Objectives Nasogastric (NG) tube feeding versus assisted oral feeding is associated with different longitudinal trajectories of nutritional status and muscle reserve in severe dementia. Methods In this prospective longitudinal cohort study, 180 residents with severe dementia were recruited from 13 long-term care facilities in Taiwan. After 1:1 propensity-score matching, 112 residents were included. Nutritional status was assessed using the Mini Nutritional Assessment and calf circumference at baseline, 3 months, and 6 months, and data were analyzed using generalized estimating equations. Results Assisted oral feeding was associated with higher Mini Nutritional Assessment scores and greater calf circumference than NG feeding, whereas both outcomes declined significantly over time. No significant associations were found for age, sex, chronic-disease count, FAST stage, or dementia duration. Conclusion Assisted oral feeding was associated with better nutritional outcomes, although residual imbalance in dementia severity limits causal inference.
We explored the comparability of the “Serial 7s” (S7) and Spelling Backwards (SB) tasks from MMSE in 313 patients with MCI ( N =54) and dementia ( N =259) due to Alzheimer’s disease (AD), frontotemporal lobar degeneration, Lewy body disease, non-AD degenerative (NADD), chronic cerebrovascular disease (CVD) or mixed (AD+CVD) etiologies. Although the two tasks were significantly associated with each other ( r =.54), a two one-sided test revealed that they were not statistically equivalent. Consistently, a linear mixed model testing the effect of task Type (S7 vs. SB) net of demographics, disease duration, disease severity and etiology revealed that the S7 condition was more difficult to be performed ( M =1.69) than the SB one ( M =3.03). Hence, in MCI and dementia due to chronic-degenerative etiologies, the S7 and the SB tasks from the MMSE are not comparable. Users should exert caution when qualitatively interpreting examinees’ attentional levels based on these tasks.
Introduction The purpose of this secondary data analysis of an RCT, was to examine the preliminary efficacy of moderate-intensity cycling exercise versus control on cognitive and affective symptoms (i.e., depressive and anxiety), and quality of life (QoL) in older adults with subjective cognitive decline (SCD). Methods Community-dwelling older adults with SCD (N=38) were randomized to 12 weeks/36 sessions. For this secondary data analysis, between-group change was evaluated by analysis of covariance, adjusting for baseline values. Results The participants’ mean age was 74.6(7.4) years, and 69% female. There were no significant between-group changes in all outcomes (p-values ranged from .06-.70. Large and moderate between-group effect sizes were seen in favor of the control group for anxiety symptoms (between-group change=−5.36 [4.74], η p 2 =0.11. Discussion Attention and social interaction received by this secluded population of older adults and COVID-19 losses likely impacted results. Further mixed-methods research with larger groups that does not span a pandemic, is necessary. Clinical Trial Registry Concurrent Aerobic Exercise and Cognitive Training to Prevent Alzheimer’s in At-risk Older Adults (Exergames): NCT04311736.
Background This study aimed to investigate the correlation between multi-metric resting-state fMRI (rs-fMRI) changes and cognitive performance in amnestic mild cognitive impairment (aMCI), moving beyond single-metric analyses. Methods Forty aMCI patients and twenty healthy controls underwent 3.0T rs-fMRI and neurocognitive assessment (MoCA, DST). Multiple rs-fMRI metrics (ReHo, ALFF/fALFF, RSFC) were analyzed for their association with cognition. Results aMCI patients showed increased frontal ReHo, decreased ALFF in default mode network hubs, and reduced prefrontal-parietal-temporal RSFC. Frontal hyper-synchronization correlated negatively with cognitive scores, while DMN ALFF correlated positively. Conclusions Multi-metric fMRI detects characteristic functional alterations in aMCI, indicating regional brain damage or compensatory changes linked to cognitive performance.
The worldwide rise in dementia cases is creating significant pressures on healthcare systems, clinicians, and decision-makers. As dementia does not follow a single predictable pathway, individuals commonly move across different care settings as their needs evolve, requiring coordinated and integrated responses across the healthcare system rather than isolated efforts within single services. This perspective study explores service quality and underlying structural challenges throughout the dementia care pathway with a particular concentration on transitions between various stages. Key barriers to successful implementation include fragmented service delivery, short-term funding structures, weak coordination across care settings, staffing constraints, and challenges in staff retention. These challenges undermine care standards and result in avoidable emergency department and acute care utilization that contribute to increasing health systems expenditures. Strengthening integrated, person-centered, and transition-oriented care frameworks is critical to enhance outcomes and support sustainable health system responses to an increasing global impact of dementia.
Objective To assess external counterpulsation (ECP) effects on cognitive and functional decline in early AD. Methods This 12-month, multicenter, blinded, randomized, sham-controlled trial enrolled 190 patients with early AD (MCI due to AD or mild AD per NIA-AA clinical criteria). Participants received either full-pressure ECP (150-300 mmHg) or sham (25 mmHg): 3-5 weekly one-hour sessions for 35 treatments, then twice-weekly through six months. Assessments occurred at baseline and weeks 6, 12, 18, 24, 36, and 52. Primary endpoints included ADCS-ADL, ADAS-cog-14, and VADAS-cog. Results Full-pressure ECP significantly improved ADCS-ADL scores versus sham (mean change 2.57 vs. -0.49; p=0.036) and VADAS-cog scores (9.95 vs. 5.22; p=0.005) at 12-24 weeks. Benefits persisted through 52 weeks despite treatment cessation at 6 months. No serious device-related adverse events occurred. Conclusions Full-pressure ECP therapy significantly improved cognition and ADL compared to sham treatment in early AD. ECP represents a novel therapeutic approach warranting further investigation.
The increasing incidence of Alzheimer’s disease (AD) coupled with emerging diagnostics and treatments underscores the need for early detection of AD, yet identifying these individuals remains challenging. This US study sought to examine community-based physician attitudes regarding diagnosis and treatment of early AD (mild cognitive impairment [MCI] due to AD and mild AD). A total of 177 primary care physicians (PCPs) and 147 neurologists recruited through a national physician panel were surveyed about early AD diagnostic and treatment processes, and self-confidence in identifying and managing the condition. Physicians identified patient and family/caregiver involvement as critical in triggering the diagnostic process. Patterns of use of neurocognitive assessments, structural imaging tests, and AD-specific biomarkers varied between PCPs and neurologists. Confidence diagnosing and managing early AD was a concern across specialties, although was greater among PCPs. Programs promoting awareness of early AD symptoms, and emerging technologies and treatments are critical to timely management.
This study examined the associations of activities of daily living (ADL) limitations and depressive symptoms with global and domain-specific cognition among older adults with chronic diseases. Data were drawn from the 2020 wave of the China Health and Retirement Longitudinal Study, including 5,112 participants aged ≥60 years. Functional ability and depressive symptoms were assessed using the ADL scale and CES-D-10, respectively. Cognitive function was assessed using CHARLS cognitive measures, including the Telephone Interview of Cognitive Status-10 and other cognition-related items. Spearman correlation and path analyses were performed using AMOS and Stata. ADL limitations were associated with poorer global and domain-specific cognitive function, and depressive symptoms accounted for part of these associations in the path models. The proportion accounted for by the indirect effect ranged from 17.39% for visuospatial ability to 60.27% for delayed recall. These findings suggest that functional status, depressive symptoms, and cognition are closely interrelated in this population.
Understanding public beliefs about patients at memory centers may inform efforts to promote early diagnosis and guide clinical discussions of Alzheimer’s disease (AD). Adults (N=3,527) read a vignette describing a fictional person at a memory center and rated the person’s condition as a mental illness, part of typical aging, and psychological or biological origins. Vignettes varied by AD biomarker result, symptom stage, and treatment availability. Participants most strongly believed that the condition was part of typical aging and biological in origin, though beliefs varied across subgroups. Black and Asian participants reported stronger beliefs than White participants that the condition was a mental illness ( β =0.39, P <0.001) and psychological ( β =0.46, P <0.001). Men reported stronger beliefs that the condition was a mental illness ( β =0.19, P <0.001), psychological ( β =0.14, P <0.001), and part of typical aging (β=-0.08, P =0.04). Biomarker positivity heightened biological and lowered psychological attributions (all P <0.05). The findings offer specific insights to guide intervention.
This study examined the association between social distancing measures and Quality of Life (QoL), behavioural problems, and cognition among older adults with severe dementia in residential homes. QoL (Chinese version of the Quality of Life for Late-Stage Dementia), behavioural problems (Chinese version of the Neuropsychiatric Inventory), cognition (Chinese version of the Cognitive Test for Severe Dementia), and clinical variables were evaluated at baseline, 6, and 12 months. Activity involvement was recorded on a monthly basis. Sixty-four participants completed the one-year follow-up. QoL worsened continuously from baseline to month-12; correlated with reduced activity involvement and increased depression level. Behavioural problems increased significantly from baseline to month-12; correlated with reduced activity involvement and deteriorated self-care function. Cognition declined significantly from baseline to month-12; correlated with reduced non-sedentary time. The findings suggest that social restrictions may be negatively related to the QoL, behavioural problems, and cognition of residents with severe dementia.
Understanding the clinical utility of patient-reported outcome measures is critical for using these measures in research and clinical practice. Therefore, the purpose of this analysis was to establish the psychometric properties of three TBI-CareQOL measures in caregivers of people living with Alzheimer's disease or Alzheimer's disease-related dementias (ADRD): Caregiver Strain, Caregiver-Specific Anxiety, and Feeling Trapped. One-hundred-and-ninety-seven caregivers of individuals living with ADRD (n=197) completed three TBI-CareQOL measures, three additional measures to establish convergent and discriminant validity (NIH Toolbox Perceived Stress, Dementia Management Strategies Scale, PROMIS Pain Intensity), and the Dementia Severity Rating Scale to establish known groups validity. Internal consistency and test-retest reliability of the TBI-CareQOL measures were supported (alphas >.70). The TBI-CareQOL measures were also free of floor and ceiling effects. Convergent, discriminant, and known groups validity were also supported. Taken together, findings support the clinical utility of the TBI-CareQOL measures for caregivers of people living with ADRD.
Despite comprising the largest segment of the sexual minority population and experiencing unique stressors and health disparities, bi+ dementia caregivers remain underrepresented in health and caregiving research. This secondary analysis of cross-sectional survey data from LGBTQ+ dementia caregivers (bi+, n = 125; gay[g]/lesbian[l], n = 161) examined whether associations between minority and caregiving stressors and global health differed by caregiver group. Bi+ caregivers reported significantly higher minority stress and lower family quality of life but better health than g/l caregivers. Moderation analyses revealed: higher perceived stress predicted worse health for bi+ but better health for g/l; higher family quality of life predicted better health for both groups, with a stronger effect among bi+ caregivers; and more lifetime discrimination predicted worse health for both groups, with a stronger effect among bi+ caregivers. Results underscore the need for inclusive, affirming research and interventions addressing bi+ caregiver stress experiences.
Timely detection of dementia is crucial for reducing its health and societal burden. Standard tools such as the Mini-Mental State Examination (MMSE) and Cognitive Abilities Screening Instrument (CASI), although widely used, are limited by time and resource demands. This study developed and validated a machine learning-based screening tool using the Six-Question Dementia Screening Test (6Q-DS), a brief interview of six items. Data from 533 older adults at a neurology clinic in Taiwan (331 with dementia, 202 without) were analyzed with eXtreme Gradient Boosting. The 6Q-DS achieved an AUC of 0.936, sensitivity 0.879, specificity 0.951, and accuracy 0.907 for dementia vs non-dementia. For identifying very mild dementia vs non-dementia, the AUC was 0.874, with a sensitivity of 0.818, specificity of 0.805, and accuracy of 0.810. Comparable to MMSE and CASI, the 6Q-DS provides a practical, rapid, and user-friendly tool for dementia screening.
Religiosity and spirituality (R/S) encompass organizational activity, private practice, and intrinsic beliefs, which may relate differently to cognitive and mental health outcomes in older adults. This study identified latent R/S profiles among South Korean older adults with mild cognitive impairment (MCI) and Alzheimer's disease (AD), and examined differences in cognitive function, psychological well-being, and depressive symptoms. Latent profile analysis using Duke University Religion Index indicators was conducted with 518 patients (MCI: n = 224; AD: n = 294). In MCI, three classes that differed in well-being and verbal fluency were identified; they showed no differences in depressive symptoms or other cognitive domains. In AD, four classes were identified that differed in the Short Blessed Test and Word List Recall; in these, well-being, depression, and other cognitive outcomes did not differ across classes. These findings underscore the relevance of diverse R/S patterns in individualized care for older adults with neurocognitive disorders.
We aimed to explore the value and interpretability of a multimodal deep learning model integrating optical coherence tomography angiography (OCTA) and electronystagmography (ENG) for the early screening of Alzheimer's disease (AD) and mild cognitive impairment (MCI). A total of 250 subjects were retrospectively recruited. OCTA images, ENG signals and neurocognitive scores were collected from all subjects. The model had an area under curve of 0.85 for the independent validation cohort, with the sensitivity and specificity of 0.73 and 0.90 at the optimal cut-off of receiver operating characteristic curve, respectively. According to Gradient-weighted Class Activation Mapping analysis, the model focused on regions with reduced microvascular density. SHapley Additive exPlanations analysis revealed that saccade accuracy (left eye), saccade latency (right eye) and smooth pursuit gain (left eye) contributed the most to the model. The multimodal model effectively improves early, non-invasive screening of AD/MCI with good interpretability.
Subarachnoid hemorrhage (SAH) has been reported to cause glial scarring within a short timeframe. Due to the high mortality rate of SAH, there is limited research on its long-term effects and relation to neurodegenerative disorders. This report aims to investigate a combination of healed SAH and Alzheimer's Disease (AD) pathology. A 90-year-old female cadaver, in the anatomy laboratory, was found to have an irregular surgical scar in the right frontoparietal bone. Upon dissection, the right frontal lobe was discovered to be atrophic with a concavity. Histopathology exhibited significant gliosis and corpora amylacea (CA). The cause of death was AD, and past medical history revealed an aneurysmal SAH during childbirth 60 years ago. CA and gliosis are common findings in aging, ischemia, and AD. These findings contribute to the knowledge of the long-term effects of SAH and necessitate further research on the pathogenesis of AD in relation to cerebral ischemia.
BackgroundPhysical activity is crucial for preventing cognitive decline in elders with mild cognitive impairment (MCI) or dementia, but increasing it in this group poses challenges.ObjectiveTo summarize and update barriers and facilitators to physical activity using the COM-B (Capability-Opportunity-Motivation-Behavior) model, and examine variations across settings, cognitive levels, and stakeholders' perspectives.MethodsEight databases (PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, China National Knowledge Network, Wanfang Data and VIP) were searched from inception to January 20, 2024. Barriers and facilitators were analyzed using directed content analysis based on the COM-B model.ResultsFrom 33 studies, 18 barriers and 15 facilitators were identified, spanning all COM-B domains, with variations across settings, cognitive levels, and stakeholders' perspectives.ConclusionThe findings provide a foundation for developing tailored physical activity promotion strategies for older adults with MCI/dementia, which should be differentiated based on residential settings, cognitive impairment levels, and stakeholders involved.
This scoping review examines the impact of inappropriate sexual behaviors (ISBs) in people with dementia on their family caregivers. Through synthesizing 15 studies from 8 countries, 6 themes were identified: complex emotional responses, psychological distress, increased caregiver burden, practical caregiving challenges, impaired marital relationships, and social isolation. Findings reveal caregivers frequently experience helplessness, embarrassment, anger, anxiety, depression, and social withdrawal, exacerbated by societal taboos surrounding sexuality and limited professional support. Spousal caregivers are particularly affected, reporting increased emotional strain and marital distress. Practical caregiving difficulties, including safety and privacy concerns, limited access to care services, and challenging institutionalization decisions, further intensify caregiver burden. The review highlights significant research gaps, including the need for specialized assessment tools, broader and culturally diverse studies, and exploration of ISBs as distinct phenomena. Addressing these gaps is crucial for developing targeted interventions and adequately supporting caregivers, particularly within home-based and culturally sensitive dementia care services.
Objective: Alzheimer's disease (AD) continues to be a major challenge because handling high-dimensional data is time-consuming and expensive due to its complexity. A large feature space often increases computational costs and reduces model interpretability. This study addresses this problem by evaluating and comparing multiple feature selection techniques to identify the most informative biomarkers for AD diagnosis.Methods: Our study used data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to implement and test three feature selection approaches, visualization-based, filter-based, and wrapper-based, within a Naive Bayes (NB) classification framework.Results: Based on the results of the analysis, the wrapper method achieved 96.77% classification accuracy, outperforming both visualization and filter methods with 86.19 and 91.87%, respectively. Interestingly, even when over 92.5% of the original features were removed the classifier still performed well, indicating that only a small set of features is necessary to ensure reliable diagnosis.Discussion: This study illustrates that strategically selecting features improves diagnostic accuracy while reducing computational burden, providing a more efficient framework for machine learning applications in Alzheimer's disease research.
Using LGBTQ+ Social Networks, Aging, and Policy Study Wave 3 data (N = 982), this study examines how caregiving for individuals with mild cognitive impairment, Alzheimer's disease, and related dementias (MCI/ADRD) impacts everyday stressors, discrimination, and health outcomes among LGBTQ+ older adults in the Southern United States. Using chi-square tests, Fisher's exact tests, and logistic regression models, we assessed associations of caregiver role with stress and health outcomes. We then conducted moderation analyses to test interactions between caregiver role and LGBTQ+ minority stress. LGBTQ+ caregivers of individuals with MCI/ADRD were 3 times more likely to experience proximal minority stress (P < 0.05), twice as likely to report suicidal ideation (P < 0.1), and more likely to report cognitive problems (P < 0.05) and high blood pressure (P < 0.05) than non-caregivers. Interaction effects suggest that minority stress may exacerbate mental health problems among MCI/ADRD caregivers. Findings underscore the need for targeted supports and interventions for LGBTQ+ older adult dementia caregivers.
