BACKGROUND:Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) are common and strongly associated with caregiver distress. Switching cholinesterase inhibitors (ChEIs) may be considered when NPS remain clinically problematic. Although switching ChEIs may improve NPS in some patients, published reports describing improvement in delusional jealousy after switching to a donepezil transdermal patch remain limited. CASE PRESENTATION:We report a woman in her 60s with probable AD who developed caregiver-reported delusional jealousy and near-daily marital conflicts during oral galantamine therapy. NPS were assessed using the caregiver-rated Neuropsychiatric Inventory Questionnaire (NPI-Q) at three time points: prior to initiating galantamine (baseline symptoms were predominantly non-psychotic), immediately prior to switching and 6 months after switching. Total NPI-Q severity increased from 4 to 20 and then decreased to 11; total caregiver distress increased from 3 to 31 and then decreased to 13. After switching from oral galantamine, 16 mg/day, to a donepezil transdermal patch, 27.5 mg/day, improvements in domain-level severity were observed in the delusions domain, driven mainly by reduced caregiver-rated delusional jealousy, as well as in agitation/aggression, disinhibition and irritability/lability. Clinically, the conviction of delusional jealousy gradually diminished with a reduction in conflict frequency; at 6 months, delusional jealousy had almost completely resolved, whereas caregiver-attributed negative self-appraisals (e.g., a persistent belief that she was useless, perceived by the caregiver as delusional) persisted. No psychotropic medications were initiated or dose-adjusted from immediately prior to switching through the 6-month follow-up. Subsequently, the patient became able to attend day care services. CONCLUSION:This case suggests that switching from oral galantamine to a donepezil transdermal patch may be associated with improvement in delusional jealousy, selected caregiver-rated NPS domains and caregiver distress in some patients, although causal inference is not possible in a single case and responses may vary.
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has shown potential for improving cognitive function in Alzheimer's disease (AD), though findings remain inconsistent. This meta-analysis evaluated the efficacy and durability of rTMS in patients with mild to moderate AD and explored potential moderating factors. Randomised controlled trials (RCTs) comparing active rTMS with sham stimulation were identified through systematic searches of major databases. Effect sizes were calculated using Hedges' g, with random-effects models applied. Risk of bias was assessed using the Cochrane RoB 2 tool. Five RCTs (N = 143) were included in the primary analysis. rTMS showed a small-to-moderate improvement in MMSE scores (g = 0.41, 95% CI [0.06, 0.75], p = 0.021, I2 = 6.5%). Excluding two studies with methodological concerns yielded a similar effect (g = 0.46), though with wider confidence intervals. Sensitivity analysis including studies with change scores confirmed the robustness of results (g = 0.48). Given the limited number of studies (k < 10), formal publication bias tests and trim-and-fill adjustment were not applied, in line with current methodological guidance. Notably, all five studies employed excitatory stimulation protocols (high-frequency rTMS or iTBS), with four of five targeting the left dorsolateral prefrontal cortex (DLPFC), suggesting that excitatory stimulation of key cognitive network hubs represents the most consistent evidence base to date. Meta-regression identified treatment duration as a significant moderator (β = -0.193, p = 0.034), suggesting shorter, more intensive protocols may be more effective. Follow-up analyses indicated a nonsignificant trend towards sustained benefits (g = 0.25), while time-trend analysis demonstrated a stable overall effect (g = 0.38). In conclusion, rTMS provides modest cognitive benefits in mild to moderate AD, with excitatory protocols targeting the left DLPFC showing the most consistent efficacy and treatment duration influencing outcomes. However, evidence remains limited, highlighting the need for larger, standardised, multi-centre trials with long-term follow-up.
BACKGROUND:Rapid population ageing in Indonesia has heightened the importance of understanding late-life depressive symptoms. However, recent nationally representative evidence remains limited, warranting updated estimates of prevalence and associated factors to inform public health policy and practice. The study aimed to estimate the prevalence of depressive symptoms and identify associated factors among persons aged 45 years and older in Indonesia, overall and stratified by sex. METHODS:This study analysed data from 3808 adults aged 45 years and older who participated in the 2023 Indonesia Longitudinal Ageing Survey (ILAS), a national cross-sectional survey. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10). A total CES-D-10 score of ≥ 10 indicated depressive symptoms. Multivariable logistic regression examined factors associated with depressive symptoms. RESULTS:The overall prevalence of depressive symptoms was 9.3%, 9.0% in men and 9.6% in women. In the final adjusted models, overall, having been hospitalised in the past 12 months, poor self-rated health status, multisite pain, overweight, and having a disability were positively associated with depressive symptoms. Religious activity was in unadjusted analysis negatively associated with depressive symptoms. In addition, among men, current smoking increased the odds of depressive symptoms. CONCLUSION:Depressive symptoms affected about one in ten persons 45 years and older in Indonesia in 2023 and were associated with poorer physical health, including hospitalisation, disability, multisite pain, poor self-rated health, and overweight. Among men, current smoking was an additional risk factor.
PURPOSE:This study aimed to assess the efficacy and safety of electroconvulsive therapy (ECT) for treating psychiatric symptoms and parkinsonism in patients affected by dementia with Lewy bodies (DLB), its prodromal phase, and Parkinson's disease dementia (PDD). METHODS:We retrospectively reviewed eight patients (four males, four females; mean age 71.5 ± 8.9 years) diagnosed with probable DLB or its prodromal phase, based on diagnostic criteria, who underwent ECT between January 2020 and December 2025. The efficacy and safety of ECT for psychiatric symptoms was evaluated using the Brief Psychiatric Rating Scale (BPRS) before and after treatment, and parkinsonism was assessed based on pre- and post-Hoehn-Yahr (HY) stage. Changes in scores were statistically analysed using the Wilcoxon signed-rank test. Adverse effects occurring during and after ECT were also recorded. RESULTS:Three patients underwent ECT using the dose-titration method, while the others were treated using the half-age method. One patient experienced recurrent delirium following ECT, while no complications were noted in the other patients. There was a significant improvement in BPRS score observed (Wilcoxon signed-rank test, p = 0.012), though no significant change was noted in HY stage (p = 0.197). CONCLUSION:These results suggest that ECT is a safe, well-tolerated, and effective treatment for patients with psychiatric-onset prodromal DLB, or mild DLB who present pharmacotherapy-resistant psychiatric symptoms. ECT may be a viable therapeutic option for DLB, particularly in an early stage of dementia.
OBJECTIVE:To examine the relationship between cognitively stimulating activities and cognitive function among older adults in residential care homes. METHODS:A convenience sampling method was used to recruit older adults from three residential care homes in East China. Data were collected on cognitive function, sociodemographic characteristics and participation in cognitively stimulating activities (foreign language learning, musical instrument skills, hobbies, smart product use, physical exercise and household chores). Statistical analyses included univariate analysis (rank sum test and chi-squared test) and multivariable logistic regression. RESULTS:A total of 246 older adults were included. Cognitive impairment was identified in 111 participants (45.1%), with 81 (32.9%) diagnosed with mild cognitive impairment (MCI) and 30 (12.2%) with severe cognitive impairment (SCI). In the MCI group, depressive symptoms (OR = 3.66) were associated with poorer cognitive performance, while hobbies (OR = 0.32), smart product use (OR = 0.25) and household chores (> 3 times/week: OR = 0.27; ≤ 3 times/week: OR = 0.24) were linked to better cognitive function. In the SCI group, age 80-89 years (OR = 8.35) was associated with cognitive decline, while hobbies (OR = 0.08), physical exercise > 3 times/week (OR = 0.24) and household chores ≤ 3 times/week (OR = 0.04) were linked to better cognitive function (all p < 0.05). CONCLUSIONS:This study highlights a positive association between cognitively stimulating activities and cognitive function in older adults in residential care homes. Advanced age and depressive symptoms were associated with cognitive decline, whereas cognitively stimulating activities, including hobbies, smart product use, physical exercise and household chores, were linked to better cognitive performance, emphasising the importance of promoting these activities for cognitive health in this population.
PURPOSE:To identify individual and institutional characteristics that are associated with the quality of life (QoL) of institutionalized older adults aged 60 and above in Portuguese nursing homes. METHODS:This cross-sectional study involved 22 nursing homes from the central region of Portugal and a total of 213 institutionalized older adults aged 60 or older without cognitive impairment, selected through random cluster sampling. Participants were interviewed using a structured questionnaire to collect data on sociodemographic, lifestyle behaviours, and information related to their nursing home experience. Institutional characteristics were reported by the Technical Director of each nursing home. Multiple linear regression models were conducted to identify individual and institutional characteristics associated with QoL, controlling for potential confounders. QoL was assessed using the Portuguese version of the WHOQOL-OLD scale. RESULTS:The mean age of participants was 84.8 years, with 67.1% being female. The average WHOQOL-OLD total score was 63.3 on a 0-100 scale. Higher levels of loneliness were associated with a decrease in the QoL score (β = -0.790; 95% confidence intervals [CI]: -0.981; -0.599). Collaborating in the institution chores (β = 7.669; 95% CI: 3.220; 12.118), monthly visits (β = 7.099; 95% CI: 2.450; 11.748), and the existence of outdoor spaces (β = 6.519; 95% CI: 2.459; 10.579) were positively associated with participants' QoL. CONCLUSION:QoL in nursing homes is shaped by both individual and institutional factors. Loneliness, participation in chores, family visits, and access to outdoor spaces significantly impact well-being, emphasizing the need for targeted interventions and policies to enhance the lives of institutionalized older adults.
BACKGROUND:Alzheimer's disease (AD) is associated with memory impairment and social cognitive dysfunction, including facial emotion recognition (FER) deficits. Our previous diffusion tensor imaging (DTI) study linked poor recognition of negative facial emotions in patients with AD to increased mean diffusivity (MD) in the left uncinate fasciculus (UF). Whether FER deficits in AD reflect microstructural alterations in related grey matter regions remains unclear. METHODS:In this cross-sectional study, 74 patients with AD and 28 cognitively normal (CN) subjects underwent behavioural assessments using the Facial Emotion Selection Test (FEST). A subset of 67 AD patients and 23 CN patients underwent magnetic resonance imaging. DTI was used to assess the fractional anisotropy (FA) and MD of the bilateral UF, and neurite orientation dispersion and density imaging (NODDI) was used to evaluate the neurite density index (NDI) and orientation dispersion index (ODI) of the insula, amygdala and temporal lobe. RESULTS:Patients with AD showed significantly lower FEST total, negative emotion, positive emotion and neutral expression scores. DTI revealed significantly lower FA and higher MD in the bilateral UF. In the AD group, higher bilateral UF MD was significantly associated with lower total FEST and negative emotional scores. NODDI analyses demonstrated significantly lower ODI in the insula, amygdala and temporal lobe in the AD group, whereas no significant between-group differences were observed in the NDI. In the uncorrected analyses, ODI showed trend-level positive associations with FEST performance; however, these associations did not remain significant after false discovery rate correction. Bilateral UF MD was negatively correlated with ODI in the insula and temporal lobes. CONCLUSIONS:FER is broadly impaired in AD and is associated with bilateral UF abnormalities and reduced ODI in the frontotemporal-limbic regions. These findings suggest that social cognitive dysfunction in AD involves broader frontotemporal-limbic network disruption than isolated white matter abnormalities.
BACKGROUND:Very late-onset schizophrenia-like psychosis (VLOSLP) is clinically heterogeneous, and its relationship with dementia-related neurodegenerative disease remains unresolved. We examined whether Alzheimer's disease (AD) and Lewy body disease (LBD) biomarker status were associated with dementia progression in VLOSLP. METHODS:We retrospectively identified patients who visited the University of Osaka Hospital between January 2018 and December 2023 and met criteria for VLOSLP. Twenty-two participants with AD and/or LBD biomarker data and at least one follow-up assessment within 775 days were classified as biomarker-negative (BMs-neg; n = 7) or biomarker-positive (BMs-pos; n = 15). Group comparisons were performed using Mann-Whitney U tests and Fisher's exact tests. RESULTS:The BMs-pos group showed older onset age and lower memory scores than the BMs-neg group. Dementia progression was more frequent in the BMs-pos group than in the BMs-neg group, although the difference was not statistically significant (8/15 [53.3%] vs. 1/7 [14.3%]; p = 0.165; odds ratio 6.31; 95% CI 0.55-353.18). Five of eight participants with AD biomarker positivity progressed to AD dementia. Three of seven participants with LBD biomarker positivity progressed to dementia, including two diagnosed with dementia with Lewy bodies. Follow-up MMSE, CDR, and CDR-SB scores differed significantly between groups. CONCLUSIONS:AD and/or LBD biomarker-positive VLOSLP may be associated with greater dementia progression and cognitive decline, although findings should be interpreted cautiously given the small sample size and retrospective design. These results support the clinical value of considering neurodegenerative biomarkers when evaluating the prognosis and underlying pathology of VLOSLP.
BACKGROUND:Postoperative delirium (POD) is a common complication in older adults after hip fracture surgery. Although cognitive impairment is a key risk factor, accurately assessing baseline cognition in acute settings remains challenging. Informant-based tools may better reflect premorbid cognitive status; however, their utility in hip fracture populations is unclear. METHODS:This retrospective analysis used data from a prospective cohort of patients aged ≥ 80 years who underwent hip fracture surgery at two acute hospitals in Japan. Pre-fracture cognitive status was assessed using the Dementia Assessment Sheet for Community-based Integrated Care System (DASC-21), primarily based on reports from informants. For selected patients without available informants and with Mini-Mental State Examination (MMSE) scores ≥ 21, structured patient interviews and clinical observations were used. The DASC-21 categories were classified as normal cognition, mild impairment and moderate-to-severe impairment. Cognitive function at admission was evaluated using the MMSE. POD was assessed using the Confusion Assessment Method within the first three postoperative days. Multivariable logistic regression analyses were performed. RESULTS:Among 368 patients, 137 (37.2%) developed POD. POD incidence increased with worsening pre-fracture cognitive impairment (5.6%, 44.3% and 48.7% for normal, mild and moderate-to-severe impairment, respectively; p < 0.001). Each 1-point increase in the MMSE score was associated with lower odds of POD (OR 0.91, 95% CI 0.88-0.94). Compared with normal cognition, the adjusted ORs for POD were 14.11 (95% CI 5.08-39.24) for mild impairment and 15.39 (95% CI 5.56-42.61) for moderate-to-severe impairment. Discrimination was similar between MMSE and DASC-21 (area under the receiver operating characteristic curve 0.75 vs. 0.74). CONCLUSIONS:Pre-fracture cognitive impairment, including DASC-21-defined mild impairment, was associated with POD. The DASC-21 categories showed comparable discriminative performance to the MMSE and may help estimate baseline cognitive vulnerability in acute clinical settings.
Identify digital technology interventions designed for older adults and examine their effects on mental health, including cognition, loneliness, depression and anxiety. A systematic search was conducted in seven English databases and four Chinese databases, encompassing the period from inception to 24 June 2025. Meta-analysis was performed by Review Manager 5.4 and Stata 16. The GRADE (Recommendation, Assessment, Development and Evaluation) system was used to assess the reliability of the evidence. A total of 19 randomised controlled trials involving 1947 older adults were included. The results showed that older adults who received the digital technology intervention had significant improvements in cognitive function (SMD: 1.04, 95% CI: 0.69-1.38, p < 0.001) and significant reductions in depression (SMD: -0.32, 95% CI: -0.51 to 0.14, p < 0.001) and anxiety (SMD: -0.66, 95% CI: -0.90 to -0.43, p < 0.001). However, there was no significant difference in terms of alleviating loneliness (SMD: -0.52, 95% CI: -1.05 to 0.00, p = 0.05) of the older adults. Low-certainty evidence suggests that digital technology interventions may benefit older adults. In the future, more high-quality studies are needed to further verify its effect.
OBJECTIVES:This study aimed to explore how individuals living with early-stage dementia experience stigma and disclosure, and how these processes contribute to the renegotiation of autonomy, identity and social participation in everyday life. METHODS:An interpretive qualitative design was employed. Semi-structured interviews were conducted with 20 individuals diagnosed with early-stage dementia within the past 2 years, recruited from a neurology clinic in northwestern Türkiye. Data were analysed using reflexive thematic analysis. RESULTS:Four interrelated themes were identified, forming a conceptual sequence: vulnerability and continuity in identity, anticipated stigma and disclosure strategies, renegotiation of autonomy in everyday life and changing patterns of social participation and psychosocial support needs. Participants described autonomy not as lost, but as relationally and culturally renegotiated through interactions with family members and social networks, shaped by decisions about disclosure. CONCLUSIONS:Findings position early-stage dementia as a dynamic psychosocial experience in which stigma and disclosure processes directly shape how autonomy is renegotiated. The study underscores the importance of person-centred, stigma-sensitive care approaches that recognise the relational and cultural dimensions of autonomy.
BACKGROUND:This study aimed to clarify the structure of the individual matching support process within Team Orange, a community-based dementia support initiative in Japan. METHODS:Using reflexive thematic analysis, we qualitatively examined semi-structured interviews with seven coordinators who facilitate matching between people living with dementia and community supporters. We also analysed 14 implementation reports documenting actual support cases from community comprehensive support centres in Sapporo, Hokkaido. RESULTS:Analysis identified seven themes constituting a cyclical support process: 'diverse triggers for initiating matching', 'assessing needs and evaluating support potential', 'safe and sustainable support coordination', 'building trust relationships to facilitate matching', 'reaching consensus among people living with dementia, families and supporters', 'implementing individual matching support' and 'reviewing and readjusting toward sustainable support'. CONCLUSIONS:These findings suggest that individual matching is not simply a combination of volunteer activities, but rather a support process in which the coordinator's clinical reasoning and relational coordination cyclically support the agency of people living with dementia, family members and supporters. This practice has the potential to serve as an implementation model that flexibly connects informal community resources with individuals whose needs fall outside the scope of formal care services.
BACKGROUND:This study was conducted to examine the mediating role of eudaimonic well-being in the effect of perceived poverty on quality of life in the elderly. METHODS:This descriptive cross-sectional study was conducted with 523 elderly individuals aged 65 years and over living in Erzurum province between July and November 2024. R programming language 4.1.3, G*Power 3.1, and SPSS-22 program were used in the analysis of the study. RESULTS:The variable 'Perceived Poverty' has a negative and statistically significant effect on eudaimonic well-being (coefficient = -0.2546, p < 0.001). The variable 'eudaimonic well-being' has a positive and statistically significant direct effect on Quality of Life (coefficient = 0.4366, p < 0.001). The variable 'Perceived Poverty' has a negative and statistically significant direct effect on Quality of Life (coefficient = -0.2580, p < 0.001). The indirect effect measured through the variable 'eudaimonic well-being' was statistically significant (Effect = -0.1111, BootLLCI = -0.1385, BootULCI = -0.0826). According to the Shap graph, Perceived Poverty is identified as the most important variable in predicting the Quality of Life variable. CONCLUSIONS:Eudaimonic well-being significantly mediates the negative impact of perceived poverty on elderly quality of life. These findings highlight the need for holistic care programs that combine material support with interventions fostering purpose and personal growth. It is recommended that longitudinal studies be conducted on quality of life among the elderly.
BACKGROUND:Population ageing is accompanied by increasing exposure to psychosocial challenges, including age-related stereotypes and stigma. Internalized age-related stigma has emerged as an important psychosocial factor associated with mental health and well-being among older adults. However, empirical evidence examining its associations with well-being, quality of life, depressive symptoms and perceived social support remains limited, particularly in non-Western cultural contexts. METHODS:This cross-sectional quantitative study included 139 adults aged 65 years and older attending an internal medicine outpatient clinic. Cognitive eligibility was assessed using the revised Turkish version of the Mini-Mental State Examination. Data were collected through face-to-face interviews. Measures included the Internalized Stigma of Ageing Scale (ISAS), WHO-5 Well-Being Index, Geriatric Depression Scale (GDS-15), WHO Quality of Life-AGE (WHOQOL-AGE), Multidimensional Scale of Perceived Social Support (MSPSS), and the Attitudes Towards Ageing Questionnaire. Statistical analyses comprised t-tests, one-way analysis of variance, Pearson correlation and hierarchical multiple linear regression. RESULTS:Participants demonstrated moderate levels of internalized age-related stigma. Internalized stigma was significantly higher among participants who were unemployed and those living alone or with adult children. Internalized stigma was negatively associated with well-being, quality of life and perceived social support, and positively associated with depressive symptoms. Regression analyses indicated that lower well-being, poorer quality of life, higher depressive symptoms and lower perceived social support were significantly associated with higher internalized stigma. CONCLUSIONS:Internalized age-related stigma is a significant psychosocial correlate of mental well-being and quality of life in later life. Interventions targeting psychological well-being and social support may play a role in mitigating stigma-related vulnerability in later life.
AIM:To estimate the association between self-reported visual difficulty and depressive symptoms among adults aged 60 years and older in Peru during 2020. METHODS:A secondary analysis of cross-sectional data from the 2020 Demographic and Family Health Survey (ENDES) was conducted. The exposure variable was self-reported visual difficulty, and the outcome variable was the presence of depressive symptoms, assessed using the Patient Health Questionnaire-9 (PHQ-9). Multiple potential confounding variables were also included. Crude and adjusted ordinal logistic regression models were fitted, and odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs) were estimated. All analyses were weighted to account for the complex sampling design of ENDES 2020. RESULTS:Data from 5066 Peruvians aged 60 years and older were analysed. Overall, 28.0% reported visual difficulty, and 30.3% presented depressive symptoms. In the adjusted ordinal logistic regression model, individuals with visual difficulty had 2.27 times higher cumulative odds of being in a more severe category of depressive symptoms compared with those without visual difficulty (OR = 2.27; 95% CI: 1.86-2.77), after adjusting for multiple potential confounders. CONCLUSIONS:In Peru, self-reported visual difficulty was associated with greater severity of depressive symptoms among adults aged 60 years and older in 2020. These findings highlight the importance of integrating visual function assessment into mental health screening and intervention strategies for the older adult population.
