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INTRODUCTION: The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS: We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort‐specific Cox proportional hazard regression analyses in a two‐step individual participant data meta‐analysis. RESULTS: A one‐standard‐deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow‐up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION: Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. Highlights: A two‐step individual participant data meta‐analysis was conducted.This was done at a global scale using data from 21 ethno‐regionally diverse cohorts.The association between a modifiable dementia risk score and dementia was examined.The association was modified by geographical region and age at baseline.Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions. [ABSTRACT FROM AUTHOR]

Increases in harmful drinking among older adults indicate the need for a more thorough understanding of the relationship between later‐life alcohol use and brain health. The current study investigated the relationships between alcohol use and progressive grey and white matter changes in older adults using longitudinal data. A total of 530 participants (aged 70 to 90 years; 46.0% male) were included. Brain outcomes assessed over 6 years included total grey and white matter volume, as well as volume of the hippocampus, thalamus, amygdala, corpus callosum, orbitofrontal cortex and insula. White matter integrity was also investigated. Average alcohol use across the study period was the main exposure of interest. Past‐year binge drinking and reduction in drinking from pre‐baseline were additional exposures of interest. Within the context of low‐level average drinking (averaging 11.7 g per day), higher average amount of alcohol consumed was associated with less atrophy in the left (B = 7.50, pFDR = 0.010) and right (B = 5.98, pFDR = 0.004) thalamus. Past‐year binge‐drinking was associated with poorer white matter integrity (B = −0.013, pFDR = 0.024). Consuming alcohol more heavily in the past was associated with greater atrophy in anterior (B = −12.73, pFDR = 0.048) and posterior (B = −17.88, pFDR = 0.004) callosal volumes over time. Across alcohol exposures and neuroimaging markers, no other relationships were statistically significant. Within the context of low‐level drinking, very few relationships between alcohol use and brain macrostructure were identified. Meanwhile, heavier drinking was negatively associated with white matter integrity. [ABSTRACT FROM AUTHOR]

Aim: Recovery from stroke is adversely affected by neuropsychiatric complications, cognitive impairment, and functional disability. Better knowledge of their mutual relationships is required to inform effective interventions. Network theory enables the conceptualization of symptoms and impairments as dynamic and mutually interacting systems. We aimed to identify interactions of poststroke complications using network analysis in diverse stroke samples. Methods: Data from 2185 patients were sourced from member studies of STROKOG (Stroke and Cognition Consortium), an international collaboration of stroke studies. Networks were generated for each cohort, whereby nodes represented neuropsychiatric symptoms, cognitive deficits, and disabilities on activities of daily living. Edges characterized associations between them. Centrality measures were used to identify hub items. Results: Across cohorts, a single network of interrelated poststroke complications emerged. Networks exhibited dissociable depression, apathy, fatigue, cognitive impairment, and functional disability modules. Worry was the most central symptom across cohorts, irrespective of the depression scale used. Items relating to activities of daily living were also highly central nodes. Follow‐up analysis in two studies revealed that individuals who worried had more densely connected networks than those free of worry (CASPER [Cognition and Affect after Stroke: Prospective Evaluation of Risks] study: S = 9.72, P = 0.038; SSS [Sydney Stroke Study]: S = 13.56, P = 0.069). Conclusion: Neuropsychiatric symptoms are highly interconnected with cognitive deficits and functional disabilities resulting from stroke. Given their central position and high level of connectedness, worry and activities of daily living have the potential to drive multimorbidity and mutual reinforcement between domains of poststroke complications. Targeting these factors early after stroke may have benefits that extend to other complications, leading to better stroke outcomes. [ABSTRACT FROM AUTHOR]

Introduction: There are limited data on prevalence of dementia in centenarians and near‐centenarians (C/NC), its determinants, and whether the risk of dementia continues to rise beyond 100. Methods: Participant‐level data were obtained from 18 community‐based studies (N = 4427) in 11 countries that included individuals ≥95 years. A harmonization protocol was applied to cognitive and functional impairments, and a meta‐analysis was performed. Results: The mean age was 98.3 years (SD = 2.67); 79% were women. After adjusting for age, sex, and education, dementia prevalence was 53.2% in women and 45.5% in men, with risk continuing to increase with age. Education (OR 0.95;0.92–0.98) was protective, as was hypertension (odds ratio [OR] 0.51;0.35–0.74) in five studies. Dementia was not associated with diabetes, vision and hearing impairments, smoking, and body mass index (BMI). Discussion: Among the exceptional old, dementia prevalence remains higher in the older participants. Education was protective against dementia, but other factors for dementia‐free survival in C/NC remain to be understood. [ABSTRACT FROM AUTHOR]

Background: Access to a "gold‐standard" in‐person neuropsychological assessment to detect cognitive decline in older adults using paper‐and‐pencil (PnP) tests is limited. Computerized neuropsychological assessments (CNAs) potentially provide lower cost, scalable, accessible alternatives but critical psychometric data on the validity, reliability and user‐experience of CNAs in older adults are lacking. Method: 263 community‐dwelling individuals aged 60 years and older without dementia were assigned to complete two CNA batteries and one standardised neuropsychological assessment with 14 PnP tests, one week apart (Construct Validity Group) or two CNAs on two occasions, one month apart (Reliability Group). CNAs were self‐administered under supervision. Orders of CNA batteries, and of CNA and PnP sessions were counterbalanced (Figure 1). Participants completed questionnaires evaluating their experience after each CNA battery. Four CNA batteries were investigated: Cambridge Brain Sciences (CBS), CANTAB, Cogstate, and NIH Toolbox, each containing 5—8 tests; key variables recommended by the test developers were examined (Table 1). Result: Participant characteristics are summarised in Table 2. Concurrent Validity: Modest correlations (r's of 0.3‐0.6) between CNA and PnP measures were observed for all CNA batteries, generally aligning with corresponding domains, though notably reflecting the multidimensionality of cognitive measures (Table 3); the strongest associations (r ≥0.5) were with attention and processing speed measures across three CNA batteries, also NIH Toolbox vocabulary, memory and executive measures. Reliability: One‐month test‐retest reliabilities of individual measures were variable (Table 4); across three batteries some, typically speed measures, had reliability coefficients ≥ 0.7. User Experience: Completion rates were high (96‐100%). Usability ratings of CNAs were high on average, although variability was large for CBS (Figure 2). Ratings of acceptability were lower than usability, though on average, participants endorsed CNAs positively. Conclusion: A selection of computerized measures demonstrated adequate psychometric standards for concurrent validity with 'gold standard' in‐person neuropsychological assessments, alongside good usability and acceptability, though test‐retest reliability was low for many measures. CogSCAN's comprehensive comparative data will guide researchers in selecting the most suitable CNA measures for older adults. Work in progress is investigating CNA validity, reliability and user experience in older adults with cognitive decline and culturally and linguistically diverse older adults. [ABSTRACT FROM AUTHOR]

Background: Subjective cognitive complaints (SCCs) are a risk factor for dementia; however, little is known about their trajectories. Method: Participants were 873 older adults (mage = 78.65 years; 55% females) from the Sydney Memory and Ageing Study that were followed‐up biennially. SCCs were measured using the six‐item Memory Complaint Questionnaire. Associations between initial level of SCC reporting, linear change in SCC reporting, and change in global cognition over 6 years was examined using latent growth curve analysis. Risk of dementia was examined over 10 years using Cox regression. Results: After controlling for demographics, mood and personality, results revealed a negative longitudinal association between the slope of SCCs and the slope of global cognition scores (b = −0.01, p = 0.005, β = −0.44), such that participants who reported increasing SCCs showed a steeper rate of decline in global cognition over 6 years. Cox regression also revealed participants who reported increasing SCCs had a nearly fourfold increased risk of developing dementia over 10 years (hazard ratio 3.70, 1.24–11.01). Conclusion: This study explored whether initial levels of, and change in, SCCs over time are associated with both cognitive decline and risk of dementia. These findings are clinically relevant as GPs should note patients reporting increasing SCCs as they may be at greater risk of cognitive decline and incident dementia. Highlights: Existing longitudinal data on the association between subjective cognitive complaints (SCCs) and cognitive outcomes over time has focused on associations with decline in memory or other cognitive domains, or on associations with risk of incident dementia, but not both.To our knowledge, no study has examined whether changes in SCCs reporting predict both cognitive decline and incident dementia in the same cohort.Controlling for mood and personality, participants who reported increasing SCCs showed a steeper rate of cognitive decline over 6 years and had a nearly fourfold increased risk of dementia over 10 years.Examining longitudinal features of SCCs provides novel and important insight into their association with underlying cognitive changes. GPs and Clinicians should note patients reporting increasing SCCs over time as this is associated with future cognitive decline and risk of dementia. [ABSTRACT FROM AUTHOR]

Background: Computers and related technologies are increasingly used for cognitive assessment. However, few studies have considered older adults' experience using computerized neuropsychological assessment (CNA), or individual characteristics that may influence acceptability and emotional responses to computerized tests. Method: 205 community‐dwelling native English speakers aged 60‐95 were randomly assigned to complete two of four CNA batteries: Cogstate, CANTAB, CBS, and NIH Toolbox, on an iPad. After test completion, participants rated their emotions during testing on a Mood Adjective Checklist (MAC) with four subscales ‐ high stress (worried), low stress (relaxed), high arousal (energised), low arousal (tired), and provided ratings of test acceptability. Multiple regression analyses investigated associations of demographics (age, sex, education), cognitive level (MoCA, premorbid ability), subjective memory, mood over the past week (depression, anxiety, stress), computer/technology attitudes and experience, with the four MAC subscales and test acceptability score. Parallel analyses were performed in a subsample of participants also completing a pen‐and‐paper neuropsychological battery (PnP). Potential differences in predictors for CNA and PNP and the influence of potential confounders (PnP yes/no, CNA test pair) were examined. Result: Over half of the participants had considerable experience with computers or tablets (Table 1). Demographics were not significantly related to emotion ratings or test acceptability and were excluded from further analyses. Higher stress over the past week was associated with feeling more worried and tired during test‐taking. Higher premorbid ability was associated with feeling less relaxed (Table 2). Greater computer anxiety, higher premorbid ability and more computer experience were associated with lower CNA acceptability. Although some predictors of PnP acceptability and emotional response differed (Table 3), interactions between predictors and testing mode were non‐significant for all outcome variables (p's>.05). Inclusion of potentially confounding variables did not alter the overall findings. Conclusion: Recent mood, cognitive level, computer attitudes and experience influenced emotions during testing and test acceptability. These relationships and their potential association with CNA and PnP performance will be investigated in future work. Data on emotional response to testing and test acceptability will need to be triangulated with psychometric information about CNA and PnP measures to determine the most suitable test options for individuals. [ABSTRACT FROM AUTHOR]

Background: Subjective cognitive complaints (SCCs) are now an established risk factor for dementia, however, little is known about whether changing patterns in SCCs over time are associated with cognitive decline and dementia risk. We examine the trajectory of SCCs over a 6‐year period to determine whether intraindividual patterns of reporting SCCs over time is related to cognitive decline and incident dementia. Method: Participants were 1037 older adults without dementia (Mage = 78.65 years; 55% females) from the Sydney Memory and Ageing Study who were followed‐up biennially. Global cognition was measured using a comprehensive neuropsychological battery, and clinical diagnoses were made by an expert consensus panel. SCCs were obtained as participants' response to a single question concerning their subjective report of memory decline. Patterns of SCCs over time were modelled by conducting categorical latent growth curve analysis using the logit transformation (Figure 1). We examined the associations between average level of SCC likelihood and change in SCC likelihood, with global cognition over six years using latent growth curve analysis, and with risk of incident dementia over 10 years using Cox regression. Result: In this community‐dwelling older adult sample, there was an annual 10% increase in the odds of reporting SCCs (Figure 2). After controlling for demographics, depression, and personality, results revealed a negative longitudinal association between the slope of SCCs and the slope of global cognition scores, such that participants with an increasing propensity of reporting SCCs over time also showed a steeper rate of decline in global cognition (Figure 4). Cox regression revealed an association between increased SCCs and incident dementia risk (Table 1). That is, participants with an increasing propensity of reporting SCCs over time are also at greater risk for developing dementia (Figure 5). Conclusion: This is the first study to use latent growth curve analysis to examine patterns of change in SCCs overtime. Traditionally, studies examining SCCs longitudinally categorise people as 'stable' versus 'not stable', however, important information may be lost this way. Understanding patterns of change in SCC reporting over time has significant potential to identify individuals at greater risk of cognitive decline and incident dementia. [ABSTRACT FROM AUTHOR]

Background: The Reading the Mind in the Eyes test (RMET) is a 36-item assessment for theory of mind (ToM) performance. While this measure has been shown to be sensitive to age-related ToM difficulties, there are no established cutoffs or guidelines currently available that are specific to older adults. This article seeks to validate a short-form version of the RMET appropriate for use in such populations.Methods: Cross-sectional data from 295 participants (mean age 86 years) from the Sydney Memory and Ageing Study, a longitudinal community observational cohort. Participants underwent an assessment battery that included the RMET. Individuals who scored >1SD below the RMET scores of cognitively normal participants were deemed to have below average RMET scores. Various model-building methods were used to generate short-form solutions of the RMET, which were compared with previously validated versions in their predictive power for below average full RMET performance.Results: Individuals with below average RMET performance tended to be older and have poorer global cognition. Of the eight short-form solutions, the 21-item version generated using genetic algorithm exhibited the best classification performance with an area under the receiver operating curve (AUROC) of 0.98 and had 93.2% accuracy in classifying individuals with below average ToM. A shorter 10-item solution derived by ant colony optimization also had acceptable performance.Conclusion: We recommend the 21-item version of the RMET for use in older adult populations for identifying individuals with impaired ToM. Where an even shorter version is needed with a trade-off of slightly reduced performance, the 10-item version is acceptable. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Telephone‐based cognitive screens, such as the Telephone Interview for Cognitive Status (TICS), can potentially reduce the barriers and costs of assessing older adults. However, validation of clinically relevant psychometric properties is lacking in a large and comprehensively assessed sample of older adults. Furthermore, published normative data may lack sensitivity as they have not used regression‐based demographic corrections or accounted for cases with subsequent dementia. We address these gaps using the modified TICS (TICS‐M; a modified, 13‐item, 39‐point version) and provide an online norms calculator for clinicians and researchers. DESIGN: Prospective longitudinal study. SETTING: Sydney, Australia. PARTICIPANTS: A total of 617 community‐living older adults, aged from 71 to 91 years. MEASUREMENTS: The measures used included the TICS‐M, the Mini‐Mental State Examination (MMSE), Addenbrooke's Cognitive Examination‐Revised (ACE‐R), and a comprehensive neuropsychological test battery. Descriptive statistics, correlations, area under the curve, and regression analyses were used to determine the validity and normative properties of the TICS‐M. RESULTS: TICS‐M total scores (mean = 24.20; SD = 3.76) correlated well with the MMSE (0.70) and ACE‐R (0.80) and moderately with neuropsychological tests tested noncontemporaneously. A cutoff score of 21 or lower reliably distinguished between those with and without incident dementia after 1 year (sensitivity = 77%; specificity = 88%) but was less reliable at distinguishing mild cognitive impairment from normal cognition. TICS‐M scores decreased with age and increased with higher education levels. The robust normative sample, which excluded incident dementia cases, scored higher on the TICS‐M and with less variability than the whole sample. An online calculator is provided to compute regression‐based norms and reliable change statistics. CONCLUSIONS: In a large sample of community‐dwelling older adults, the TICS‐M performed well in terms of construct validity against typical screening tools and neuropsychological measures and diagnostic validity for incident dementia. The comprehensive, regression‐based, and robust normative data provided will help improve the sensitivity, accessibility, and cost‐effectiveness of cognitive testing with older adults. J Am Geriatr Soc 67:2108–2115, 2019 [ABSTRACT FROM AUTHOR]

Background: Computer‐administered neuropsychological assessment batteries (CNAs) have the potential to allow large‐scale cognitive screening and monitoring, increasing older adults' access to cognitive assessment, and earlier diagnosis of and intervention for cognitive impairment. There is, however, little research on whether experience with and attitudes to computers and technology affect the validity, reliability and acceptability of CNAs in older adults. Here, we report the development and validation of an instrument to measure computer attitudes and computer experience in an older adult cohort from the CogSCAN study. Method: The Computer and Technology Attitude Questionnaire (CaTAQ) is a new 27‐item self‐report questionnaire comprising five subscales (computer anxiety, comfort with computers, positive and negative attitudes to computers and computer learning self‐efficacy) that have been individually validated in diverse populations (young, predominantly Hispanic Los Angeles adults; Canadian business employees; older Pennsylvanian Caucasian adults), as well as items measuring experience with computers and related technologies. Responses from 196 community‐living older adults without dementia in Sydney, Australia (67% female, mean age 72.1 years, range 60‐91 years, mean years' education 14.7, limited/no computer experience 9.2%) have been analysed to date. Result: Confirmatory factor analysis supported a three‐factor model (anxiety/discomfort, positive about technology, negative about technology) with good fit to items from the first four subscales (Figure 1), and four computer learning efficacy items formed a single factor with good fit in a subsample of 79 participants who reported not knowing how to use a computer (Figure 2). Our measurement models for this older Australian sample therefore replicate previous validation of these subscales. Analyses in progress will further clarify the factor structure of the questionnaire and remove redundant items. Conclusion: Results suggest the CaTAQ can provide nuanced information about older adults' attitudes to computers and technology that have the potential to influence CNA performance and acceptability. The results will need to be confirmed in a less‐educated sample with less computer experience, and in people with Mild Cognitive Impairment or mild dementia. This new instrument has the potential to inform decisions about suitability of computerised cognitive testing for older adults in research and clinical settings. [ABSTRACT FROM AUTHOR]

Background: The latent continuous construct delta (δ) has been proposed as a novel approach to model dementia phenotype using structural equation modelling that reflects the "cognitive correlates of functional status" (Royall & Palmer, 2012. J Neuropsychiatry Clin Neurosci; Royall et al., 2012. J Alzheimers Dis). This δ factor has been demonstrated to be associated with clinically diagnosed dementia status and severity of dementia. However, thus far there are few studies validating the model longitudinally and these are in American samples. To establish the potential research and clinical utility of δ, the current research constructs and validates this latent dementia factor over a 6‐year period in a community sample of Australian older adults. Method: A community‐dwelling sample of Australian older adults without dementia (at baseline) from the Sydney Memory and Ageing Study was used (n = 1037; Mage = 78.65 years; 55% females). Biennially, participants completed a battery of neuropsychological tests measuring performance in four major cognitive domains, and informants rated their functional status on instrumental activities of daily living. Dementia status and severity were established through consensus diagnosis by an expert panel of clinicians and the Clinical Dementia Rating Scale Sum of Boxes (CDR‐SOB), respectively. Result: A latent growth curve model of δ and Spearman's general intelligence factor (g) built on four waves of cognitive and function data revealed good fit: CFI = 0.97, RMSEA = 0.04, SRMR = 0.06. A significant increase in δ over time was observed, and this latent change in δ (Δδ) was significantly associated with CDR‐SOB at wave 4 after controlling for demographics, APOE*4, and baseline CDR‐SOB. Cox regression revealed a significant association between Δδ and incident dementia. Further, Δδ accurately discriminated diagnosed dementia cases at wave 4 (ROC area under the curve = 0.91, 95% CI [0.88, 0.95]). Conclusion: This study tests and validates the δ framework in Australian older adults by demonstrating that the change in δ over 6 years is associated with dementia risk and prospective severity of dementia. Future research should further test the model using longitudinal data from geographically and ethnoculturally diverse samples. [ABSTRACT FROM AUTHOR]

Background: Subjective cognitive decline (SCD), in the absence of impaired clinical testing, may be a clinical indicator of early Alzheimer's disease (AD) and other dementias. However, not all individuals with SCD have cognitive decline. Corroboration of decline by an informant (i.e., close friend or family member) is one feature of SCD thought to increase the likelihood of preclinical AD. Few studies have examined whether different patterns of SCD in individuals and their informants are related to risk of dementia over time. Method: Data from 628 dyads comprising participants (M = 78.65 years, 56.1% female) and their informants from the Sydney Memory and Ageing Study were analysed to determine whether different dyadic patterns of SCD recorded at baseline were associated with differential risk of incident dementia ten years later. Four groups were formed by categorizing participants' and informants' responses on a binary SCD measure at baseline: [1] both participant and informant NO (n = 180, 28.7%); [2] participant YES, informant NO (n = 232; 36.9%); [3] participant NO, informant YES (n = 41; 6.5%); [4] Both YES (n = 175; 27.9%). We compared incident dementia risk across these groups and conducted Cox regression adjusting for demographics, APOE4 status, mood, and personality. Result: Figure 1 shows the incidence dementia risk of the four groups. After controlling for covariates in the Cox regression, compared to Group 1, participants in Group 3 were at higher risk of incident dementia over 10 years (HR = 2.35, p =.020) as were participants in Group 4 (HR = 2.24, p =.004). Participants in Group 4 were at greater risk of incident dementia than participants in Group 2 (HR = 1.61 p =.034; see Table 1). Conclusion: Participants from dyads where both individuals endorsed SCD at baseline, and where the informant, but not the participant endorsed SCD, had a more than two‐fold increased risk of progressing to dementia over 10 years. Our results, though preliminary, highlight the value of collecting both self‐ and informant SCD ratings in research and clinical contexts and suggest that informant reports of SCD may be especially important for identifying pre‐clinical AD. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the implications of obtaining one or more low scores on a battery of cognitive tests on diagnosing mild cognitive impairment (MCI). DESIGN: Observational longitudinal study. SETTING: Alzheimer's Disease Neuroimaging Initiative. PARTICIPANTS: Normal controls (NC, n = 280) and participants with MCI (n = 415) according to Petersen criteria were reclassified using the Jak/Bondi criteria and number of impaired tests (NIT) criteria. MEASUREMENTS: Diagnostic statistics and hazard ratios of progression to Alzheimer's disease (AD) were compared according to diagnostic criteria. RESULTS: The NIT criteria were a better predictor of progression to AD than the Petersen or Jak/Bondi criteria, with optimal sensitivity, specificity, and positive and negative predictive value. CONCLUSION: Considering normal variability in cognitive test performance when diagnosing MCI may help identify individuals at greatest risk of progression to AD with greater certainty. [ABSTRACT FROM AUTHOR]

Background: Previous studies have developed a latent continuous indicator of dementia phenotype, referred to as delta (δ), capturing the overlap of cognition and functional status in dementia (Royall & Palmer, 2012. J Neuropsy Clin Neurosci; Gravett et al., 2015. Neuropsy). To investigate this as a potential tool for harmonizing cognitive test and function data and identifying dementia cases in heterogeneous samples of older adults across studies, the current research constructed and examined the latent dementia factor (LDF) in 10 longitudinal population‐based studies from the Cohort Studies of Memory in an International Consortium (COSMIC). Method: A total sample of 19,208 older individuals (mean age = 73 years; 58% females) with a median follow‐up of 6 years was analysed. Longitudinal confirmatory factor analysis was first conducted to establish measurement invariance of LDF constructed by available neuropsychological tests and instrumental activity measures in each study (see Figure 1). The LDF scores were then standardised at common values of age, sex, and education to ensure comparability. Latent growth curve analysis was then conducted to estimate the initial level of and per year change in LDF. Measures for examining validity included dementia diagnosis, the Mini‐Mental State Examination (MMSE), and the Clinical Dementia Rating Scale Sum of Boxes (CDR‐SOB). Result: A significant linear increase in LDF in the overall sample was observed (an increase of 0.13 standard deviation per year). Mixed effects cox regression revealed significant associations between initial level of and change in LDF and incident. Further, one standard deviation increase in LDF was associated with 0.72 point decrease in MMSE and 0.34 point increase in CDR‐SOB over time. Change in LDF accurately discriminated diagnosed dementia cases in all except two studies with limited neuropsychological data (average ROC area under the curve = 0.84). Conclusion: This research shows the validity of a latent dementia indicator with dementia risk in a geographically and ethnoculturally diverse sample of older adults. This supports the utility of this approach to harmonise studies with different cognitive and functional measures to identify cases at risk of dementia (based on cutoffs of LDF). [ABSTRACT FROM AUTHOR]

Background: Since the late 1980's, Memory Clinics have been an integral part of Australia's dementia assessment and care services. Despite their continuous growth over the past 30 years, little benchmarking data is available and no best practice standards have been established. The Australian Dementia Network‐Memory Clinics initiative (ADNeT‐MC) is committed to initiate change and facilitate the harmonisation of assessment process and national collaboration. The main objective is to provide a state‐of‐the‐art diagnostic assessment to all individuals with cognitive disorders. Method: A survey of Australian Memory Clinics was conducted to evaluate the current situation and determine the most commonly used clinical test instruments. Further a Delphi process to develop national Memory Clinic guidelines will be completed in 2021. Informed by the survey results and national and international dementia care and assessment guidelines, a set of best practice recommendations are being developed. A group of national experts, including researchers, clinicians, patients and careers, rates and assesses each recommendation to arrive at consensual final guidelines. Result: The ADNeT‐MC national Memory Clinics survey showed a vast heterogeneity in clinical (e.g., assessment protocols used) and structural aspects (e.g., staffing, funding). We identified more than 100 different cognitive assessment instruments currently in use, but with agreement on the screening tool (MMSE) and subset of neuropsychological tests (see Table 1). Geriatricians were the most commonly involved specialists. Few clinics reported allied health professionals or social workers, which likely affects post‐diagnostic care delivery. Indeed, the provision of post‐diagnostic care is often limited to short‐term support, whereas more extensive support (e.g., cognitive intervention) is often not funded. First results of the Delphi process as well as recommendations for a consensus assessment protocol will be presented at this session. Conclusion: ADNeT‐MC will outline one possible pathway to achieve national harmonisation across Memory Clinics. The development of standards that can be met by all Australian Memory Clinics, independent of their location and funding constraints, has the potential to enhance the quality of diagnostic assessments of all neurocognitive disorders and make post‐diagnostic care an integral part of the service delivery. [ABSTRACT FROM AUTHOR]

Background: Midlife hypertension is a known risk factor for cognitive decline and Alzheimer's disease but in late life hypertension has been associated variously with better or no different cognition. New research suggests rather than average blood pressure, blood pressure variability best predicts cognitive decline because of excessive flow pulsatility that damages cerebral microcirculation and results in ischaemia. Method: The Cohort Studies of Memory in an International Consortium (COSMIC) (10 Studies, n=26,227) comprises adults aged 53 – 102 with follow up between 1 and 19.6 years. Cognitive domain scores were aggregated into global cognition scores. Baseline Systolic Blood Pressure (SBP) was analysed categorically (in three groups <120 mmHg, 120 – 139 mmHg, ≥140 mmHg). Visit‐to‐visit SBP variability was captured by variation independent of the mean (VIM). Mixed models were used to examine the association between the parameters at baseline, mean studies mid‐point (3.2 years) and over time with global cognition. Result: SBP groups 120 – 139 mmHg and ≥140 mmHg had significantly worse global cognition at baseline and study midpoint than those with SBP <120 mmHg (Fully adjusted model at baseline, B=‐.148, p=.000 and B=‐.503, p=.000 respectively). There were no between‐group differences in cognitive trajectories over time. There was no significant effect of the antihypertensive use*SBP interaction either at baseline, study midpoint or over time on cognition. Increasing variability was also associated with poorer cognition at study midpoint (B=‐.024, p=.000) but had no effect on cognitive trajectories over time. This effect was reduced but still present when controlling for SBP at baseline (B= ‐.018, p=.000). Conclusion: This study showed that baseline hypertension is associated with poorer cognition at baseline and study midpoint in a dose dependent fashion indicating a likely causative relationship. Interestingly, this relationship was not modified by antihypertensive use, possibly reflecting an inability of late‐life antihypertensive use to reverse hypertensive damage established in mid‐life. This study also showed that blood pressure variability (VIM) is associated with poorer cognition at study mid‐point in a separate but overlapping manner to baseline blood pressure itself. Future blood pressure management guidelines should consider treatment modalities for controlling blood pressure variability as well as mean blood pressure itself. [ABSTRACT FROM AUTHOR]