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Objectives: To investigate the differences in patient/caregiver characteristics, their treatment needs, and the attending physician's understanding of those treatment needs according to the duration after diagnosis of dementia with Lewy bodies (DLB). Methods: This was a post hoc analysis of a multicenter, cross‐sectional, questionnaire survey study. A total of 263 patient–caregiver pairs were reclassified into two groups according to the median duration after diagnosis of DLB as follows: short (<24 months; S‐group) and long (≥24 months; L‐group) post‐DLB diagnosis duration. Treatment need was defined as the symptom domain that caused the patient or caregiver the most distress. Concordance rates between patient–physician and caregiver–physician were calculated for physicians' understanding of treatment needs. Results: In this analysis, 126 pairs (32 physicians) and 137 pairs (34 physicians) were classified as the S‐ and L‐groups, respectively. Patient and caregiver characteristics were broadly similar between groups (mean age for patients 78.7 ± 6.6 vs. 79.8 ± 6.7, for caregivers 64.7 ± 12.9 vs. 64.9 ± 12.8; number of male/female for patients 61/65 vs. 67/70, for caregivers 34/92 vs. 38/99), but the prevalence of parkinsonism (82.5% vs. 66.7%) and autonomic dysfunction (49.6% vs. 33.3%), severity of parkinsonism (MDS‐UPDRS Part III total scores, 29.2 ± 22.6 vs. 18.0 ± 16.4; Part II total score, 14.6 ± 12.0 vs. 7.6 ± 7.9), and caregiver burden (J‐ZBI_8 score, 9.1 ± 6.7 vs. 7.5 ± 5.8) were higher in the L‐group than the S‐group. Regarding treatment needs, the invalid answer rates for patients were 34.9% and 46.8%, and those for caregivers were 28.6% and 34.9% in the S‐ and L groups, respectively. Patients' treatment needs did not significantly differ (p = 0.056), but S‐group patients were more likely to select cognitive impairment (p = 0.045) as their treatment need, whereas L‐group patients were more likely to select parkinsonism (p = 0.003). Caregivers' treatment needs significantly differed (p = 0.032) between groups. S‐group caregivers were more likely to select cognitive impairment (p = 0.001), whereas L‐group caregivers were more likely to select other symptom domains such as parkinsonism (S‐group vs. L‐group: 10.3% vs. 16.7%), psychiatric symptoms (20.6% vs. 24.6%), sleep‐related disorder (4.0% vs. 7.1%), and autonomic dysfunction (4.8% vs. 9.5%). Concordance rates between patient–physician and caregiver–physician were low in both groups. Conclusions: There were some differences in characteristics according to the duration after diagnosis of DLB. Cognitive dysfunction may be a particular concern for patients and caregivers soon after diagnosis of DLB. Treatment needs of patients and caregivers for parkinsonism, psychiatric symptoms, sleep‐related disorder, or autonomic dysfunction were different according to the duration after diagnosis of DLB. Physicians' perception of patients'/caregivers' treatment needs was poor regardless of the duration after diagnosis of DLB. Clinical trial registration: UMIN Clinical Trials Registry (UMIN000041844). Key points: This multicenter, cross‐sectional observational study collected survey data from 263 patient–caregiver pairs and 66 physicians to investigate how the duration after diagnosis of dementia with Lewy bodies (DLB) influences clinical symptoms, prescribed medications, and caregiver burden, and how perception of treatment needs differs among patients, their caregivers, and their physicians.Presence of parkinsonism and autonomic dysfunction, severity of parkinsonism, and caregiver burden were all found to be higher in patients with more than 24 months duration.Although patient treatment needs did not differ significantly between patients by post‐diagnosis duration (<24 vs. ≥ 24 months), patients with short (<24 months) post‐diagnosis duration were more likely to select cognitive impairment as treatment need; while those with long (≥24 months) post‐diagnosis duration were more likely to select parkinsonism.Caregivers for patients with short post‐diagnosis duration were more likely to select cognitive impairment as the greatest treatment need, whereas caregivers for patients with long post‐diagnosis duration were more likely to select other symptom domains such as parkinsonism, psychiatric symptoms, sleep‐related disorder, and autonomic dysfunction as the greatest treatment need.Physicians' perception of patients' and caregivers' treatment needs was poor, regardless of the duration after diagnosis of DLB. [ABSTRACT FROM AUTHOR]

Background: The association between depression and dementia is still unclear, particularly regarding depression as a potential risk factor preceding dementia. Therefore, we aimed to verify if the presence of depression at baseline may increase the risk of dementia and cognitive impairment during 15 years of follow‐up in the SHARE (Survey of Health, Aging and Retirement in Europe) study. Methods: Depressive symptoms were defined using the EURO‐D, with a score ≥4 indicative of depression. Incident dementia was ascertained using self‐reported data and caregivers' information, cognitive impairment using objective cognitive tests. Cox regression analysis, adjusted for 10 baseline confounders, was run and hazard ratios (HRs), with their 95% confidence intervals, were estimated. Results: In total 22,789 participants were included in the present analysis (mean age 64.2 years) and were predominantly female. The prevalence of depression at baseline was 24.9%. Over 15 years of follow‐up, the onset of dementia occurred a median 2 years earlier in people with depression compared to those without. Depression at the baseline significantly increased the risk of dementia in the overall sample (HR = 1.74; 95% CI: 1.54–1.95) and the risk of cognitive impairment (HR = 1.15; 95% CI: 1.06–1.25). For dementia, the association was stronger in people less than 60 years (HR = 2.07; 95% CI: 1.42–3.02) than in participants aged ≥80 years (HR = 1.47; 95% CI: 1.14–1.91). A similar trend was observed for cognitive impairment. Among the single items of the EURO‐D, loss of concentration was the strongest individual variable predicting the onset of dementia. Conclusions: Depression increased the risk of dementia and cognitive impairment, particularly in younger adults, whereas loss of concentration was the strongest individual predicting variable of dementia. These findings demonstrate the need for early detection of depression for preventing future cognitive worsening. Key points: Depression is a common condition. Its role as a potential risk factor for dementia has been explored in several studies, but these have limitations, for example, differences in study population, insufficient numbers of younger patients, limited follow‐up duration, and differences in the assessment of depression and dementia.Our study, carried out using data from the SHARE project, showed that the presence of depression at baseline increased the risk of dementia by 74% and of cognitive impairment of 15%. The effect was stronger when considering young‐age depression. Among the single items of the questionnaire proposed for assessing depression, loss of concentration showed the strongest association.Our study indicates that depression may be associated with dementia and cognitive impairment in later life. Therefore, in the early recognition of depression we should remember that cognitive aspects are of critical importance for better individualizing pharmacological and non‐pharmacological approaches. [ABSTRACT FROM AUTHOR]

The central nervous system (CNS) is widely recognized as the only organ system without lymphatic capillaries to promote the removal of interstitial metabolic by‐products. Thus, the newly identified glymphatic system which provides a pseudolymphatic activity in the nervous system has been focus of latest research in neurosciences. Also, findings reported that, sleep stimulates the elimination actions of glymphatic system and is linked to normal brain homeostatis. The CNS is cleared of potentially hazardous compounds via the glymphatic system, particularly during sleep. Any age‐related alterations in brain functioning and pathophysiology of various neurodegenerative illnesses indicates the disturbance of the brain's glymphatic system. In this context, β‐amyloid as well as tau leaves the CNS through the glymphatic system, it's functioning and CSF discharge markedly altered in elderly brains as per many findings. Thus, glymphatic failure may have a potential mechanism which may be therapeutically targetable in several neurodegenerative and age‐associated cognitive diseases. Therefore, there is an urge to focus for more research into the connection among glymphatic system and several potential brain related diseases. Here, in our current review paper, we reviewed current research on the glymphatic system's involvement in a number of prevalent neurodegenerative and neuropsychiatric diseases and, we also discussed several therapeutic approaches, diet and life style modifications which might be used to acquire a more thorough performance and purpose of the glymphatic system to decipher novel prospects for clinical applicability for the management of these diseases. Key points: Age‐associated dementia is growing rapidly leading to various neurological diseases and is currently one of the prime reasons for diseases and related morbidity which impacts a wide range of populations.Recently discovered glymphatic system, through which CNS is cleared of potentially harmful substances and plays a significant role in modulating various neurodegenerative and neuropsychiatric illnesses.To avert these diseases various natural interventions like traditional herbal medicine, non‐invasive neurological stimulation, regular sleep cycle and dietary additives may ameliorate disease pathogenesis by improving glymphatic activity are recently identified.Furthermore, investigations are going on the role of nutrigenomics and micronutrients in boosting the activity of glymphatic clearance in various neurological diseases. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive impairment, pain and depressive symptoms are common and interrelated factors in older adults. However, the directionality and specificity of their association remains unclarified. This study explored whether these factors prospectively increase reciprocal risk and examined the longitudinal association between these factors and quality of life (QoL). Methods: This study used longitudinal data from The Older Persons and Informal Caregivers Survey Minimal Data Set (TOPICS‐MDS; the Netherlands). Older adults self‐reported cognitive impairment, pain, depressive symptoms and QoL at baseline and after 6 and 12 months of follow‐up. The Random Intercept Cross‐Lagged Panel Model was used to assess the prospective association between the three factors, while a multilevel linear regression analysis in a two‐level random intercept model was used to examine the longitudinal associations between the three factors and QoL at the within‐person level. Results: The data of 11,582 home‐dwelling older adults with or without subjective cognitive impairment were analysed. At the within‐person level, pain at 6 months was associated with subsequent depressive symptoms (β = 0.04, p = 0.024). The reverse association from depression to pain, and longitudinal associations between pain and subjective cognitive impairment and between depressive symptoms and subjective cognitive impairment were non‐significant. Pain, depressive symptoms and subjective cognitive impairment showed a significant association with poor QoL 6 months later. Conclusions: A directional relationship was observed from pain to depressive symptoms. Pain reduction holds a potential benefit in the prevention of depressive symptoms, ultimately optimising the QoL of older adults. Key points: Older adults have multiple chronic conditions, and subjective cognitive impairment, pain and depressive symptoms are common and interrelated factors which affect the quality of life.Home‐dwelling older adults experiencing pain were more likely to report later depressive symptoms.Pain, depressive symptoms and subjective cognitive impairment were associated with subsequent poor quality of life.Pain reduction may help prevent depressive symptoms and poor quality of life. [ABSTRACT FROM AUTHOR]

Background: Executive function deficits (EFD) in late‐life depression (LLD) has been reported to be associated with antidepressant treatment resistance, increased disability, and poor quality of life. However, the underlying neutral mechanisms of EFD in patients with the first episode of LLD remains unclear. Methods: A total of 27 patients with first‐episode, drug‐naive LLD and 27 non‐depressed controls (NC) were recruited for the present research. Participants underwent the Trail Making Test, the 17‐item Hamilton depression rating scale (HAMD‐17) test, and task‐state functional magnetic resonance imaging scans under the neutral Stroop task. LLD patients' executive functions, depressive symptoms, and brain activity were examined again after 6 months of antidepressant treatment. Results: Of the 27 LLD patients, 16 cases completed 6‐month follow‐ups. Patients in the LLD baseline group spent more time on the Trail Making Test A test than those in the NC group (p < 0.05). In the presence of an incongruency between the word color and meaning, the accuracy rate of the neutral Stroop task in the LLD baseline group was lower, and the reaction time was greater than that in the NC group, with statistically significant difference (p < 0.05). The HAMD‐17 score in the LLD follow‐up group was significantly lower than that in the LLD baseline group (p < 0.05). More activated brain regions were present in the LLD baseline group than in the NC group when performing the neutral Stroop task. Compared with the LLD baseline group, abnormal activation of relevant brains in the cingulate‐prefrontal‐parietal network of LLD patients still existed in the LLD follow‐up group. Conclusions: LLD patients engaged more brain areas than the NC group while performing the neutral Stroop task. Abnormal activation of the cingulate‐prefrontal‐parietal network could be a contributing factor to EFD in LLD. Trial registration: ChiCTR, ChiCTR2100042370 (Date of registration: 21/01/2021). Limits: We didn't enroll enough first‐episode, LLD patients, the robustness of the findings need to be confirmed by large sample clinical trials. Key points: The findings of this study suggest that there is no significant correlation between the relief of depressive symptoms and the improvement of executive dysfunction in individuals with first‐episode, late‐life depression (LLD).Patients with first‐episode, LLD engaged more brain areas than the normal control group while performing the neutral Stroop task.Abnormal activation of the cingulate‐prefrontal‐parietal network could be a contributing factor to executive function deficits in LLD. [ABSTRACT FROM AUTHOR]

Background: While some people with mild cognitive impairment (MCI) progress to dementia, many others show no progression. The aim of this study was to identify factors associated with risk of dementia development in this population. Method: A large naturalistic retrospective cohort study was assembled from mental healthcare records in a south London catchment. Patients were selected at first recorded diagnosis of MCI and subsequent dementia diagnosis was ascertained from case notes or death certificate, excluding those with dementia diagnoses and deaths within 6 months of MCI diagnosis. A range of demographic and clinical characteristics were ascertained around MCI diagnosis and Cox proportional hazards models were used to investigate independent predictors of dementia, focussing on neuropsychiatric symptoms, contextual factors, and antidepressant treatment. Results: Of 2250 patients with MCI, 236 (10.5%) developed dementia at least 6 months after MCI diagnosis. Aside from older age, lower cognitive function, and activities of daily living impairment, impaired social relationships and recorded loneliness were associated with a higher risk of developing dementia. Patients of Black (compared to White) ethnicity were at a lower risk. For depression and antidepressant receipt, only tricyclic use compared to no antidepressant use was associated with an increased dementia risk. Conclusions: No evidence was found for co‐morbid affective disorders or different antidepressant classes as risk factors for dementia development following MCI diagnosis, but loneliness and social impairment were independent predictors and would be worth evaluating as targets for interventions to delay progression. Key points: Of 2250 patients with MCI, 10.5% received a recorded dementia diagnosis at least 6 months after MCI diagnosis.Older age, lower cognitive function and impaired ADLs were associated with dementia development.Problems with social relationships and loneliness led to a higher risk of developing dementia.Affective disorder diagnoses, antidepressant treatment, and choice of antidepressant did not affect dementia risk. [ABSTRACT FROM AUTHOR]

Objectives: The herbs in Tao Hong Si Wu Decoction (THSWD) are beneficial in the treatment of cognitive impairment. However, the underlying mechanisms of THSWD in treating diabetes‐associated cognitive dysfunction (DACD) are not entirely explored. This study is aimed to investigate the therapeutic effects of THSWD in DACD model rats and the underlying mechanism. Methods: Ultra‐high‐phase liquid chromatography was employed to identify the main compounds contained in the THSWD extract. DACD rat model was induced by feeding with a high‐sugar and high‐fat diet and injecting streptozotocin (35 mg/kg). DACD rats were gavaged with THSWD for 1 week. The learning and memory abilities of the rats were measured by using the Morris water maze. Western blotting was used to detect the changes in DACD rat targets. Statistical methods were used to evaluate the correlation between proteins. Results: The results show that THSWD effectively reduced the escape latency, hippocampal neuron damage, glycosylated hemoglobin, type A1C, and blood lipid levels in DACD rats. Furthermore, DACD rats showed significantly increased amyloid precursor protein, β‐secretase, Aβ1−40, Aβ1−42, Tau phosphorylation, and advanced glycation end products (AGEs) expression. However, THSWD treatment can reverse this phenomenon. Conclusions: THSWD can improve the learning and memory abilities of DACD rats by inhibiting the expression of AEGs‐AGE receptors pathway, which provides an experimental basis for the clinical application of THSWD. In addition, the experiment combines pharmacological and statistical methods, which offers a new perspective for the study of Chinese herbal medicine. Key points: Tao Hong Si Wu Decoction (THSWD) can improve the learning and memory abilities of diabetes‐associated cognitive dysfunction (DACD) rats.Reduced Aβ content was associated with more favorable cognitive abilities.The advanced glycation end products (AGEs)‐AGE receptors (RAGE) pathway may be a key pathway for THSWD to alleviate symptoms in DACD rats and exert therapeutic effects. [ABSTRACT FROM AUTHOR]

Objectives: Late Life Depression (LLD) is associated with increased mortality rates, but it remains unclear which depressed patients are at increased risk. This study examined the mortality risk of previously identified subgroups of depressed older patients based on age‐related clinical features (the presence of physical and cognitive frailty). Methods: A six‐year follow‐up of a clinical cohort study including 375 depressed older patients and 132 non‐depressed persons (NESDO). Depressed patients were diagnosed with the Composite International Diagnostic Interview (CIDI) according to DSM‐IV criteria and classified by latent profile analysis on depressive symptom severity, cognitive domains and physical frailty. We estimated the hazard rate of mortality for the four depressed subgroups compared to non‐depressed persons by applying Cox‐regression analyses. Models were adjusted for age, sex and education as confounders and for explanatory variables per pathway in separate models: somatic burden, lifestyle characteristics, vascular burden or inflammation markers. Results: A total of 61/375 (16.3%) depressed patients and 8/132 (6.1%) non‐depressed persons died during the 6‐year follow‐up. Two of the four subgroups (n = 186/375 (50%) of the depressed sample) had a higher hazard rate (HR) for mortality compared to non‐depressed participants, that is, frail‐depressed patients (HR = 5.25, [95%‐CI: 2.13–13.0]) and pure mild depressed patients (HR = 3.32 [95%‐CI: 1.46–7.58]) adjusted for confounders. Adding possible underlying pathways did not explain these associations. Conclusions: Age‐related features (the presence of physical and cognitive frailty) contribute to the increased mortality risk in late‐life depression. Future studies in depressed older patients should study the additional value of a clinical geriatric assessment and integrated treatment aimed to at reduce frailty and ameliorate their mortality risk. Key points: Ageing related features (the presence of physical and cognitive frailty) contribute to the increased mortality risk in late life depressionDepressive symptom severity may not be independent related to the mortality in late‐life depression.Geriatric interventions aimed at reducing frailty in late life depression may ameliorate the mortality risk. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive impairment and change are a focus of research into late‐life depression. The aims of this 5‐year prospective study were (1) to observe cognitive status change; (2) to investigate the rate and risk ratio of dementia or cognitive decline; and (3) to examine the cognitive domain predictors for conversion to dementia within 5 years among a clinical cohort with remitted major depressive disorder (MDD). Methods: The study cohort included 130 elderly persons with late‐life remitted MDD and 100 normal controls. Comprehensive neuropsychological tests were conducted to determine cognitive domain status. Diagnoses of mild cognitive impairment (MCI) and dementia were made at baseline and at a follow‐up visit at the 5‐year point. In total, 98 cases and 55 normal controls completed the 5‐year follow‐up assessment. Results: Of the study cohort with late‐life remitted MDD, 28.6% had MCI and 25.5% developed dementia within 5 years. Patients with late‐life remitted MDD had an approximate 3 times higher risk of subsequent cognitive decline as compared with the normal controls. Information‐processing speed (p = 0.009) and memory (p = 0.041) could predict subsequent progression to dementia within 5 years among patients with MDD. Conclusions: This study demonstrated that compared with the general elderly population, elderly patients with depression have more significant impairment in cognitive function after 5 years. Further, we found that in depressed patients, deficits in information‐processing speed and memory domains were highly suggestive of progression to dementia within 5 years. Key points: Elderly patients with depression had higher risk of subsequent cognitive decline.In elder patients with remitted major depressive disorder (MDD), deficits in information‐processing speed and memory domains were highly suggestive of progression to dementia within 5 years. [ABSTRACT FROM AUTHOR]

Objectives: Obstructive sleep apnea (OSA) is linked to cognitive impairment. We aimed to investigate subjective cognitive complaints (SCCs) and objective cognitive scores and their relation to polysomnography (PSG) parameters in patients suspected of having OSA. Methods: A prospective cohort cross‐sectional study was conducted at Siriraj Hospital. Patients suspected of OSA who were scheduled for PSG were recruited. Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT). The Memory Index Score (MIS) was calculated from the MoCA. Subjective cognitive complaint presence was assessed through direct questioning of patients and by employing the Cognitive Change Index rated by self or informants (CCI‐I). Patients with severe dementia were excluded. Results: Among 258 patients (mean age 61.46 ± 7.05 years, 51.2% female), the mean MoCA score was 23.89 ± 3.89. Based on PSG results, patients were categorized into groups as follows: those without OSA or with mild OSA (combined total of 20.1%), moderate OSA (28.3%), or severe OSA (51.6%). Cognitive Change Index rated by self and CCI‐I scores correlated significantly (r = 0.238, p = 0.019) but not with the MoCA score or CTT time. Objective cognitive scores were associated with PSG parameters: total sleep time (TST), sleep onset latency, wake after sleep onset, sleep stages, mean O2 saturation, and time spent with SaO2 below 90% (all p < 0.05). Subjective cognitive scores were not associated with PSG parameters, except CCI‐I with TST. Participants with objective cognitive impairment had lower education, higher body mass index, more comorbidities, and lower SCC percentage (all p < 0.05). Patients with moderate to severe OSA had a higher proportion of objective cognitive impairment (64.1%) but a lower incidence of SCC (38.3%) than patients with no OSA or mild OSA. Thirty patients with severe OSA and cognitive impairment received continuous positive airway pressure (CPAP) treatment for a mean of 12.2 months. These patients showed MoCA and MIS improvement, but no significant changes were observed in their CTT and Cognitive Change Index scores. Conclusions: Most patients with OSA had objective cognitive impairment, but SCC was less frequent in patients with more severe OSA. Several PSG parameters correlated with cognitive scores but not with subjective cognitive scores. Patients with severe OSA may benefit cognitively from CPAP treatment. Key points: Patients suspected of obstructive sleep apnea (OSA) had a high prevalence of subjective cognitive complaints (SCCs) and objective cognitive dysfunction.Unlike the Alzheimer's disease, SCCs are not well correlated with the objective cognitive scores in patients with OSA.Some specific polysomnography (PSG) parameters are correlated with objective cognitive impairment.Patients diagnosed with severe OSA and mild cognitive impairment may have measurable improvement in cognition following treatment with continuous positive airway pressure (CPAP). [ABSTRACT FROM AUTHOR]

Objective: Although delirium is well known to acute care clinicians, the features required for its diagnosis and how to understand and operationalize them remain sticking points in the field. To clarify the delirium phenotype, we present a close reading of past and current sets of delirium diagnostic criteria. Methods: We first differentiate the delirium syndrome (i.e., features evaluated at bedside) from additional criteria required for diagnosis. Next, we align related features across diagnostic systems and examine them in context to determine intent. Where criteria are ambiguous, we review common delirium instruments to illustrate how they have been interpreted. Results: An acute disturbance in attention is universally attested across diagnostic systems. A second core feature denotes confusion and has been included across systems as disturbance in awareness, impaired consciousness, and thought disorganization. This feature may be better understood as a disturbance in thought clarity and operationalized in terms of neuropsychological domains thereby clearly linking it to global neurocognitive disturbance. Altered level of activity describes a third core feature, including motor and sleep/wake cycle disturbances. Excluding stupor (wherein mental content cannot be assessed due to reduced arousal) from delirium, as in DSM‐5‐TR, is appropriate for a psychiatric diagnosis, but the brain injury exclusion in ICD‐11 is unjustified. Conclusions: The delirium phenotype involves a disturbance in attention, qualitative thought clarity, and quantitative activity level, including in relation to expected sleep/wake cycles. Future diagnostic systems should include a severity threshold and specify that delirium diagnosis refers to a 24‐h period. Key points: Disturbance in attention is a hallmark feature of delirium and may manifest in any number of attentional domains (e.g., directed, focused/selective, shifting, sustained, or attention span).The second hallmark feature of delirium, disturbance in thought clarity, has met with considerable confusion and been included variously across diagnostic systems as a disturbance in awareness, impaired consciousness, or thought disorganization.Altered level of activity, either cross‐sectionally or in relation to sleep/wake patterns, represents a third core feature of delirium.Excluding stupor from delirium is justified for a psychiatric diagnosis, but acute confusion after brain injury that otherwise meets delirium criteria should be regarded as delirium. [ABSTRACT FROM AUTHOR]

Objectives: The trail making test part B (TMT‐B) evaluates executive functions, memory, and sensorimotor functions. No previous study was found to examine the longitudinal effect of APOE‐ε4 genotypes on the TMT‐B scores in Alzheimer's disease (AD) across racial groups. Methods: This study used the data from Alzheimer's Disease Neuroimaging Initiative (ADNI): 382 participants with AD, 503 with cognitive normal (CN), 1293 with mild cognitive impairment (MCI) at baseline and follow‐up of four years. The multivariable linear mixed model was used to investigate the effect of APOE‐ε4 genotypes on changes in TMT‐B scores. Results: Compared with Whites, African Americans (AA) and Hispanics had higher TMT‐B scores (poor cognitive function). Furthermore, Whites subjects with 1 or 2 APOE‐ε4 alleles had significantly higher TMT‐B scores compared with individuals without APOE‐ε4 allele at baseline and four follow‐up visits; however, no differences in TMT‐B were found between APOE‐ε4 alleles in the Hispanic and AA groups. No APOE‐ε4 by visit interactions was found for 3 racial groups. Stratified by AD diagnosis, the APOE‐ε4 allele was associated with TMT‐B scores only in the MCI group, while there were significant interactions for visit by education, APOE‐ε4 allele, and the Mini Mental State Examination (MMSE) score in the MCI group. In addition, TMT‐B was significantly correlated with the MMSE, AD Assessment Scale‐cognitive subscale 13 (ADAS13), tTau, pTau, Aβ42, and hippocampus. Conclusions: APOE‐ɛ4 allele is associated with TMT‐B scores in Whites subjects, but not in the Hispanic and AA groups. APOE‐ε4 showed interaction with visit in the MCI group. Key points: African American (AA) and Hispanic populations had higher TMT‐B scores than Whites.Individuals with 1 or 2 APOE‐ε4 alleles had significantly higher TMT‐B scores compared with individuals without APOE‐ε4 allele in the Whites but not in the AA and Hispanic subjects.APOE‐ε4 genotypes had significant interactions with visit on TMT‐B in the mild cognitive impairment (MCI) subjects.TMT‐B was significantly correlated with the MMSE, ADAS13, tTau, pTau, Aβ42 and hippocampus. [ABSTRACT FROM AUTHOR]

Background: Subjective memory complaints (SMCs) are a possible prodrome of cognitive decline but are understudied in low‐ and middle‐income countries (LMIC). We aimed to estimate the prevalence of SMCs in a large, nationally representative sample of older adults from Brazil and to identify sociodemographic and health‐related factors that are associated with SMCs independently of objective memory. Methods: Baseline data (n = 7831) from the ELSI‐Brazil study, a national representative sample of adults aged 50 and over. They were asked to rate their memory and then divided into two groups ‐ having or not having SMCs. Logistic regression models were used to estimate the association of demographic characteristics, health related factors, objective memory performance and disability in basic (b‐ADL), instrumental (i‐ADL), and advanced (a‐ADL) activities of daily living associated with SMCs. Whether sex was an effect modifier of the association between age and objective memory performance and SMCs was also tested. Results: Of the sample, 42% (95% CI; 39.9–43.9) had SMCs, and it was higher among women (46.9%) than men (35.9%). SMC prevalence decreased with age among women and increased among men, and for both it decreased with better cognitive performance. Fully adjusted logistic regression model showed that older age, higher education, higher b‐ADL scores, and better cognitive performance were associated with decreased SMCs, while being female, with higher number of chronic conditions, higher i‐ADL scores, worst self‐rated health, and an increased number of depressive symptoms were associated with increased SMCs. However, the interaction test (p < 0.001) confirmed that increased age was associated with decreased SMCs only among women, and that better objective memory performance was associated with decreased SMCs only among men. Conclusions: SMCs are common in the Brazilian older population and are associated with health and sociodemographic factors, with different patterns between men and women. There is a need for future studies looking at the cognitive trajectory and dementia risk in older adults with subjective cognitive complaints. Key Points: Subjective Memory Complaints (SMCs) are a possible prodrome of cognitive decline but are understudied in low‐ and middle‐income countries (LMIC).SMC prevalence is high among older Brazilians, being higher among women (46.9%) than men (35.9%)Higher education and a lower number of chronic conditions and depressive symptoms were independently associated with decreased SMCsIncreased age was associated with decreased SMCs only among women, and better objective memory performance was associated with decreased SMCs only among men. [ABSTRACT FROM AUTHOR]

Objectives: Motoric cognitive risk syndrome (MCR), a pre‐dementia syndrome, is characterized by slow gait and subjective cognitive complaints among older adults. This study assessed the relationship between multimorbidity, its patterns, and MCR. Methods: Data for this study were obtained from three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study. Participants who were aged 60 years and older and had complete data at baseline as well as complete data about MCR at follow‐up were selected. Patients without MCR at baseline were selected for further analyses. Longitudinal associations between multimorbidity, its patterns, and MCR were examined using a Cox proportional hazards model. Multimorbidity patterns were classified using latent class analysis. Results: A total of 4923 respondents were included at baseline, 43.47% of whom had multimorbidity. Additionally, the prevalence of MCR at baseline was 12.61%. After adjusting for covariates, multimorbidity was positively associated with MCR (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.06–1.68). A higher number of multimorbidity was also significantly associated with an increased risk of developing MCR (HR = 1.10, 95% CI = 1.02–1.19). Three multimorbidity patterns were selected: relatively healthy pattern, respiratory pattern, and cardiovascular pattern. Older adults with the cardiovascular pattern were 1.57 times more likely to develop MCR than those with the relatively healthy pattern (HR = 1.57, 95% CI = 1.16–2.13). There was no significant difference between the relatively healthy pattern and the respiratory pattern (HR = 1.31, 95% CI = 0.91–1.92). Conclusions: MCR is highly prevalent among older Chinese adults. MCR may be exacerbated by multimorbidity. For older adults with multimorbidity (especially cardiovascular multimorbidity), attention should be paid to MCR to achieve early detection, diagnosis, and treatment. Key points: Multimorbidity was associated with motoric cognitive risk syndrome.The association between different multimorbidity patterns and motoric cognitive risk syndrome varies and cardiovascular multimorbidity deserves more attention.Multimorbidity in the elderly should be managed categorically. [ABSTRACT FROM AUTHOR]

Objectives: We developed a predictive model for all‐cause mortality and examined the risk factors for cause‐specific mortality among people with cognitive impairment in a Japanese memory clinic‐based cohort (2010–2018). Methods: This retrospective cohort study included people aged ≥65 years with mild cognitive impairment or dementia. The survival status was assessed based on the response of participants or their close relatives via a postal survey. Potential predictors including demographic and lifestyle‐related factors, functional status, and behavioral and psychological status were assessed at the first visit at the memory clinic. A backward stepwise Cox regression model was used to select predictors, and a predictive model was developed using a regression coefficient‐based scoring approach. The discrimination and calibration were assessed via Harrell's C‐statistic and a calibration plot, respectively. Results: A total of 2610 patients aged ≥65 years (men, 38.3%) were analyzed. Over a mean follow‐up of 4.1 years, 544 patients (20.8%) died. Nine predictors were selected from the sociodemographic and clinical variables: age, sex, body mass index, gait performance, physical activity, and ability for instrumental activities of daily living, cognitive function, and self‐reported comorbidities (pulmonary disease and diabetes). The model showed good discrimination and calibration for 1–5‐year mortality (Harrell's C‐statistic, 0.739–0.779). Some predictors were specifically associated with cause‐specific mortality. Conclusions: This predictive model has good discriminative ability for 1‐ to 5‐year mortality and can be easily implemented for people with mild cognitive impairment and all stages of dementia referred to a memory clinic. Key points: There is a paucity of mortality prediction models applicable to people with all stages of dementia, including mild cognitive impairment.Based on a memory clinic‐based cohort, we developed a model to predict 1–5‐year mortality among older adults with mild cognitive impairment and all stages of dementia with good discriminative ability and calibration.The model included 9 factors: age, sex, body mass index, gait performance, physical activity, ability for instrumental activities of daily living, cognitive function, and self‐reported comorbidities (pulmonary disease and diabetes). Some predictors were specifically associated with cause‐specific mortality.Further studies are required to investigate the external validity of the model and its usefulness for patients and informal caregivers as well as health professionals in terms of management and care planning. [ABSTRACT FROM AUTHOR]

Objectives: The proportion of older people with dementia in China is gradually increasing with the increase in the aging population over recent years. Hypertension and diabetes are common non‐communicable diseases among rural populations in China. However, it remains unclear whether these conditions affect the occurrence and development of cognitive impairment as there is limited research on cognitive status and its risk factors among residents of rural areas. Methods: A multi‐stage stratified cluster random sampling method was used to select 5400 participants from rural permanent residents. A self‐designed structured questionnaire was used to investigate demographic data of the participants. Cognitive function was assessed using the Montreal Cognitive Function Assessment Scale (MoCA). The results were analyzed using chi‐square test, ANOVA and multiple linear regression analysis. Results: A total of 5028 participants returned the survey, giving a response rate of 93.1%. Higher education (odds ratio (OR) = 3.2, 95% confidence interval (CI) 2.87–3.54, p < 0.001), higher income (OR = 1.61, 95% CI 1.16–2.07, p < 0.001), and dietary control (OR = 0.66, 95%CI 0.34–0.98, p < 0.001) were protective factors. A visual representation of the relationship between annual income and MoCA score showed an inverted U‐curve, the group with an annual income of 6000–7999 RMB had a maximum OR of 1.93 (95%CI 0.12–2.74, p < 0.001). While difficulty in maintaining sleep were risk factors for cognitive impairment (OR = −2.28, 95% CI–4.18–0.39, p = 0.018). Conclusions: Participants with middle incomes had better cognitive status than those with the highest incomes. Higher education, proper diet control and good sleep are beneficial to the cognitive status of residents in rural areas. Key points: Higher education level, higher income level and diet control are protective factors for the development of cognitive dysfunction.Cognitive dysfunction is more likely to occur in women and in people who have difficulty maintaining sleep.There were no significant differences in the demographic characteristics of patients with hypertension, diabetes, the combination of hypertension and diabetes, and healthy residents in low‐income rural areas.The cognitive status of middle‐income people is better than that of high‐income people than that of low‐income people, a visual representation of the relationship between annual income and MoCA score showed an inverted U‐curve. [ABSTRACT FROM AUTHOR]

Introduction: Predicting caregiver burden in individuals with suspected dementia – is critical due to the debilitating nature of these disorders and need for caregiver support. While some examination of the factors affecting burden has been undertaken in Sub‐Saharan Africa, each country presents with its own unique challenges and obstacles. This pilot study investigates predictors of caregiver burden in family caregivers of individuals with suspected dementia living in the Democratic Republic of the Congo (DRC). Methods: Linear and multiple regression analyses were conducted to explore factors associated with caregiver burden in 30 patient‐caregiver dyads with the Zarit Burden Interview (ZBI) for caregiver burden evaluation. Cognitive impairments of patients were assessed using the Community Screening Instrument for Dementia, Alzheimer's Questionnaire (AQ), the African Neuropsychology Battery, and the Neuropsychiatric Symptoms Inventory (NPI). Results: Average caregiver burden on the ZBI was 36.1 (SD = 14.6; range = 12–58). Greater impairments in patient cognition (orientation, visuospatial, memory, executive functioning), fragility, and neuropsychiatric symptoms (delirium, agitation, depression) were predictive of caregiver burden. After controlling for AQ scores and caregiver gender, greater symptoms of depression, and worse performances on verbal memory and problem solving were associated with greater caregiver burden. Conclusion: Worsening patient fragility, cognition, functioning, and neuropsychiatric symptoms influenced caregiver burden in caregivers of individuals with suspected cognitive impairment in the DRC. These findings are consistent with the prior literature. Future studies may wish to explore supportive factors and caregiver specific characteristics that buffer against perceived burden. Key points: It is critical to predict caregiver burden in individuals with suspected dementia due to the debilitating nature of these disorders and need for caregiver support.While some examination of the factors affecting caregiver burden has been undertaken in Sub‐Saharan Africa, these findings have had little impact on clinical care or research in Democratic Republic of Congo (DRC) where dementia is considered as "witchcraft."This study has shown that the worsening of patient fragility, cognition, functioning, and neuropsychiatric symptoms influenced caregiver burden in caregivers of individuals with suspected cognitive impairment in the DRC. [ABSTRACT FROM AUTHOR]

Objective: Depression in patients undergoing coronary artery graft bypass (CABG) surgery is associated with morbidity and mortality, making its early identification and clinical management crucial. Vasculopathy and older age, hallmarks of patients requiring CABG, are also features of vascular depression. In this study, we assess for features of vascular depression in patients undergoing CABG surgery. Methods: This is a cross‐sectional analysis of a single‐site prospective observational cohort study of patients undergoing CABG surgery. Subjects were assessed preoperatively using the Depression Interview and Structured Hamilton (DISH), depression scales, transcranial Doppler, neuropsychological testing, and clinical dementia rating (CDR). Results: Of 161 subjects (mean age 66.2 ± 9.3, female 25%) who completed DISH, 18 had major or minor depression, 17 of whom had a past history of major or minor depression (mean age of onset 35.8 years‐old). Pre‐CABG depression was associated with greater functional impairment on CDR Sum of Boxes (OR = 3.7, 95% CI: 1.4, 9.7) and worse performance on letter fluency test (OR = 0.90, 95% CI: 0.81, 0.99) and trail‐making tests (A: OR = 1.06, 95% CI: 1.01, 1.12; B: OR 1.02, 95% CI: 1.01, 1.04). Pre‐CABG depression was not associated with middle cerebral artery (MCA) stenosis. Conclusions: Pre‐CABG depression is associated with cognitive and functional impairment similar to vascular depression, but we did not find evidence of an association with older age of onset and MCA stenosis. Further studies on white matter disease in this population are needed to examine the vascular depression hypothesis for pre‐CABG depression. Key points: Pre‐coronary artery graft bypass (CABG) depression is associated with cognitive and functional impairment in domains that are also impaired in vascular depression.Unlike vascular depression, pre‐CABG depression is associated with history of early‐life depression and presence of family history of depression.Pre‐CABG depression is not associated with the degree of middle cerebral artery stenosis as measured by transcranial Doppler.Future study is needed with direct measurement of white matter disease and a wider range of depression severity to test the vascular depression hypothesis of pre‐CABG depression. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to compare the effectiveness of interventions in cognitive function and frailty status and rank these interventions. Methods: Data Sources‐We searched PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, Central Register of Controlled Trials (CENTRAL), CNKI, Wanfang, VIP and Google scholar. Data synthesis‐The risk of bias was assessed using the Cochrane risk bias assessment tool. Statistical heterogeneity was assessed using the Chi‐square test and quantified by I2. The results were pooled using the standardized mean difference (SMD). The rank probability for each intervention was calculated using the surface under the cumulative ranking curve (SUCRA). Additionally, the quality of the evidence was evaluated using the GRADE approach. Results: A total of 10 randomized controlled trials (RCTs) involving 1110 patients were included in our analysis. The network map of cognitive function comprised 9 RCTs with 1347 participants, examining eight different interventions. Nutritional support (SUCRA = 99.9%, SMD = 3.02, 95% CI: 2.53, 3.51) may be the most effective intervention to improve cognitive function. The network map of frailty (including 9 RCTs with 1017 participants and 9 interventions) suggested that multicomponent exercises (SUCRA = 96.4%, SMD = −5.10, 95% CI: −5.96, −4.23) tended to have a greater effect. Conclusions: Community‐based multicomponent exercises have shown significant benefits for improving cognitive function and frailty status in older adults, with moderate certainty. For hospitalized older patients with Cognitive frailty (CF), current evidence suggests that nutritional support yields the most improvement. Additionally, aerobic exercise and dual‐task training have proven effective in managing CF. Further studies are needed to validate these preliminary findings and exploring more accessible and effective physical and cognitive interventions to prevent CF in aging. Key points: The optimal interventions for frailty and cognition were multicomponent exercises and nutritional support.Doing multicomponent exercises in the community is likely the best effect on older adults with CF.Nutritional support may be the best improvement for hospitalized older adults with CF.Simultaneous cognitive/mindfulness training and physical exercises are effective components of CF management. [ABSTRACT FROM AUTHOR]

Objects: Dementia has physical, social and economic impacts, causing considerable distress for people with age‐related cognitive impairment (PWACI) and their caregivers. Electronic health (e‐health) interventions can provide convenient education to improve the coping competence of caregivers and have become an important approach to supporting them. Understanding the economic evidence of e‐health interventions will facilitate the decision making and implementation of integrating e‐health into routine health services. The present review aimed to appraise economic evidence related to e‐health interventions for PWACI and their caregivers. Methods: We systematically searched multiple cross‐disciplinary databases from inception to February 28, 2023. Two reviewers independently selected the trials, assessed the quality, and checked the data. A descriptive‐analytical narrative method was used to analyze the review findings. Results: Thirteen studies were analyzed, including 12 randomized controlled trials and one quasi‐experimental study. All included studies were conducted in developed countries. The included studies reported limited economic information. There were six cost‐effectiveness analysis, five cost‐consequence analysis and one partial economic evaluation. The included studies were heterogeneous, and varied in quality. The results demonstrated that e‐health multicomponent interventions can reduce the cost of health service utilization in short term (10–104 weeks). Conclusions: Few studies calculated the incremental cost‐effectiveness ratio to evaluate the cost‐effectiveness of e‐health interventions. Preliminary evidence indicates that e‐health interventions can reduce the cost of health service utilization in the short term, but the cost‐effectiveness of e‐health interventions hasn't been identified. More robust evidence is needed to clarify the value of e‐health interventions for PWACI and their caregivers. Key points: This review identifies the characteristics of e‐health interventions for PWACI and their caregivers in economic evaluations through cost‐effectiveness analysis and cost‐consequence analysis.Preliminary evidence suggests that e‐health interventions can reduce the cost of health service utilization in the short term (10–104 weeks), but the cost‐effectiveness should be identified further.The results of this study contribute to the understanding of the economic effects of e‐health based on existing evidence and provide more robust evidence‐based practices.More long‐term and high‐quality economic evaluation trials are warranted to determine the value of e‐health interventions for PWACI and their caregivers. [ABSTRACT FROM AUTHOR]

Objectives: Neuropsychiatric symptoms (NPS) are highly prevalent in individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI), and are strongly linked to accelerated cognitive decline and dementia onset. While mindfulness‐based interventions have shown promise in improving psychological well‐being in clinical and community settings, their efficacy for individuals in these pre‐dementia stages remains unclear. This meta‐analysis examined the effects of mindfulness‐based interventions on NPS and psychological outcomes in these preclinical cohorts. Methods: Eligible studies were retrieved from PubMed, EMBASE, JBI EPB, Web of Science, and Cochrane library. Two independent researchers conducted the literature search and data extraction. Cochrane Risk‐of‐Bias Assessment Tool was used to assess the methodological quality of included studies. Quality of evidence was evaluated using the GRADE approach. Intervention effects were estimated by Hedge's g and 95% confidence interval (CI). Results: A total of 18 randomized controlled trials (including 974 participants from 21 studies) were included in the meta‐analysis. The results demonstrated statistically significant immediate post‐intervention effects of mindfulness‐based interventions on anxiety (g = −0.30, 95% CI −0.49 to −0.11), stress (g = −0.58, 95% CI −0.91 to −0.24), and quality of life (g = 0.50, 95% CI 0.12–0.87). However, no significant effects were found for depression, apathy, mindfulness, and stress‐related biomarkers. Follow‐up data analysis also did not reveal significant effects for depression and anxiety. Conclusions: The findings of this meta‐analysis suggest that mindfulness‐based interventions may improve anxiety, stress, and quality of life in individuals with SCD and MCI. However, more rigorous randomized controlled trials with larger sample sizes and evaluation using physiological parameters are needed to establish more definitive conclusions. Future interventions could consider incorporating cognitive training and health education to address the specific needs of the pre‐dementia population. Registration Number: PROSPERO: CRD42022359906. Key points: Neuropsychiatric symptoms are highly prevalent in individuals with subjective cognitive decline and mild cognitive impairment, and strongly associated with an increased risk of developing dementia.The effectiveness of mindfulness‐based interventions for individuals in the pre‐dementia stages is still uncertain, despite their widespread use in improving psychological well‐being among clinical and community populations.Mindfulness‐based interventions showed immediate beneficial effects on anxiety, stress, and quality of life compared to control treatments.More rigorous and large‐scale randomized controlled trials, evaluated using physiological parameters, are needed to ensure the robustness of study findings and draw definitive conclusions. [ABSTRACT FROM AUTHOR]

Background: Memory problems are common in advanced age. Memory strategies can be used to manage such challenges. To assist older people facing memory problems, we conducted a pilot study to evaluate the usability of a memory aid handbook that we developed specifically for this purpose. Method: A memory aid handbook with a 7‐week program was developed based on a systematic review. A total of 19 older people with self‐reported memory problems (mean age: 76.11 years, female: 73.68%) tested the memory aid handbook and completed the System Usability Scale (SUS), a checklist on the relevance of the strategies in the handbook, and questionnaires on daily life functioning and self‐efficacy. Further, they participated in cognitive tests. In a pre‐post design, within‐subject differences were determined using paired t‐tests. Results: The usability of the memory aid handbook scores as were high (mean SUS score: 99.21). The checklist indicated that the handbook was perceived as beneficial for confirming already established memory strategies and stimulating new ones, such as self‐acceptance, visualizing and verbalizing daily routines, and asking for help. In addition, the checklist revealed that using a calendar was considered the most helpful strategies for daily living, followed closely by taking notes, having specific places for certain items and creating routines in daily life. After the 7 weeks, participants scored significantly better in the cognitive and self‐efficacy tests. The exploratory nature of the study combined with the small sample size should be considered when interpreting the results. Conclusion: The usability of the handbook was high, reflecting the relevance of the strategies it contains. Teaching memory strategies can be a useful, inexpensive method to foster independence among those at risk for cognitive impairment. Key points: People with memory problems perceived a memory aid handbook as useful in confirming already established memory strategies and stimulating new ones or revising old ones.Using a calendar was considered the most helpful strategy for daily living, followed closely by taking notes, staying organized, having specific places for specific things, creating routines in daily life, and avoiding time pressure.New incentives provided by the memory aid handbook included self‐acceptance, visualizing and verbalizing daily routines, and asking for help and encouraging older people with memory problems to rethink old such as putting frequently used items in a more prominent place.The memory aid handbook received the best imaginable usability score, and is characterized by great ease of use, rendering it suitable for independent use by elderly individuals with subjective cognitive impairment. [ABSTRACT FROM AUTHOR]

Introduction: At rest, the brain's higher cognitive systems engage in correlated activity patterns, forming networks. With mild cognitive impairment (MCI), it is essential to understand how functional connectivity within and between resting‐state networks changes. This study used resting‐state functional connectivity to identify significant differences within and between the cingulo‐opercular network (CON) and default mode network (DMN). Methods: We assessed cognitive function in patients using the Chinese version of the Alzheimer's disease assessment scale‐Cognitive subscale (ADAS‐Cog). A group of MCI subjects (ages 60–83 years, n = 45) was compared to age‐matched healthy controls (n = 70). Resting‐state functional connectivity was used to determine functional connectivity strength within and between the CON and DMN. Results: Compared to healthy controls, the MCI group showed significantly lower functional connectivity within the CON (F = 10.76, df = 1, p = 0.001, FDR adjusted p = 0.003). Additionally, the MCI group displayed no distinct differences in functional connectivity within DMN (F = 0.162, df = 1, p = 0.688, FDR adjusted p = 0.688) and between CON and DMN (F = 2.270, df = 1, p = 0.135, FDR adjusted p = 0.262). Moreover, we found no correlation between ADAS‐Cog and within‐ or between‐connectivity metrics among subjects with MCI. Conclusions: Our findings indicate that specific patterns of hypoconnectivity within CON circuitry may characterize MCI relative to healthy controls. This work improves our understanding of network dysfunction underlying MCI and could inform more targeted treatment. Key points: Identification of mild cognitive impairment (MCI) is essential for dementia treatments and research.Understanding the alterations in functional connectivity within and between resting‐state networks in MCI is crucial.Compared to healthy controls, our study found the MCI group showed significantly lower functional connectivity within the cingulo‐opercular network (CON).Specific patterns of hypoconnectivity within CON circuitry may characterize MCI relative to healthy controls. [ABSTRACT FROM AUTHOR]

Background: Delirium is an acute and transient disorder of brain function that often occurs in post‐surgical patients. Rivastigmine is a cholinesterase inhibitor drug that has been proposed as an adjuvant drug in recent years, still, despite significant theoretical evidence, few clinical studies have been performed on its impact on delirium. Aim: Due to the widespread use of cholinesterase inhibitors in pediatric and adult surgery, the present study aims to investigate the impact of Rivastigmine as a cholinesterase inhibitor on delirium after radical surgery. Methods: In this randomized double‐blind clinical trial, a hundred recruited patients were randomly assigned to either Rivastigmine (n = 50) or placebo (n = 50) groups, and we measured post‐operative impact on delirium, by Confusion Assessment Method (CAM) score, and cognitive impairment, by the Mini‐Mental State Examination (MMSE). Our univariate and multivariate logistical regression models assessed this hypothesized impact. Results: Treatment with Rivastigmine was significantly associated with reduced day one post‐op delirium, as measured by CAM score (Odds Ratio (OR) = 0.35, 95% Confidence Interval (CI) 0.11 to 0.97, p = 0.05), and cognitive impairment, as measured by MMSE (OR = 0.25, 95% CI 0.1 to 0.59, p = 0.0022). These associations became stronger after controlling for age, blood loss, and post‐op blood sodium levels: Delirium (OR = 0.23, 95% CI 0.05 to 0.92, p = 0.05), cognitive impairment (OR = 0.12, 95% CI 0.03 to 0.42, p = 0.000178). Conclusion: The significant result of our randomized clinical trial is that pre‐op Rivastigmine treatment may be associated with a substantial drop in patients experiencing post‐op delirium and post‐op cognitive impairment. Key points: Delirium is an acute and transient disorder of brain function that often occurs in post‐surgical patients.Rivastigmine is a cholinesterase inhibitor drug that has been proposed as an adjuvant drug in recent years, still, despite significant theoretical evidence, few clinical studies have been performed on its impact on delirium.In this randomized double‐blind clinical trial, a hundred recruited patients were randomly assigned to either Rivastigmine (n = 50) or placebo (n = 50) groups.The Confusion Assessment Method (CAM) was used to assess delirium as a binomial variable.Mini‐Mental State Examination (MMSE) instruments were also used to assess the patient's cognitive status, performed on the first day after surgery.Treatment with Rivastigmine was significantly associated with decreased day one post‐op delirium. [ABSTRACT FROM AUTHOR]

Background: Cognitive deficits are evident throughout the course of Parkinson's disease (PD), with 24% of patients experiencing subtle cognitive disturbances at the time of diagnosis, and with up to 80% of patients developing PD dementia (PDD) at advanced stages of the disease PD patients with mild cognitive impairment (MCI), an at‐risk phenotype of PDD, present with heterogeneous clinical characteristics that complicate the management of PD. Objectives: This study aims to examine the characteristics of PD‐MCI by using the Movement Disorder Society (MDS) diagnostic criteria and evaluate the validity of global cognitive scales in identifying PD‐MCI. Methods: Seventy‐nine (79) PD patients completed neuropsychological assessments and a comprehensive cognitive battery. PD‐MCI was classified according to the level 2 MDS task force criteria. Mini‐Mental State Examination (sMMSE), Montreal Cognitive Assessment (MoCA) and Parkinson's Disease Cognitive Rating Scale (PDCRS) were examined against a level 2 dichotomised PD‐MCI diagnosis. Characteristics of PD‐MCI were evaluated using logistic regression analysis. Results: Twenty‐seven patients met criteria for PD‐MCI (34%). The MoCA and PDCRS demonstrated high validity to screen for PD‐MCI. Impairments in multiple cognitive domains were observed in 77.8% of PD‐MCI patients. There were significantly more males in the PD‐MCI group compared to PD patients without MCI (p < 0.01). Conclusions: PD patients with MCI exhibited impairments in the attention/working memory, executive function and memory domains. Heterogeneous cognitive characteristics in PD warrant further investigation into specific cognitive subtypes to advance understanding and effective evaluation of PD‐MCI. Key points: MoCA and PDCRS demonstrated high validity to screen for PD‐MCIThere were more males than females in the PD‐MCI group77.8% of PD‐MCI showed multiple cognitive domain impairment22.2% of PD‐MCI presented with impairment in memory, executive function and attention/working memory. [ABSTRACT FROM AUTHOR]

Objectives: Subjective cognitive complaints (SCC) are the earliest symptom of Alzheimer's disease (AD) progression. Increasing evidence shows an association between poor sleep quality and SCC, but the current conclusions regarding the association between poor sleep quality and SCC in older adults are contradictory. Here, we aimed to explore the correlation of SCC with poor sleep quality among older adults without dementia living in nursing home and community in China. Methods: A cross‐sectional survey on sleep and psychosomatic health of older adults was conducted in Guangdong, China, between November 2020 and March 2021. Socio‐demographic, health‐related information, psychological factors, sleep quality and SCC of participants were evaluated through a face‐to‐face interview. A 9‐item Subjective Cognitive Decline Questionnaire (SCD‐Q9) was used to measure SCC; SCD‐Q9 > 3 was defined as SCC. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality; PSQI > 7 was defined as poor sleep quality. The relationship between SCC and sleep quality was evaluated using logistics regression analysis. Results: The study involved 730 participants (mean age 74.14 ± 8.246 years). The total SCC prevalence was 59.59%. The SCC group had poor sleep quality than the reference group (p < 0.05). Adjusted multiple logistic regression analysis revealed an association of poor sleep quality with SCC (OR = 1.841; 95% CI, 1.267–2.647; p = 0.001) after controlling for age, sex, residence, education level, marital status, income, smoking, alcohol consumption, tea drinking, multimorbidity, waist circumference, napping duration, anxiety symptoms, and depression symptoms. Hierarchical logistics regression analysis showed an association between sleep quality and SCC among community older adults (OR = 2.872; 95% CI: 1.787–4.615; p < 0.001), but not in nursing home residents (OR = 0.845; 95% CI: 0.437–1.637; p = 0.619). Conclusions: Poor sleep quality is associated with SCC in community older adults. Therefore, medical staff should take measures, such as earlier cognitive intervention, to postpone cognitive decline in older adults, in the meantime, earlier management and treatment of sleep disorders should be taken into consideration. Key points: Total SCC prevalence rate is high in older adults, and the rate in nursing home residents is higher than in community residents.Poor sleep quality is associated with SCC among the Chinese older adults, especially community older adults.The association between poor sleep quality and SCC in institutionalized older adults are warrant to further elucidate. [ABSTRACT FROM AUTHOR]

Objectives: Subjective cognitive decline (SCD) is a preclinical stage of AD. White matter hyperintensities (WMH), an MRI marker of cerebral small vessel disease, associate with AD biomarkers and progression. The impact of WMH on SCD phenotype is unclear. Methods/Design: A retrospective, cross‐sectional analysis was conducted on a diverse cohort with SCD evaluated at the NYU Alzheimer's Disease Research Center between January 2017 and November 2021 (n = 234). The cohort was dichotomized into none‐to‐mild (n = 202) and moderate‐to‐severe (n = 32) WMH. Differences in SCD and neurocognitive assessments were evaluated via Wilcoxon or Fisher exact tests, with p‐values adjusted for demographics using multivariable logistic regression. Results: Moderate‐to‐severe WMH participants reported more difficulty with decision making on the Cognitive Change Index (1.5 SD 0.7 vs. 1.2 SD 0.5, p = 0.0187) and worse short‐term memory (2.2 SD 0.4 vs. 1.9 SD 0.3, p = 0.0049) and higher SCD burden (9.5 SD 1.6 vs. 8.7 SD 1.7, p = 0.0411) on the Brief Cognitive Rating Scale. Moderate‐to‐severe WMH participants scored lower on the Mini‐Mental State Examination (28.0 SD 1.6 vs. 28.5 SD 1.9, p = 0.0491), and on delayed paragraph (7.2 SD 2.0 vs. 8.8 SD 2.9, p = 0.0222) and designs recall (4.5 SD 2.3 vs. 6.1 SD 2.5, p = 0.0373) of the Guild Memory Test. Conclusions: In SCD, WMH impact overall symptom severity, specifically in executive and memory domains, as well as objective performance on global and domain‐specific tests in verbal memory and visual working/associative memory. Key points: White matter hyperintensities impact subjective cognitive decline in executive and memory domainsWhite matter hyperintensities also affect objective measures of cognition in verbal memory and visual working/associative memory [ABSTRACT FROM AUTHOR]

Objectives: Cognitive frailty combines physical frailty and cognitive impairment in the absence of dementia. The prompt detection of cognitive frailty and early implementation of preventive interventions may reduce the incidence of dementia. However, intervention studies of exergaming in older adults with cognitive frailty are scant. Therefore, we aim to investigate the effectiveness of exergaming on cognitive functions and loneliness among older adults with cognitive frailty. Design: Quasi‐experimental design. Methods: Participants were recruited from four community settings. The experimental group participated in two 40‐min group exergaming sessions weekly for eight weeks; the control group received usual care. The outcome measures were the Montreal Cognitive Assessment (MoCA) and the Chinese Version of the Loneliness Scale. Analyses of covariance were conducted to analyze whether exergaming influenced participants' cognitive functions and loneliness. In addition, the effect size of the posttest of the experimental group relative to its baseline value was calculated to determine the effectiveness of the intervention. Result: 69 older adults with cognitive frailty were included, and 35 and 34 were assigned to the experimental and control groups, respectively. The exergaming effectively improved the cognitive function of older adults with cognitive frailty. Conclusions: Exergaming interventions can effectively improve the cognitive functions of older adults with cognitive frailty but do not positively affect loneliness. We provide evidence to healthcare workers to apply exergaming interventions for older adults with cognitive frailty to improve cognitive function. Key points: This paper highlights that an exergaming intervention can effectively improve the cognitive functions of older adults with cognitive frailty.Older adults with cognitive frailty are a crucial group in the gerontology field, and this study emphasizes that healthcare workers can apply exergaming to achieve improvements in cognitive function based on our research results. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative delirium (POD) is a common postsurgical complication. The early identification of its risk factors is the first step toward reducing POD. The predictive factors for POD in patients after major abdominal surgery remain obscure. Therefore, this meta‐analysis aimed to comprehensively summarize the risk factors of POD after major abdominal surgery. Methods: POD studies published between January, 1900 and June 2022 were obtained by searching PubMed, Cochrane Library, Web of Science, Embase, and Medline. Two authors independently reviewed the studies to extract the risk factors and assessed the quality of related articles using the Newcastle‐Ottawa Scale. Data were recorded, and a meta‐analysis was performed using Review Manager version 5.4.1. Results: Ten studies including total 2900 patients undergoing major abdominal surgery, were eligible for analysis, 608 of whom developed POD, for a cumulative incidence of 21%. This pooled analysis suggested the statistically significant risk factors for POD were age, higher American Society of Anesthesiologists grade, lower preoperative Mini‐Mental State Examination score, cognitive impairment, preoperative Katz‐ADL score <6, preoperative and postoperative hypoalbuminemia, lower preoperative insulin‐like growth factor‐1 levels, and longer duration of anesthesia. Conclusion: POD is common in patients undergoing major abdominal surgery. This meta‐analysis identified risk factors that may aid the early detection of POD and play a prominent role in preventing POD. Key points: Our report was the first to comprehensively summarize the related risk factors for postoperative delirium (POD) after major abdominal surgery; the results of this pooled analysis suggested the statistically significant risk factors for POD were age, higher American Society of Anesthesiologists grade, lower preoperative Mini‐Mental State Examination score, cognitive impairment, preoperative Katz‐ADL score <6, preoperative and postoperative hypoalbuminemia, lower preoperative insulin‐like growth factor‐1 levels, and longer durations of anesthesia, which may better predict the risk of POD. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the associations between social isolation, loneliness, and motoric cognitive risk syndrome (MCR) among older adults in China. Methods: Data were obtained from the China Health and Retirement Longitudinal Study in the 2011 and 2015 waves. Social isolation and loneliness were measured by an index and an item, and MCR was defined as subjective cognitive complaints and slow gait. Multivariable logistic regression analyses were performed to examine the associations between social isolation, loneliness, and MCR by gender. Results: Of 3251 eligible participants, the incidence of MCR was 10.03%. Social isolation and loneliness were not significantly associated with incident MCR in men. Loneliness was positively associated with incident MCR in women (OR: 1.45, 95% CI: 1.05, 2.01), while social isolation was not. Conclusions: Loneliness is associated with incident MCR among female older adults in China. More attention is advised to be paid to loneliness among female older adults, to hold promise for the prevention and reduction of MCR. Key points: The incidence of MCR among community‐dwelling older adults in China was 10.03%.Loneliness, rather than social isolation, was associated with incident MCR in women.Neither social isolation nor loneliness was found to be related to incident MCR in men. [ABSTRACT FROM AUTHOR]

Background: Although cognitive function and depressive symptoms have been suggested to be closely related, less attention has been paid to this association within married couples. This study explored the reciprocal dyadic relationship between cognitive function and depressive symptoms over time. Methods: This study used four waves of data from the China Health and Retirement Longitudinal Study and analyses were restricted to middle‐aged and older couples aged 45 or older. Actor‐partner interdependence model adjusted for confounding factors was employed to examine the reciprocal association between cognitive function and depressive symptoms at both the individual and couple levels. Measures of cognitive function consisted of episodic memory and mental status. Depressive symptoms were measured by the Center for Epidemiological Studies Depression scale. Results: For both husbands and wives, cognitive function was reciprocally associated with depressive symptoms at the individual level. Spouses' lower cognitive function was significantly linked to their partners' greater depressive symptoms. However, ones' depressive symptoms were not related to their partners' cognitive function. Conclusions: These findings expand our knowledge about the dyadic relationship between cognitive function and depressive symptoms in Chinese couples. Effects of interventions for depression in middle‐aged and older adults may be enhanced by considering the marital context. Key points: Cognitive function and depressive symptoms were reciprocally related at the individual level among middle‐aged and older Chinese couples.Partner effects were found. One spouse's lower cognitive function at baseline was significantly associated with the other's greater depressive symptoms. [ABSTRACT FROM AUTHOR]

ObjectivesRelatively few APOE ε4+ carriers survive to old age (age 80+) without cognitive impairment (CI); thus, little is known about distinguishing characteristics of resilient APOE ε4+ carriers. Herein, we describe the sociodemographic characteristics of a large sample of resilient APOE ε4+ women from the Women's Health Initiative Memory Study (WHIMS) and compare them to noncarriers and APOE ε4+ women who developed CI before age 80.MethodsWomen were recruited for clinical trials evaluating postmenopausal hormone therapy and incidence of dementia. During posttrial follow-up, cognitive status was adjudicated annually. Among 5716 women, we compared groups by APOE ε4 status using logistic regression, covarying for treatment, demographics, lifestyle, cardiovascular and physical function, well-being, and self-rated general health.ResultsAmong 557 APOE ε4+ women, those who survived to age 80+ without CI had higher baseline self-rated general health (odds ratio [OR]: 1.02; 95% confidence interval [CI], 1.01-1.04) and cognitive scores (OR: 1.18; 95% CI, 1.12-1.25) than those who did not reach age 80 without CI. Baseline high total cholesterol and low-density lipoprotein (LDL) levels were similar across APOE ε4+ groups but were higher compared with APOE ε4- women. Among women who survived to 80+ without CI, more APOE ε4+ women had a history of high total cholesterol (P = .003) and LDL cholesterol (OR: 1.01; 95% CI, 1.00-1.01). There were no differences in hypertension, diabetes, or other vascular risk factors in APOE ε4+ women compared with noncarriers.ConclusionsResults highlight the importance of baseline cognitive function and general health for late-life cognition among ε4+ women.

Objectives: This narrative review describes the clinical features of apathy and depression in individuals with neurocognitive disorders (NCDs), with the goal of differentiating the two syndromes on the basis of clinical presentation, diagnostic criteria, neuropathological features, and contrasting responses to treatments. Methods: Literature was identified using PubMed, with search terms to capture medical conditions of interest; additional references were also included based on our collective experience and knowledge of the literature. Results: Evidence from current literature supports the distinction between the two disorders; apathy and depression occur with varying prevalence in individuals with NCDs, pose different risks of progression to dementia, and have distinct, if overlapping, neurobiological underpinnings. Although apathy is a distinct neuropsychiatric syndrome, distinguishing apathy from depression can be challenging, as both conditions may occur concurrently and share several overlapping features. Apathy is associated with unfavorable outcomes, especially those with neurodegenerative etiologies (e.g., Alzheimer's disease) and is associated with an increased burden for both patients and caregivers. Diagnosing apathy is important not only to serve as the basis for appropriate treatment, but also for the development of novel targeted interventions for this condition. Although there are currently no approved pharmacologic treatments for apathy, the research described in this review supports apathy as a distinct neuropsychiatric condition that warrants specific treatments aimed at alleviating patient disability. Conclusions: Despite differences between these disorders, both apathy and depression pose significant challenges to patients, their families, and caregivers; better diagnostics are needed to develop more tailored treatment and support. Key points: Apathy and depression are distinct neuropsychiatric syndromes that share overlapping features and may occur concurrently in individuals with neurocognitive disorders (NCDs)Distinguishing apathy from depression can be challenging, but proper identification of each syndrome is important for appropriate interventionThis narrative review describes clinical features associated with apathy and depression and differentiates each syndrome based on clinical presentation and diagnostic criteria, neuropathological features, and differences in response to treatment [ABSTRACT FROM AUTHOR]

Objectives: The population of older adults is growing fast, especially in Europe and Northern America. Old age is often associated with mental health comorbidities. Moreover, life expectancy of people suffering from psychiatric disorders has increased, but with age-related difficulties, such as loss of independence. This represents a challenge for public health policies, as this population requires specific care and living conditions. As a response, a convention was signed between living facilities for dependent elderly (EHPAD) and the GHU Paris Psychiatry and Neurosciences. The agreement included dedicated places in EHPAD for older patients with psychiatric disorders. The aim of the study was to describe the sociodemographic and clinical characteristics of those patients.Methods: We conducted a cross-sectional study among patients who applied for an EHPAD admission.Results: Between 2016 and 2019, 163 patients applied for placement in an EHPAD, and 117 were admitted (72%). Applicants were 71 years old on average. Admitted patients were older than non-admitted and lived in different Parisian sectors. Among admitted patients, nine in 10 were single, divorced or widowed, and 64.3% were childless. Almost half of them were schizophrenic or had delusional disorders (46.9%), and 65.3% were considered as moderately dependent. At the time of the study, 89 patients still lived in EHPAD. Almost half of them had anxiety and depressive disorders (48.3%), 19.1% had cognitive disorders, and 42.7% manifested agitation.Conclusions: Our study highlighted older psychiatric patients' specificities regarding their admission status into long-term living facilities. [ABSTRACT FROM AUTHOR]

Objectives: Although hand grip strength and cognitive function are associated with fear of falling (FOF), little is known about whether coexisting physical and cognitive decline is jointly related to FOF. This study examines whether grip strength and cognitive function interact to shape FOF and FOF-related activity restriction (FAR) among Korean older adults.Methods/design: This study used seven waves of the Korean Longitudinal Study of Ageing (N = 3373 older adults aged 65 or over). Grip strength was assessed by a handgrip dynamometer, and cognitive function by Korean Mini-mental State Examination (K-MMSE). Fixed effects models were estimated to account for time-invariant confounders such as genetic predispositions, innate ability, and health endowments. This study estimated a joint model that included interaction effects between grip strength and cognitive function.Results: Declines in grip strength and cognitive function were independently associated with FOF. Fixed effects estimates suggested that, despite some attenuation, controlling for individual heterogeneity does not confound the associations. The interaction model showed that coexistence of low grip strength and cognitive decline leads to a greater risk of FOF and FAR than having a single condition. Similar patterns were found for FAR.Conclusions: This study provides evidence that coexistent cognitive and physical decline are a significant risk factor for FOF and FAR. Given the well-established adverse effects of FOF on older adults' health and well-being, results of this study lend support to interventions to target old adults with coexistent cognitive and physical decline to remove excessive concerns about FOF. [ABSTRACT FROM AUTHOR]

Objectives: Various informant-based questionnaires are used in clinical practice to screen for pre-stroke cognitive problems. However, there is no guidance on which tool should be preferred. We compared the validity of the two most commonly used informant-based tools.Methods: We recruited consecutively admitted stroke patients. Patients' informants completed the Informant Questionnaire for Cognitive Decline in the Elderly Short Form (IQCODE-SF, 16-item) and Ascertain Dementia 8 (AD8). We assessed construct validity (accuracy) against a semi-structured clinical interview for dementia or mild cognitive impairment (MCI), describing test accuracy metrics and comparing area under ROC curves (AUROC). We described criterion validity by evaluating associations between test scores and neuroimaging markers of dementia and overall 'brain frailty'. Finally, we described prognostic validity comparing ROC curves for 18-month clinical outcomes of dementia, death, stroke, and disability.Results: One-hundred-thirty-seven patient-informant dyads were recruited. At usual clinical cut-points, the IQCODE-SF had comparable sensitivity to the AD8 (both = 92%) for pre-stroke dementia, but superior specificity (IQCODE-SF: 82% vs. AD8: 58%). Youden index suggested that the optimal AD8 threshold for diagnosis of dementia is ≥4. The IQCODE-SF demonstrated stronger associations with markers of generalised and medial-temporal lobe atrophy, neurovascular disease, and overall brain frailty. IQCODE-SF also demonstrated greater accuracy for predicting future dementia (IQCODE-SF AUROC = 0.903, 95% CI = 0.798-1.00; AD8 AUROC = 0.821, 95% CI = 0.664-0.977).Conclusions: Both IQCODE-SF and AD8 are valid measures of pre-stroke dementia. Higher cut points for AD8 may improve performance in the acute stroke setting. Based on consistent superiority across a range of validity analyses, IQCODE-SF may be preferable to AD8 for pre-stroke dementia screening. [ABSTRACT FROM AUTHOR]

Objectives: Routinization reflects how older people cope with the health problems. It remains to be seen whether it should be considered as a risk factor of negative health outcomes, or rather, a mechanism of adjustment to health issues: mortality, institutionalization, dementia, disability, cognitive decline, depression and subjective health.Methods: From longitudinal data of two large-scale French epidemiological studies, the study sample consists of 961 participants aged 77 years on average, living at home and with no neurocognitive disorder. The relationship between the level of routines measured by the Preferences for Routines Scale-Short form and the adverse health outcomes are studied considering the level of routines at baseline and in time-dependent using Cox proportional hazards models and Latent process mixed models.Results: After adjustment for sociodemographic variables, the routinization score at baseline is not associated with any health outcomes while the routinization score as a time-dependent variable is significantly associated with an increased risk of dementia (hazard ratios (HR) = 1.08, 95% confidence intervals (CI) = 1.02-1.15, p = 0.016) and institutionalization (HR = 1.18, 95% CI = 1.03-1.36, p = 0.019), greater global cognitive decline (β = -0.02, p = 0.001) and depressive symptoms (β = 0.02, p = 0.023) and a decrease in subjective health (β = 0.02, p = 0.008).Conclusions: The level of routines measured at a given time is not associated with long-term prediction of negative health outcomes, while in time-dependent, it reveals to be a significant predictor. It should be seen as a marker of adjustment process. [ABSTRACT FROM AUTHOR]

Introduction: Hospital-associated deconditioning (HAD) or post-hospital syndrome is well recognized as reduced functional performance after an acute hospitalization. Recommendations for the management of HAD are still lacking, partly due to a poor understanding of the underlying processes. We aimed to review existing data on risk factors, pathophysiology, measurement tools, and potential interventions.Materials and Methods: We conducted a systematic review from bibliographical databases in English, Spanish and French with keywords such as 'post-hospitalization syndrome' or 'deconditioning'. We selected studies that included people aged 60 years or older. Three researchers independently selected articles and assessed their quality.Results: From 4421 articles initially retrieved, we included 94 studies. Most were related to risk factors, trajectories and measures, and focused on the physical aspects of deconditioning. Risk factors for HAD included age, nutritional status, mobility, and pre-admission functional status, but also cognitive impairment and depression. Regarding interventions, almost all studies were devoted to physical rehabilitation and environmental modifications. Only one study focused on cognitive stimulation.Discussion: In the last decade, studies on HAD have mostly focused on the physical domain. However, neurological changes may also play a role in the pathophysiology of HAD. Beyond physical interventions, cognitive rehabilitation and neurological interventions should also be evaluated to improve deconditioning prevention and treatment in the hospital setting. [ABSTRACT FROM AUTHOR]

Objectives: Social isolation among older adults with cognitive impairment is understudied. The purpose of this study is to examine the relationship between social isolation and anxiety in people with cognitive impairment in the United States.Methods/design: Secondary data analyses were conducted using the National Social Life, Health, and Aging Project (NSHAP) Wave 2 (2010-2011) dataset which includes a nationally representative sample of American older adults living at home. A total of 1343 people who had probable cognitive impairment measured by a Montreal Cognitive Assessment (MoCA) score of 22 or less were selected. Anxiety was measured using the anxiety measure of Hospital Anxiety and Depression Scale (HADS-A) and social isolation was measured using Perceived Social Isolation Scale. A weighted multivariable linear regression analysis and weighted F tests were used to examine the relationship between social isolation and anxiety.Results: We observed that greater social isolation was related to increased anxiety in people with cognitive impairment (coefficients = 0.7242, t = 2.51, p = 0.015), adjusting for severity of cognitive impairment, race, pain, depression, activities of daily living, and instrumental activities of daily living. Weighted F tests showed that persons with clinically significant anxiety (HADS-A ≥ 8) had higher levels of loneliness, including feeling a lack of companionship, feeling left out, and greater social isolation.Conclusions: The results of our study suggest that people with cognitive impairment can feel social isolation and it may contribute to their anxiety. Health care professionals, family, and friends of people with cognitive impairment should pay greater attention to social isolation of their loved ones. [ABSTRACT FROM AUTHOR]

Objectives: Delirium frequently arises in older demented and non-demented patients in postoperative, clinical settings. To date, the underlying pathophysiological mechanisms remain poorly understood. Monoamine neurotransmitter alterations have been linked to delirium and cognitive impairment. Our aim was to investigate if this holds true in cognitively normal and impaired patients experiencing delirium following hip surgery.Methods: Monoamines and metabolites were measured in plasma samples of 181 individuals by means of reversed-phase ultra-high-performance liquid chromatography with electrochemical detection. Delirium and delirium severity were scored with the Confusion Assessment Method and Delirium Rating Scale-Revised-1998. Cognitive function was assessed using the Informant Questionnaire on Cognitive Decline and the Mini-Mental State Examination, multimorbidity with the Charlson Comorbidity Index.Results: Plasma 5-hydroxyindoleacetic acid (5-HIAA), the major metabolite of serotonin (5-HT), was significantly higher in delirious and non-delirious cognitively impaired subjects as compared to control individuals without delirium and cognitive impairment (p < 0.001 and p = 0.007), which remained highly significant after excluding patients taking psychotropic medication (p < 0.0001 and p = 0.003). No significant differences were found for cognitively normal delirious patients, although serotonergic levels were numerically higher compared to control counterparts.Conclusions: Our findings indicate a general serotonergic disturbance in delirious and non-delirious postoperative patients suffering from cognitive impairment. We observed a similar, but less pronounced difference in delirious patients, which suggests serotonergic disturbances may be further aggravated by the co-occurrence of delirium and cognitive impairment. [ABSTRACT FROM AUTHOR]

Background and Objectives: In Argentina, government has established lockdown on 19 March 2020 to decrease SARS‐COV‐2 infection. The study aim was to understand how mandatory quarantine imposed due to COVID‐19 pandemic has affected quality of life, mood, and cognitive performance of older adults with cognitive impairment. Design: Longitudinal descriptive–observational study. Participants: Patients with cognitive impairment attending to online cognitive training sessions. Measurements: Participants have completed by themselves Quality of Life in Alzheimer's Disease scale (QOL‐AD), Beck Depression Inventory (BDI‐II), Test your Memory (TYM), and an attention and executive task created by our institution. Same assessments were done at the beginning of the lockdown and 7 months later. Results: Fifty‐one adults were included. An increase in BDI‐II score (p = 0.049) and worse performance in one of the executive attention tests (p = 0.012) have been found. No significant differences in QOL‐AD, TYM, verbal fluency, or memory tests total scores have been observed. Reviewing scales subitems, differences in changes in sleep habits (p = 0.021), energy level decrease (p = 0.004), worse subjective record of memory capacity (p = 0.028), and decrease in ability to do housework (p = 0.007) have been shown. In those who lived alone, BDI and TYM higher scores in BDI‐II (p = 0.030) (p = 0.022) have been found. Conclusion: Mandatory quarantine imposed due to COVID‐19 pandemic was associated with worsening of mood, some quality‐of‐life variables, and decrease in attention in older adults with cognitive impairment in Argentina. Key points: These results provide evidence of the negative impact of social isolation in the emotional and cognitive sphere of patients with cognitive impairment [ABSTRACT FROM AUTHOR]

Background: Marital status may have an impact on the elderly population's health, but few studies in China discussed about the association between marital status and cognitive impairment. Objective: To investigate the relationship between marital status and cognitive impairment. To compare the influences of marital status on dementia between men and women. Methods: This study was based on a representative national cross‐sectional epidemiological survey in China. We randomly selected 13 provinces and municipalities and included 19,276 participants aged 65 years or older in our study. Data was collected by interviewing the participants about their sociodemographic characteristics, and neuropsychological testing was administered to the participants by neurologists. To analyze the association between marital status and cognitive impairment, multiple logistic regression was based on a series of models. Results: Among the 19,276 subjects, about 77.2% were married, 1.6% were single, 21.2% were divorced/separated or widowed. The odds ratios (OR) of dementia were higher in single (OR: 2.13, CI: 1.53–2.97; p < 0.001), divorced/separated/widowed when they were ≤55 years old (OR: 1.75, CI: 1.30–2.35; p < 0.001), and divorced/separated/widowed when they were >55 years old (OR: 1.16, CI: 1.03–1.31; p < 0.001) participants than in married ones. Divorced/separated/widowed ≤55 men had about 2.75 times increase in dementia risk than married men. Conclusion: People with long‐term divorced/separated/widowed status would be associated to cognitive impairment more than those with short‐term divorced/separated/widowed status. Men may be affected by marriage disruption more than women in terms of increasing the risk of dementia. Key points: People divorced/separated/widowed ≤55 would be associated to cognitive impairment more than those divorced/separated/widowed >55 years oldMen may be affected by marriage disruption more than women in terms of increasing the risk of dementia [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine the feasibility of an intergenerational remote intervention program designed to promote the wellbeing and social connection of vulnerable older adults, mainly people with aphasia and dementia during the COVID‐19 pandemic in the south of Brazil. Undergraduate students were guided to lead weekly sessions of clowning, storytelling, dancing, and cooking‐related activities for 3 months (from November/2020 to February/2021). Method: The mixed‐method design of the study addresses the implementation and feasibility of the program. Data analysis considered both quantitative—number of individuals who accepted the invitation to participate, voluntary dropouts, attendance—and qualitative data—participative observation and thematic analysis of evaluative conversations. An inclusive group of 34 older adults with stroke‐induced cognitive impairments, dementia and individuals without any neurological conditions enrolled in the program based on social and racial equity principles. Feasibility and acceptability were addressed in terms of recruitment, implementation, remote evaluation, delivery of remote intervention, adherence, and attendance. Activities and participants' perceptions are described. Results: The initial period of the program achieved 83.7% of adherence and sustainability for additional 3 months. Preliminary results suggest feasibility and acceptability, considering formal and informal support in digital inclusion. Participatory observations describe that the structure of sessions and activities were well received. The analysis of participants' perceptions detects the thematic saliency of feelings of social connection and a sense of having learned with the group. Conclusions: Preliminary results of this study demonstrate the feasibility and acceptability of the program, pointing to its potential mental health benefits. Key points: Group‐based remote playful activities and one‐to‐one interactions through video calls from undergraduate students to older adults living with cognitive impairments was feasible and well received by this population.Results indicate that the intervention was perceived as promoting a positive effect and social engagement during the pandemic in Brazil.Further, larger scale trials are needed to assess the potential of the program to improve communication and reduce depression and anxiety symptoms of older adults with cognitive impairments. [ABSTRACT FROM AUTHOR]

Objectives: Evidence in mouse models has found that the antidepressant trazodone may be protective against neurodegeneration. We therefore aimed to compare cognitive decline of people with dementia taking trazodone with those taking other antidepressants. Methods: Three identical naturalistic cohort studies using UK clinical registers. We included all people with dementia assessed during 2008–16 who were recorded taking trazodone, citalopram or mirtazapine for at least 6 weeks. Linear mixed models examined age, time and sex‐adjusted Mini‐mental state examination (MMSE) change in people with all‐cause dementia taking trazodone compared with those taking citalopram and mirtazapine. In secondary analyses, we examined those with non‐vascular dementia; mild dementia; and adjusted results for neuropsychiatric symptoms. We combined results from the three study sites using random‐effects meta‐analysis. Results: We included 2,199 people with dementia, including 406 taking trazodone, with mean 2.2 years follow‐up. There was no difference in adjusted cognitive decline in people with all‐cause or non‐vascular dementia taking trazodone, citalopram or mirtazapine in any of the three study sites. When data from the three sites were combined in meta‐analysis, we found greater mean MMSE decline in people with all‐cause dementia taking trazodone compared to those taking citalopram (0·26 points per successive MMSE measurement, 95% CI 0·03–0·49; p = 0·03). Results in sensitivity analyses were consistent with primary analyses. Conclusions: There was no evidence of cognitive benefit from trazodone compared to other antidepressants in people with dementia in three naturalistic cohort studies. Despite preclinical evidence, trazodone should not be advocated for cognition in dementia. Key points: There is no evidence of cognitive benefit of trazodone in dementiaPeople taking trazodone had worse cognitive decline than those taking citalopramResults were similar in analyses restricted to people with mild dementiaResults were consistent after adjustment for severity of neuropsychiatric symptoms [ABSTRACT FROM AUTHOR]

Objectives: Persons with progressive cognitive impairment (CI) increasingly rely on surrogate decision‐makers for everyday activities. Yet, little is known about changes in everyday preferences over time or about concordance between persons with CI and their care partners regarding longitudinal changes. Methods: The sample included 48 dyads of persons with CI (Clinical Dementia Rating Scale score ≥0.5) and their care partners. The Preferences for Everyday Living Inventory was used to assess importance of preferences among persons with CI at baseline and follow‐up (mean 486 days). Care partners separately completed concurrent proxy assessments. Mixed random and fixed effects longitudinal models were used to evaluate changes in ratings and concordance levels between persons with CI and care partners. Results: There were significant gender differences regarding importance ratings of "autonomous choice" and "social engagement" preferences over time: women with CI rated these preferences as more important across time as a whole. Higher levels of neuropsychiatric symptoms were associated with less importance of "social engagement" preferences across time as a whole for persons with CI and a more negative discrepancy between persons with CI and care partner proxy assessments as time went on. Conclusion: This study yields new insights into predictors of longitudinal change in everyday preferences among persons with CI and their care partners. Although preferences were largely stable over time, there is increasing support for the relationship between differences in "social engagement" preferences and neuropsychiatric symptoms, which may have implications for monitoring and/or treatment in the context of cognitive impairment. Key points: The primary question addressed by this study is how do everyday preferences change over time for persons with cognitive impairment and how does concordance between persons with cognitive impairment and their care partners' change over time in assessment of everyday preferences?In this longitudinal study, there were significant gender differences regarding importance ratings of "autonomous choice" and "social engagement" preferences over time. Higher levels of neuropsychiatric symptoms were associated with less importance of "social engagement" preferences across time as a whole for persons with cognitive impairment and a more negative discrepancy between persons with cognitive impairment and care partner proxy assessments as time went on.This study yields new insights into predictors of longitudinal change in everyday preferences among persons with cognitive impairment and their care partners and lends increasing support to the relationship between differences in "social engagement" preferences and neuropsychiatric symptoms, which may have implications for monitoring and/or treatment in the context of cognitive impairment. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the diagnostic accuracy of three brief cognitive screening (BCS) tools, Peruvian version of Addenbrooke's Cognitive Examination (ACE‐Pe), of INECO Frontal Screening (IFS‐Pe) and of the Mini‐Mental State Examination (MMSE‐Pe), for the diagnosis of vascular cognitive impairment (VCI) and its non‐dementia stages (VCI‐ND) and vascular dementia (VD) in patients with cerebral stroke in Lima—Peru. Materials and methods: A cohort analysis to evaluate the diagnostic accuracy of three BCS for VCI. Results: Two hundred and four patients were evaluated: 61% Non‐VCI, 30% VCI‐ND and 9% VD. To discriminate patients with VCI from controls, the area under the curve (AUC) of ACE‐Pe, IFS‐Pe and MMs‐Pe were 0.99 (95% confidence interval [CI] 0.98–0.99), 0.99 (95%CI 0.98–0.99) and 0.87 (95%CI 0.82–0.92), respectively. Of the three BCS, the IFS‐Pe presented a larger AUC to discriminate VCI‐ND from VD (AUC = 0.98 [95%CI 0.95–1]) compared to ACE‐Pe (AUC = 0.84 [95%CI 0.74–0.95]) and MMSE‐Pe (0.92 [95%CI 0.86–0.99]). The IFS‐Pe presented a higher sensitivity (S), specificity (Sp), and positive (+LR) and negative likelihood ratios (−LR) (S = 96.72%, Sp = 89.47%, +LR = 9.1 and −LR = 0.03) than ACE‐Pe (S = 96.72%, Sp = 63.16%, +LR = 2.62 and −LR = 0.05) and MMSE‐Pe (S = 90.16%, Sp = 78.95%, +LR = 4.28 and −LR = 0.12). In the multiple regression analysis, the IFS‐Pe was not affected by age, sex or years of schooling. Conclusion: The IFS‐Pe has the best diagnostic accuracy for detecting VCI and discriminating between pre‐dementia (VCI‐ND) and dementia (VD) stages. Key points: Brief cognitive screening (BCS) tools for the detection of vascular cognitive impairment (VCI) must be adapted and validated for each region and include evaluation of individuals with a low level of education and illiterate subjects from urban and rural settingsA diagnostic test design was used to determine the diagnostic accuracy indicators of the three BSC: Peruvian version of Addenbrooke's Cognitive Examination (ACE‐Pe), INECO Frontal Screening (IFS‐Pe) and the Mini‐Mental State Examination (MMSE‐Pe)IFS‐Pe presented a higher sensitivity, specificity, and positive and negative likelihood ratios than ACE‐Pe and MMSE‐PeIFS‐Pe was more accurate in differentiating pre‐dementia (VCI non‐dementia stage) from dementia stages (vascular dementia) compared to ACE‐Pe and the MMSE‐Pe [ABSTRACT FROM AUTHOR]

Objectives: To describe characteristics and compare clinical outcomes including falls, fractures, infections, and neuropsychiatric symptoms (NPS) among long‐term care residents with dementia with and without agitation. Methods: A cross‐sectional secondary analysis of administrative healthcare data was conducted whereby residents with dementia residing in a long‐term care facility for ≥12 months were identified from the AnalytiCare LLC database (10/2010–06/2014) and were classified into mutually exclusive cohorts (Agitation Cohort or No‐Agitation Cohort) based on available agitation‐related symptoms. Entropy balancing was used to balance demographic and clinical characteristics between the two cohorts. The impact of agitation on clinical outcomes was compared between balanced cohorts using weighted logistic regression models. Results: The study included 6,265 long‐term care residents with dementia among whom, 3,313 were included in the Agitation Cohort and 2,952 in the No‐Agitation Cohort. Prior to balancing, residents in the Agitation Cohort had greater dementia‐related cognitive impairment and clinical manifestations compared to the No‐Agitation Cohort. After balancing, residents with and without agitation, respectively, received a median of five and four distinct types of medications (including antipsychotics). Further, compared to residents without agitation, those with agitation were significantly more likely to have a recorded fall (OR = 1.58), fracture (OR = 1.29), infection (OR = 1.18), and other NPS (OR = 2.11). Conclusions: Agitation in long‐term care residents with dementia was associated with numerically higher medication use and an increased likelihood of experiencing falls, fractures, infections, and additional NPS compared to residents without agitation, highlighting the unmet need for effective management of agitation symptoms in this population. Key points: Agitation symptoms in long‐term care residents with dementia can be disabling and lead to a loss of independent functionThis study suggests that agitation is associated with higher use of polypharmacy, including antipsychotics, and an increased likelihood of falls, fractures, infections as well as other neuropsychiatric symptomsTogether, these outcomes present a major burden not only to the patient, but also to the long‐term care facilities, caregivers, and healthcare systemFindings of this study highlight the complexity of care for long‐term care residents with dementia and the current unmet need for effective management of agitation symptoms in this setting [ABSTRACT FROM AUTHOR]

Objectives: We aimed to examine whether loneliness mediates these associations between perceived neighborhood characteristics and cognition among middle‐aged and older adults. Methods: Data from wave 10 (2010–2012) to wave 13 (2016–2017) of the Health and Retirement Study were analyzed. Perceived neighborhood characteristics were self‐reported. Loneliness was measured by Revised University of California Los Angeles (R‐UCLA) Loneliness Scale. Cognition was evaluated by the modified version of Telephone Interview for Cognitive Status. Baron and Kenny's causal steps and multiple linear regression models based on Karlson/Holm/Breen (KHB) method were used to examine the mediating effect. Results: At baseline, 15,142 participants had no cognitive impairment, and 11,413 individuals were finally included in our analysis after 6‐year follow‐up. Multiple linear regression models suggested that lower perceived neighborhood physical disorder (β = 0.073, p = 0.033) and greater perceived neighborhood safety (β = 0.350, p = 0.009) were associated with better cognition. KHB test identified the significant mediating effect of loneliness on the relationships between perceived neighborhood physical disorder (β = 0.011, p = 0.016) and perceived neighborhood safety (β = 0.023, p = 0.026) and cognition. Conclusions: Perceived neighborhood characteristics are associated with cognition among middle‐aged and older American adults. Loneliness mediated associations between perceived neighborhood physical disorder and perceived neighborhood safety and cognition. Key points: Perceived neighborhood characteristics were associated with cognition among middle‐aged and older American adults.Loneliness mediated associations between perceived neighborhood physical disorder, perceived neighborhood safety and cognition.The public health interventions aimed at preventing cognitive decline may benefit greatly via focusing on reducing loneliness among middle‐aged and older adults. [ABSTRACT FROM AUTHOR]

Background: Long‐term use of anticholinergics, benzodiazepines and related drugs (or "Z‐drugs") have been associated with cognitive impairment and dementia. However, the relationship of these medications with cognitive function and domain‐specific neuropsychological performance in older adults without dementia, is unclear. Methods: 5135 older adults (74.0 ± 8.3 years; 67.4% female) without a diagnosis of dementia were recruited in Ireland to the Trinity‐Ulster‐Department of Agriculture (TUDA) study. Detailed cognitive and neuropsychological assessment was conducted using the Mini‐Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Repeatable Battery for Assessment of Neuropsychological Status (RBANS). Results: A total of 44% (2259 of 5153) used either a potential or definite anticholinergic medication. Overall, 9.7% (n = 500) used a definite anticholinergic medication. Regular benzodiazepine use was reported by 7% (n = 363), whilst 7.5% (n = 387) used a "Z‐drug". Use of definite, but not potential anticholinergic medication was associated with poorer performance on all three assessments (β: −0.09; 95% CI: −0.14, −0.03, p = 0.002 for MMSE; β: −0.04; 95% CI: −0.06, −0.02; p < 0.001 for FAB; β: −4.15; 95% CI: −5.64, −2.66; p < 0.001 for RBANS) in addition to all domains of the RBANS. Regular benzodiazepine use was also associated with poorer neuropsychological test performance, especially in Immediate Memory (β: −4.98; 95% CI: −6.81, −3.15; p < 0.001) and Attention (β: −6.81; 95% CI: −8.60, −5.03; p < 0.001) RBANS domains. Conclusions: Regular use of definite anticholinergic medications and benzodiazepines, but not potential anticholinergics or "Z‐drugs", was associated with poorer overall and domain‐specific neuropsychological performance in older adults. Key points: Use of both anticholinergic medication and benzodiazepines have been associated with dementia in older adults.Use of these medications and domain‐specific cognitive performance in those without dementia, is less well‐understood.In >5000 older adults, use of these medications was associated with poorer overall and domain‐specific cognitive performance.These findings have important implications for risk vs benefit decisions of prescribing these medications in older adults. [ABSTRACT FROM AUTHOR]