Early detection of possible cognitive decline (PwCD) is crucial for preserving function and independence in aging. Objective:To examine whether dual-task and functional assessment tools can help detect cognitive impairment in older adults without prior diagnosis of neurocognitive disorders. Methods:A cross-sectional study was conducted with healthy older adults (≥60 years). The following exclusion criteria were adopted: neurological diseases with motor deficits, severe functional limitations, mobility aid use, and inability to walk six meters unaided. Assessments included the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test (CDT), Verbal Fluency (VF), Pfeffer Functional Activities Questionnaire, Timed Up and Go (TUG), Sit-to-Stand Test (STS), Berg Balance Scale (BBS), Step Test, and dual-task TUG (TUGdt) using animal naming (TUGdt-NA) and serial subtraction (TUGdt-S7). Statistical analyses included t-tests, Mann-Whitney U, ꭓ2 tests, and logistic regression (p≤0.05). Results:Among 144 participants, 89 were classified as healthy and 55 as PwCD. Most were female (90.9%), black (57.7%), with an average of 11.04 years of education. Groups did not differ in age, gender, or comorbidities. The PwCD group had lower education (p=0.01), more black individuals (p=0.03), and scored significantly worse on all cognitive tests (p<0.0001) and TUGdt (NA: p=0.040; S7: time p=0.027; accuracy p<0.001). No differences were found in STS, Step Test, BBS, or total Pfeffer scores; however, the PwCD group showed greater instrumental activities of daily living (IADL) impairment. Conclusion:The ability to perform dual tasks appears to be associated with functional capacity.
ABSTRACT Functional decline in activities of daily living (ADL) is considered a marker of ageing and Alzheimer’s disease. However, there is a lack of performance-based instruments specifically designed to assess ADL in adults and older adults with Down syndrome. Objective: To describe the adaptation process of the Direct Assessment of Functional Status (DAFS) to assess the functional capacity of adults with Down syndrome. Methods: The Direct Assessment of Functional Status-Brazilian Version (DAFS-BR) was administered to 15 adults with Down syndrome (nine men and six women) who were divided into two diagnostic groups: stable cognition and suspected dementia or cognitive impairment. The process was conducted in two phases: phase one was characterized by an adaptation in the tasks. In phase two, (cultural and semantic) equivalences were verified, as well as structural aspects, including layout and instructions. This phase was essential for verifying the applicability and comprehensibility of newly adapted tasks Results: The DAFS-BR was adapted for the time orientation, communication (telephone use), moneyhandling skills, and shopping skills domains, considering the target population. Conclusion: The adaptation process of the DAFS-BR for people with Down syndrome was made considering linguistic, psychological, and cultural idiosyncrasies in the target population, with the input of experts with relevant experience in each domain. After psychometric studies, the Direct Assessment of Functional Status-Down Syndrome (DAFS-DS) could be considered the first ecological instrument for evaluating functional status in adults with Down syndrome in Brazil to enhance both clinical practice and research.
Advances in healthcare have led to increased life expectancy among individuals with Down syndrome, resulting in a growing population of older adults within this group. As a result, the prevalence of cognitive decline and dementia has increased, largely due to the genetic predisposition of Down syndrome to early and significant accumulation of brain amyloid and intensified formation of neurofibrillary tangles. Early detection of functional alterations, particularly those related to gait and balance, may serve as a valuable clinical marker of emerging neurocognitive impairment. Objective:To synthesize the current evidence on the relationship between gait, cognitive decline, and dementia in adults and older adults with Down syndrome. Methods:A systematic search was conducted in the PubMed database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Original observational studies evaluating gait, balance, or fall risk in relation to cognitive decline or dementia in adults with Down syndrome were included. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Results:Thirty-seven records were identified, of which five original studies met the inclusion criteria. Overall, the findings suggest an association between gait alterations, balance, and cognitive decline in individuals with Down syndrome. Commonly reported abnormalities included reduced gait speed, increased gait variability, inconsistency in gait parameters, and impaired balance. However, heterogeneity in study design, different measurement protocols, and small sample sizes limited the comparability and generalizability of the results. Conclusion:Gait assessment holds promise as a non-invasive, accessible approach for early identification of cognitive decline in individuals with Down syndrome. Future research should prioritize longitudinal designs, standardized assessment protocols, and larger representative samples to inform targeted and evidence-based clinical interventions.
Aphasia is a neurological condition characterized by partial or total loss of verbal communication, most commonly caused by stroke. In hospital settings, brief and reliable tools are essential to identify and quantify aphasia early, enabling prompt diagnosis and appropriate rehabilitation planning. However, Brazil lacks language assessment instruments adapted for bedside use. Objective:To perform the cross-cultural adaptation and validation of the Bedside Language test for Brazilian Portuguese. Methods:The BL underwent translation, back-translation, expert review, and cultural adaptation. The final version was administered to 70 participants. Two evaluators applied the instrument on the same day to assess inter-rater reliability, and the same examiner reapplied it within two days to assess test-retest reliability. The Bedside Evaluation Screening Test (BEST-2) language test was also used for concurrent validity. Results:The Brazilian version of the BL demonstrated high internal consistency (Cronbach's alpha: spontaneous reading - LE=0.80; comprehension - CO=0.86; repetition - RE=0.95; writing - ES=0.73; overall=0.87), as well as satisfactory intra-rater (p=0.22) and inter-rater (p=0.77) reliability. It showed a strong correlation with the BEST-2 across all linguistic domains except writing. Conclusion:The Brazilian Portuguese version of the BL is a brief, valid, and reliable bedside screening tool for identifying aphasia in patients with ischemic stroke, supporting high-quality care in specialized stroke centers.
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.
ABSTRACT Crossed aphasia is a rare form of aphasia in right-handed individuals with right-hemisphere lesions. We report a man aged 67 years who developed crossed aphasia after a right posterior cerebral artery infarction involving the occipital lobe, thalamus, and medial parietal lobe. Neurological and neuropsychological examinations revealed mild anomic aphasia with preserved repetition and comprehension, left homonymous hemianopia, unilateral spatial neglect, prosopagnosia, and no apraxia. Writing showed a marked script-specific dissociation: kana writing was intact, whereas kanji writing was severely impaired and dominated by recall-failure errors (>90%), with few orthographic or component errors. One-year follow-up using the same language and writing tasks demonstrated partial improvement in accuracy but a stable error profile dominated by recall failures. This rare case indicates that selective kanji agraphia can occur in crossed aphasia due to right-hemisphere lesions and suggests impaired access to the visual orthographic lexicon with atypical hemispheric lateralization of writing functions in Japanese.
ABSTRACT Alzheimer’s disease (AD) is the most common form of dementia worldwide, creating substantial clinical and socioeconomic burdens. Randomized controlled trials (RCTs) provide the highest level of evidence to evaluate interventions, yet global publication trends and thematic evolution have not been systematically analyzed. Objective As far as we are aware, there has been no bibliometric analysis that has thoroughly assessed RCTs in AD, despite their pivotal influence on the development of treatment and prevention strategies. Therefore, in this study, we conducted a bibliometric mapping analysis of global RCTs on AD. Methods A bibliometric analysis of human RCTs on AD from September 2010 to September 2025 was conducted using PubMed and Web of Science. VOSviewer was employed for keyword co-occurrence, co-authorship mapping, and co-citation analyses to identify research themes, collaborations, and temporal trends. Results A total of 4,482 RCTs were identified, revealing five main themes: pharmacological interventions, lifestyle and prevention strategies, pathophysiological mechanisms, cognitive and behavioral interventions, and clinical trial methodology. After 2015, focus shifted from traditional pharmacology to multidomain, prevention-oriented, and precision-driven approaches. Emerging topics included digital health, gut microbiome, and machine learning. Collaboration networks highlighted the dominance of the US and Europe, with rapid growth in Asia and emerging regions. Conclusion Findings indicate a paradigm shift in AD RCTs toward integrative, technology-enabled designs, emphasizing both pharmacological and non-pharmacological strategies. These trends can guide future global research priorities and intervention development.
ABSTRACT Neuropsychiatric symptoms (NPS) are common in dementia and may hinder differential diagnosis between behavioral variant frontotemporal dementia (bvFTD) and Alzheimer’s disease (AD). Despite investigations of NPS and social cognition, particularly Theory of Mind (ToM) and emotion recognition, their precise, differential impact on social cognition in bvFTD versus AD remains less characterized. Objective: This study examined NPS in bvFTD and their association with social cognition, comparing results to AD. Methods: Patients with bvFTD (n=13) and AD (n=18) were assessed using neuropsychiatric and cognitive batteries measuring depression, anxiety, mania, and psychosis. Social cognition was evaluated with the Mini-Social and Emotional Assessment (mini-SEA), including the Faux-Pas test (ToM) and the Facial Emotion Recognition Test (FERT). Results: The groups did not differ in sex, education, or disease duration. Compared to AD, bvFTD patients had higher manic symptoms (p<0.001) and schizophrenia spectrum symptoms, particularly in negative (p<0.001) and resistance/hostility (p=0.034) symptoms. In bvFTD, depressive (p=0.020) and anxious (p=0.045) symptoms positively correlated with the Faux-Pas test, while positive psychotic symptoms correlated negatively (p=0.005). In AD, obsessive-compulsive (p=0.013) and disorganized psychotic symptoms (p=0.009) negatively correlated with the Faux-Pas test, while manic symptoms negatively correlated with the FERT (p=0.033). Conclusion: bvFTD patients displayed more schizophrenic and manic symptoms than AD, with NPS impacting social cognition differently in each condition.
ABSTRACT The study of subjective well-being (SWB) is fundamental to positive psychology, being considered a potential protective factor for health and the maintenance of cognitive reserve during aging. Despite international evidence, there are gaps in the Brazilian literature regarding how specific components of SWB relate to different cognitive domains. Objective: To analyze the relationship between subjective well-being and cognitive performance in cognitively healthy Brazilian older adults. Methods: A longitudinal study was conducted with 183 older adults (mean age 67.3 years). Scales for General Life Satisfaction (SGV), Domain-Referenced Life Satisfaction (SVRD), and the Positive and Negative Affect Scale were applied. Cognitive performance was assessed using the Addenbrooke’s Cognitive Examination-Revised (ACE-R) and the Mini-Mental State Examination (MMSE). Data were analyzed via Spearman’s correlation matrix. Results: The sample showed a female predominance and high educational level (mean of 17 years). Participants exhibited high levels of SWB and good cognitive performance. General life satisfaction correlated positively with the MMSE and the attention/orientation domains of the ACE-R. Satisfaction with mental capacity (SVRD_Mental) showed a significant correlation with global performance in both cognitive tests. However, no significant correlations were found between affect states (positive or negative) and cognition in this sample. Conclusion: Healthy, highly educated older adults exhibit high levels of subjective well-being and satisfactory cognitive performance. The results reinforce the association between life satisfaction and cognitive reserve, suggesting that SWB may act as a marker of successful aging.
ABSTRACT Vanishing white matter (VWM) disease is a leukodystrophy caused by mutations in EIF2B1–5 genes, which impair cellular stress responses and protein synthesis regulation, leading to astrocytic dysfunction and white matter degeneration. While typically a pediatric condition, adult-onset cases are increasingly recognized. We report a 39-year-old Brazilian woman with a six-year history of progressive cognitive decline, gait impairment, and rapid deterioration following an infection. Neurological examination revealed spastic tetraparesis and severe cognitive impairment. Brain magnetic resonance imaging (MRI) showed diffuse white matter abnormalities with cystic degeneration. Whole-exome sequencing identified a homozygous EIF2B3 c.260C>T (p.Ala87Val) variant, previously associated with a founder effect in Quebec but not reported in Brazil. This case highlights the phenotypic variability of VWM, stress-triggered exacerbations, and the importance of genetic testing in adult patients with cognitive decline. It also expands the genotypic diversity of VWM in Brazil and underscores the need for multidisciplinary care.
ABSTRACT With population aging, the prevalence of cognitive deficits increases, highlighting the importance of nonpharmacological interventions for promoting mental health in older adults. Objective: To evaluate the efficacy of a remote cognitive stimulation program (Mentes Ativas) in cognitively healthy older adults. Methods: The initial sample included 56 participants enrolled in the USP 60+ program at the School of Arts, Sciences, and Humanities of the University of São Paulo. For the final analyses, 22 participants who completed at least 80% of the sessions over a six-month period were assessed. Assessments included the Geriatric Depression Scale, Geriatric Anxiety Inventory, Cognitive Function Instrument, and Satisfaction with Life Scale. Data were collected at baseline and post-intervention and analyzed using non-parametric statistical tests. Results: There was a significant reduction in perceived subjective cognitive decline (mean score from 4.07 to 3.07; p=0.005) and in depressive symptoms (3.55 to 2.32; p=0.046), as well as a decrease in anxiety symptoms (5.88 to 3.95) and slight improvement in life satisfaction (7.59 to 7.95), although not statistically significant (p=0.132). Significant correlations were found among greater perceived cognitive decline, both depressive and anxiety symptoms, and with lower life satisfaction. Conclusion: The Mentes Ativas program may help promote cognitive and psychosocial improvements in older adults, reinforcing the role of cognitive interventions in promoting healthy aging.
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.
ABSTRACT The diagnosis of Alzheimer’s disease (AD) based on biomarkers of the pathological process represents a significant change from previous criteria, which required the presence of dementia for AD diagnosis. These new criteria create difficulties in disclosing the diagnosis of AD to asymptomatic individuals. A similar example exists in the history of cognitive and behavioral disorders, where the risk of developing dementia paralytica (DP), a form of neurosyphilis (NS), could be detected even in the asymptomatic phase. Treatment in this phase of DP or in its early symptomatic phase was successful due to the discovery of new therapeutic modalities and new evolutionary biomarkers, which are not yet widely available in AD. This type of biomarker was very important in NS and will certainly be in AD, allowing for faster and less expensive clinical trials.
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.
ABSTRACT. Subjective cognitive decline (SCD) is characterized by the individual’s self-perception of cognitive decline, without functional impairment and objective confirmation through neuropsychological testing. SCD has been studied as a possible clinical marker of early stages of neurodegenerative diseases, especially Alzheimer’s disease. This article presents a narrative review of the available literature on the context of SCD in Brazil, covering conceptual aspects, diagnosis, etiologies, assessment measures used in the country, case outcomes, epidemiological data, and predictors of progression. Proposals for the evaluation and clinical monitoring of patients with SCD were also developed. Although there is growing scientific interest in the topic, gaps remain in the clinical approach to SCD, and a lack of national data and specific tools validated for the Brazilian population persists.
ABSTRACT. Self-perception of aging is considered one of the indicators of health and vulnerability. Understanding how older adults perceive their aging can be an effective way to develop strategies to prevent vulnerability and promote healthy aging. Objective: The aim of this study was to investigate the self-perception of aging and its associated factors in a group of older adults in Morocco to contribute to healthy aging. Methods: This was a cross-sectional study conducted between June 2022 and July 2023 among 496 people aged 60 years and over who visited health centers in the province of Essaouira. A positive or negative self-perception of aging was established using the Attitudes Toward Own Aging subscale, which includes five items from the Philadelphia Geriatric Center Morale Scale. Sociodemographic characteristics and data related to lifestyle and health status were collected through interviews, by consulting health records, and were supplemented with anthropometric measurements. Binary logistic regression was used to determine the potential factors influencing self-perception of aging. Results: A negative self-perception of aging was identified in 21.4% of participants. Multivariate analysis revealed that being unmarried (OR 2.027; 95%CI 1.261–3.259), having depressive symptoms (OR 1.729; 95%CI 1.082–2.765), and being dependent (OR 1.926; 95%CI 1.134–3.272) were the main factors statistically associated with a negative self-perception of aging. Conclusion: A strategy to prevent loneliness and social isolation, as well as screening programs for depression and dependency in older adults, could contribute to successful and healthy aging.
ABSTRACT. In Tsurezuregusa, a medieval Japanese essay written by Kenkō, a priest with the characteristics of behavioral variant frontotemporal dementia (bvFTD), has been described. He had characteristics such as early behavioral disinhibition; loss of sympathy and empathy; perseverative, stereotyped, and compulsive/ritualistic behavior; and hyperorality and dietary changes. Based on the diagnostic criteria for bvFTD, it is possible that he had probable bvFTD. According to the essay, despite his abnormal behavior, the priest had adapted to his surroundings, including the temple where he worked. His successful adaptation was likely due to the tolerance of people around him and/or the education he had acquired before the onset of the disease, which may have functioned as a "cognitive reserve."
ABSTRACT. Education for active aging, combined with technologies and cognitive games, promotes well-being, social engagement and cognitive stimulation in older adults. Objective: The aim of this study was to analyze the effects of digital games on cognitive stimulation in older adults, combined with an educational intervention on active aging. Methods: A workshop comprising 10 weekly 90-min sessions was run. Data collection was conducted online and involved application of a sociodemographics questionnaire. The protocol included the Cognitive Function Instrument, Geriatric Anxiety Inventory, Geriatric Depression Scale-15, Satisfaction with Life Scale, Social Support Scale of Medical Outcome Study, and Lubben Social Network Scale. Sessions were conducted by two monitors who were Gerontology graduates. A total of 31 older adults took part (mean age=67; standard deviation=6.40 years). Most participants were women (96.77%) and had complete higher educational level (77.42%). Results: On the post-test, participants had a mean score for cognitive performance of 416.43 points (scale 0–1,000), most notably for impulsivity control (55.93 points), followed by reaction time (43.93) and decision-taking (41.07). Participants showed a reduction in anxious and depressive symptoms, and improved self-perceived performance in cognitive skills. Conclusion: The digital cognitive games platform proved feasible and well accepted, showing potential for expanding self-awareness about aging and promoting cognitive and psychosocial health in older adults.
