consistent across sensitivity analyses. CONCLUSIONS:Primary use of gaseous or electric cooking fuel was associated with better mental health, reflected in fewer depressive symptoms, whereas neither infrastructure indicator showed a clear association. Nominal availability and routine use should be measured separately. Longitudinal evidence is needed before causal conclusions can be drawn.
BACKGROUND:Caring for a family member with dementia places long-term emotional, physical, and social strain on primary caregivers. Although extensive research has examined the caregiving phase, relatively few studies have explored caregivers' recovery experiences following bereavement, particularly in Chinese cultural contexts. OBJECTIVES:To explore the post-bereavement recovery among primary family caregivers of individuals with dementia, with specific attention to emotional adjustment, life transitions, and identity reconstruction. DESIGN:Descriptive qualitative study. SETTING AND PARTICIPANTS:13 former full-time co-resident family caregivers were purposively recruited within 24 months of the death of a family member with dementia. All participants had provided care for at least 1 year before bereavement. METHODS:Semi-structured, in-depth interviews were conducted between October 2022 and January 2024. Data were analyzed using inductive content analysis informed by Lincoln and Guba's 10-step framework. Trustworthiness was enhanced through credibility, dependability, transferability, and confirmability. RESULTS:Four themes were identified: (1) Weathering the storm of caregiving-persistent emotional, physical, and spiritual distress; (2) Gradual relief and reclaiming freedom-restoration of daily routines, health, and autonomy; (3) Reconnecting with social life-renewed engagement in social roles and community; and (4) Reflection and emerging hope-lingering grief alongside future planning and personal growth. Many participants reported a sense of emotional relief after the death of the person with dementia, whereas others continued to struggle with loneliness, unresolved guilt, and role loss. Preliminary patterns also suggested that gender and the caregiver-care recipient relationship may influence recovery trajectories. CONCLUSIONS:Post-bereavement recovery among family caregivers of people with dementia is a complex, culturally mediated process. Tailored, culturally sensitive interventions are needed to support emotional healing, identity redefinition, and social reintegration, with particular attention to male caregivers and adult children.
BACKGROUND:Depression has been identified as a risk factor for the development of dementia, but the relationship between the two conditions is complex. If the mechanism by which depression increased the risk of dementia was better understood then new treatment targets could be identified. Previous studies have found evidence of reduced hippocampal volume in depressed patients, but because depression may also be an early sign of dementia, these studies may have inadvertently included individuals in the early stages of dementia. We used genetic risk of depression as our exposure and examined whether older adults with the highest genetic risk of depression had reduced regional brain volumes or greater longitudinal regional atrophy. METHODS:We used clinical, genetic and neuroimaging data from the ROSMAP and ADNI studies, which are both older adult focused longitudinal cohort studies with derived regional brain volumes a subset of available from MRI scans. Polygenic scores for depression were generated in PLINK from genotyped data imputed using 1000 genomes Phase 3 v5 using the clumping and thresholding method, based on the Howard et al., 2019 GWAS of depression. In ADNI n = 473 at baseline and 342 at 12 months, in ROSMAP n = 187 at baseline and n = 113 at 12 months. In a secondary analysis we excluded those with dementia at baseline. Our primary outcome was the effect of PRS-D on hippocampal volume in both studies using linear regression. The results from the 2 studies were then meta-analysed. RESULTS:We did not find any evidence of an effect of polygenic risk for depression on regional brain volume changes at baseline or after 12 months, either in ROSMAP or ADNI individually or in the meta-analysis. This finding was not affected by excluding individuals with evidence of dementia at baseline in ADNI or in ROSMAP those with AD at post-mortem examination. CONCLUSIONS:We found no strong evidence of an effect of polygenic risk of depression on regional brain volumes in older adults either at baseline or after 12 months. Our work was limited to genetic risk of depression and further research is required to investigate the complex relationship between depression and dementia.
OBJECTIVES:(1) To describe financial decision-making experienes and financial literacy, and (2) to examine associations between multiple cognitive functions and financial literacy, including whether these associations are modified by gender and education. METHODS:We analysed cross-sectional data from Wave 5 of the PATH Through Life Study, including 1036-1440 adults aged 60-66 years (mean age 62.5 years [SD 1.5]; 53% women). Subjective financial literacy was assessed using self-rated knowledge, and objective financial literacy using a PRIDIT-weighted score derived from four items. Associations between ten cognitive measures and financial literacy were examined using multivariable linear regression, adjusting for sociodemographic characteristics. Interactions with gender and education were assessed. RESULTS:Overall, 69% of participants had made a major financial decision, and 22% had acted as substitute decision-makers during the previous 5-6 years. Self-rated financial literacy was high (mean 5.0 [SD 1.2] on a 7-point scale). Objective financial literacy was lower, especially for risk diversification (56% correct) and bond pricing (27% correct). Subjective financial literacy was associated only with self-reported memory impairment. Objective financial literacy was associated with all cognitive function tests except self-reported memory impairment. Associations between certain cognitive functions and objective financial literacy were weaker among participants with higher education. No gender-based interactions were observed. CONCLUSIONS:Better cognitive function was associated with higher objective financial literacy, whereas subjective financial literacy showed no association with cognitive performance. These findings highlight the importance of cognitive function for financial literacy in later midlife to early older age adults.
AIM:Major depressive disorder (MDD) in older adults can result in detrimental health consequences and often presents with resistance to antidepressant treatment. While Hesed-coil 4 (H4) and 7 have shown great promise in the treatment of MDD in older adults, not all participants will respond. Establishing biomarkers to predict individual treatment responses and to better understand how these coils work to treat MDD in older adults is essential. Resting-state electroencephalography (rsEEG), a cost-effective technique, has been previously used to identify response biomarkers to psychiatric treatments. This study therefore aims to identify rsEEG biomarkers of response to the H4 and H7 coils in older adults with MDD. METHODS:Twenty-one older adults with treatment-resistant MDD were randomly assigned to undergo 20 sessions of either H4 or H7 coils. rsEEG recordings were ascertained at baseline and posttreatment, along with the 24-item Hamilton Depression Scale (HDRS-24). RESULTS:Although none of the effects remained significant after correction, several preliminary biomarker patterns emerged. Higher baseline gamma power at Fp1 and F4 predicted a lower likelihood of treatment response. Investigation into treatment correlate signals revealed that decreases in alpha power at F4 and P3, and increases theta power at F7, were associated with greater improvement in HDRS-24 scores. CONCLUSION:This study identified preliminary rsEEG biomarkers of H4 and H7 coil response in older adults with MDD, providing initial proof-of-concept. Therefore, these findings can help guide hypothesis generation in future research. With larger sham-controlled trials needed for definitive characterization and validation.
INTRODUCTION:There is a potential link between Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and depression in later life. This study aims to examine whether MASLD is associated with elevated clinically relevant depressive symptoms in community-dwelling older adults. METHODS:This study utilised longitudinal data from a prospective cohort to quantify the association between MASLD at baseline and depressive symptom trajectories. MASLD, introduced by multinational liver societies to replace Non-Alcoholic Fatty Liver Disease (NAFLD), highlights the central role of metabolic dysfunction in the pathogenesis of steatotic liver disease. Depression trajectories were estimated across a median follow-up of 4.6 years (IQR: 0.1-7.1 years) and were identified as four distinct patterns of symptoms: 'non-depressed', 'subthreshold depression', 'persistent depression', and 'emerging depression'. Multivariable multinomial logistic regressions were performed to examine the association between baseline MASLD presence and membership of the depression trajectories, adjusting for sociodemographic and lifestyle factors, anthropometric indices, cognitive function, polypharmacy and the number of morbidities. Additional subgroup analyses were also performed. RESULTS:Of 9097 individuals (mean age 75.1 ± 4.2 years; 55.0% males), 2998 (33%) had MASLD at baseline. Participants with MASLD were significantly more likely to belong to the persistent depression trajectory (RRR = 1.13; 95% CI: 1.02-1.24) and the subthreshold depression trajectory (1.43; 1.22-1.67) than those without MASLD. CONCLUSION:This study shows that the presence of MASLD is significantly associated with an increased risk of a worse depression trajectory. In subgroup analysis, this relationship was particularly pronounced amongst females and among individuals with key cardiometabolic morbidities such as dyslipidaemia.
BACKGROUND:Dementia imposes a growing public health burden in Korea, with substantial implications for families living with affected members. Although prior Korean studies have suggested an association between dementia-related household context and depressive symptoms, population-based evidence on co-residence with a family member with dementia remains limited. This study examined the association between co-residence with a family member with dementia and depressive symptoms among Korean adults aged 50 years and older. METHODS:We conducted a cross-sectional analysis using data from the 2024 Korea Community Health Survey. Among 231,728 respondents, 120,029 adults aged ≥ 50 years living in non-single-person households were included. The exposure was co-residence with a family member reported to have dementia, rather than a direct measure of caregiving status, intensity, or duration. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), with a score ≥ 10 indicating clinically significant depressive symptoms. Survey-weighted multiple logistic regression was used to estimate odds ratios and 95% confidence intervals. RESULTS:Overall, 15.8% of individuals reported depressive symptoms. Living with a family member with dementia was highly associated with depressive symptoms (OR = 1.35; 95% CI: 1.29-1.42; p < 0.0001). Among men, significant lower associations showed with good health status (OR = 0.14; 95% CI: 0.13-0.16). Among women, similar patterns were observed, with high income (OR = 0.71; 95% CI: 0.63-0.80) and good health (OR = 0.14; 95% CI: 0.13-0.16) being strongly protective against depression. CONCLUSIONS:Co-residence with a family member with dementia was associated with higher odds of depressive symptoms among Korean adults aged 50 years and older. These findings suggest the need to consider mental health screening and support strategies for families living with dementia, while acknowledging the cross-sectional and self-reported nature of the data.
OBJECTIVES:Aligned with the World Health Organization's call for enhanced dementia research to inform national strategies, this systematic mapping review identifies critical gaps in the evidence base for Chinese populations. Representing over 20% of people living with dementia globally, this group remains underrepresented in the Western-centric research that currently guides best practices. This is the first study that comprehensively reviews evidence on dementia-related interventions trialled among participants identified as Chinese worldwide across both Chinese and English literature. It addresses critical gaps in previous Anglo-centric reviews by capturing culturally specific interventions and assessing the evolving evidence landscape for Chinese population. METHODS:Following PRISMA guidelines, we systematically searched two widely used Chinese databases (China National Knowledge Infrastructure, Wanfang Data) and 12 English bibliographical databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit, Cochrane Database of Systematic Reviews) to identify randomised controlled trials (RCTs) published between 2008 and 2020 (registered on PROSPERO: CRD42019134135). Dual-language teams employed culturally sensitive strategies to maximise coverage of regionally prevalent interventions. Risk of bias was assessed using version two of the Cochrane risk-of-bias tool for randomised trials. A narrative approach was used to review and assess the current landscape of dementia intervention research in Chinese communities. RESULTS:We identified 183,277 records across Chinese and English databases and included 525 unique RCTs for synthesis (93% published in Chinese). The most commonly studied interventions were multicomponent interventions (35.2%), followed by pharmacological (29.5%), non-pharmacological (18.3%), and traditional Chinese medicine (TCM; 14.5%) interventions. 62.7% of multicomponent RCTs were those combining TCM with Western drugs. Cognitive outcomes were measured in 86.9% of RCTs and functional outcomes in 60.2%, while only 3% evaluated quality of life (QoL) and 1% carer-related outcomes. Most trials (91.8%) were hospital-based. Over 80% of included RCTs were assessed as having overall 'some concerns'. CONCLUSIONS:Despite rapid growth of dementia intervention research in Chinese communities, evidence remains skewed towards hospital-based trials conducted predominantly in mainland China, with a focus on cognitive and functional outcome. High-quality evidence is urgently needed to rebalance research priorities and address critical knowledge gaps in improving QoL, carer support, and community-based interventions. Our finding that most trials were published in Chinese involving TCM illustrates the value of integrating non-English literature in global evidence synthesis, especially for identifying culturally specific interventions common in lower- and middle-income countries.
OBJECTIVES:Despite evidence and guidelines supporting rehabilitation, people with dementia experience limited access due to health professionals' attitudes, knowledge gaps, and systemic barriers. The INCLUDE package is an interdisciplinary online training programme and Community of Practice (CoP) designed to address these barriers. The aim of this study was to evaluate the impact of the INCLUDE package on health professionals' knowledge, attitudes, confidence, advocacy, and practice change in dementia rehabilitation. METHODS:A pre-post longitudinal study involved two groups of health professionals across Australia. Group 1 (n = 103) completed the online training and an 8-month CoP; Group 2 (n = 373) completed training only. Surveys administered at pre-training (T1), post-training (T2), and 10-month follow-up (T3; Group 1 only) assessed knowledge, attitudes and confidence towards dementia and dementia rehabilitation. Multilevel mixed-effects regression models were used to examine changes over time. Content analysis was used to explore advocacy, practice changes, barriers, and sustainability. RESULTS:476 health professionals participated. The largest groups were physiotherapists (n = 121, 26.7%), occupational therapists (n = 120, 26.5%) and nurses (n = 37,13.6%). The Dementia Attitudes Scale (coefficient 10.4, 95% CI 9.4-11.4), Dementia Rehabilitation Questionnaire (3.8, 95% CI 3.0-4.5), and Confidence in Delivering Dementia Rehabilitation Scale (3.2, 95% CI 2.8-3.5) improved from T1 to T2. In Group 1, improvements in attitudes towards dementia and confidence in rehabilitation were sustained at T3, but knowledge and attitudes towards dementia rehabilitation declined from T2 to T3. Participants advocated for dementia rehabilitation and made changes in their workplace including revising rehabilitation access criteria, advertising dementia rehabilitation to referrers, and developing interdisciplinary programs. CONCLUSIONS:The INCLUDE package improved health professionals' attitudes, knowledge and confidence in dementia rehabilitation. Although participants made changes in their workplace, barriers still existed. Organisational and system-level changes are also required to improve access to dementia rehabilitation. TRIAL REGISTRATION:This study is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12623001029684.
BACKGROUND:The National Health Service (NHS) England Primary Care Dementia Data (PCDD) provides a comprehensive dementia registry, underpinning national policy to improve diagnosis, care, and support. METHODS:This paper evaluates the PCDD in comparison with international quality dementia registries (SveDem, NorCog, ADNeT). RESULTS:We highlight strengths in PCDD coverage and case ascertainment, but also weaknesses in diagnostic specificity and post-diagnostic metrics. CONCLUSIONS:We review currently collected metrics and discuss potential data expansions, including dementia severity and NICE-approved therapy uptake, alongside new targets, such as an 18-week standard for memory assessment service referrals.
BACKGROUND:Older adults represent a high-risk group for suicide and are frequently exposed to central nervous system (CNS) drugs. Yet, the role of CNS drugs in late-life suicide remains unclear. METHODS:We conducted a nationwide register-based matched case-control study (1:30) including all individuals aged 65 years and older who died by suicide in Sweden between 2007 and 2020. Each case was matched to controls from the general population on age and sex, alive at the index date. Use of CNS medications was examined within 1-month, 3-month, and 12-month windows prior to the index date (date of suicide). Conditional logistic regression was used to estimate odds ratios (ORs) with adjustment for sociodemographic factors, number of other classes of medications (proxy for comorbidities), frailty score, self-harm history and major psychiatric diagnoses. RESULTS:Among 5971 older adults who died by suicide, 71.7% of cases used at least one type of CNS drug (vs. 35.2% of controls), while 34.7% of cases had dispensations for three or more CNS drug types (vs. 7.3% of controls) within one year before death by suicide. The most common drug classes among cases were hypnotics and sedatives (46.5%) and antidepressants (38.8%). About one third of cases used anxiolytics (32.3%) or minor analgesics and antipyretics (29.9%). Compared with controls, individuals who died by suicide more often used hypnotics and sedatives (adjusted OR 3.54, 95% CI 3.32-3.77), anxiolytics (aOR 3.27, 95% CI 3.04-3.52), antidepressants (aOR 2.50, 95% CI 2.33-2.68), and opioids (aOR 1.93, 95% CI 1.79-2.09) within 12 months before suicide. Patterns were consistent across time windows. CONCLUSIONS:CNS medications are commonly dispensed before suicide in older adults, particularly hypnotics and sedatives, antidepressants, anxiolytics, and opioids. These findings describe medication use patterns preceding suicide and identify drug classes for further investigation.
OBJECTIVES:The objective of this study was to examine the long-term perceptions of the value of receiving an amyloid PET scan, a test used to diagnose Alzheimer's disease, among Medicare beneficiaries with cognitive impairment and their care partners. METHODS:An exploratory qualitative research design was used. A total of 100 in-depth semi-structured interviews were conducted with a purposeful sample of CARE-IDEAS participants two to three years post-scan. A team of coders applied qualitative content analysis to identify content about the value of the scan, which was then analyzed using thematic analysis, and stratified by diagnostic category (mild cognitive impairment vs. dementia) and scan results (elevated amyloid vs. not elevated). RESULTS:A majority of amyloid PET scan recipients and their care partners emphasized major benefits of receiving the scan including increased certainty about diagnosis, the ability to prepare for the future, potentially accessing treatment or trials, the ability to contribute to research, and limited procedural risks. Some participants also reported concerns about the cost of the scan, the lack of effective treatment options and clear prognostic information, the limited impact on their lives or treatment plans, and the emotional toll of living with the results. Their views and endorsements of the scan were shaped by their health and personal circumstances (e.g., seen as less relevant among those with rapidly declining health), and by their preference for more information and involvement in decision-making. CONCLUSION:The perspectives of persons living with cognitive impairment and their care partners about the value of amyloid PET scans differed across disease trajectories and personal circumstances. These experiences should be taken into consideration when advising symptomatic patients on the benefits and drawbacks of biomarkers for Alzheimer's disease.
Background Pen-and-paper cognitive assessment tools to detect dementia have higher rates of misdiagnosis amongst minority populations, especially those who complete the assessment in their second language. CognoSpeak is an automated cognitive assessment tool that uses machine learning to detect early signs of cognitive impairment from speech. We assess the utility of different pen-and-paper cognitive assessments and CognoSpeak in ethnic minority populations living in the UK.Methods Research champions from four community centres across Yorkshire recruited cognitively healthy adults from their community: 51 Somali, 50 South Asian (South Yorkshire), 50 Chinese, and 49 South Asian (West Yorkshire). Participants completed the Montreal Cognitive Assessment (MoCA), Rowland Universal Dementia Assessment Scale (RUDAS), Multicultural Cognitive Examination (MCE), and CognoSpeak.Results A high percentage (47.5%) of participants recruited from ethnic minority community centres were misclassified as cognitively impaired with the MoCA, compared to just 3.4% in the RUDAS and 2% in the MCE. An acoustic-based SVM model analysis of responses to CognoSpeak achieved 83% accuracy in the ethnic minority cohort, at a similar rate to monolinguals (86%). Linguistic and text-based models showed higher levels of bias.Conclusion Cognitive assessments, such as the MCE and RUDAS, may be superior to the MoCA in multilingual ethnic minority populations. Automated AI tools like CognoSpeak show promise in reducing healthcare burden in detecting dementia; however, additional work is required on managing implicit bias in any AI model before they could be clinically implemented.
OBJECTIVES:Nursing homes in Sweden provide housing and care for people aged 65 years or older who require assistance with everyday activities. An increasing number of nursing home residents have cognitive and functional decline, which can result in additional time needed for care provision. This study aimed to explore changes in resource use and associated factors in Swedish nursing homes over a 5-year period. METHODS:This repeated cross-sectional study analyzed baseline (2013-2014) and follow-up (2018-2019) proxy-rated data from 4599 participants from the Swedish National Inventory of Care and Health in Residential Aged Care study. Resource use was measured using the Resource Use in Dementia scale. Descriptive statistics, t-tests, chi-square tests, and multiple linear regressions were performed. RESULTS:Total resource use increased from 7.15 h/day to 7.83 h/day between baseline and follow-up. The number of residents living in a dementia unit increased from 34.6% to 43%. Higher independence in activities of daily living was associated with lower total resource use at follow-up while living in a dementia unit was associated with higher total resource use. Higher total resource use was associated with seven neuropsychiatric symptoms. For residents living in a dementia unit, four neuropsychiatric symptoms were associated with higher total resource use. CONCLUSIONS:Resource use in Swedish nursing homes increased between baseline and follow-up. These results may inform future policy, financing, and implementation decisions to support resource utilization in nursing homes.
