While sleep disturbances are prevalent in older people and are linked with poor health and cognitive outcomes, screening for the range of sleep disturbances is inefficient and therefore not ideal nor routine in memory and cognition clinic settings. We aimed to develop and validate a new brief self-report questionnaire for easy use within memory and cognition clinics. The design for this study was cross-sectional. Older adults (aged ≥50 in Sydney, Australia) were recruited from a memory and cognition research clinic. Participants (N = 497, mean age 67.7 years, range 50-86, 65.0% female) completed a comprehensive medical, neuropsychological, and mental health assessment, alongside self-report instruments, including existing sleep questionnaires and a new 10-item sleep questionnaire, the CogSleep Screener. We examined the factor structure, convergent validity, internal consistency, and discriminant validity of this novel questionnaire. Using exploratory factor analysis, a 3-factor solution was generated highlighting the factors of Insomnia, Rapid Eye Movement (REM) Symptoms and Daytime Sleepiness. Each factor was significantly correlated with currently used sleep questionnaires for each subdomain (all Spearman rho >0.3, all p < 0.001), suggesting good convergent validity. Internal consistency was also good (Revelle's ω = .74). Receiver operating characteristic curves showed good discriminative ability between participants with and without sleep disturbances (all area under curve >0.7, all p < 0.01). The CogSleep Screener has good psychometric properties in older to elderly adults attending a memory and cognition clinic. The instrument has the potential to be used in memory clinics and other clinical settings to provide quick and accurate screening of sleep disturbances. [Correction added on April 2025, after first publication: The number of participants has been updated and associated statistics have been updated].

Accumulating research suggests that individuals with Mild Cognitive Impairment (MCI) experience subtle functional changes, but that available functional assessment tools are insensitive to this. To address this gap, we describe the development and validation of the self-report, “Healthy Brain Ageing Functional Assessment Questionnaire” (HBA-FAQ). We examined the factor structure and psychometric properties of the HBA-FAQ in 503 participants with normal cognition, subjective cognitive decline (SCD), MCI or dementia. Our results found the HBA-FAQ to have good reliability, validity and stronger discriminative ability between healthy control participants and those with SCD (0.734, p = .001), MCI (0.666, p = .012) and dementia (0.798, p < .001) compared to a widely-used instrumental activities of daily living screener. In conclusion, the HBA-FAQ is a valid, reliable self-report tool, providing an efficient and sensitive approach to identifying subtle changes in daily functioning in older people at risk of dementia.

AIMS AND OBJECTIVES To understand the nutritional status, observing eating difficulties during mealtimes for people living with dementia in acute care settings. BACKGROUND Changed eating behaviours caused by declining cognitive function is common in people living with dementia which can lead to malnutrition. Malnutrition is associated with prolonged hospitalisation and increased mortality. People living with dementia in acute care settings are at high risk of malnutrition. This highlights the importance of better understanding the nutritional intake and eating behaviours of people living with dementia in acute care settings. DESIGN This study is a cross-sectional, observational study. METHODS Data of mealtime difficulties and nutritional status of people living with dementia were collected in four geriatric care wards (in acute or sub-acute hospitals) by using Feeding Difficulty Index and Mini Nutritional Assessment Short-Form. The STROBE checklist was used throughout this study. RESULTS The study included 94 people living with dementia. The median age of the participants was 85.86 years old, with a Feeding Difficulty Index of 8.27 and had stayed in hospitals for average 14.46 days, with an average total feeding time of 24.61 min. Only 1.2% of participants were considered to be in normal nutritional status, whereas 72.1% were malnourished. All participants required partial or full assistance during mealtime. Participants with higher scores on the Feeding Difficulty Index have longer total feeding times, compared to those with lower scores. CONCLUSIONS Malnutrition is prevalent in people living with dementia. People living with dementia demonstrate varying mealtime difficulties depending on the level of dependence. Mealtime assistance training programs are warranted and are beneficial for nursing staff and family members to improve their feeding skills and knowledge. NO PATIENT OR PUBLIC CONTRIBUTION This study did not involve patients, service users, caregivers or members of the public. RELEVANCE TO CLINICAL PRACTICE The study is relevant to clinical practice by identifying changed eating behaviours or mealtime difficulties in people living with dementia in acute care settings can significantly decrease the risk of malnutrition.

Functional impairment is a diagnostic criterion for dementia and distinguishes mild cognitive impairment (MCI) from dementia. Self- or informant reports are most commonly used but can be biased and may not reflect actual functional ability. Alternatives include performance-based assessments, such as the Sydney Test of Activities of daily living in Memory disorders (STAM). The aim of this study is to develop, and validate, a new computerised diagnostic tool (C-STAM) to assess functional ability that can be administered remotely to increase accessibility. The C-STAM will realistically simulate everyday activities to assess functional performance. The C-STAM is being developed by a multidisciplinary team of psychologists, old age psychiatrists, occupational therapists, and computer scientists. A Delphi study with 31 international experts was conducted to select and refine suitable tasks. An additional step is consultation with consumers (i.e., older people with and without cognitive impairment) and caregivers who have an active role in shaping the C-STAM. A pilot study with 30 people aged 60+ with normal cognition, MCI, and dementia plus their informants will assess feasibility and user-experience. After adjustments based on the pilot study, we will conduct a validation study with 180 participants and their informants. The Delphi study resulted in nine C-STAM tasks, addressing the domains of communication, shopping, dressing, community mobility, handling finances, managing medications, and memory. Feasibility and acceptability of these tasks will be confirmed through pilot testing and the validation study. We will develop an automated scoring and interpretation guide, age- and sex-specific norms, and clinical cut-offs to differentiate the three diagnostic groups. Automated data exporting and reporting will be useful for clinical referrals and in research and will facilitate interpretation and communication of results across different clinical settings. The C-STAM will facilitate early diagnosis of dementia and MCI and will enable a better understanding of disease progression by monitoring functional ability in a time- and resource-efficient way. Results will be used to inform service development to better meet the needs of people with dementia for access to appropriate assessments of functional performance. The C-STAM will be freely available for use by clinicians and in research.

Accumulating research suggests individuals with subjective cognitive concerns (SCC) and Mild Cognitive Impairment (MCI) experience subtle but noticeable functional changes, despite diagnostic criteria emphasising predominantly intact daily functioning to differentiate them from more severe stages of decline, i.e. dementia. This study investigates how factors associated with cognition, general health, and psychosocial wellbeing relate to functional change longitudinally in older adults with early‐stage cognitive change.

Study Objectives Cardiovascular autonomic dysfunction, as measured by short-term diurnal heart rate variability (HRV), has been reported in older adults with mild cognitive impairment (MCI). However, it is unclear whether this impairment also exists during sleep in this group. We, therefore, compared overnight HRV during sleep in older adults with MCI and those with subjective cognitive impairment (SCI). Methods Older adults (n = 210) underwent overnight polysomnography. Eligible participants were characterized as multi-domain MCI or SCI. The multi-domain MCI group was comprised of amnestic and non-amnestic subtypes. Power spectral analysis of HRV was conducted on the overnight electrocardiogram during non-rapid eye movement (NREM), rapid eye movement (REM), N1, N2, N3 sleep stages, and wake periods. High-frequency HRV (HF-HRV) was employed as the primary measure to estimate parasympathetic function. Results The MCI group showed reduced HF-HRV during NREM sleep (p = 0.018), but not during wake or REM sleep (p > 0.05) compared to the SCI group. Participants with aMCI compared to SCI had the most pronounced reduction in HF-HRV across all NREM sleep stages-N1, N2, and N3, but not during wake or REM sleep. The naMCI sub-group did not show any significant differences in HF-HRV during any sleep stage compared to SCI. Conclusions Our study showed that amnestic MCI participants had greater reductions in HF-HRV during NREM sleep, relative to those with SCI, suggesting potential vulnerability to sleep-related parasympathetic dysfunction. HF-HRV, especially during NREM sleep, may be an early biomarker for dementia detection.

Nocturnal high‐frequency heart rate variability (HF‐HRV), an indicator of parasympathetic tone, is decreased in older adults with amnestic mild cognitive impairment (aMCI) during slow wave sleep. However, it is unclear whether or how this parasympathetic dysfunction relates to early cognitive decline. We therefore aimed to explore associations between nocturnal HF‐HRV during slow wave sleep and verbal memory retention in older adults at risk for dementia, and whether this relationship is related to amygdala volume, a sub‐cortical brain region linked to both verbal memory and parasympathetic modulation.

OBJECTIVES:With the rapid growth of the older population worldwide, understanding how older adults with mild cognitive impairment (MCI) use memory strategies to mitigate cognitive decline is important. This study investigates differences between amnestic and nonamnestic MCI subtypes in memory strategy use in daily life, and how factors associated with cognition, general health, and psychological well-being might relate to strategy use.METHODS:One hundred forty-eight participants with MCI (mean age = 67.9 years, SD = 8.9) completed comprehensive neuropsychological, medical, and psychological assessments, and the self-report 'Memory Compensation Questionnaire'. Correlational and linear regression analyses were used to explore relationships between memory strategy use and cognition, general health, and psychological well-being.RESULTS:Memory strategy use does not differ between MCI subtypes (p > .007) despite higher subjective everyday memory complaints in those with amnestic MCI (p = .03). The most marked finding showed that increased reliance-type strategy use was significantly correlated with more subjective memory complaints and poorer verbal learning and memory (p < .01) in individuals with MCI. Moreover, fewer subjective memory complaints and better working memory significantly predicted (p < .05) less reliance strategy use, respectively, accounting for 10.6% and 5.3% of the variance in the model.CONCLUSIONS:In general, the type of strategy use in older adults with MCI is related to cognitive functioning. By examining an individual's profile of cognitive dysfunction, a clinician can provide more personalized clinical recommendations regarding strategy use to individuals with MCI, with the aim of maintaining their day-to-day functioning and self-efficacy in daily life.