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Objective: As the number of individuals diagnosed with dementia increases, so does the need to understand the preferences of persons living with dementia (PLWD) and caregivers for how clinicians can deliver a dementia diagnosis effectively, which can be a difficult process. This study describes the diagnostic communication preferences of PLWD and caregivers. Methods: We conducted semi-structured individual phone interviews with two groups: PLWD who were diagnosed in the past two years (n = 11) and family caregivers of PLWD (n = 19) living in Florida. PLWD and caregivers were not recruited/enrolled as dyads. Results: The groups' communication preferences were largely similar. Data were analyzed thematically into five themes: communicate the diagnosis clearly, meet information needs, discuss PLWD/caregiver resources, prepare for continued care, and communicate to establish and maintain relationships. Conclusion: Participants wanted clear communication, information, and support, but differed in some details (e.g. the language used to describe the diagnosis and the amount/type of desired information). Clinicians can apply general principles but will need to tailor them to individual preferences of PLWD and caregivers. Innovation: Limited research has elicited PLWD and caregivers' communication preferences for receiving dementia diagnoses, particularly through an individualized data collection method allowing for richer descriptions and deeper understanding.

Se presentan las estrategias de evaluación en neuropsicología para el diagnóstico diferencial entre envejecimiento normal y patológico (demencia). Se ha sugerido que la enfermedad de Alzheimer (EA) puede iniciarse como un deterioro cognoscitivo leve (DCL). Se analizan los diferentes subtipos de DCL, considerando que sólo algunos de ellos resultan en una EA. Se subraya que existen dos estrategias de evaluación cognoscitiva: las pruebas de tamizaje y las evaluaciones extensas. Se presen- tan las principales pruebas neuropsicológicas para una y otra y se señalan las adaptaciones disponibles en español. A pesar de los avances neuropsicológicos en lo conceptuales y diagnóstico sobre el envejecimiento, se estima que más del 50% de los casos de demencia no se diagnostican en etapas iniciales.

La maduración cerebral se correlaciona con muchos de los cambios cognoscitivos y de comportamiento observados durante la infancia y la adolescencia. En este artículo se revisa el concepto de maduración cerebral y su asociación con el desarrollo de la preferencia manual, del lenguaje verbal y de la función ejecutiva en el niño. Se describe el incremento de las arborizaciones dendríticas como el cambio cortical más importante asociado a la adquisición de funciones cognoscitivas complejas. Se asocia la maduración del hemisferio derecho con la conducta emocional y la maduración del hemisferio izquierdo con el lenguaje. La maduración de las áreas prefrontales se correlaciona con el desarrollo de las funciones ejecutivas. Se presentan ejemplos específicos sobre la existencia de asimetría cerebral motriz desde el nacimiento y sobre la lateralización posterior de funciones visuales, auditivas y táctiles. Se analiza la participación cualitativamente diferente de los hemisferios cerebrales en los procesos cognoscitivos durante las distintas etapas del desarrollo del niño. Finalmente, se presentan algunos ejemplos de las secuelas cognoscitivas secundarias a lesiones cerebrales tempranas como un método más para entender la ontogenia de la asimetría cerebral

Abstract INTRODUCTION Commercially available plasma p‐tau217 biomarker tests are not well studied in ethnically diverse samples. METHODS We evaluated associations between ALZPath plasma p‐tau217 and amyloid‐beta positron emission tomography (Aβ‐PET) in Hispanic/Latino (88% of Cuban or South American ancestry) and non‐Hispanic/Latino older adults. One‐ and two‐cutoff ranges were derived and evaluated to assess agreement with Aβ‐PET. RESULTS A total of 239 participants underwent blood draw and Aβ‐PET (age 70.8 ± 7.8, 55.2% female, education 15.6 ± 3.4 years, 48.9% Hispanic/Latino, 94.9% white). Plasma p‐tau217 showed excellent discrimination of Aβ‐PET positive and negative participants (visual read: AUC = 0.91 [0.87–0.95], p

Given telemetry datasets (e.g., GPS location, speed, direction, distance.), the Older Driver Classification (ODC) problem identifies two groups of drivers: normal and abnormal. The ODC problem is essential in many societal applications, including road safety, insurance risk assessment, and targeted interventions for elderly drivers with dementia or Mild Cognitive Impairment (MCI). The problem is challenging because of the volume and heterogeneity of temporally-detailed vehicle datasets. This paper proposes a novel spatial deep-learning approach that leverages Grid-Index based data augmentation to enhance the detection of abnormal driving behaviors. Through extensive experiments and a real-world case study, the proposed approach consistently identifies abnormal drivers with high accuracy. The findings demonstrate the potential of grid-based methods to improve telematics-based driving behavior analysis significantly. This approach offers valuable implications for enhancing road safety measures, optimizing insurance risk assessments, and developing targeted interventions for at-risk drivers.

Abstract Background Driving is a complex behavior that may be affected by early changes in the cognition of older individuals. Early changes in driving behavior may include driving more slowly, making fewer and shorter trips, and errors related to inadequate anticipation of situations. Sensor systems installed in older drivers’ vehicles may detect these changes and may generate early warnings of possible changes in cognition. Method A naturalistic longitudinal design is employed to obtain continuous information on driving behavior that will be compared with the results of extensive cognitive testing conducted every 3 months for 3 years. A driver facing camera, forward facing camera, and telematics unit are installed in the vehicle and data downloaded every 3 months when the cognitive tests are administered. Results Data processing and analysis will proceed through a series of steps including data normalization, adding information on external factors (weather, traffic conditions), and identifying critical features (variables). Traditional prediction modeling results will be compared with Recurring Neural Network (RNN) approach to produce Driver Behavior Indices (DBIs), and algorithms to classify drivers within age, gender, ethnic group membership, and other potential group characteristics. Conclusion It is well established that individuals with progressive dementias are eventually unable to drive safely, yet many remain unaware of their cognitive decrements. Current screening and evaluation services can test only a small number of individuals with cognitive concerns, missing many who need to know if they require treatment. Given the increasing number of sensors being installed in passenger vehicles and pick-up trucks and their increasing acceptability, reconfigured in-vehicle sensing systems could provide widespread, low-cost early warnings of cognitive decline to the large number of older drivers on the road in the U.S. The proposed testing and evaluation of a readily and rapidly available, unobtrusive in-vehicle sensing system could provide the first step toward future widespread, low-cost early warnings of cognitive change for this large number of older drivers in the U.S. and elsewhere.

IntroductionThis study investigated the role of proactive semantic interference (frPSI) in predicting the progression of amnestic Mild Cognitive Impairment (aMCI) to dementia, taking into account various cognitive and biological factors.MethodsThe research involved 89 older adults with aMCI who underwent baseline assessments, including amyloid PET and MRI scans, and were followed longitudinally over a period ranging from 12 to 55 months (average 26.05 months).ResultsThe findings revealed that more than 30% of the participants diagnosed with aMCI progressed to dementia during the observation period. Using Cox Proportional Hazards modeling and adjusting for demographic factors, global cognitive function, hippocampal volume, and amyloid positivity, two distinct aspects of frPSI were identified as significant predictors of a faster decline to dementia. These aspects were fewer correct responses on a frPSI trial and a higher number of semantic intrusion errors on the same trial, with 29.5% and 31.6 % increases in the likelihood of more rapid progression to dementia, respectively.DiscussionThese findings after adjustment for demographic and biological markers of Alzheimer’s Disease, suggest that assessing frPSI may offer valuable insights into the risk of dementia progression in individuals with aMCI.

IntroductionSemantic intrusion errors (SI) have distinguished between those with amnestic Mild Cognitive Impairment (aMCI) who are amyloid positive (A+) versus negative (A−) on positron emission tomography (PET).MethodThis study examines the association between SI and plasma – based biomarkers. One hundred and twenty-eight participants received SiMoA derived measures of plasma pTau-181, ratio of two amyloid-β peptide fragments (Aβ42/Aβ40), Neurofilament Light protein (NfL), Glial Fibrillary Acidic Protein (GFAP), ApoE genotyping, and amyloid PET imaging.ResultsThe aMCI A+ (n = 42) group had a higher percentage of ApoE ɛ4 carriers, and greater levels of pTau-181 and SI, than Cognitively Unimpaired (CU) A− participants (n = 25). CU controls did not differ from aMCI A− (n = 61) on plasma biomarkers or ApoE genotype. Logistic regression indicated that ApoE ɛ4 positivity, pTau-181, and SI were independent differentiating predictors (Correct classification = 82.0%; Sensitivity = 71.4%; Specificity = 90.2%) in identifying A+ from A− aMCI cases.DiscussionA combination of plasma biomarkers, ApoE positivity and SI had high specificity in identifying A+ from A− aMCI cases.

The vast majority of individuals with dementia want to receive a diagnosis. Research suggests, however, that only a fraction of individuals with dementia receive a diagnosis and patients and families often feel the information is poorly explained. We thus aimed to assess clinician-reported barriers to dementia disclosure and recommendations for giving a dementia diagnosis. To accomplish this, we performed telephone interviews with 15 clinicians from different specialties using a semi-structured interview guide. Transcripts were analyzed thematically. Clinician-reported barriers fit 3 categories: patient and caregiver-related barriers, clinician-related barriers, and barriers related to the triadic interaction. Patient and caregiver-related barriers included lack of social support, misunderstanding the diagnosis , and denial. Clinician barriers included difficulty giving bad news, difficulty communicating uncertainty , and lack of time. Triadic interaction barriers included c hallenges meeting multiple goals or needs and family requests for non-disclosure. Recommendations for best practice included for clinicians to foster relationships, educate patients and family, and take a family-centered approach. Clinicians described recommendations for fostering relationships such as using empathic communication and developing and maintaining connection . Educating patients and families included tailoring communication , explaining how the diagnosis was reached , and following up . Family approaches included meeting with family members prior to delivering the diagnosis and involving the caregiver in the discussion. Findings may inform updated recommendations for best practices when communicating a dementia diagnosis.

BackgroundIndividuals with cognitive impairment and their families place a high value on receiving a dementia diagnosis, but clinician approaches vary. There is a need for research investigating experiences of giving and receiving dementia diagnoses. The current study aimed to investigate clinician approaches to giving dementia diagnoses as part of a larger study investigating patient, caregiver, and clinician experiences during the diagnosis encounter.MethodInvestigators conducted telephone interviews with Florida-based clinicians who give dementia diagnoses either rarely or commonly. Interviews employed a semi-structured interview guide querying communication practices used by clinicians when giving dementia diagnoses and how clinicians learned to give dementia diagnoses. Investigators used a descriptive qualitative design to conduct a thematic analysis of data.ResultsFifteen Florida-based clinicians participated, representing diverse backgrounds related to gender, race/ethnicity, specialty, and practice setting. Participants reported using patient- and family-centered communication practices including checking patient understanding, communicating empathically, and involving family members. Some clinicians explicitly asked patients and/or family members about their preferences regarding diagnosis disclosure; many clinicians tailored their disclosure based on patient and family characteristics or reactions. Some clinicians reported using specific diagnoses, while others used general terms such as "memory disorder." Clinicians reported positively framing information, including instilling hope, focusing on healthy behaviors, and discussing symptom management. Finally, clinicians provided patient/family education and arranged follow up. Clinicians reported learning approaches to dementia diagnosis disclosure through formal training and self-education.ConclusionsDiverse Florida-based clinicians described dementia disclosure practices largely consistent with published guidance, but clinicians varied on approaches relating to soliciting patient disclosure preferences and terminology used. Clinicians caring for diverse populations described that cultural background affects the disclosure process, but more research is needed regarding this finding and best practices for individuals from different backgrounds.

Background and Objectives: Prediction of decline to dementia using objective biomarkers in high-risk patients with amnestic mild cognitive impairment (aMCI) has immense utility. Our objective was to use multimodal MRI to (1) determine whether accurate and precise prediction of dementia conversion could be achieved using baseline data alone, and (2) generate a map of the brain regions implicated in longitudinal decline to dementia.Methods: Participants meeting criteria for aMCI at baseline (N = 55) were classified at follow-up as remaining stable/improved in their diagnosis (N = 41) or declined to dementia (N = 14). Baseline T1 structural MRI and resting-state fMRI (rsfMRI) were combined and a semi-supervised support vector machine (SVM) which separated stable participants from those who decline at follow-up with maximal margin. Cross-validated model performance metrics and MRI feature weights were calculated to include the strength of each brain voxel in its ability to distinguish the two groups.Results: Total model accuracy for predicting diagnostic change at follow-up was 92.7% using baseline T1 imaging alone, 83.5% using rsfMRI alone, and 94.5% when combining T1 and rsfMRI modalities. Feature weights that survived the p < 0.01 threshold for separation of the two groups revealed the strongest margin in the combined structural and functional regions underlying the medial temporal lobes in the limbic system.Discussion: An MRI-driven SVM model demonstrates accurate and precise prediction of later dementia conversion in aMCI patients. The multi-modal regions driving this prediction were the strongest in the medial temporal regions of the limbic system, consistent with literature on the progression of Alzheimer’s disease.

Abstract Introduction Culturally fair cognitive assessments sensitive to detecting changes associated with prodromal Alzheimer's disease are needed. Methods Performance of Hispanic and non‐Hispanic older adults on the Loewenstein‐Acevedo Scale of Semantic Interference and Learning (LASSI‐L) was examined in persons with amnestic mild cognitive impairment (aMCI) or normal cognition. The association between a novel cognitive marker, the failure to recover from proactive semantic interference (frPSI), and cortical thinning was explored. Results English‐speaking aMCI participants scored lower than cognitively normal participants on all LASSI‐L indices, while Spanish‐speaking aMCI participants scored lower in learning, frPSI, and delayed recall. Healthy controls obtained equivalent scores on all indices except retroactive semantic interference. English‐speaking and Spanish‐speaking aMCI participants had equivalent scores except English speaker's greater vulnerability to frPSI. Across aMCI groups, frPSI was associated with cortical thinning of the entorhinal cortex and precuneus (r = −0.45 to r = 0.52; P < .005). Discussion In diverse populations, LASSI‐L performance differentiated patients with aMCI from cognitively normal older adults and was associated with thinning in Alzheimer's disease–prone regions, suggesting its clinical utility.

Background: In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru. Methods: 1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru. Findings: Mean age for all participants was 66.7 (SD = 7.7) years and mean education was 15.4 (SD = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact (p

Acalculia is an acquired disorder in calculation abilities, usually associated with left posterior parietal damage. Two types of acalculic disorders are usually distinguished: (1) primary acalculia or anarithmetia, where the patient presents a loss of numerical concepts (difficulties are observed both in oral and written calculations), and (2) secondary acalculia due to a different disturbance in cognition and affecting mathematical abilities. Secondary acalculias are associated with aphasia, alexia, agraphia, executive function disorders, or visuospatial difficulties. This paper is a proposal for clinical intervention to rehabilitation of acquired primary and secondary acalculias.

Background. Understanding the functions of different brain areas has represented a major endeavor of neurosciences. Historically, brain functions have been associated with specific cortical brain areas; however, modern neuroimaging developments suggest cognitive functions are associated to networks rather than to areas. Objectives. The purpose of this paper was to analyze the connectivity of Brodmann area (BA) 37 (posterior, inferior, and temporal/fusiform gyrus) in relation to (1) language and (2) visual processing. Methods. Two meta-analyses were initially conducted (first level analysis). The first one was intended to assess the language network in which BA37 is involved. The second one was intended to assess the visual perception network. A third meta-analysis (second level analysis) was then performed to assess contrasts and convergence between the two cognitive domains (language and visual perception). The DataBase of Brainmap was used. Results. Our results support the role of BA37 in language but by means of a distinct network from the network that supports its second most important function: visual perception. Conclusion. It was concluded that left BA37 is a common node of two distinct networks—visual recognition (perception) and semantic language functions.

A 74-year-old, left-handed man presented with a rapidly evolving loss of strength in his right leg associated with difficulty in walking. MR images disclosed an extensive left hemisphere tumor. A neuropsychological examination revealed that language was broadly normal but that the patient presented with severe nonlinguistic abnormalities, including hemineglect (both somatic and spatial), constructional defects, and general spatial disturbances; symptoms were usually associated with right hemisphere pathologies. No ideomotor apraxia was found. The implications of crossed-brain representations of verbal and nonverbal functions are analyzed.