BACKGROUND:Diagnostic criteria for apathy in neurocognitive disorders (DCA-NCD) have recently been updated. OBJECTIVES:We investigated whether validated scales measuring apathy severity capture the three dimensions of the DCA-NCD (diminished initiative, diminished interest, diminished emotional expression). MEASUREMENTS:Degree of mapping ("not at all", "weakly", or "strongly") between items on two commonly used apathy scales, the Neuropsychiatric Inventory-Clinician (NPI-C) apathy and Apathy Evaluation Scale (AES), with the DCA-NCD overall and its 3 dimensions was evaluated by survey. DESIGN:Survey participants, either experts (n = 12, DCA-NCD authors) or scientific community members (n = 19), rated mapping for each item and mean scores were calculated. Interrater reliability between expert and scientific community members was assessed using Cohen's kappa. RESULTS:According to experts, 9 of 11 (81.8%) NPI-C apathy items and 6 of 18 (33.3%) AES items mapped strongly onto the DCA-NCD overall. For the scientific community group, 10 of 11 (90.9%) NPI-C apathy items and 7 of 18 (38.8%) AES items mapped strongly onto the DCA-NCD overall. The overall mean mapping scores were higher for the NPI-C apathy compared to the AES for both expert (t (11) = 3.13, p = .01) and scientific community (t (17) = 3.77, p = .002) groups. There was moderate agreement between the two groups on overall mapping for the NPI-C apathy (kappa= 0.74 (0.57, 1.00)) and AES (kappa= 0.63 (0.35, 1.00)). CONCLUSIONS:More NPI-C apathy than AES items mapped strongly and uniquely onto the DCA-NCD and its dimensions. The NPI-C apathy may better capture the DCA-NCD and its dimensions compared with the AES.

Schizophrenia is associated with early mortality of 15 to 20 years, and 80 % of deaths are due to cardiovascular disease with a three-times greater risk of sudden-cardiac-death. While lifestyle, medications, genetics, and healthcare disparities are contributing factors, the etiology of this complex process is not fully understood. The aim of this study is to examine cardiac-related healthcare utilization and electrocardiogram (ECG) outcomes in schizophrenia at the end of life (EOL). A cohort of individuals with schizophrenia (SG) (n = 610, ≥50 years) were identified retrospectively from a unified clinical data platform and measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Similarly, a control group (n = 610) was randomly identified and matched by gender (53 % females) and age of death (72.8 ± 12.4 years). Statistical methods included Cochran-Mantel-Haenszel and mixed-effects logistic & linear regression tests with adjustments for match strata and marital status, race, age, and gender as covariates. Results indicate that SG was more likely to be unmarried, unemployed, or from minority groups (all p < 0.001), and more likely to have diabetes and/or cardiovascular disease (p < 0.001). SG was less likely to receive an ECG (p = 0.001) or cardiac catheterization procedure (p < 0.001). SG had a greater mean QTc (447.2 ms vs. 434.6 ms; p = 0.001) and were twice as likely to have "prolonged QT" on ECG report (p = 0.006). In conclusion, SG had reduced likelihood of cardiac-related healthcare interventions, and despite greater likelihood of prolonged QTc, a recognized biomarker of cardiac risk, ECG was less likely at EOL. Given greater cardiac comorbidity and risk of sudden cardiac death in schizophrenia, improved practice guidelines are needed.

INTRODUCTION:Apathy is common in neurocognitive disorders (NCD) but NCD-specific diagnostic criteria are needed.METHODS:The International Society for CNS Clinical Trials Methodology Apathy Work Group convened an expert group and sought input from academia, health-care, industry, and regulatory bodies. A modified Delphi methodology was followed, and included an extensive literature review, two surveys, and two meetings at international conferences, culminating in a consensus meeting in 2019.RESULTS:The final criteria reached consensus with more than 80% agreement on all parts and included: limited to people with NCD; symptoms persistent or frequently recurrent over at least 4 weeks, a change from the patient's usual behavior, and including one of the following: diminished initiative, diminished interest, or diminished emotional expression/responsiveness; causing significant functional impairment and not exclusively explained by other etiologies.DISCUSSION:These criteria provide a framework for defining apathy as a unique clinical construct in NCD for diagnosis and further research.

Objectives To characterize pretransfer on-site nursing home (NH) management, transfer disposition, and hospital discharge diagnoses of long-stay residents transferred for behavioral concerns. Design This was a secondary data analysis of the Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care project, in which clinical staff employed in the NH setting conducted medical, transitional, and palliative care quality improvement initiatives and gathered data related to resident transfers to the emergency department/hospital setting. R software and Microsoft Excel were used to characterize a subset of transfers prompted by behavioral concerns. Setting NHs in central Indiana were utilized (N = 19). Participants This study included long-stay NH residents with behavioral concerns prompting transfer for acute emergency department/hospital evaluation (N = 355 transfers). Measurements The measures used in this study were symptoms prompting transfer, resident demographics and baseline characteristics (Minimum Data Set 3.0 variables including scores for the Cognitive Function Scale, ADL Functional Status, behavioral symptoms directed toward others, and preexisting psychiatric diagnoses), on-site management (e.g., medical evaluation in person or by phone, testing, and interventions), avoidability rating, transfer disposition (inpatient vs emergency department only), and hospital discharge diagnoses. Results Over half of the transfers, 56%, had a medical evaluation before transfer, and diagnostic testing was conducted before 31% of transfers. After transfer, 80% were admitted. The most common hospital discharge diagnoses were dementia-related behaviors (27%) and altered mental status (27%), followed by a number of medical diagnoses. Conclusion Most transfers for behavioral concerns merited hospital admission, and medical discharge diagnoses were common. There remain significant opportunities to improve pretransfer management of NH transfers for behavioral concerns.

Apathy is one of the most prevalent, stable and persistent neuropsychiatric symptom across the neurocognitive disorders spectrum. Recent advances in understanding of phenomenology, neurobiology and intervention trials highlight apathy as an important target for clinical intervention. We conducted a comprehensive review and critical evaluation of recent advances to determine the evidence-based suggestions for future trial designs. This review focused on 4 key areas: 1) pre-dementia states; 2) assessment; 3) mechanisms/biomarkers and 4) treatment/intervention efficacy. Considerable progress has been made in understanding apathy as a treatment target and appreciating pharmacological and non-pharmacological apathy treatment interventions. Areas requiring greater investigation include: diagnostic procedures, symptom measurement, understanding the biological mechanisms/biomarkers of apathy, and a well-formed approach to the development of treatment strategies. A better understanding of the subdomains and biological mechanisms of apathy will advance apathy as a treatment target for clinical trials.

Persons with dementia (PWD) benefit from participating in meaningful activities. This study's objective was to learn the characteristics of successful meaningful activities from community-based service providers who work with PWD. Six group interviews were performed with 15 unique professionals from an adult day service or community-based coordinated care program. These were supplemented by 100 hr of researcher immersion through weekly volunteering. Data were analyzed by a team, using qualitative content analysis. Participants reported successful activity content incorporated personalization; continuity and incremental challenges; and social engagement. Successful delivery of activities required managing necessary resources; involving informal (family/friend) caregivers; having a backup plan; monitoring time of day and energy levels; facilitating a domino effect; and ensuring safety. Outcomes of successful activities were experiencing fulfillment and purpose; overcoming challenges; and unexpected triggers. Research and practice recommendations include testing innovative, dynamic, and technology-enabled approaches to providing such activities.

Introduction Schizophrenia is a severe and persistent mental illness associated with early mortality and a higher rate of medical comorbidity compared to the general population. Individuals with schizophrenia are at risk of healthcare disparities including reduced access to primary care and suboptimal health maintenance interventions. Barriers to care can include impairment communicating with healthcare providers, the stigma of psychiatric disease, and a poor understanding of medical condition and need for treatment all of which can delay diagnosis and timely treatment. However, only few studies exist related to healthcare access at the end-of-life. Because individuals with schizophrenia die 10-20?years younger than the general population, it is important to identify modifiable risk factors to improve care in this vulnerable population. Specifically, we aimed to investigate the prevalence of cardiovascular disease and diabetes compared to controls, and evaluate occurrence of routine laboratory studies and preventive health measures. Methods We conducted a retrospective examination of healthcare access among deceased individuals with and without schizophrenia. The Mayo Clinic Advanced Cohort Explorer was used to identify records with ICD -9/10 codes (295.0 – 295.9; F20.0 –F20.9) to establish a cohort of deceased patients with schizophrenia (N = 1191) and a date of death between 1/1/1999 – 1/1/2019. A control group without schizophrenia or any mental disorder was established (N = 1191) and matched by gender and age at time of death. Using a retrospective cohort design the prevalence of cardiovascular disease and diabetes were measured in subjects ≥ 50?years of age within the 3?years preceding death; the following routine health maintenance studies were also evaluated: complete blood count (CBC), low density lipoprotein (LDL), hemoglobin A1C (HbA1c), and electrocardiography (ECG).Between group differences were determined using chi-square (Х2) with p < 0.05 indicating statistical significance. The study was IRB-approved and only included those with research authorization. Results The average age of death was 71.4?years in both groups due to matching by age of death. The age range among patients and controls spanned from 50 to 104?years. Individuals with schizophrenia were significantly more likely to be single, divorced, or separated (p<0.05) and were more likely to have diabetes (41.2% vs. 18.9%, p<0.001) and cardiovascular disease (76.0% vs. 62.0%, p<0.001) compared to matched controls. Despite higher rates of cardiovascular disease significantly fewer patients with schizophrenia underwent an ECG (42.1% vs. 76.1%, p<0.001). However the patients with schizophrenia had a greater number of ECGs on average per patient. Furthermore the patients with schizophrenia had a significantly more frequent lipid panels (45.6% vs. 36.4%, p<0.001) and hemoglobin A1C tests (40.4% vs. 14.6%, p<0.001) performed compared to controls. Conclusions Our findings indicate higher rates of diabetes and cardiovascular disease in individuals with schizophrenia compared to controls ≥ 50?years of age matched by gender and age of death which is consistent with other studies. However patients with schizophrenia were less likely to have received an ECG within the three years preceding death despite the aforementioned comorbidities. The schizophrenia group was significantly more likely to have received routine HbA1c and lipid panel testing however. This research was funded by: No funding sources were used for this project

To identify knowledge gaps regarding new-onset agitation and impulsivity prior to onset of cognitive impairment or dementia the International Society to Advance Alzheimer's Research and Treatment Neuropsychiatric Syndromes (NPS) Professional Interest Area conducted a scoping review. Extending a series of reviews exploring the pre-dementia risk syndrome Mild Behavioral Impairment (MBI), we focused on late-onset agitation and impulsivity (the MBI impulse dyscontrol domain) and risk of incident cognitive decline and dementia. This scoping review of agitation and impulsivity pre-dementia syndromes summarizes the current biomedical literature in terms of epidemiology, diagnosis and measurement, neurobiology, neuroimaging, biomarkers, course and prognosis, treatment, and ongoing clinical trials. Validations for pre-dementia scales such as the MBI Checklist, and incorporation into longitudinal and intervention trials, are needed to better understand impulse dyscontrol as a risk factor for mild cognitive impairment and dementia.

BACKGROUND AND OBJECTIVES Decisions about long-term care and financing can be difficult to comprehend, consider, and communicate. In a previous needs assessment, families in rural areas requested a patient-facing website; however, questions arose about the acceptability of an online tool for older adults. This study engaged older adults and family caregivers in (a) designing and refining an interactive, tailored decision aid website, and (b) field testing its utility, feasibility, and acceptability. RESEARCH DESIGN AND METHODS Based on formative work, the research team engaged families in designing and iteratively revising paper drafts, then programmed a tailored website. The field test used the ThinkAloud approach and pre-/postquestionnaires to assess participants' knowledge, decisional conflict, usage, and acceptability ratings. RESULTS Forty-five older adults, family members, and stakeholders codesigned and tested the decision aid, yielding four decision-making steps: Get the Facts, What Matters Most, Consider Your Resources, and Make an Action Plan. User-based design and iterative storyboarding enhanced the content, personal decision-making activities, and user-generated resources. Field-testing participants scored 83.3% correct on knowledge items and reported moderate/low decisional conflict. All (100%) were able to use the website, spent an average of 26.3 min, and provided an average 87.5% acceptability rating. DISCUSSION AND IMPLICATIONS A decision aid website can educate and support older adults and their family members in beginning a long-term care plan. Codesign and in-depth interviews improved usability, and lessons learned may guide the development of other aging decision aid websites.

ABSTRACT Background: Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research. Methods: Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: “mild cognitive impairment,” “dementia,” “prodromal dementia,” “preclinical dementia,” “Alzheimer's,” “depression,” “dysphoria,” “mania,” “euphoria,” “bipolar disorder,” and “irritability.” Results: Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset. Conclusion: Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.

Objective To investigate the relationship between amyloid burden and frequency of existing and incidence of new neuropsychiatric symptoms (NPS) in elderly with and without cognitive decline. Methods 275 cognitively normal controls (NC), 100 subjective memory complaint (SMC), 559 mild cognitive impairment (MCI) and 143 Alzheimer’s disease dementia subjects from the Alzheimer’s Disease Neuroimaging Initiative received (18F)-florbetapir positron emission tomography (PET) scans. Yearly neuropsychiatric inventory (Neuropsychiatric Inventory (NPI)/NPI-Questionnaire) data were collected from the study partners at each visit. Mean standard uptake volume ratios (SUVR) normalised to whole cerebellum were obtained. Positive amyloid PET scan was defined as mean SUVR ≥1.17. Fisher’s exact test was used to compare frequency and incidence between amyloid positive and amyloid negative subjects. Survival analyses were used to estimate of neuropsychiatric symptoms (NPS) between amyloid positive and amyloid negative subjects. Survival analyses were used to estimate hazard ratios for developing the most common NPS by amyloid status. Results No differences in NPS frequency were seen between amyloid positive and amyloid negative NC, SMC, MCI or dementia groups. MCI subjects with amyloid pathology however tended to have greater frequency x severity (FxS) of anxiety, hallucinations, delusions, apathy, disinhibition, irritability, aberrant motor behavior, and appetite, but not agitation, depression, night-time disturbances, or elation. MCI subjects with amyloid pathology were at greater risk for developing apathy, anxiety and agitation over time. Baseline presence of agitation and apathy and new onset agitation, irritability and apathy predicted faster conversion to dementia among MCI subjects. Conclusions Amyloid pathology is associated with greater rate of development of new NPS in MCI. Anxiety and delusions are significant predictors of amyloid pathology. Agitation, irritability and apathy are significant predictors for conversion from MCI to dementia.

The number of Americans with dementia is increasing, and there is a need to assist clinicians, patients, and informal caregivers in the assessment and monitoring of disease progression, and activities of daily living in patients with dementia. Technologies that use avatars to help patients with dementia have become more prevalent and hold promise to assist caregivers and healthcare teams. Describe the state of the literature for current and potential applications of avatar technology for individuals with dementia. Articles were screened using the search engines Pubmed and Google Scholar. The search terms used for the screening were a combination of: “avatar”, “geriatric”, “dementia”, and “mild cognitive impairment”. Each article was assessed by its methodological quality to determine its value for the review. Avatars can be beneficial for a range of dementia care objectives. Virtual reality environments with avatar implementations, speech recognition technology and sensor technology can be used to assess a patient’s cognitive function. Gamifying virtual experiences with avatars, conversational artificial intelligence, and avatar-based virtual support groups can improve socialization in patients with dementia and their caregivers. Avatars can also help patients with dementia by prompting sequential tasks, setting reminders, and providing emotional support. We recommend avatars have several characteristics to optimally benefit the older population with dementia. These characteristics include: physical neutrality in terms of gender and ethnicity, emotional value, use of sound and large icons for the benefit of patients with sensory impairments, and adaptability to the patients’ emotions and cognitive function. The devices that implement avatars should be easy to use for the patient using large icons, clickable buttons, and using familiar interfaces. Implementation of these facets into avatar-based technology can help improve their efficacy in patients with dementia. Avatars can assist patients with dementia, caregivers, and healthcare providers in a number of ways. More research is needed in this area of focus.

Introduction Unpaid informal caregivers of adult care recipients, including persons with dementia, experience multiple unmet information needs and information management challenges. Objectives To understand the current personal health information management (PHIM) practices in informal caregiving for adults with and without dementia. Methods Semi-structured interviews were performed with ten informal caregivers—half of whom were caring for persons with dementia—and four formal caregivers at an adult day service. Interviews centered on a paper-based tool distributed by the day service, the CARE Kit, permitting an artifacts analysis of the tools used by participants for PHIM. Qualitative thematic analysis was applied to interview data. Results Caregivers’ PHIM practices aimed to support daily care management and decision-making on behalf of care recipients, through: 1) information acquisition and integration across multiple sources and records; 2) information maintenance, updating, and use over time; and 3) information sharing and communication with healthcare professionals and other family caregivers. Participants reported advantages and challenges of their PHIM practices and tools, including fitting PHIM into their daily lives, managing PHIM-related cognitive workload, the functionality of PHIM tools, and the dynamic, longitudinal nature of PHIM. Conclusion The study produced a number of implications for caregiver health information management information technology (CHIM IT), based on findings about the nature of caregivers’ practices for managing information for adult care recipients. We present CHIM IT requirements related to privacy and security, customization and flexibility, ease of use, credibility and sensitivity, situation awareness, information integration, delegation and shared use, updating and maintenance, archiving and versioning, communication, agency and information access, and validation.

The workforce available to care for older adults has not kept pace with the need. In response to workforce limitations and the growing complexity of healthcare, scientists have tested new models of care that redesign clinical practice. This article describes why new models of care in aging, dementia, and mental health diffuse inadequately into the healthcare systems and communities where they might benefit older adults. We review a general framework for the diffusion of innovations and highlight the importance of other features of innovations that deter or facilitate diffusion. Although scientists often focus on generating evidence-based innovations, end-users apply their own criteria to determine an innovation's value. In 1962, Rogers suggested six features of an innovation that facilitate or deter diffusion suggested: relative advantage, compatibility with the existing environment, ease or difficulty of implementation, trial-ability or ability to "test drive", adaptability, and observed effectiveness. We describe examples of models of care in aging, dementia and mental health that enjoy a modicum of diffusion into practice and place the features of these models in the context of deterrents and facilitators for diffusion. Developers of models of care in aging, dementia, and mental health typically fail to incorporate the complexities of health systems, the barriers to diffusion, and the role of emotion into design considerations of new models. We describe agile implementation as a strategy to facilitate the speed and scale of diffusion in the setting of complex adaptive systems, social networks, and dynamic macroenvironments.

Introduction: Hearing loss is a common issue for older adults, affecting almost two-thirds of Americans over seventy. There are multiple psychiatric implications for this population, as hearing loss is associated with worsened cognitive status, greater depressive symptoms, and, in the case of Deaf patients, a distinct collective identity that necessitates culturally sensitive care. For older adults with hearing loss, multiple studies have shown a lower likelihood of depressive symptoms among those using hearing aids, though this does not imply causality. Given the morbidity associated with depression, strong evidence supporting auditory intervention would signify an important opportunity for clinical impact, particularly in light of the limited utilization of assistive devices; less than one-fifth of adults with hearing loss utilize a hearing aid.

We are proposing this session to equip AAGP members to address the translational gap between clinical studies and clinical practice. In 2003, the Institute of Medicine's Clinical Research Roundtable recognized scientific discoveries are being incompletely translated to concrete health benefits. Moreover, the Roundtable determined that "bench to bedside" translation efforts, i.e. developing new treatment options, alone were insufficient to achieve better health for our population. They advocated investing in translation of research to everyday clinical practice and health decision making. Although this focus has led to increased NIH funding, effective systematic approaches to implementation science that aim to select, implement, scale up, and sustain evidence based geriatric psychiatry health solutions are lacking. Our workshop aims to provide the training in the methods needed for AAGP members to become effective change agents and evidence implementers at their home institutions. Sessions within the workshop will help participants develop new knowledge utilizing innovation and implementation science tools and processes to facilitate change within health care delivery systems. Participants will use the tools provided in this workshop to develop processes and strategies for rapid, efficient, and sustainable implementation of evidence-based programs and practices in the local "real world" to accomplish the quadruple aim.

This research piloted an e-health intervention that used social media to friendsource peer support for Alzheimer's disease (AD) caregivers. Friendsourcing is a variant of crowdsourcing. Crowdsourcing recruits online participants who share a characteristic that makes their volunteerism meaningful when they join to achieve an outcome. Friendsourcing recruits online participants who share membership in a social network that makes their volunteerism meaningful when they join to achieve an outcome. This article introduces our friendsourcing intervention research and examines the effects on the psychological well-being of AD caregivers. After a 6-week intervention, caregivers were found to have significantly decreased burden (Z = -2.01, p < .05) and perceived stress (Z = -2.95, p < .01). Emotional and informational support scores were significantly increased (Z = -2.32, p < .05). Qualitative data analysis of the intervention identified positive effects in new caregiving knowledge acquisition and application and reduced stress in the acceptance of the caregiving role. Joining social networks in support groups through friendsourcing was feasible for AD caregivers who were familiar with social media, and can provide another means of guiding the development of their personal support networks.

The importance of advanced diagnostic techniques and a systematic approach to making an accurate diagnosis of a neurodegenerative disorder cannot be underestimated. Amyloid imaging, cerebrospinal fluid findings, structural imaging, neuropsychological testing and clinical history all help clinicians diagnose, mild cognitive impairment, Alzheimer's disease (AD), frontotemporal dementia (FTD) and other neurodegenerative disorders. This session seeks to educate geriatric psychiatrists and other clinicians in the most up to date imaging techniques, biomarkers, genetics and approaches to making a diagnosis of a neurodegenerative disorder. Beginning with an update on the value of amyloid imaging and the Centers for Medicare and Medicaid Services IDEAS study, clinicians will learn cutting edge approaches to diagnosing neurodegenerative disorders. Appropriate indications for the use of amyloid imaging will be reviewed during this session. Behavioral variant frontotemporal dementia and atypical Alzheimer's disease type dementias are often misdiagnosed as psychiatric disorders. This session provides clinicians with a systematic approach to differentiating FTD and atypical AD from primary psychiatric disorders. By the end of this session, clinicians will appreciate the potential pitfalls, clinical pearls, imaging and other biomarker differences that lead to an accurate neurodegenerative disorder diagnosis.

This study aimed to determine the pattern of [18F]flortaucipir uptake in individuals affected by Gerstmann-Sträussler-Scheinker disease (GSS) associated with the PRNP F198S mutation. The aims were to: 1) determine the pattern of [18F]flortaucipir uptake in two GSS patients; 2) compare tau distribution by [18F]flortaucipir PET imaging among three groups: two GSS patients, two early onset Alzheimer’s disease patients (EOAD), two cognitively normal older adults (CN); 3) validate the PET imaging by comparing the pattern of [18F]flortaucipir uptake, in vivo, with that of tau neuropathology, post-mortem. Scans were processed to generate standardized uptake value ratio (SUVR) images. Regional [18F]flortaucipir SUVR was extracted and compared between GSS patients, EOADs, and CNs. Neuropathology and tau immunohistochemistry were carried out post-mortem on a GSS patient who died 9 months after the [18F]flortaucipir scan. The GSS patients were at different stages of disease progression. Patient A was mildly to moderately affected, suffering from cognitive, psychiatric, and ataxia symptoms. Patient B was moderately to severely affected, suffering from ataxia and parkinsonism accompanied by psychiatric and cognitive symptoms. The [18F]flortaucipir scans showed uptake in frontal, cingulate, and insular cortices, as well as in the striatum and thalamus. Uptake was greater in Patient B than in Patient A. Both GSS patients showed greater uptake in the striatum and thalamus than the EOADs and greater uptake in all evaluated regions than the CNs. Thioflavin S fluorescence and immunohistochemistry revealed that the anatomical distribution of tau pathology is consistent with that of [18F]flortaucipir uptake. In GSS patients, the neuroanatomical localization of pathologic tau, as detected by [18F]flortaucipir, suggests correlation with the psychiatric, motor, and cognitive symptoms. The topography of uptake in PRNP F198S GSS is strikingly different from that seen in AD. Further studies of the sensitivity, specificity, and anatomical patterns of tau PET in diseases with tau pathology are warranted.

Background: Use of mobile health (mHealth) apps is growing at an exponential rate in the United States and around the world. Mild cognitive impairment (MCI), Alzheimer disease, and related dementias are a global health problem. Numerous mHealth interventions exist for this population, yet the effect of these interventions on health has not been systematically described. Objective: The aim of this study is to catalog the types of health outcomes used to measure effectiveness of mHealth interventions and assess which mHealth interventions have been shown to improve the health of persons with MCI, Alzheimer disease, and dementia. Methods: We searched 13 databases, including Ovid MEDLINE, PubMed, EMBASE, the full Cochrane Library, CINAHL, PsycINFO, Ei Compendex, IEEE Xplore, Applied Science & Technology Source, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar from inception through May 2017 for mHealth studies involving persons with cognitive impairment that were evaluated using at least one quantitative health outcome. Proceedings of the Annual ACM Conferences on Human Factors in Computing Systems, the ACM User Interface Software and Technology Symposium, and the IEEE International Symposium on Wearable Computers were searched in the ACM Digital Library from 2012 to 2016. A hand search of JMIR Publications journals was also completed in July 2017. Results: After removal of duplicates, our initial search returned 3955 records. Of these articles, 24 met final inclusion criteria as studies involving mHealth interventions that measured at least one quantitative health outcome for persons with MCI, Alzheimer disease, and dementia. Common quantitative health outcomes included cognition, function, mood, and quality of life. We found that 21.2% (101/476) of the fully reviewed articles were excluded because of a lack of health outcomes. The health outcomes selected were observed to be inconsistent between studies. For those studies with quantitative health outcomes, more than half (58%) reported postintervention improvements in outcomes. Conclusions: Results showed that many mHealth app interventions targeting those with cognitive impairment lack quantitative health outcomes as a part of their evaluation process and that there is a lack of consensus as to which outcomes to use. The majority of mHealth app interventions that incorporated health outcomes into their evaluation noted improvements in the health of persons with MCI, Alzheimer disease, and dementia. However, these studies were of low quality, leading to a grade C level of evidence. Clarification of the benefits of mHealth interventions for people with cognitive impairment requires more randomized controlled trials, larger numbers of participants, and trial designs that minimize bias. Trial Registration: PROSPERO Registration: PROSPERO 2016:CRD42016033846; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42016033846 (Archived by WebCite at http://www.webcitation.org/6sjjwnv1M)