ABSTRACT Recent clinical observations indicate that late‐onset psychosis can precede the onset of dementia with Lewy bodies (DLB). However, its longitudinal clinical trajectory remains poorly understood. Delusional disorder (DD) in older adults is relatively uncommon and poor insight frequently leads to refusal of psychiatric care, limiting available data despite its long‐standing diagnostic recognition. This article focuses on late‐onset DD in relation to subsequent development of DLB. We revisited our previously reported cases in which delusions were the initial manifestation of Lewy body disease (LBD) and aimed to identify the shared clinical features to help delineate more homogeneous subgroups within the heterogeneous spectrum of late‐onset psychosis. These cases with late‐onset DD revealed a recurring phenotype characterised by onset in the 50s and 60s, reluctance to seek psychiatric care, eventual hospitalisation, poor antipsychotic tolerance and delayed emergence of dementia accompanied by core features of DLB. Clinicopathological examination of four cases raises the hypothesis that persistent delusions may emerge in the presence of relatively restricted Lewy pathology, preceding the development of widespread cortical involvement and overt dementia. Relative preservation of neuronal populations in the substantia nigra may account for the absence of parkinsonism during the early phases dominated by isolated delusions. Despite long‐standing delusions beginning in the 50s and 60s, a common age range for DLB onset (mid‐70s and older) was observed, indicating an exceptionally prolonged prodromal period. These findings suggest that late‐onset DD associated with LBD may follow a clinical trajectory distinct from that of mild cognitive impairment with Lewy bodies (MCI‐LB), the most common clinical phenotype of prodromal DLB. Differentiating DD from broader late‐onset psychosis categories may facilitate future research by reducing heterogeneity and stratifying cases with potentially prolonged periods without dementia or parkinsonism. Clinical and pathological reports of late‐onset DD remain scarce and further case documentation is warranted.
ABSTRACT Background Population ageing and its associated challenges have become a significant public health issue globally. Like other countries, Iran is witnessing a rapid increase in the number of older adults. It is estimated that the population aged 60 years and older will constitute 10.5% and 21.7% of Iran's population in 2025 and 2050, respectively. These figures emphasize the necessity of finding appropriate strategies for healthy ageing. This study aimed to examine the indirect association of psychological well‐being in the relationship between social anxiety and loneliness among older adults in Tehran. Pet ownership was an inclusion criterion and was not analysed as a study variable. Methods This descriptive–correlational study was conducted in Tehran, Iran, between October 2025 and March 2026. A total of 430 older adults with pets were recruited and completed the study. After removing six outliers, 424 participants were included in the final analysis. Data were collected using the Revised UCLA Loneliness Scale, Psychological Well‐Being Scale and Liebowitz Social Anxiety Scale (LSAS‐SR). The collected data were analysed using descriptive and inferential statistics, including structural equation modeling (PLS‐SEM). Results Based on the findings of this cross‐sectional study among 424 older adults in Tehran, most participants were aged 60–70 years and female. The mean scores of psychological well‐being (39.73), loneliness (32.26) and social anxiety (47.68) were moderate. Social anxiety was associated with higher levels of loneliness directly ( β = 0.496) and showed a positive indirect association with loneliness through lower levels of psychological well‐being ( β = 0.083). Moreover, psychological well‐being was negatively correlated with loneliness ( β = −0.192) and social anxiety ( β = −0.432). In general, the results showed that psychological well‐being and social anxiety were significantly associated with loneliness. Conclusion According to the results of this study, social anxiety had the strongest association with loneliness among older adults. There was a partial indirect association through psychological well‐being in the relationship between social anxiety and loneliness. Thus, the findings highlight the need to pay more attention to social anxiety and psychological well‐being among older adults with pets.
ABSTRACT Background and Purpose Remote cognitive assessment has gained prominence due to limited access to in‐person services. The purpose was to investigate the agreement between in‐person and telephone administration of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Methods For this methodological study, the IQCODE was administered to the caregiver or family member of the older adults in‐person and by telephone. The order of the administration modalities was randomized, with the assessments conducted 5–7 days apart. Each participant was assessed by two different and previously trained researchers, who were blinded to the previous assessment. The intraclass correlation coefficient (ICC) was used to assess the level of agreement between the total and item scores obtained using the two methods. Results The study included 51 individuals. There were no statistically significant differences between the two methods ( p = 0.227). Regarding the total score, a high ICC (ICC = 0.74) was observed. Regarding the items, the ICCs ranged from 0.17 to 0.98, representing low to high agreement. Conclusion The telephone assessment of the IQCODE showed adequate agreement with the in‐person assessment for evaluating cognitive decline in older adults. Therefore, telephone‐based assessments may be used in clinical and research settings via telephone interviews, expanding access to cognitive assessment and contributing to more inclusive care strategies.
ABSTRACT Background Assessment scales to detect subtle declines in activities of daily living (ADL) among patients with mild cognitive impairment (MCI) are needed for early diagnosis and support. This study examined the psychometric properties of the Japanese version of the Alzheimer's Disease Cooperative Study‐Activities of Daily Living for Mild Cognitive Impairment (ADCS‐MCI‐ADL‐J), an ADL assessment scale adapted for patients with early‐stage Alzheimer's disease (AD). Methods This multisite study recruited patients with MCI due to AD or mild AD dementia (ADD), and healthy controls (HC) between March 2024 and March 2026. Reliability (internal consistency, inter‐rater reliability, and test–retest reliability) and validity (discriminative, concurrent, convergent, and construct validities) were analysed as psychometric properties. As an interpretability analysis, we also checked the score distributions of the ADCS‐MCI‐ADL‐J to investigate a ceiling effect compared with other existing ADL assessment scales. Results A total of 102 participants were included in the analysis (HC, n = 30; MCI due to AD, n = 37; mild ADD, n = 35). Sixty participants (58.8%) were female and the overall mean age (standard deviation) was 72.6 (9.1). The Cronbach's α for the ADCS‐MCI‐ADL‐J was 0.893, indicating acceptable internal consistency. The inter‐rater and test–retest reliabilities were excellent, indicated by intraclass correlation coefficients of 0.917 and 0.915, respectively. Areas under the curve were 0.937 for MCI versus HC and 0.859 for MCI versus mild ADD. The ADCS‐MCI‐ADL‐J significantly distinguished MCI due to AD from HC and mild ADD. The ADCS‐MCI‐ADL‐J score was significantly correlated with other ADL scales and the severity of dementia, cognitive impairment, and neuropsychiatric symptoms. The ADCS‐MCI‐ADL‐J was divided into three factors. The ADCS‐MCI‐ADL‐J scores showed a wider distribution without a ceiling effect compared to other existing scales. Conclusions This study examined several psychometric properties of ADCS‐MCI‐ADL‐J. This assessment scale is useful for reliably detecting subtle declines in ADL at the MCI stage. Trial Registration UMIN‐CTR: UMIN000055015
