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Background: Hearing loss is highly prevalent and can have significant consequences for older adults aging with cognitive impairment. However, few older adults use hearing aids and disparities in care exist by race, ethnicity, and socioeconomic position. To understand the intersection of hearing loss and cognitive impairment with the ultimate goal of developing an affordable, accessible hearing care intervention responsive to the needs of end‐users, a series of semi‐structured interviews was conducted. Method: We conducted 20 semi‐structured interviews with 10 participants with mild cognitive impairment (end‐users) and their 10 care partners and 9 experts. End‐users were recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center. Experts were identified professionals with expertise in dementia, hearing, neuropsychiatric symptoms, healthcare delivery, intervention development, and program implementation and dissemination. We used a heterogeneous purposive sampling to recruit participants from diverse race/ethnicities, education, and income levels. Qualitative content analysis was used to identify themes related to the impact of hearing loss on work, relationships, family life, and neuropsychiatric symptoms along with considerations for the development of a hearing care intervention. Result: Among end‐users and care partners, 30% self‐identified as African American, 45% as male, and 40% reported less than a college degree (Table 1). End‐users and care partners identified barriers to accessing hearing care, including the stigma associated with hearing loss, the cost of hearing aids, the lack of availability of hearing care, and the participants' denial of hearing difficulties (Table 2). Suggested facilitators for improving access to hearing care include more affordable hearing aids and incorporating hearing screenings into routine medical care. The participants' desire to improve communication and care partner support motivate accessing hearing care. Measures of hearing intervention success include strengthened social connections, reduced tension with care partners, and increased social activity. Experts emphasize the importance of education on hearing and dementia, the role of care partners, minimizing burden, and reliance on practical, affordable technology. Conclusion: In a diverse sample of persons living with cognitive impairment, their care partners, and experts, participants identified unique barriers, facilitators, motivators, and measures of success to guide the development of an affordable, accessible hearing care intervention. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined clinicians' documentation of hearing concerns identified during a Medicare Annual Wellness Visit (AWV) for patients with or without dementia or cognitive issues. Topics discussed include the use of electronic medical record (EMR) data for patients with a Medicare AWV, opportunities to improve workflow for patient-collected hearing concerns, and clinicians' elaboration of hearing concerns in the clinical notes.

Background: Hearing loss is prevalent and consequential but under‐diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient‐reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown. Methods: We use 5 years of electronic medical record (EMR) data (2017–2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care. Results: Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race. Conclusion: Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Neuropsychiatric symptoms (NPS) are nearly universal in dementia; some cross‐sectional studies of NPS in dementia have found racial/ethnic differences, though it is unknown if NPS prevalence differs among racial/ethnic groups before and after dementia diagnosis. METHODS: Participants were followed annually at Alzheimer's Disease Centers and were assessed on the Neuropsychiatric Inventory‐Questionnaire (NPI‐Q) with at least one follow‐up visit at which they were diagnosed with dementia. Descriptive statistics were generated by race/ethnicity. NPS were modeled over time as a function of race/ethnicity and with diagnosis date as the baseline. RESULTS: NPS were present in 95% in at least one time point. After adjusting for covariates, there were no statistically significant differences in NPI‐Q total scores among racial/ethnic groups at the time of and after dementia diagnosis. DISCUSSION: Findings from our prospective cohort study suggest that when individuals are matched at the time of conversion to dementia, there are no racial/ethnic differences in NPS. Highlights: Neuropsychiatric symptoms of dementia are frequent and increase caregiver burden.Prior studies reported more neuropsychiatric symptoms (NPS) in Black compared to White individuals with dementia.National Alzheimer's Coordinating Center Black, White, and Hispanic participants did not differ in NPS at the time of dementia diagnosis. [ABSTRACT FROM AUTHOR]

This perspective outlines the Artificial Intelligence and Technology Collaboratories (AITC) at Johns Hopkins University, University of Pennsylvania, and University of Massachusetts, highlighting their roles in developing AI‐based technologies for older adult care, particularly targeting Alzheimer's disease (AD). These National Institute on Aging (NIA) centers foster collaboration among clinicians, gerontologists, ethicists, business professionals, and engineers to create AI solutions. Key activities include identifying technology needs, stakeholder engagement, training, mentoring, data integration, and navigating ethical challenges. The objective is to apply these innovations effectively in real‐world scenarios, including in rural settings. In addition, the AITC focuses on developing best practices for AI application in the care of older adults, facilitating pilot studies, and addressing ethical concerns related to technology development for older adults with cognitive impairment, with the ultimate aim of improving the lives of older adults and their caregivers. Highlights: Addressing the complex needs of older adults with Alzheimer's disease (AD) requires a comprehensive approach, integrating medical and social support. Current gaps in training, techniques, tools, and expertise hinder uniform access across communities and health care settings.Artificial intelligence (AI) and digital technologies hold promise in transforming care for this demographic. Yet, transitioning these innovations from concept to marketable products presents significant challenges, often stalling promising advancements in the developmental phase.The Artificial Intelligence and Technology Collaboratories (AITC) program, funded by the National Institute on Aging (NIA), presents a viable model. These Collaboratories foster the development and implementation of AI methods and technologies through projects aimed at improving care for older Americans, particularly those with AD, and promote the sharing of best practices in AI and technology integration. Why Does This Matter? The National Institute on Aging (NIA) Artificial Intelligence and Technology Collaboratories (AITC) program's mission is to accelerate the adoption of artificial intelligence (AI) and new technologies for the betterment of older adults, especially those with dementia. By bridging scientific and technological expertise, fostering clinical and industry partnerships, and enhancing the sharing of best practices, this program can significantly improve the health and quality of life for older adults with Alzheimer's disease (AD). [ABSTRACT FROM AUTHOR]

Alzheimer's disease and related dementias (ADRDs) and age‐related hearing loss are the intersection of two major public health challenges. With age as the primary risk factor for both disease processes, the burden of ADRDs and age‐related hearing loss is growing, and each field maintains significant barriers to broadscale identification and management that is affordable and accessible. With the disproportionate burden of ADRDs among racial and ethnic minority older adults and existing disparities within hearing care, both areas face challenges in achieving equitable access and outcomes across diverse populations. The publication of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial in July 2023 marked a significant moment in the fields of brain and hearing health. The ACHIEVE trial was the first randomized controlled trial to examine whether providing hearing intervention, specifically provision of hearing aids, compared to an education control, would reduce cognitive changes over 3 years. The participants most at risk for cognitive decline, with lower education, lower income, more likely to identify as Black, and have more cardiovascular risk factors, were the participants who benefited most from the hearing intervention and are also the least likely to be represented in research and the least likely to obtain hearing care. With growing evidence of the interconnection between cognitive and sensory health, we have an opportunity to prioritize equity, from purposeful inclusion of diverse participants in trials to influencing the emerging market of over‐the‐counter hearing aids to supporting expanded models of hearing care that reach those who have traditionally gone unserved. No longer can hearing go unrecognized by clinicians, researchers, and advocates for brain health. At the same time, the fields of brain and hearing health must center equity if we are going to meet the needs of diverse older adults in a world in which hearing health matters. [ABSTRACT FROM AUTHOR]

Objective: Hearing loss may negatively impact satisfaction with health care via patient‐provider communication barriers and may be amenable to hearing care treatment. Study Design: Cross‐sectional. Setting: National Health Interview Survey, a nationally representative survey of noninstitutionalized US residents, 2013 to 2018 pooled cycles. Methods: Participants described satisfaction with health care in the past year, categorized as optimal (very satisfied) versus suboptimal (satisfied, dissatisfied, very dissatisfied) satisfaction. Self‐report hearing without hearing aids (excellent, good, a little trouble, moderate trouble, a lot of trouble) and hearing aid use (yes, no) were collected. Weighted Poisson regression models adjusted for sociodemographic and health covariates were used to estimate prevalence rate ratios (PRRs) of satisfaction with care by hearing loss and hearing aid use. Results: Among 137,216 participants (mean age 50.9 years, 56% female, 12% black), representing 77.2 million Americans in the weighted model, 19% reported trouble hearing. Those with good (PRR = 1.20, 95% confidence interval [CI]: 1.18‐1.23), a little trouble (PRR = 1.27, 95% CI, 1.23‐1.31), moderate trouble (PRR = 1.29, 95% CI, 1.24‐1.35), and a lot of trouble hearing (PRR = 1.26, 95% CI, 1.18‐1.33) had a higher prevalence rate of suboptimal satisfaction with care relative to those with excellent hearing. Among all participants with trouble hearing, hearing aid users had a 17% decrease in the prevalence rate of suboptimal satisfaction with care (PRR = 0.83, 95% CI, 0.78‐0.88) compared to nonusers. Conclusion: Hearing loss decreases patient satisfaction with health care, which is tied to Medicare hospital reimbursement models. Hearing aid use may improve patient‐provider communication and patient satisfaction, although prospective studies are warranted to truly establish their protective effect. [ABSTRACT FROM AUTHOR]

The article highlights the National Institute on Aging (NIA) Summer Institute of Butler-Williams (B-W) Scholars Program in 2024. Topics include background of Dr. Robert Butler, founding director of the NIA; attendees of the B-W Scholars Program, and the 50th Anniversary celebration of the Program in 2036.

BACKGROUND: Delirium, a common syndrome with heterogeneous etiologies and clinical presentations, is associated with poor long‐term outcomes. Recording and analyzing all delirium equally could be hindering the field's understanding of pathophysiology and identification of targeted treatments. Current delirium subtyping methods reflect clinically evident features but likely do not account for underlying biology. METHODS: The Delirium Subtyping Initiative (DSI) held three sessions with an international panel of 25 experts. RESULTS: Meeting participants suggest further characterization of delirium features to complement the existing Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Text Revision diagnostic criteria. These should span the range of delirium‐spectrum syndromes and be measured consistently across studies. Clinical features should be recorded in conjunction with biospecimen collection, where feasible, in a standardized way, to determine temporal associations of biology coincident with clinical fluctuations. DISCUSSION: The DSI made recommendations spanning the breadth of delirium research including clinical features, study planning, data collection, and data analysis for characterization of candidate delirium subtypes. Highlights: Delirium features must be clearly defined, standardized, and operationalized.Large datasets incorporating both clinical and biomarker variables should be analyzed together.Delirium screening should incorporate communication and reasoning. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairment (CI) among liver transplant (LT) candidates is associated with increased risk of waitlist mortality and inferior outcomes. While formal neurocognitive evaluation is the gold standard for CI diagnosis, the Montreal Cognitive Assessment (MoCA) is often used for first‐line cognitive screening. However, MoCA requires specialized training and may be too lengthy for a busy evaluation appointment. An alternate approach may be the Quick Dementia Rating System (QDRS), which is patient‐ and informant‐based and can be administered quickly. We compared potential LT candidates identified by MoCA and QDRS as potentially benefiting from further formal cognitive evaluation. Methods: We identified 46 potential LT candidates enrolled at a single center of a prospective, observational cohort study who were administered MoCA and QDRS during transplant evaluation (12/2021–12/2022). Scores were dichotomized as (1) normal versus abnormal and (2) normal/mild impairment versus more‐than‐mild impairment. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of QDRS compared to MoCA. Results: By MoCA, this population had a prevalence of 48% normal cognition, 48% mild, 4% moderate, and 0% severe impairment. This was categorized as 96% normal/mild and 4% more‐than‐mild impairment. When comparing to MoCA cognitive screening, QDRS had a sensitivity of 61%, specificity of 56%, NPV of 56%, and PPV of 61%. When identifying more‐than‐mild impairment, QDRS had a sensitivity of 100%, specificity of 73%, NPV of 100%, and PPV of 10%. Conclusion: The high sensitivity and NPV of QDRS in identifying more‐than‐mild impairment suggests it could identify potential LT candidates who would benefit from further formal cognitive evaluation. The ability to administer QDRS quickly and remotely makes it a pragmatic option for pre‐transplant screening. [ABSTRACT FROM AUTHOR]

Delirium is a significant geriatric condition associated with adverse clinical and economic outcomes. The cause of delirium is usually multifactorial, and person‐centered multicomponent approaches for proper delirium management are required. In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) launched a national initiative, Age‐Friendly Health System (AFHS), promoting the use of a framework called 4Ms (what matters, medication, mentation, and mobility). The 4Ms framework's primary goal is to provide comprehensive and practical person‐centered care for older adults and it aligns with the core concepts of optimal delirium management. In this special article, we demonstrate how a traditional delirium prevention and management model can be assessed from the perspective of AFHS. An example is the crosswalk with the Hospital Elder Life Program (HELP) Core Interventions and the 4MS, which demonstrates alignment in delirium management. We also introduce useful tools to create an AFHS environment in delirium management. Although much has been written about delirium management, there is a need to identify the critical steps in advancing the overall delirium care in the context of the AFHS. In this article, we suggest future directions, including the need for more prospective and comprehensive research to assess the impact of AFHS on delirium care, the need for more innovative and sustainable education platforms, fundamental changes in the healthcare payment system for proper adoption of AFHS in any healthcare setting, and application of AFHS in the community for continuity of care for older adults with delirium. [ABSTRACT FROM AUTHOR]

Background: Hearing loss is highly prevalent and associated with adverse health outcomes but undertreated among individuals with cognitive impairment, particularly African Americans. The incorporation of community health worker (CHW)‐partnered models may increase access and reduce disparities. The HEARS intervention is a hearing care program delivered by CHWs that provides a low‐cost amplification device. To assess the efficacy of CHW‐delivered hearing care provided to community‐dwelling older adults, including those with cognitive impairment, a randomized clinical trial was conducted. Method: An open label randomized clinical trial took place in 13 community sites in Baltimore, Maryland. 348 older adults were screened and 151 participants with hearing loss were randomized to receive a CHW‐delivered hearing care intervention versus 3‐month waitlist control. The primary outcome was change in communication function (Hearing Handicap Inventory for the Elderly‐Screening [HHIE‐S]) from baseline to 3‐months post‐randomization. The average treatment effect was estimated using the doubly‐robust weighted least squares estimator. This pre‐specified subgroup analysis was stratified by cognitive status using the total MoCA score (≤25: cognitive impairment; post hoc sensitivity analysis using ≤22). Result: Among 149 randomized participants with MoCA data, 100 individuals were cognitively impaired (Mean adjusted MoCA: 21(SD 3.5); 52% African American; 70% low‐income). At 3‐months post‐intervention, 66% with cognitive impairment reported daily device use versus 76% for those without cognitive impairment. Communication function significantly improved among individuals with cognitive impairment compared with the control, with an estimated average treatment effect of ‐13.92 HHIE‐S change (95% CI:‐16.84,‐10.86), comparable to those without cognitive impairment (‐11.47; 95% CI:‐18.04,‐4.17). Post hoc sensitivity analysis using a ≤22 MoCA cut‐off for cognitive impairment yielded similar findings. Conclusion: Among individuals with cognitive impairment, a CHW‐delivered low‐cost amplification device intervention, compared with a waitlist control, significantly improved communication function. The improvements were comparable to participants without cognitive impairment and similar in magnitude to improvements documented for older adults who received conventional clinic‐based hearing care with hearing aids fit by audiologists. To the authors' knowledge, this trial was the largest trial to date of a hearing care intervention in the U.S. of African American older adults and low‐income older adults with hearing loss and cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is characterized by progressive loss or damage to the nervous system which can cause impairment in movement, coordination, and cognition. Due to the complexity of clinical features at different stages of the disease, it may require months for an accurate diagnosis. Oculomotor researchers have demonstrated the utility of examining eye movements for differentiating various neurodegenerative disorders including AD, Parkinson's disease (PD), and other PD mimics (PDM). In this study, we propose an automatic pipeline to identify saccade, fixation, and blinks and extract response‐to‐stimuli‐derived interpretable biomarkers that could inform clinicians in making accurate assessment. Method: Eye tracking data in smooth pursuit, pro‐saccade, and anti‐saccade tasks were recorded from 146 participants ‐ 14 with AD or Mild Cognitive Impairment (MCI), 46 with PD, 16 with PDM, and 70 age‐matched normal controls (CTL). Biomarkers based on the identified eye movement and interaction with the stimuli were extracted with our algorithms. Then, pairwise Kruskal‐Wallis H tests were conducted to determine if there were statistically significant differences between groups. The Benjamini‐Hochberg correction was performed to control the false discovery rate. Result: The results show that, in the smooth pursuit task, the AD/MCI group had a significantly higher (p < 0.05) saccade count than CTL and PD groups. The AD/MCI group also exhibited significantly longer (p < 0.05) average saccade duration than CTL and PDM groups. The mean and standard deviation for the number of saccadic adjustments to reach and stay on the target significantly differed (p < 0.05) between AD/MCI and CTL and between PD and CTL in trials of the pro‐saccade task. The magnitude of overshoot or undershoot was significantly greater (p < 0.05) for AD/MCI, PD, and PDM compared to CTL. Moreover, the number of saccades in the wrong direction was significantly higher (p < 0.05) for AD/MCI and PD compared to CTL in the anti‐saccade task. Conclusion: Oculographic biomarkers can be leveraged within a machine learning framework and may be useful in distinguishing different types of neurodegenerative diseases in their early stages yielding more objective and precise protocols to monitor disease progression than current methods. [ABSTRACT FROM AUTHOR]

Background: How clinicians discuss, document, and diagnose health concerns within a visit shapes patient perceptions of their health conditions. Undiagnosed hearing loss among older adults with dementia or cognitive concerns may exacerbate neuropsychiatric symptoms and care challenges. This study investigates clinician documentation of hearing concerns and whether documentation, diagnosis, and referral vary for older adults with dementia/cognitive concerns. Method: We use patient‐level health and demographic information from the electronic medical record and associated clinician visit notes for Medicare beneficiaries who indicated hearing concerns for the first time at an Annual Wellness Visit (AWV) between 2017‐2022 at a large academic health system. We analyzed the text of a random sample of AWV clinical notes to evaluate clinical documentation of hearing concerns/loss and placement of hearing‐related referrals. Logistic regression models investigate odds of clinician documentation of hearing concerns or diagnosis by diagnosed dementia (from ICD codes) or cognitive concerns (from AWV health risk assessment). Result: Among 2,593 beneficiaries who reported hearing concerns at an AWV (mean age 78.8 years, 56.6% female), 6.5% had a concurrent dementia diagnosis, nearly 40% indicated congruent cognitive concerns, and 20% had a prior diagnosis of hearing loss in the medical record. Text analysis (Table 1) of clinician visit notes from a random sample of patients (n = 474) found hearing concerns were less frequently documented for those with (versus without) diagnosed dementia (44.2% vs 30.2%). Clinicians were half as likely to comment on hearing (OR:0.51; 95%CI:0.34,0.76) or indicate known hearing loss in the AWV note (OR:0.56; 95% CI:0.38,0.84) for those with vs. without dementia (Table 2). Regardless of dementia status, about 8‐10% were recommended/received a referral to hearing care; only 50% with index hearing concerns received a diagnosis of hearing loss in the medical record following the AWV. Conclusion: Clinicians are less likely to document hearing concerns and incorporate hearing concerns as a health problem at the AWV for patients with dementia. The complex care needs of dementia may inhibit clinician ability to attend to other patient health concerns‐ like hearing. Opportunity to embed hearing and communication educational interventions which support clinicians in addressing patient‐collected health risks can improve overall dementia care. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the relationship between the perception of patient-centered healthcare experiences of patients with and without hearing loss and whether race is a factor in said perceptions. The research used data from the Health & Retirement Study (HRS) among aging and retired adult individuals in the U.S. Also cited is the link between hearing loss and perceived suboptimal patient-centered care.

This editorial discusses the need for fully informing patients, particularly minoritized individuals and underrepresented demographic groups, about the potential risks and benefits of anti-amyloid immunotherapies for treating Alzheimer's disease. The editorial highlights the limitations of clinical trials, which have predominantly included a homogeneous White population, and emphasizes the importance of considering health disparities and demographic differences in disease understanding and treatment. It advocates for providing objective and clear information to practitioners and patients, modifying drug labeling to reflect the limitations of the trials, and ensuring an inclusive and safe approach to treating Alzheimer's disease. [Extracted from the article]

Background: Alzheimer's disease (AD) is a progressive neurodegenerative disease. Like for other dementias, biomarkers may help characterize distinct aspects of the underlying pathology, predict decline, and monitor disease progression. We extracted a composite array of 24 speech‐based biomarkers using machine learning and signal processing techniques. We then determined which of the given biomarkers was predictive of MCI and AD progression from baseline by conducting a correlation analysis. Method: Spoken responses to a Cookie Theft Picture description task were recorded from 2 subjects with AD, 4 subjects with Mild Cognitive Impairment (MCI) due to AD (biomarker confirmed AD), and 4 subjects with MCI. We automatically extracted acoustic, linguistic, and cognitive biomarkers using speech recognition, acoustic, and language modeling techniques. We later computed Kendall's tau‐b (τb) correlation between the biomarker values and Montreal Cognitive Assessment (MoCA) scores. Recordings and MoCA scores were collected at baseline, at 6 months after baseline, and at 12 months for a subgroup of the subjects. To perform the correlation analysis, we used scipy.stats.kendalltau library in Python. Result: With respect to the acoustic biomarkers, a strong negative correlation (τb= ‐0.50) was observed between the MoCA scores and features such as pause time, pause percentage, and pause speech ratio, while a moderate positive correlation (τb= 0.2) was found for rhythm standard deviation. With respect to the linguistic biomarkers a strong positive correlation(τb= 0.50) for the features of corrected type‐token ratio, average sentence length in words, and noun count was reported, while a moderate positive correlation (τb= 0.27) was found for the features of word type count, word token count, and moving average type‐token ratio. The other acoustic, linguistic, and cognitive biomarkers showed a very weak (τb= 0.00 ‐ 0.10) or weak correlation (τb= 0.10 ‐ 0.20). Conclusion: Altogether, these results suggest that speech‐based interpretable biomarkers may help clinicians to diagnose AD at earlier stages and monitor disease progression. Our preliminary data suggest that AD patients encounter more problems delivering longer and linguistically elaborated narratives as the disease progresses. [ABSTRACT FROM AUTHOR]

Background: Motor changes are early signs of neurodegenerative diseases such as Alzheimer's disease (AD), but they are often difficult to detect, especially in the early stages. In the past, the examination of handwriting has been used to investigate motoric changes in different neurodegenerative diseases. In this study, we explore a wide array of explainable characteristics of the handwriting of patients obtained with signal processing, and study their potential for assessment of Mild Cognitive Impairment (MCI) and AD. Method: We collected the written tasks from 37 participants, 7 with AD, 17 with MCI, and 13 for the control group (CTL) on a digital tablet. We analyzed 14 different tasks, including holding the pen over a point, copying images, free writing/drawing, and memory copying. We extracted multiple movement characteristics, including the length of each stroke, the ratio of the time the pen spent on‐air vs in‐tablet and the standard deviation of the distance between consecutive points. The drawings of each subject were manually supervised, then processed to extract multiple characteristics, and compared to identify the ones providing the most significant differences between the three studied groups using Welch's t‐test, with false discovery rate (FDR) correction. Result: Preliminary results showed that the ratio between the time with the pen in contact with the tablet and without (on‐air vs in‐tablet) for writing tasks, significantly differentiate between AD and CTL patients (p‐value<0.01), as well as the position standard deviation when asked to maintain the pen at a fixed position (p‐value<0.05). The comparison between MCI and CTL populations also showed that the length of the strokes for drawings and copying tasks can deliver clues to distinguish both groups (p‐value<0.05). Conclusion: Automated analysis of a large variety of handwriting segments employing machine learning techniques can provide an assessment of patients with AD and MCI that may be useful in their early diagnosis and assessment of progression. [ABSTRACT FROM AUTHOR]

Background: Dementia and hearing loss (HL) are conditions, which restrict communication ability and amplify the difficulty of implementing effective care coordination and communication with medical providers. We examined how the presence of HL and dementia influence communication with medical providers, and the role of involved care partners during medical visits. Methods: Drawing on responses from 7070 community-dwelling older adults who participated in the 2015 National Health and Aging Trends Study, we used logistic regression to quantify care partner accompaniment to medical visits and the role care partners assume during visits by older adult hearing and dementia status. Results: Nearly 4 in 10 older adults with dementia also reported HL. Eighty-two percent of older adults with both HL and dementia were accompanied to medical visits by a care partner. Those with HL and dementia were six times more likely to be accompanied by a care partner to medical visits than those with neither condition (OR: 6.04; 95% CI:4.06, 8.99). Care partners of older adults with both (vs neither) HL and dementia were more actively engaged in: (1) facilitating understanding between the older adult and doctor (OR: 4.55, 95% CI:2.68, 7.71); (2) asking or telling the doctor information (OR: 6.13, 95% CI:3.44, 10.9); and (3) reminding the older adult of their questions (OR: 2.52, 95% CI: 1.66, 3.83). Conclusions: Care partners have an active role during medical visits of older adults with HL and dementia. Efforts to support care partner engagement and teach advocacy skills may close gaps in care quality for the subgroup of older adults who are living with HL and dementia. [ABSTRACT FROM AUTHOR]

The article discusses the development and implementation of a formalized curriculum on perioperative delirium for surgery residents based on prevention, assessment, and management of delirium as of 2023. It cites participants' assenting views on its mandatory inclusion in surgical training education with longitudinal refresher courses throughout residency. Also noted is the creation of a sustainable model for training residents which is on its 7th edition this year.

Background: Similar to other neurological diseases, subtle early neurological changes that occur in Alzheimer's Disease (AD) are difficult to quantify and track objectively. One relevant bio‐signal is eye movement, as it presents a unique window into cognitive processes as a direct measure of real‐time inputs to the brain. Eye‐tracking allows us to estimate timestamped activity of neural function and begin to infer and quantify attention, reprocessing (eg. word revisits), and many other aspects relevant to assessing AD. The goal of this study was to investigate the saccadic movements and trial progress during administration of the Stroop test in AD compared to normal controls. Method: 5 AD subjects and 12 age‐matched cognitively normal controls were recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center and the Movement Disorders Clinic at the Johns Hopkins University School of Medicine. An Eyelink Portable Duo in head‐free‐to‐move mode was used to track eye movements. Movement of the eyes were analyzed by automatically segmenting saccade movements throughout a trial. We then analyzed the eye movements in the context of cognitive performance, by identifying when subjects progress to each word in the Stroop test. We compared the performance of each group using a Wilcoxon RankSum test with the SciPy package using Python. Result: Preliminary results show that 60% (3/5) of AD subjects were unable to complete the Stroop task in 80 seconds. Individuals with AD had more saccades (p=0.105) with greater saccadic overshoot (p=0.092) and a greater maximum saccade velocity (p=0.035) on average compared to cognitively normal controls. AD subjects also took much longer to complete the first (p=0.114) and second lines (p=0.092) compared to healthy controls, suggesting initial confusion and hesitation. Conclusion: AD subjects change their gaze more often with greater speed and less precision than age‐matched controls. These data demonstrate feasibility of using automatic quantitative evaluation of eye movements in AD. In the future, we will determine the utility of using this tool for early detection of AD and tracking its progression, along with combining other measures such as voice and handwriting (multimodal) to provide insights into early physiological changes in AD. [ABSTRACT FROM AUTHOR]

The article discusses the results of the health, aging and body composition study on the link between thyroid hormone use and the diagnosis of dementia. Topics mentioned include the distribution of thyroid stimulating hormone (TSH) by thyroid hormone use and dementia status, the risk of isolated TSH elevation for iatrogenic thyrotoxicosis resulting to accelerating cognitive decline, and the association of thyroid hormone supplementation with increased risk of both over and under-treatment.

Background: The ability to rate delirium severity is key to providing optimal care for persons with Alzheimer's Disease and Related Dementias (ADRD). Such ratings would allow clinicians to assess response to treatment, recovery time and prognosis, nursing burden and staffing needs, and to provide nuanced, appropriate patient‐centered care. Given the lack of existing tools, we defined content domains for a new delirium severity instrument for use in individuals with mild to moderate ADRD, the DEL‐S‐AD. Methods: We built upon our previous study in which we created a content domain framework to inform development of a general delirium severity instrument, the DEL‐S. We engaged a new expert panel to discuss issues of measurement in delirium and dementia and to determine which content domains from the prior framework were useful in characterizing delirium severity in ADRD. We also asked panelists to identify new domains. Our panel included eight interdisciplinary members with expertise in delirium and dementia. Panelists participated in two rounds of review followed by two surveys over 2 months. Results: Panelists endorsed the same content domains as for general delirium severity, including Cognitive, Level of Consciousness, Inattention, Psychiatric‐Behavioral, Emotional Dysregulation, Psychomotor Features, and Functional; however, they excluded six of the original subdomains which they considered unhelpful in the context of ADRD: cognitive impairment; anxiety; fear/sense of unease; depression; gait/walking; and incontinence. Debated measurement challenges included assessment at one point in time versus over time, accounting for differences in clinical settings, and accurate assessment of symptoms related to delirium versus dementia. Conclusions: By capturing a range of characteristics of delirium severity potentially present in patients with ADRD, a population that may already have attention, functional, and emotional changes at baseline, the DEL‐S‐AD provides a novel rating tool that will be useful for clinical and research purposes to improve patient care. [ABSTRACT FROM AUTHOR]

Objective: Delirium is a common postoperative complication of hip fracture. Various methods exist to detect delirium as a reference standard. The goal of this study was to characterize the properties of the measures obtained in a randomized controlled trial, to document their relationship to the Diagnostic and Statistical Manual of Mental Disorders:Text Revision based diagnosis of postoperative delirium by a consensus panel, and to describe the method in detail to allow replication by others.Methods: A secondary analysis of the randomized trial STRIDE (A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients) was conducted. Delirium assessments were performed in 200 consecutive hip fracture repair patients ≥65 years old. Assessors underwent extensive training in delirium assessment and the final delirium diagnosis was adjudicated by a consensus panel of three physicians with expertise in delirium assessment.Results: A total of 680 consensus panel delirium diagnoses were completed. There were only 19 (2.8%, 19/678) evaluations where the delirium adjudication by the consensus panel differed from delirium findings by the Confusion Assessment Method (CAM). In 16 (84%, 16/19) of the cases, CAM was negative but the consensus panel diagnosed the patient as having delirium based on all of the available information including the CAM.Conclusion: The consensus panel diagnosis was more sensitive compared to CAM alone, however the magnitude of the difference was not large. When assessors are well trained and delirium assessments are closely supervised throughout the study, CAM may be adequate for delirium diagnosis in a clinical trial. Future studies are needed to test this hypothesis. [ABSTRACT FROM AUTHOR]

Background: Hearing loss is highly prevalent among older adults with cognitive impairment and may exacerbate neuropsychiatric symptoms and affect interactions with others. Although audiometry is the gold standard for measuring hearing, it is not always used in research or clinical settings focused on the care of individuals with cognitive impairment. Subjective assessments of hearing, both self‐ and proxy‐rated, are widespread but may not adequately capture the presence of hearing loss as compared to audiometry. This study investigates the concordance between subjective and objective hearing assessments among older adults with and without cognitive impairment and evaluates factors associated with concordance. Methods: Participants were a subset of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC‐NCS), a prospective cohort study representing four US communities with adjudicated cognitive diagnoses and audiometric data, totaling 3326 self‐rated and 520 proxy‐rated hearing assessments. Sensitivity and specificity were calculated, and multivariable logistic regression estimated the magnitude of the association between the concordance of hearing assessments and variables of interest. Results: Sensitivity and specificity for self‐rated hearing status were 71.2% and 85.9% among cognitively normal older adults, 61.1% and 84.9% among persons with MCI, and 52.6% and 81.2% among persons with dementia, respectively. For proxy‐rated hearing, sensitivity and specificity were 65.7% and 83.3% for persons with MCI and 73.3% and 60.3% for persons with dementia, respectively. Female sex was positively associated with concordance for self‐rated hearing assessments. Conclusions: The low sensitivity of self‐ and proxy‐rated hearing assessments compared to audiometry suggests that hearing loss among older adults with cognitive impairment may go underreported and unaddressed in subjective assessments. Clinicians and researchers should recognize the limitations of using self‐ and proxy‐rated hearing assessments as measures of hearing status and incorporate objective audiometric evaluation whenever possible. See related editorial by Chodosh & Blustein in this issue. [ABSTRACT FROM AUTHOR]

Background: Speech and language problems are one of the earliest signs of neurodegenerative diseases including Alzheimer's disease (AD), but they are often difficult to detect especially in the early stages. Utility of assessing speech and language problems using artificial intelligence (AI) has been examined in the past. However, the accuracy of different methods has been variable, preventing incorporation of these techniques in clinical use. In this study, we present different speech‐based machine learning techniques. We focused on the automatic extraction of a wide array of interpretable features from the speech signals, then compared these features across different neurological disorders. Method: Spoken responses to four different tasks (i.e., Cookie Theft Picture (CTP) and Stroop Task) were recorded from 80 participants, 5 with AD, 28 with Parkinson's disease (PD), 18 normal controls (NCs), and the remaining with other neurological diseases (OTRs). We automatically extracted several acoustic and linguistic features using speech and language technologies. We conducted pairwise Kruskal–Wallis tests to assess how speech and language abilities differed between different neurodegenerative disease vs. control groups. We used SciPy Python library. Result: The total amount of speech time and pauses as well as the average duration and the variance of the number pauses significantly differed between AD and NC and between PD and NC in almost every task (p <0.05). Prosodic features based on F0 contour and F0 on the first and last voiced segment resulted in significant differences across tasks between AD and NC, AD and PD, AD and OTR (p <0.05). The phonological posterior for the phonological classes of consonantal, voiced, labial, nasal, velar, trill, and close significantly differed in almost every task between AD and NC, AD and PD and AD and OTR (p <0.05). Moreover, from the transcriptions of the CTP task, the number of sentences and noun phrases differed significantly between AD and NC, whereas the number of contrastive connectives and the moving average type‐token ratio were significant between NC and OTR (p <0.05). Conclusion: Automated analysis of speech employing machine learning techniques can provide objective assessment of patients with AD that may be useful in distinguishing AD from other neurological disorders. [ABSTRACT FROM AUTHOR]

The article "Dementia Diagnosis Before and After Hip Fracture in Medicare Patients" published in the Journal of the American Geriatrics Society explores the prevalence and trajectory of dementia diagnosis in older adults hospitalized for hip fractures. The study found that the proportion of patients with a dementia diagnosis increased from 28.5% pre-fracture to 42.3% at 180 days post-fracture. Patients with dementia had longer hospital stays, higher rates of post-operative delirium, and were more likely to be discharged to a skilled nursing facility or experience mortality within 180 days. The study highlights the need for cognitive screening for older adults hospitalized for hip fractures and emphasizes the importance of care coordination initiatives for providing high-quality, cost-effective care. [Extracted from the article]

The high prevalence of hearing loss among older adults creates a perception that it is simply a benign consequence of aging, which leads to unaddressed communication needs. Strategies to address hearing loss as part of routine clinical care are pertinent to the geriatric care setting where hearing loss is prevalent in two out of every three patients 70 years and older. Our objectives are to briefly discuss the pathophysiology of hearing loss, describe the epidemiologic prevalence and impact, identify statutory barriers facing older adults in accessing hearing care, discuss current progress on legislation to address accessibility issues, and provide actionable strategies for addressing hearing loss as a barrier to effective communication. Simple steps can be taken to improve hearing care accessibility for older adults with hearing loss and can optimize understanding in daily communication, re‐engage patients in being actively involved in their care, and promote patient autonomy in informed decision‐ making. [ABSTRACT FROM AUTHOR]

Background: TDP‐43 nuclear clearance and cytoplasmic aggregation occur in multiple neurodegenerative diseases, including amyotrophic lateral sclerosis‐frontotemporal dementia (ALS‐FTD), Alzheimer's disease (AD), and limbic‐predominant age‐related TDP‐43 encephalopathy (LATE). Nuclear clearance of TDP‐43 leads to its failure to repress splicing of nonconserved cryptic exons. This loss of TDP‐43 splicing repression is well‐documented in postmortem tissues, but there is currently no method of detecting TDP‐43 dysfunction in living patients. As some cryptic exons are spliced in‐frame and translated into proteins carrying novel epitopes, we hypothesize that these "cryptic peptides" may be found in patient CSF as biomarkers of TDP‐43 dysfunction. Method: We generated novel monoclonal antibodies against several TDP‐43 cryptic exon targets and then developed a sandwich ELISA using the Meso Scale Discovery (MSD) platform, which we validated in cells deficient in TDP‐43 for the cryptic exon target in HDGFL2. We then screened CSF samples of C9ORF72‐mutation carriers with or at risk of ALS‐FTD and control individuals for the presence of this cryptic peptide. Result: The MSD signal for cryptic HDGFL2 was elevated in CSF of C9ORF72‐mutation carriers with ALS (n = 5, mean = 1601) compared to those of controls (n = 5, mean = ‐64.10; p<0.013), so we examined a larger cohort of C9ORF72‐mutation carriers. In symptomatic individuals (n = 27), cryptic peptide levels showed a correlation nearing significance with symptom duration (r = ‐0.368, p = 0.059), suggesting that levels of the cryptic peptide tend to be higher during the earlier symptomatic phase. We also found elevated cryptic peptide levels in CSF of several pre‐symptomatic individuals. To clarify cryptic peptide dynamics during disease progression, we began to assess longitudinal CSF samples and found that in 82.35% (14/17) of symptomatic individuals, levels of the cryptic peptide decreased with disease progression. Conclusion: Our findings indicate that loss of TDP‐43 splicing repression occurs early in disease progression in ALS‐FTD, even pre‐symptomatically, and that detection of HDGFL2's cryptic neoepitope may facilitate earlier diagnosis of TDP‐43‐related diseases. Further efforts linking the presence of cryptic HGDFL2 to TDP‐43 co‐pathology in AD may help expand biomarker development in AD. Additionally, evaluating dynamics of these biomarkers could provide a way of measuring target engagement for new therapeutics aimed at restoring TDP‐43 function. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES There are growing concerns about the safety and efficacy of psychotropic medications in Alzheimer's disease (AD). We sought to examine associations between psychotropic medication exposure and longitudinal change in cognitive, functional, and neuropsychiatric outcomes in a large clinical AD cohort. DESIGN Longitudinal observational study. SETTING National Alzheimer's Disease Coordinating Center combining data from 39 Alzheimer's disease centers. PARTICIPANTS 8,034 participants with AD dementia. MEASUREMENTS Mini‐Mental State Exam (MMSE), Clinical Dementia Rating Scale‐Sum of Boxes (CDR‐SB), and Neuropsychiatric Inventory Questionnaire (NPI‐Q) Total. Probability of exposure to medication (the propensity score, PS) calculated via logistic regression. Medication classes included all antipsychotics (atypical vs conventional), antidepressants (Selective Serotonin Reuptake Inhibitor [SSRI] vs non‐SSRI), and benzodiazepines. Participants treated with a medication class were matched with participants not treated with that class with the closest‐matched PS. The effect of medication treatment was assessed using linear mixed‐effects models. RESULTS: Participants had a mean (SD) age of 75.5 (9.8) years, and mean (SD) scores of MMSE 21.3 (5.7), CDR‐SB 5.5 (3.4), and NPI‐Q Total 4.5 (4.4). Mean duration of follow‐up was 2.9–3.3 years depending on medication class. Non‐SSRI antidepressant use was associated with better CDR‐SB (2‐year difference in change‐DIC: −0.38 [−0.61, −0.15], P =.001). Atypical antipsychotic use was associated with greater decline on MMSE (DIC: −0.91 [−1.54, −0.28] P =.005) and CDR‐SB scores (DIC: 0.50 [0.14, 0.86], P =.006). Notably, no drug class was associated with better NPI‐Q scores. CONCLUSIONS: Use of atypical antipsychotics was associated with poorer cognition and function, and no drug class was associated with improvement in neuropsychiatric symptoms. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are few studies demonstrating how kidney function affects the risk of developing delirium in older adult surgical patients administered opioids. This study determined whether baseline kidney function influences the relationship between morphine equivalent dose and the development of delirium on postoperative day (POD) 2 in patients with hip fracture. METHODS: This retrospective study analyzed emergency department (ED) estimated glomerular filtration rate (eGFR), perioperative serum creatinine, intravenous morphine equivalents, and POD2 delirium assessment by the Confusion Assessment Method in 652 patients aged 65 years or older without preoperative delirium. ED eGFR was used to divide subjects into groups by presence or absence of chronic kidney disease (CKD), and associations of opioid dose with POD2 delirium were compared using multivariable logistic regression. RESULTS: POD2 delirium incidence was 29.8% (N = 194). Intraoperative and postanesthesia care unit (PACU) morphine equivalent dosage as well as ED eGFR were similar comparing patients with and without POD2 delirium. Age, American Society of Anesthesiologists status, and dementia were associated with delirium on POD2. The odds of POD2 delirium increased significantly with increase of intraoperative opioid in patients with CKD (odds ratio = 1.6; 95% confidence interval = 1.2–2.2), but not in patients without CKD (P‐interaction =.04). PACU or POD1 opioid doses were not associated with POD2 delirium after covariate adjustment. CONCLUSION: This study suggests that incremental increases in intraoperative opioids combined with CKD increase odds of POD2 delirium after hip fracture repair, compared with patients without CKD. [ABSTRACT FROM AUTHOR]

Introduction: The interaction between delirium and dementia is complex. We examined if Alzheimer’s disease (AD) biomarkers in patients without clinical dementia are associated with increased risk of postoperative delirium, and whether AD biomarkers demonstrate a graded association with delirium severity. Methods: Participants (n = 59) were free of clinical dementia, age ≥70 years, and scheduled for elective total knee or hip arthroplasties. Cerebrospinal fluid (CSF) was collected at the time of induction for spinal anesthesia. CSF AD biomarkers were measured by enzyme-linked immunosorbent assay (ELISA) (ADX/Euroimmun); cut points for amyloid, tau, and neurodegeneration (ATN) biomarker status wereA = amyloid beta (Aβ)42 <175 pg/mL or Aβ42/40 ratio <0.07; T = p-tau >80 pg/mL; and N = t-tau >700 pg/mL. Confusion Assessment Method (CAM) and CAM-Severity (CAM-S) were rated daily post-operatively for delirium and delirium severity, respectively. Results: Aβ42, tau, and p-tau mean pg/mL (SD) were 361.5 (326.1), 618.3 (237.1), and 97.1 (66.1), respectively, for those with delirium, and 550.4 (291.6), 518.3 (213.5), and 54.6 (34.5), respectively, for those without delirium. Thirteen participants (22%) were ATN positive. Delirium severity by peak CAM-S [mean difference (95% confidence interval)] was 1.48 points higher (0.29-2.67), P = 0.02 among the ATN positive. Delirium in the ATN-positive group trended toward but did not reach statistical significance (23% vs. 7%, p = 0.10). Peak CAM-S [mean (SD)] in the delirium group was 7 (2.8) compared to no delirium group 2.5 (1.3), but when groups were further classified by ATN status, an incremental effect on delirium severity was observed, such that patients who were both ATN and delirium negative had the lowest mean (SD) peak CAM-S scores of 2.5 (1.3) points, whereas those who were ATN and delirium positive had CAM-S scores of 8.7 (2.3) points; other groups (either ATN or delirium positive) had intermediate CAM-S scores. Discussion: The presence of AD biomarkers adds important information in predicting delirium severity. Future studies are needed to confirm this relationship and to better understand the role of AD biomarkers, even in pre-clinical phase, in delirium. [ABSTRACT FROM AUTHOR]

Background: Although both age‐related and highly prevalent, little is known regarding the prevalence of hearing loss among persons with dementia (PwD). Current understanding is based on convenience samples primarily from specialized memory clinics. The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC‐NCS) is a large, prospective study of a population‐based cohort from 4 U.S. community sites with audiometric and neurocognitive testing and bi‐racial representation. We examined the prevalence of hearing loss and hearing aid use among older adults with cognitive impairment and whether cognitive status influences hearing aid use. Method: We analyzed audiometric and hearing care data from ARIC‐NCS Visit 6 (2016‐2018). Participants underwent a full neurocognitive battery and audiometric evaluation at Visit 6. Participants with complete audiometric data and an adjudicated diagnosis of cognitively normal, mild cognitive impairment (MCI), or dementia were included in the analytical cohort (N=3,385). Differences in participant characteristics by cognitive status were descriptively compared using Chi‐square tests or one‐way ANOVAs. We performed a series of logistic regression models to estimate the odds of hearing aid non‐use by cognitive status. Result: Prevalence of hearing loss was greater with increasing cognitive impairment (cognitively normal:64.7%; MCI:71.3%; dementia:83.3%). Prevalence of hearing aid use among those with hearing loss and cognitive impairment varied by race (African Americans 7.2%; whites 32.8%). In a multivariable‐adjusted model, cognitive impairment was independently associated with higher odds of non‐use of hearing aids (MCI odds ratio (OR):1.4 (95%CI:1.0‐1.8); dementia OR:1.8 (95%CI:1.2‐2.9) versus cognitively normal). The strongest risk factor for non‐use of hearing aids was race, where African Americans have almost a 5 times higher odds of not using hearing aids compared to whites (95% CI:2.9‐7.4). Conclusion: Hearing loss is highly prevalent but vastly untreated among older adults with cognitive impairment, particularly African Americans, and cognitive impairment is independently associated with hearing aid use. These estimates are some of the first population‐based estimates of audiometric hearing loss among diverse older adults with adjudicated diagnoses of MCI or dementia. With increased calls to address ethnic/racial disparities, we must include hearing loss, as one of the most common co‐morbidities, in order to optimize health and well‐being among all PwD. [ABSTRACT FROM AUTHOR]

Delirium is an acute disorder of attention and cognition. It occurs across the life span, yet it is particularly common among older adults, and is closely linked with underlying neurocognitive disorders. Evidence is mounting that intervening on delirium may represent an important opportunity for delaying the onset or progression of dementia. To accelerate the current understanding of delirium, the Network for Investigation of Delirium: Unifying Scientists (NIDUS) held a conference "Advancing Delirium Research: A Scientific Think Tank" in June 2019. This White Paper encompasses the major knowledge and research gaps identified at the conference: advancing delirium definition and measurement, understanding delirium pathophysiology, and prevention and treatment of delirium. A roadmap of research priorities is proposed to advance the field in a systematic, interdisciplinary, and coordinated fashion. A call is made for an international consortium and biobank targeted to delirium, as well as a public health campaign to advance the field. [ABSTRACT FROM AUTHOR]

Objective: Dementia affects over 47 million people worldwide. Olfactory impairment (OI) is a well-established predictive marker of conversion to dementia among those with mild cognitive impairment. This systematic review aims to describe the predictive value of OI for future cognitive decline among cognitively normal adults.Methods: A literature search encompassing PubMed, EMBASE, and Cochrane for longitudinal cohort studies following cognitively normal adults with baseline OI in comparison to those without OI reporting incident cognitive impairment or dementia was included. Study design, participant demographics, olfactory testing method, and incidence of cognitive decline or dementia were abstracted. Two investigators independently reviewed all articles.Results: The search yielded 964 nonduplicate abstracts and titles, from which 19 full-text articles were reviewed and 10 were included. Studies included were all good quality (mean score 8.7 of 9), and all studies (100%) found a statistically significant association between baseline OI and incident cognitive decline compared with normosmic controls.Conclusion: The existing literature suggests that OI predicts future cognitive decline among cognitively normal adults, supporting olfactory evaluation as a low-cost, minimally invasive, and widely available screening tool to be used in combination with other tests to identify adults at early risk of dementia.Level Of Evidence: NA Laryngoscope, 130:840-847, 2020. [ABSTRACT FROM AUTHOR]

Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non-cardiac surgery. Other than the inclusion of non-surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face-to-face meetings followed by online editing of draft versions. Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5) and National Institute for Aging and the Alzheimer Association (NIA-AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM-5 nomenclature. The working group recommends that 'perioperative neurocognitive disorders' be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder). [ABSTRACT FROM AUTHOR]

Objective To examine the use of antimuscarinics for treating urinary incontinence (UI) in older adults with varying levels of cognition. Design Cross-sectional. Setting National Alzheimer's Coordinating Center from 2005 through 2015. Participants Community-dwelling men and women aged 65 and older (N = 24,106). Measurements Clinicians and staff evaluated each participant's dementia status during annual in-person assessments. Participants or their informants reported all medications taken in the 2 weeks before each study visit. Results Overall, 5.2% (95% confidence interval (CI) = 4.9-5.5%) of the cohort took a bladder antimuscarinic. Participants with impaired cognition were more likely to be taking an antimuscarinic than those with normal cognition. Rates of bladder antimuscarinic use were 4.0% (95% CI = 3.6-4.4%) for participants with normal cognition, 5.6% (95% CI = 4.9-6.3%) for those with mild cognitive impairment, and 6.0% (95% CI = 5.5-6.4%) for those with dementia (p < .001). Of 624 participants with dementia who took antimuscarinics, 16% (95% CI = 13-19%) were simultaneously taking other medicines with anticholinergic properties. Conclusion Use of bladder antimuscarinics was more common in older adults with impaired cognition than in those with normal cognition. This use is despite guidelines advising clinicians to avoid prescribing antimuscarinics in individuals with dementia because of their vulnerability to anticholinergic-induced adverse cognitive and functional effects. A substantial proportion of cognitively impaired individuals who took antimuscarinics were simultaneously taking other anticholinergic medications. These findings suggest a need to improve the treatment of UI in individuals with impaired cognition. [ABSTRACT FROM AUTHOR]

Objectives To describe the differences observed in risk factors for delirium and outcomes between men and women undergoing hip fracture repair surgery. Design Prospective cohort study. Setting Academic medical center. Participants Individuals with acute hip fracture admitted to an academic medical center (N = 431). Measurements Information on preoperative demographic characteristics, medical history, laboratory results, and postoperative outcomes was obtained according to history and chart review. Delirium was assessed using the Confusion Assessment Method. Results The overall incidence of postoperative delirium was 34%, with men more likely to experience postoperative delirium (44.8%) than women (30.2%) ( P = .004). Male sex was associated with postoperative delirium in individuals with hip fracture, even after adjusting for other preoperative risk factors. Other significant preoperative risk factors included age, dementia, Parkinson's disease, and American Society of Anesthesiologists classification. Men were also more likely to experience other postoperative complications and have longer hospital length of stay. Conclusion Men are at higher risk of postoperative delirium after hip fracture repair than women and have more postoperative surgical complications. Their higher risk of postoperative delirium may be due to their underlying preoperative disease severity. [ABSTRACT FROM AUTHOR]

Objective Systematically identify preoperative clinical risk factors for incident postoperative delirium in individuals undergoing hip fracture repair in order to guide clinicians in identifying high risk patients at admission. Methods This is a systematic review of prospective observational studies with estimation of association between preoperative risk factors and incident postoperative delirium in multivariate models. Electronic searches were conducted in PubMed, Embase, PsycINFO, CINAHL, Cochrane Library, Proquest Dissertations and Theses, and WorldCatDissertations. Hand searches were conducted in selected journals and their supplements. Results Search yielded 6380 titles and abstracts from electronic databases and 72 titles from hand searches, and 10 studies met inclusion criteria. The following risk factors were significant in bivariate models: cognitive impairment, age, gender, institutionalization, functional impairment, body mass index (BMI), albumin, comorbidities, American Society of Anesthesiologist classification, acute medical conditions, polypharmacy, and vision impairment. Among all of these risk factors, cognitive impairment most consistently remained statistically significant after adjusting for other risk factors in multivariate models, followed by BMI/albumin and multiple comorbidities. Conclusion In our systematic review, cognitive impairment was one of the strongest preoperative risk factors for postoperative delirium after hip fracture surgery. Preoperative cognitive assessment may be one of the most useful methods of identifying those who are at high risk for postoperative delirium and prioritizing delivery of delirium prevention measures. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim A substantial number of elderly patients take benzodiazepines ( BZD) regularly despite concerns about toxicity and possible dependence, and there are relatively few data to guide clinicians' decisions regarding discontinuing benzodiazepines in the elderly. Methods We carried out a retrospective chart review of 75 elderly patients admitted to a chronic medical/psychiatric unit who were taking a standing dose of benzodiazepines on admission, comparing 40 patients who discontinued benzodiazepines versus 35 who did not discontinue. Purpose We examined the association of BZD discontinuation versus continuation with clinical outcomes on discharge, and further examined clinical characteristics associated with BZD discontinuation. Results Discontinuers had shorter length of stay without evidence of worse cognitive and functional outcome except a trend toward increased incidence of agitation. Logistic regression models suggested anxiety, higher age and higher dose of antidepressants at the beginning were significantly related to successful discontinuation during admission after regression. Conclusion These data imply that BZD withdrawal during admission can be safe and feasible in many elderly frail patients, and that withdrawal might be associated with shorter duration of chronic hospitalization. Geriatr Gerontol Int 2014; 14: 388-394. [ABSTRACT FROM AUTHOR]

Objective Alterations of the immune system play important roles in Alzheimer's disease (AD). The primary purpose of this study was to compare the plasma levels of neopterin, a marker of cellular immune activity, in amnestic mild cognitive impairment (aMCI), early (mild to moderate) AD, and cognitively normal controls. In addition, the correlation of plasma neopterin with interferon-gamma (IFN-γ) and interleukin-6 (IL-6) was also examined. Methods Plasma samples from patients with mild-to-moderate AD ( N = 34), aMCI ( N = 27), and cognitively normal controls ( N = 30) were obtained from the Johns Hopkins Alzheimer's Disease Research Center. Plasma neopterin, IFN-γ, and IL-6 levels were measured using commercially available ELISAs. Multiple linear regression was performed to study differences in the baseline neopterin levels between normal, aMCI, and AD patients. Pearson correlation coefficients were estimated for neopterin and IFN-γ and IL-6 levels. All analyses were conducted using SAS (SAS Institute, Inc., Cary, NC) and GraphPad Prism version 5.00 for Window (GraphPad Software, San Diego, CA, USA). Results AD subjects had significantly higher neopterin values compared with aMCI ( β = 0.202, p = 0.004) and normal ( β = 0.263, p = 0.0004) subjects. There was no statistically significant difference between normal and aMCI subjects. Significant associations between neopterin and IFN-γ ( r = 0.41, p < 0.0001) and IL-6 ( r = 0.35, p = 0.0006) levels were found. Conclusions Our study demonstrates that peripheral immune response may be stronger in later stages of AD pathophysiology, when dementia has developed. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: Mild cognitive impairment (MCI) is a syndrome thought to be a prodrome of dementia for some patients. One subtype, amnestic MCI (aMCI), may be specifically predispose patients to develop Alzheimer’s dementia (AD). Since dementia has been associated with a range of neuropsychiatric symptoms (NPS), we sought to examine the prevalence of NPS in MCI and its subtypes. Methods: One thousand seven hundred seventy-nine participants in the National Alzheimer’s Coordinating Center (NACC) with MCI were included in this study. All participants were evaluated systematically with a thorough cognitive battery, clinical interview, and consensus diagnoses, and subtyped as: (1) amnestic (aMCI) (single- or multiple-domain) versus non-amnestic (non-aMCI); (2) executive dysfunction-MCI (exMCI) (single- or multiple-domain) versus no executive dysfunction-MCI (nonexMCI); (3) both aMCI and exMCI; and (4) neither aMCI nor exMCI. Additionally, aMCI versus nonaMCI and exMCI versus non-exMCI dichotomies were explored. NPS were assessed with the Neuropsychiatric Inventory Questionnaire (NPI-Q) and Geriatric Depression Scale (GDS). Results: 1379 participants (77.5%) met criteria for aMCI and 616 (34.6%) for exMCI. No differences were observed in the prevalence of NPS between aMCI versus non-aMCI. However, exMCI was associated with greater severity of depression, anxiety, agitation, disinhibition, irritability, and sleep problems, although these differences do not persist after adjustment for multiple comparisons. Conclusions: While there were few associations between aMCI and NPS, the presence of executive dysfunction in MCI was associated with greater severity of symptoms and specifically with depression (evidenced by GDS score) and anxiety. These findings may have implications for MCI prognosis and need to be explored in longitudinal studies. Copyright # 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Mitochondrial dysfunction and subsequently impaired energetics triggering cell death have been observed in both dementia and frailty. Cell death releases circulating cell‐free DNA (ccf‐DNA) from mitochondrial (ccf‐mtDNA) and nuclear (ccf‐nDNA) sources. Size and relative abundance of ccf‐mtDNA fragments is suggestive of mechanism of cell death; long ccf‐mtDNA fragments originate from cell necrosis and short ccf‐mtDNA fragments from apoptosis. Our hypothesis is that in aging there is common pathophysiology contributing to development of physical and cognitive decline and that ccf‐mtDNA are potential mediators of these changes. Method: Using ultra‐sensitive digital PCR, mitochondrial and nuclear ccf‐DNA was measured in serum from community‐dwelling individuals from the Rush Alzheimer's Disease Center Religious Orders Study/Rush Memory and Aging Project (median age 80.4, N = 670). Multiple regression analysis, adjusting for age, sex, race and education, associated ccf‐DNA with cognitive and physical measures, including neuropsychological testing and frailty including hand grip strength. Result: Higher levels of short ccf‐mtDNA fragments were associated with lower global cognitive scores, with a 0.09 decrease in global cognitive score per one copy increase in short fragment (p < 0.05). Higher levels of short ccf‐mtDNA normalized to serum ccf‐nDNA (ccf‐mtDNA/ccf‐nDNA) was associated with increased mortality (hazard ratio HR = 1.11) Longitudinal analysis demonstrated higher levels of long ccf‐mtDNA fragments at baseline was associated with greater frailty over time, with frailty score increasing 0.21 per year for every one copy increase in long fragment (p< 0.05). Cross‐sectional analysis demonstrated higher integrity ratio, defined as long ccf‐mtDNA relative to short ccf‐mtDNA, associated with increased handgrip strength (β= 0.14; 95% CI 0.01 – 0.26; p<0.05). Integrity ratio was associated with 0.14 increase in global cognition and 0.12 decrease in frailty score per increase in integrity ratio. Conclusion: Mitochondrial dysfunction is a primary theory of aging and we demonstrate that quantity and relative size of ccf‐mtDNA are associated with cognitive and physical trajectories over time. This study highlights the utility of ccf‐mtDNA fragments in identifying and risk stratifying older patients who are more likely to develop frailty and dementia. Further directions include identifying mechanisms by which ccf‐mtDNA fragments are generated and regulate downstream pathways. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is the most common cause of dementia. Although multiple potential etiologies have been proposed, no clear aging‐related etiological mechanisms have been identified. Renin Angiotensin system (RAS) is a hormonal system that is implicated in blood pressure control and has been suggested as a potential contributor to the development of AD. Here, using postmortem frontal cortex brain samples of age‐ and sex‐matched cognitively normal individuals (n=30) and AD patients (n=30), we sought to examine the brain specific RAS (b‐RAS) differences with AD and how these findings correlate with brain AD pathologies. Method: Samples were obtained from the Rush Memory and Aging Project. We measured angiotensinogen, renin, and ACE gene expression by qPCR and both gene expression and protein levels of Angiotensin II receptor type 1, 2, and 4 and their downstream signaling pathway (pERK, eNOS, and nNOS) by qPCR and Western blot. Brain cytokines (IL6, TNFα, IFNγ, and IL1β) and oxidative stress (OS) marker (protein carbonyl) as well as average paired helical filaments‐tau and β‐amyloid load were used as specific markers of AD pathology. Result: Our results demonstrate an increase in both gene and protein expression (2.47 folds p=0.01, median0.59 (range1.99) vs. 0.47 (1.95) p=0.03, respectively) and signaling activity (0.35 (11.41) vs. 0.04 (1.84), p<0.01) of AT1R in AD. We have not observed any significant changes in other RAS components. Our data show that higher AT1R levels correlate with OS (r=0.301 p=0.01) and β‐amyloid load (r=0.245 p=0.04), while higher pERK levels negatively correlate with MN (r=‐0.239 p=0.03) and positively correlate with total tangle (r=0.413 p<0.01) and amyloid (r=0.208 p=0.02) scores. Finally, mRNA, protein, and pERK levels of AT1R were negatively correlated with global cognitive function (GCF) scores (r=‐0.216 p=0.05, r=‐0.258 p=0.02, r=‐0.376 p<0.01, respectively) and were associated with greater decline in GCF (r=0.265 p=0.02, r=0.223 p=0.04, respectively) in all subjects. Conclusion: This study highlights molecular changes in b‐RAS and offers insight into the association of these changes with brain pathology in AD. These findings can be important in shedding light on the benefits of RAS‐modulating drugs in AD. [ABSTRACT FROM AUTHOR]