Objectives The dura mater likely plays a role in amyloid β (Aβ) clearance; however, characteristics of Aβ deposition in dura mater remain unclear. This study investigated the frequency and distribution of dural Aβ deposition and its association with brain pathology. Methods Dural Aβ deposition was examined in seven autopsy cases with available dura mater and compared with brain pathology. Dura samples were obtained from regions overlying the frontal, parietal, and occipital cortices at proximal sites including the superior sagittal sinus (SSS), distal sites 3 cm from SSS, and from regions overlying the temporal cortex. Results Dural Aβ deposition was observed in three cases (43%), two of which had severe cerebral amyloid angiopathy (CAA) in the brain. Dural Aβ deposition was observed only in dura overlying the parietal or occipital cortices. CAA in the dura samples was observed in all three positive cases, but only two (29%) exhibited Aβ deposition in dural connective tissue. Of the three positive cases, two showed deposition only in proximal dura adjacent to the SSS, and one in both proximal and distal dura. Conclusion Dural Aβ deposition showed a regional distribution, suggesting that the site of dural sampling may influence its detection.
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.
