Introduction: We aimed to assess Japanese community members’ knowledge of dementia and its association with sex, age, and caregiving experience through multiple correspondence analysis. Clarifying these relationships can inform future efforts to determine target strategies and the audience for disseminating dementia knowledge effectively. Methods: Data were obtained from a prior cross-sectional study (2021 and 2023) involving 466 middle-aged and older adults (>40 years) in Japan. A self-administered, anonymous questionnaire collected information on dementia knowledge, age, sex, and caregiving experience, using the Japanese Language Dementia Knowledge Assessment Scale (DKAS-J; 18 items). Results: The mean DKAS-J score was 16.2 ± 7.9. Higher scores were associated with being younger, female, employed, and more highly educated, living in Aichi, and having caregiving experience. Half of the DKAS-J items had correct response rates of ≤60%, indicating knowledge gaps. The lowest correct response rates were observed for items related to behavioural symptoms and unmet needs. Significant differences in knowledge were found among individuals based on age, sex, and caregiving experience. Females aged ≥75 years and males in general demonstrated lower knowledge levels. Individuals with caregiving experience at work had significantly higher correct response rates across many items. Multiple correspondence analysis revealed specific knowledge clusters linked to caregiving experience and younger age. Work-related caregiving was associated with knowledge of dementia, while family caregiving was associated with broader dementia knowledge. Work experience was associated with treatment, symptoms, and family experience to life. Conclusions: Dementia education should be targeted and content-specific, considering the backgrounds of males, older adults aged >75 years, and experienced caregivers.
Introduction:Anti-amyloid therapy has increased the need for noninvasive methods to assess vascular amyloid. Reductions in cerebrospinal fluid (CSF) Aβ40 and Aβ42 are characteristic of cerebral amyloid angiopathy (CAA), but lumbar puncture limits their use in routine practice. Magnetic resonance imaging-visible perivascular spaces in the centrum semiovale (CSO-PVS) have emerged as a potential imaging marker, although their relevance in amyloid-positive individuals without CAA-related hemorrhages remains uncertain. Methods:We retrospectively analyzed 30 patients with mild cognitive impairment due to Alzheimer's disease (AD) or mild AD who exhibited reduced CSF Aβ42/40 ratio and no CAA-related hemorrhagic findings. CSO-PVS were visually quantified and dichotomized into high- and low-degree groups using the median raw count. CSF Aβ40, Aβ42, and p-tau181 levels were compared between groups. Results:Patients with high-degree CSO-PVS demonstrated significantly lower CSF Aβ40 levels than those with low-degree CSO-PVS (p = 0.0235), while CSF Aβ42 showed a borderline reduction (p = 0.0502). The composite index Aβ40 × Aβ42 was also reduced in the high-degree group (p = 0.0264). CSF p-tau181 levels were significantly lower in the high-degree group than in the low-degree group (p = 0.0264). Conclusion:A higher CSO-PVS burden was associated with lower CSF Aβ40 and Aβ42 levels, suggesting that CSO-PVS dilation may serve as a noninvasive surrogate marker of vascular amyloid deposition in amyloid-positive patients undergoing anti-amyloid therapy.
Introduction:Older adults in need of care are at high risk for severe COVID-19 and cognitive impairment. This study investigates the association between COVID-19 severity, quality of life, and cognitive impairment in individuals requiring care. Methods:Data from 531 participants (68.4% female; n = 363; median age = 82.0 years, interquartile range = 13.0) of the Bavarian ambulatory COVID-19 Monitor (BaCoM) - all of whom were in need of care and had a prior SARS-CoV-2 infection - were analysed. We compared sociodemographic and health-related characteristics, cognitive performance, COVID-19 disease features, and quality of life between 80 individuals hospitalized for COVID-19 and 451 individuals who were infected but not hospitalized. Associations between cognitive impairment and COVID-19 severity were examined using binary logistic regressions with the MoCA Blind and Six-Item Screener as dependent variables. The association between quality of life and COVID-19 severity was analysed using multiple linear regression with the EQ VAS as the dependent variable. Results:Hospitalized individuals had significantly lower MoCA Blind scores than non-hospitalized peers (17.0 vs. 19.0, p = 0.039), while SIS scores showed no difference. EQ VAS scores were similar between the groups, but hospitalized individuals had lower EQ-5D-5L Index scores (0.57 vs. 0.75, p = 0.004). COVID-19 severity (hospitalization, symptom duration) was not associated with MoCA Blind <18 or with the EQ VAS. Conclusion:The study found lower MoCA-Blind scores and reduced quality of life in hospitalized individuals, but adjusted analyses showed no significant link between COVID-19 severity and cognition or quality of life.
Introduction: Geographic disparities in Alzheimer’s disease and related dementias (ADRDs) remain insufficiently understood at the national scale, limiting efforts to address inequities in dementia burden across USA communities. This study examined county-level variation in ADRD prevalence and mortality and evaluates the association between social vulnerability and these outcomes. Methods: This cross-sectional ecological study analyzes 2020 county-level ADRD prevalence and all-cause mortality among Medicare beneficiaries from the NORC Dementia DataHub. The analytic sample included 3,108 USA counties in the contiguous USA and the District of Columbia. ADRD outcomes included (1) prevalence of highly likely ADRD and (2) prevalence of all determinations, as defined in NORC’s validated case-classification algorithm using Medicare administrative claims. Mortality was defined as 2020 all-cause deaths among prevalent ADRD cases. Social vulnerability was measured using the CDC/ATSDR Social Vulnerability Index (SVI), including overall SVI and its four domains. Hotspot analysis using Getis-Ord Gi* identified spatial clusters. Multiscale geographically weighted regression (MGWR) estimates spatially varying associations between SVI and ADRD prevalence and mortality, reported with 95% confidence intervals (CIs). Results: Counties had a mean prevalence of 65.3 per 1,000 (SD 15.5) for highly likely ADRD and 123.5 per 1,000 (SD 27.0) for all determinations. The mean all-cause mortality rate among ADRD cases was 22.1 per 1,000 (SD 6.6). Hotspot analysis revealed significant high-prevalence and high-mortality clusters in the South, with cold spots in the Mountain West and Upper Midwest. MGWR results indicate that higher county-level social vulnerability was significantly associated with higher ADRD prevalence (overall β range ≈ 0.42–1.87; 95% CI: 0.31–1.98) and mortality (β range ≈ 0.55–2.12; 95% CI: 0.44–2.26), with the strongest, most spatially consistent effects observed for mortality. The magnitude and direction of associations varied regionally, with the largest positive effects in the South, Southwest, and West. Discussion: Substantial geographic disparities exist in ADRD prevalence and mortality, with disproportionately higher burdens in socially vulnerable counties. Social vulnerability, particularly socioeconomic disadvantage, is strongly and spatially heterogenously associated with ADRD outcomes, underscoring the importance of targeted public health and policy interventions in high-burden, high-vulnerability regions.
Introduction. Stable religious participation may have beneficial contributions to cognitive and mental health; however, less is known about how changes in religious participation, such as disengagement or increased engagement in church activities, affect these health outcomes and whether there are differences between racial groups. This study aimed to examine the association between changes in church activity and cognitive, functional, and mental health in older adults, and explore differences by race. Methods. Using data from the University of Pennsylvania Alzheimer’s Disease Research Center Aging Brain Cohort in 2021-2022, we examined associations between self-reported change in church activity with cognitive and functional health (Global Clinical Dementia Score (CDR) and total CDR) and neuropsychiatric symptoms (Neuropsychiatric Inventory) in cognitively normal older adults (n=158). We used multivariable regression analysis, controlling for self-reported age, sex, education, and social interaction, to examine differences between individuals who identified as either Black or White. Results. Controlling for covariates, Black participants who reported substantially more or less church activity in the last year had lower cognition and function (Global CDR, β = 0.19, 95%CI [0.04, 0.34], p<0.05) and Total CDR (β = 0.30, 95% CI [0.01, 0.58], p = 0.042), and more neuropsychiatric symptoms (β = 0.63, 95% CI [0.02, 1.24], p<0.045). No significance was found in White older adults. Black older adults reporting major changes in church activity experienced lower cognitive, functional, and mental health. Conclusion. To explore if church activity changes could be an early sign of cognitive, functional, and mental health decline, longitudinal studies are needed.
Introduction:Although sensor technologies hold potential for addressing challenges for the detection and management of behavioural and psychological symptoms of dementia (BPSD), their application in this context remains in its early stages. This review evaluated the accuracy of sensor technologies to detect and/or monitor neuropsychiatric symptoms in individuals with dementia, particularly in real-world home settings. Methods:Systematic searches were conducted in five databases on February 20, 2025. Two independent reviewers performed data extraction, with a third reviewer resolving any disagreements. Results:Of 109 records meeting the inclusion criteria for full-text review, 17 studies were included. Sensor-based detection of agitation (number of studies, n = 6) and other common BPSD, specifically sleep (n = 5) and Activities of Daily Living (ADLs) (n = 3), shows early promise, particularly when multimodal data and machine learning techniques are employed. However, the current evidence base is limited by small, predominantly observational studies and inconsistent accuracy across studies. Predictive capabilities remain underdeveloped (n = 3), and the generalizability of findings across different settings is unproven. Conclusions:This review highlights that the application of sensor technology for detecting and monitoring BPSD remains at an early stage, with existing evidence largely confined to a small subset of symptoms and providing limited clinimetric validation. Additionally, it emphasizes the need for consensus on standard definitions, outcome measures, and validation methodologies to guide and inform future research, which can then leverage these technologies to improve the care and quality of life of persons with dementia and their caregivers.
Introduction:Mild cognitive impairment with Lewy bodies (MCI-LB) is generally associated with more rapid cognitive decline than mild cognitive impairment due to Alzheimer's disease (MCI-AD). However, evidence regarding the potential cognitive trajectories of individuals with MCI-LB participating in structured non-pharmacological multimodal programs remains limited. The aim of the study was to preliminarily examine cognitive changes over time among individuals with MCI-LB and MCI-AD undergoing a multimodal intervention. Methods:Conducted at the University of Tsukuba Hospital between April 2013 and February 2020, this prospective study enrolled 74 participants (MCI-LB: 14; MCI-AD: 60) in the Cognitive Improvement Day-Care (CIDC) program. The CIDC was a multimodal intervention offering structured sessions including physical exercise, cognitive training, music therapy, and art-based activities. Participants attended the program, mostly once a week, and underwent annual cognitive assessments for up to 3 years using the Japanese version of Mini-Mental State Examination (MMSE-J). Linear mixed-effects models were used to analyze longitudinal changes in MMSE-J scores. Results:The overall annual cognitive decline was -0.36 points/year (95% CI: -0.63, 0.10). The annual decline was -0.44 points/year (95% CI: -0.95, 0.06) for the MCI-LB group and -0.34 points/year (95% CI: -0.64, -0.03) for the MCI-AD group. No significant group-by-time interaction was observed over the 3-year follow-up (p = 0.97). Conclusions:These findings suggest that individuals with MCI-LB exhibited longitudinal cognitive trajectories under a structured multimodal intervention that were comparable to those observed in individuals with MCI-AD, at least as assessed by the MMSE-J. Future studies with larger samples and more detailed cognitive assessments are needed to clarify potential subtype-specific responses.
Introduction:Caregiver burden significantly impacts patient and caregiver outcomes and is an important treatment consideration in dementia. Previous research has demonstrated that like behavioral variant frontotemporal dementia, prion disease has higher levels of caregiver burden than other forms of dementia; however, limited prospective research has investigated this specifically. Here, we aimed to describe caregiver well-being and caregiver burden in prion disease and determine whether demographic features, support group attendance, or features of the disease process predicted higher caregiver burden. Methods:Thirty patients with prion disease and their caregivers were assessed longitudinally through the Teleneurology Assessment Program for Creutzfeldt-Jakob Disease. Caregivers were administered the Neuropsychiatric Inventory Questionnaire (NPI-Q), MRC Prion Disease Rating Scale, Outcome Evaluation of the National Family Caregiver Support Program, and other assessment instruments. We performed descriptive and inferential statistics to examine the progression of caregiver burden and to identify features that impacted caregiver burden severity. Results:Thirty caregiver-patient dyads were followed longitudinally. Prion disease duration averaged 7.88 months. Mean initial NPI-Q distress score was 15. Qualitatively, distress increased from the time of study enrollment until peaking on average half-way through study participation and then declined. Higher burden (4-item Zarit Burden Interview) was associated with younger age at disease onset. Burden was not predicted by disease type, duration, caregiver demographics, relationship to the patient, MRC Prion Rating Scale scores, NPI-Q, or support group attendance. Conclusion:These findings confirm significant caregiver distress in prion disease and help better describe the course of caregiver burden throughout the disease. Statistical analyses were limited by small sample size and phenotypic heterogeneity, and future research would benefit from larger sample sizes.
Introduction:The aim of the study was to provide a comprehensive overview of the current application of tools used for assessing neuropsychiatric symptoms (NPSs) in patients with Huntington's disease (HD), amyotrophic lateral sclerosis (ALS), and multiple system atrophy (MSA) through bibliometric analysis. Methods:Publications published between 2014 and 2023 were searched using the Web of Science Core Collection database (WoSCC). Only articles and reviews published in the English language were included. CiteSpace was used to analyze the countries, keyword patterns, and reference co-citations. A detailed full-text analysis was further conducted across all studies to assess the usage of NPS assessment tools. Results:Our analysis included 530 publications demonstrating consistent annual growth, reflecting rising global interest in NPSs within neurodegenerative and neuroinflammatory diseases. However, these studies reveal research deficiency in current assessment methodologies that demands more attention. Research output remains predominantly concentrated in developed nations with aging populations, particularly the USA, which leads in both publication volume and quality. The primary focus of current research involves evaluating the validity of existing assessment tools, while emerging investigations explore next-generation assessment tools designed to enhance diagnostic precision and enable personalized treatment strategies. Despite these advances, widespread clinical adoption remains limited, and further validation studies are required to establish their reliability across diverse populations and disease stages. Conclusion:This study highlights the growing importance of NPSs in neurodegenerative diseases, particularly in HD, ALS, and MSA. We identify hotspots and deficiencies in the research field of validating NPS assessment tools, integrating NPSs into the diagnostic framework and elucidating neurobiological mechanisms. These findings will contribute to enhanced diagnostic and therapeutic approaches for neurodegenerative diseases.
Introduction:Cutoff values for cerebrospinal fluid biomarkers vary by analytic technique and population, which complicates the differentiation of Alzheimer's disease (AD) from non-AD dementias. We aimed to establish local cerebrospinal fluid biomarker cutoffs within a Thai cohort. Materials and Methods:We recruited 68 patients with various forms of dementia from the Memory Clinic at Siriraj Hospital, Thailand. Each patient underwent clinical subtyping for dementia, and their cerebrospinal fluid levels of Aβ42, p-tau181, and t-tau were quantified using the Fujirebio INNOTEST ELISA. We then employed a data-driven approach, specifically a Z-score-based Gaussian Mixture Model, to define intersection cutoffs for Aβ42, p-tau181, t-tau, and the p-tau181/Aβ42 ratio. These established biomarker cutoffs were subsequently incorporated with clinical manifestations to refine the clinicobiological diagnoses. Results:Our study included 67 patients (mean age 65.5 ± 7.4 years, 61.2% female). Using a data-driven approach, we established the following CSF biomarker cutoffs for identifying AD in this Thai cohort: Aβ42 at 492.67 pg/mL, p-tau181 at 44.00 pg/mL, t-tau at 545.97 pg/mL, and the p-tau181/Aβ42 ratio at 0.057. After incorporating these CSF biomarker results with clinical profiles, the diagnoses changed in 17.9% of the patients. Conclusions:In this study, CSF cutoffs for differentiating AD from non-AD dementia were established through a data-driven approach, which has been demonstrated as a valid alternative methodology. The integration of clinical and biological profiles is paramount in achieving accurate dementia diagnoses.
Introduction:The ε4 allele of the apolipoprotein E (APOE4) gene is a well-known risk factor for the onset and development of late-onset Alzheimer's disease (AD). Lipid metabolism also plays a key role in AD. However, data on the association between APOE4, cognitive function, and blood lipid metabolism, particularly fatty acid metabolism, in the healthy elderly Japanese population are lacking. Methods:We analyzed the baseline data of 506 healthy elderly Japanese individuals (mean age: 73 ± 0.4 years) from Shimane Prefecture, Japan, who participated in six intervention trials conducted between 2008 and 2020. Among them, participants with mild cognitive impairment (MCI) were divided into the following two groups: APOE4 carriers (n = 104) and noncarriers (n = 321). Results:Compared with the noncarriers, the APOE4 carriers had significantly lower scores in the "recalling five objects" sub-item of Hasegawa's Dementia Scale-Revised and longer total times in the Cognitive Assessment for Dementia, iPad version. The ratio of docosahexaenoic acid (DHA)-to-arachidonic acid was significantly decreased, and the erythrocyte eicosapentaenoic acid (EPA) and DHA levels tended to be reduced in APOE4 carriers. Conclusion:These findings suggest a possible association between the APOE4 allele and reduced erythrocyte EPA and DHA levels, even in healthy elderly Japanese individuals with high ω-3 fatty acid intake. Such alterations in lipid metabolism may be linked to cognitive vulnerability in older adults and individuals with MCI.
Introduction:Frontotemporal symptoms are usually associated with frontotemporal dementia (FTD), but people with all forms of dementia may develop these symptoms as the dementia disease progresses. Knowledge about psychosocial interventions that meet the needs of people with FTD symptoms, and literature on the subject, is hard to find. The aim of the study was to describe current practice as it is experienced by healthcare experts in the clinical field in Norway. Method:Three focus groups were conducted. Healthcare personnel with clinical experience in care and treatment to people with FTD and other dementia diseases with frontotemporal symptoms were eligible for inclusion. Qualitative directed content analysis with open coding focusing on both manifest and latent content was applied. Results:Four categories were described: (1) Dilemmas of anosognosia, (2) establishment of a diagnosis, (3) establishment of post-diagnostic support at home, and (4) establishment of care in the nursing home. Conclusion:People with FTD and other dementias with frontotemporal symptoms need rigid, easy-to-understand, predictable surroundings and healthcare personnel that are clear, friendly, and respectful in their communication. Post-diagnostic support provided in flexible systems ensuring smooth transitions between services and levels of care is required. To ensure quality of care, frontline healthcare staff should be able to recognize FTD symptoms. To achieve this, supervision and training are needed. More research about clinical care interventions and how to derive good nursing practice should be prioritized.
Background:Comorbid cancer and dementia, which share common risk factors and significantly burden the healthcare system, affect a growing number of individuals, especially the ageing population. As both conditions place a substantial burden on healthcare systems and may be underdiagnosed, there is an urgent need to explore effective management strategies, including the potential benefits of physical activity, which has shown promise in mitigating cognitive decline and improving physical function in both cancer and dementia populations. This scoping review aimed to explore the current knowledge of physical activity for individuals with comorbid cancer and dementia, identifying gaps in understanding and highlighting the need for future research in this area. Summary:This scoping review followed the 5-stage framework outlined by Arksey and O'Malley, with a focus on identifying the effects of physical activity on individuals with comorbid cancer and dementia. The review involved a comprehensive search across multiple databases, selecting relevant studies based on predefined criteria, and summarizing key findings to highlight research gaps and inform future studies. Out of 263 records identified from multiple databases, none were retained for full-text screening due to exclusions based on review articles, non-human participants, lack of comorbid cancer-dementia, and absence of a physical activity/exercise component. Key Messages:There is a significant gap in research on physical activity in individuals with comorbid cancer and dementia. Future studies are essential to explore the impact of exercise on the development and outcomes of these conditions, which could improve preventative strategies and care pathways for this growing population.
Introduction:Dementia patients are at increased risk of polypharmacy and inappropriate medication, exacerbating cognitive decline. The SARS-CoV-2 pandemic constrained access to medical care and monitoring services for dementia patients, potentially worsening medication-related issues. We analyzed the medical treatment of dementia patients during the SARS-CoV-2 pandemic in Bavaria, particularly regarding polypharmacy, anticholinergic medication, and antidementia medication. Methods:The Bavarian Ambulatory COVID-19 Monitor (BaCoM) is a longitudinal registry study conducted in Bavaria, Germany. Participants in need of nursing care with baseline data during the SARS-CoV-2 pandemic were included in our detailed analysis (N = 345, dementia sample n = 96 with a dementia diagnosis and/or antidementia medication treatment). Descriptive statistics and group comparisons (dementia vs. non-dementia sample; within the dementia sample: participants with vs. without antidementia medication; participants with vs. without anticholinergic medication in both the non-dementia sample and the dementia sample) are provided. Results:In the dementia sample, 91.7% of the patients received ≥4 medications (polypharmacy), 21.9% even ≥10 medications. Prescription of ≥1 anticholinergic medications was found in 65.6% and prescription of ≥1 antidementia medications in 31.2% of the dementia sample. Persons with versus without anticholinergic medication did not differ from each other in group comparisons. Conclusion:Despite known risks and adverse effects, polypharmacy as well as the use of anticholinergic and antidementia medication were common among individuals with dementia. Compared to pre-pandemic studies, levels of polypharmacy and anticholinergic medication but not of antidementia medication appeared slightly elevated in people with dementia. Because of the associated risks, polypharmacy and potentially inappropriate medication require regular review (and when possible reduction) in people with dementia. In crisis situations like a pandemic, an outreach approach might be necessary for this patient group.
Introduction:Much research has focused on the deposition of amyloid and tau proteins in the Alzheimer's disease (AD) brain, but many amyloid and tau models assumed a single spatial progression of amyloid and tau accumulation. We estimated the changing patterns of an indirect biomarker, i.e., the cerebral blood flow (CBF), in AD, and we discuss the pathological process of AD. Methods:The participants were 341 patients who visited our hospital's outpatient department for memory loss (146 males, 195 females): 115 diagnosed with AD, 176 diagnosed with mild cognitive impairment, and 50 diagnosed with subjective cognitive decline. For the evaluation of disease-related changes in their CBF, the patients underwent 99mTc-ethyl cysteinate dimer single-photon emission computed tomography scans. We differentiated the subtypes of CBF in AD by using a machine-learning algorithm called the "Subtype and Stage Inference (SuStaIn)"algorithm. Results:When we divided the data into two groups, the SuStaIn algorithm identified two different CBF subtypes: the typical AD pattern and a cortical pattern with hippocampal sparing. Conclusion:We observed two subtypes of the pattern of change in the CBF of individuals with AD, and these subtypes were highly similar to previous findings derived from SuStaIn algorithm applied differing neuroimaging modalities. Such subtyping derived from CBF imaging might have clinical utility in the treatment of AD.
Introduction: Mild cognitive impairment (MCI) represents a loss of memory or other cognitive function while maintaining the ability to independently perform most activities of daily living. This study assessed how Korean specialists in dementia care diagnosed and treated patients with MCI symptoms. Methods: A questionnaire on the current management of MCI was developed by 6 experts in MCI care. Specialists in MCI care (n = 24: 14 neurologists/10 psychiatrists) verbally answered questions relating to their experience/views in caring for MCI patients. Results: Respondents diagnosed MCI using the Seoul Neuropsychological Screening Battery (79%) and the Consortium to Establish a Registry for Alzheimer’s Disease – Korea (21%) neuropsychological battery tests. All or nearly all respondents also assessed patients with Mini-Mental State Examination, Geriatric Depression Scale, Clinical Dementia Rating, Activities of Daily Living (ADL), and Instrumental ADL tests. All respondents used MRI or CT for differential diagnosis of diseases causing MCI, about one-third used amyloid PET. Most respondents (96%) treated patients with MCI due to Alzheimer’s disease (AD) with medication, commonly choline alfoscerate (71%) and donepezil (53%), mainly as combination therapy. Unmet needs included patient/caregiver education (63%) and time constraints for consulting patients (54%). Most respondents considered that increased amyloid-β testing for patients with MCI due to AD or subjective cognitive decline is likely to increase. Conclusions: This survey described the current management of MCI due to AD, identified unmet needs and considered possible future developments in the changing landscape of early AD treatment. Early detection and diagnosis and continued development of emerging preventative or therapeutic interventions are critical for MCI outcomes.
Introduction:Nurses in Saudi Arabia lack sufficient training in dementia care, a challenge compounded by cultural beliefs that frame dementia as fate rather than a medical condition. This gap in knowledge and skills hinders nurses' ability to provide appropriate support to people living with dementia in hospital settings. This study investigated Saudi Arabian hospital nurses' knowledge (cognitive expertise), attitudes (feelings and behaviors), and perceptions (thoughts, concerns, and interpretations of behaviors) of caring for people living with dementia to inform future training programs. Methods:The study used a sequential explanatory mixed-methods design, conducted in six hospital settings in Jeddah, Saudi Arabia. Data were collected between March and July 2018. Quantitative data were gathered using two validated tools: the Dementia Attitude Scale and the Dementia Knowledge Assessment Tool Version 2. Qualitative data consisted of diary entries for ten working days followed by semi-structured interviews. Data integration was performed using the Pillar Integration Process. Results:A paper survey was completed by 710 nurses, with 17 keeping a diary and 18 participating in interviews. The survey identified themes of knowledge-attitude links, work environment impact, cultural and educational influences, low confidence levels, and gaps in dementia care knowledge. Diary-interviews revealed themes such as knowledge acquisition, attitude-driven behaviors, perceptions of dementia care, professional challenges, and suggestions for improving care. The Pillar Integration Process highlighted five key findings: (1) a lack of knowledge is linked to low confidence in nursing people with dementia, (2) nurses are eager to learn but face limited access to resources, (3) attitudes, emotions, and communication challenges influence care delivery, (4) stigmas and cultural norms negatively impact dementia care, and (5) organizational factors hinder care quality. Conclusion:Saudi Arabian nurses face significant challenges in dementia care, including inadequate knowledge, resource constraints, and negative attitudes. These findings emphasize the need for targeted training and policy interventions to improve dementia care quality. This study highlights nurses' emotional strain and practical difficulties in dementia care, providing insights for global improvements in dementia care practices and support for nurses' well-being.
Introduction:People with dementia are eligible for rehabilitation for functional difficulties resulting from cognitive symptoms, but no method for this is used in Norwegian municipalities. GREAT cognitive rehabilitation (CR) is an approach which has shown significant positive effects. The study aimed to explore the experiences of dementia case managers using the GREAT CR approach to address the rehabilitation goals of people with dementia. Method:Six dementia case managers, from four Norwegian municipalities, participated. The pilot study had two phases: phase 1: the participants learnt the approach, and each used it with two clients, to become CR practitioners; phase 2: the participants could use CR in their normal practice. Their experiences were explored in two focus groups. The focus groups were audiotaped, transcribed, and analysed in line with directed content analysis. Results:Three categories were described: (1) the training and written material, (2) professional development, and (3) proposals for solutions on how to use CR in clinical practice. The case managers found it both engaging and challenging to use CR. They observed that the experience had changed their usual practice: they asked people with dementia more questions about their everyday functioning and resources. The most important barrier to implementing CR was lack of time, although funds were provided to allow municipalities to provide cover for participants' time, participants still found they lacked the time to use the approach as planned. Conclusion:This study has demonstrated that it is feasible to implement CR in a Norwegian municipality if enough time is available and sufficient resources are provided. There is an urgent need to identify how healthcare services can be enabled to make rehabilitation methods like CR a regular part of post-diagnostic support.
Introduction:The aim of this study was to investigate whether exposure to noninvasive brain stimulation with high-frequency repetitive transcranial magnetic stimulation (rTMS) applied over the left dorsolateral prefrontal cortex (DLPFC) can improve memory and regulate white matter (WM) microstructure. Methods:Twenty-two mild cognitive impairment participants who were randomly assigned to the real and the sham groups received 10 sessions and sham-controlled 10 Hz rTMS over the DLPFC. All patients underwent cognitive assessments and diffusion tensor imaging scans before and after the intervention. Brain regions that showed significant differences in fractional anisotropy (FA) values were selected as the regions of interest to calculate the correlation with cognitive scores. Results:In the real group, FA values in the left middle frontal gyrus and bilateral parahippocampal gyrus increased and in the right superior frontal gyrus decreased. No significant FA change was detected in the sham group. Furthermore, the FA value of the left middle frontal gyrus was positively correlated with Boston Naming Test (BNT) scores. The change of FA value in the right superior frontal gyrus was positively correlated with the change in the Trail Making Test (TMT-B) score. Conclusions:This study provides new evidence for rTMS to regulate the abnormal WM microstructure in some special regions and causally ameliorate cognitive performance in MCI, which may be the underlying neural mechanism of intervention.
