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A new assessment of Activities of Daily Living has been developed specifically for use with people with dementia. The assessment is a carer rated instrument consisting of 20 daily-living abilities. The scale has 'face validity', assessing items rated as important by and using levels of ability generated by carers. It has 'construct' validity as demonstrated by principal components analysis. It has 'concurrent' validity in that it correlates well with observed task performance. It has good 'test-retest' reliability as measured by Cohen's Kappa and it correlates well with the Mini-Mental State Examination. Carers report that it is easy to use and it is relatively short. The authors believe the scale will be useful when assessing demented patients in the community or as part of clinical research trials. [ABSTRACT FROM AUTHOR]

Research suggests that there is an age-related decline in the processing of negative emotional information, which may contribute to the reported decline in emotional problems in older people. We used a signal detection approach to investigate the effect of normal aging on the interpretation of ambiguous emotional facial expressions. High-functioning older and younger adults indicated which emotion they perceived when presented with morphed faces containing a 60% to 40% blend of two emotions (mixtures of happy, sad, or angry faces). They also completed measures of mood, perceptual ability, and cognitive functioning. Older and younger adults did not differ significantly in their ability to discriminate between positive and negative emotions. Response-bias measures indicated that older adults were significantly less likely than younger adults to report the presence of anger in angry--happy face blends. Results are discussed in relation to other research into age-related effects on emotion processing. [ABSTRACT FROM AUTHOR]

Introduction: With an increasingly ageing population, understanding sensory impairments and their consequences in older adults is important., Methods: The current study sought to examine the contemporaneous relationships between subjective sensory functioning (vision and hearing) and different types of anomalous perceptions (anomalous body-centred self-experiences and anomalous external experiences) in community-dwelling older adults ( N  = 244, M age  = 71.86 ± 7.65, range = 52-91, 67.6% female) using structural equation modelling., Results: Poorer self-reported visual functioning was associated both with more anomalous body-centred self-experiences and more anomalous external experiences. However, no associations between self-reported hearing function and anomalous perceptions of any kind were found. Further, those reporting higher levels of loneliness self-reported poorer visual functioning and more anomalous body-centred self-experiences. The potential mediating role of loneliness was also explored. However, the relationship between self-reported visual function and anomalous perceptual experiences was not mediated by loneliness., Conclusions: The current cross-sectional findings suggest that poorer self-reported visual-but not hearing-function may be a risk factor for the experience of anomalous perceptions in older adults. Future research should examine these associations using objective measures of hearing and vision and longitudinal designs.

Study Objectives: To examine how past studies have conceptualised sleep discrepancy and identify and evaluate the methods used for its measurement and analysis., Method: We searched MEDLINE, Embase, PsycINFO, CINAHL Plus, PubMed, Scopus, and Web of Science in April 2022 for studies comparing self-report and objective measures of sleep. Methodological information was extracted from relevant studies and included measures of self-report and objective sleep, sleep variables (e.g., total sleep time), derived discrepancy indices (e.g., difference scores), handling of repeated measurements, and methods of measure comparison (e.g., Bland-Altman analyses)., Results: Two hundred and forty-four relevant records were identified. Studies varied according to objective sleep measure; actigraphy algorithm, software, and rest interval; polysomnography setting and scoring criteria; sleep variables; self-report sleep measure; number of nights of objective recording; time frame of self-report measure; self-report sleep variable definition; sleep discrepancy derived index; presence and handling of repeated measurements; and statistical method for measure comparison., Conclusions: Sleep discrepancy was predominantly conceived as discordance in sleep states or sleep time variables, and various forms of this discordance differed in their conceptual distance to sleep misperception. Furthermore, studies varied considerably in methodology with critical conceptual and practical implications that have received little attention to date. Substantive methodological issues were also identified relating to the use of derived indices for operationalising sleep discrepancy, defining objective sleep onset latency, calculating actigraphy rest intervals, measuring correlation and concordance, averaging sleep variables across nights, and defining sleep quality discrepancy. Solutions and recommendations for these issues are discussed., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Tom F. Walton reports financial support was provided by Australian Government Research Training Program. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This was the first study to use cluster analysis to characterise sleep discrepancy (the discordance between self-reported and objective sleep) across multiple sleep parameters, in community-dwelling older adults. For sleep efficiency, negative discrepancy (the tendency to self-report worse sleep than objectively-measured) was associated with poorer memory, independent of insomnia severity, depressive symptoms and objective sleep. This suggests a unique role for sleep discrepancy as a possible risk factor for future cognitive decline, and warrants the need for further research., (© 2024 The Author(s). Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)

Sleep discrepancy (negative discrepancy reflects worse self-reported sleep than objective measures, such as actigraphy, and positive discrepancy the opposite) has been linked to adverse health outcomes. This study is first to investigate the relationship between sleep discrepancy and brain glucose metabolism (assessed globally and regionally via positron emission tomography), and to evaluate the contribution of insomnia severity and depressive symptoms to any associations. Using data from cognitively unimpaired community-dwelling older adults ( N  = 68), cluster analysis was used to characterise sleep discrepancy (for total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE)), and logistic regression was used to explore sleep discrepancy's associations with brain glucose metabolism, while controlling for insomnia severity and depressive symptoms. Lower glucose metabolism across multiple brain regions was associated with negative discrepancy for WASO and SE, and positive discrepancy for WASO only (large effect sizes; β ≥ 0.5). Higher glucose metabolism in the superior parietal and posterior cingulate regions was associated with negative discrepancy for TST (large effect sizes; β ≥ 0.5). These associations remained when controlling for insomnia severity and depressive symptoms, suggesting a unique role of sleep discrepancy as a potential early behavioural marker of brain health., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Objective: This study aimed to gather opinions and establish consensus among audiologists and patients on supporting individuals with mental health concerns in audiology settings., Design: Utilising a modified electronic Delphi survey, a panel of 25 experts engaged in three rounds of data collection over 12 weeks. Participants provided open-text responses in Round 1 describing "clinical practices that can be employed to support to patients presenting with mental health concerns", and the research team combined these with relevant clinical practices from literature searches. In subsequent rounds, panellists then rated their level of agreement with the combined list of statements; individually (Round 2) and again after seeing the panel's collated responses (Round 3)., Study Sample: Panel experts included 11 patients (adults with hearing loss; M age 73.8 years) and 14 audiologists (with M 11.8 years of experience working in audiology)., Results: Consensus was met for 123 items categorised into: Detection, Education, Effective Communication, Provision of Emotional Support, Personal Qualities and Attitudes of the Audiologist, Interventions, Connecting the Patient to Additional Support Services, Normal Processes that are Especially Important in these Cases, and Organisational Considerations., Conclusions: The study highlights the diversity of approaches audiologists can employ to support patients with mental health concerns.

Background: Resilience refers to the process of demonstrating better outcomes than would be expected based on the adversity one experienced. Resilience is increasingly measured using a residual approach, which typically assesses adversity and mental health outcomes over a longitudinal timeframe. It remains unknown to what extent such a residual-based measurement of resilience is sensitive to variation in acute stress resilience, a candidate resilience factor., Methods: Fifty-seven emerging adults enrolled in tertiary education completed measures of adversity and emotional experiences. To assess stress recovery, participants were exposed to a lab-based adverse event from which a Laboratory Stress Resilience Index was derived., Results: We derived a residual-based measure of emotional resilience from regressing emotional experience scores onto adversity scores. This residual-based measure of emotional resilience predicted variance in the Laboratory Stress Resilience Index over and above that predicted by both a traditional resilience measure and the emotional experiences measure. These findings suggest that acute stress resilience may be a factor underpinning variation in emotional resilience, and that the residual-based approach to measuring resilience is sensitive to such variation in stress resilience., Competing Interests: Lies Notebaert is an Academic Editor for PeerJ., (© 2024 Notebaert et al.)

Background: Subjective cognitive decline (SCD), i.e. self/other-reported concerns on one's cognitive functioning without objective evidence of significant decline, is an indicator of dementia risk. There is little consensus on reliability and validity of the available SCD measures. Therefore, introducing a novel and psychometrically sound measure of SCD is timely., Objective: The psychometric properties of a new SCD measure, the McCusker Subjective Cognitive Impairment Inventory-Self-Report (McSCI-S), are reported., Methods: Through review of previously published measures as well as our clinical and research data on people with SCD, we developed a 46-item self-report questionnaire to assess concerns on six cognitive domains, namely, memory, language, orientation, attention and concentration, visuoconstruction abilities and executive function. The McSCI-S was examined in a cohort of 526 participants using factor analysis, item response theory analysis and receiver operating characteristic (ROC) curve., Results: A unidimensional model provided acceptable fit (CFI = 0.94, TLI = 0.94, RMSEA [90% CI] = 0.052 [.049, 0.055], WRMR = 1.45). The McSCI-S internal consistency was excellent (.96). A cut-off score of ≥24 is proposed to identify participants with SCDs. Higher McSCI-S scores were associated with poorer general cognition, episodic verbal memory, executive function and greater memory complaints and depressive scores (P < .001), controlling for age, sex and education., Conclusions: Excellent reliability and construct validity suggest the McSCI-S estimates SCDs with acceptable accuracy while capturing self-reported concerns for various cognitive domains. The psychometric analysis indicated that this measure can be used in cohort studies as well as on individual, clinical settings to assess SCDs., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol., Design: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews)., Results: Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC's skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants., Conclusions: The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: This study investigated whether self-reported sleep quality is associated with brain amyloid beta (Aβ) accumulation., Methods: Linear mixed effect model analyses were conducted for 189 cognitively unimpaired (CU) older adults (mean ± standard deviation 74.0 ± 6.2; 53.2% female), with baseline self-reported sleep data, and positron emission tomography-determined brain Aβ measured over a minimum of three time points (range 33.3-72.7 months). Analyses included random slopes and intercepts, interaction for apolipoprotein E ( APOE ) ε4 allele status, and time, adjusting for sex and baseline age., Results: Sleep duration <6 hours, in APOE ε4 carriers, and sleep efficiency <65%, in the whole sample and APOE ε4 non-carriers, is associated with faster accumulation of brain Aβ., Discussion: These findings suggest a role for self-reported suboptimal sleep efficiency and duration in the accumulation of Alzheimer's disease (AD) neuropathology in CU individuals. Additionally, poor sleep efficiency represents a potential route via which individuals at lower genetic risk may progress to preclinical AD., Highlights: In cognitively unimpaired older adults self-report sleep is associated with brain amyloid beta (Aβ) accumulation.Across sleep characteristics, this relationship differs by apolipoprotein E ( APOE ) genotype.Sleep duration <6 hours is associated with faster brain Aβ accumulation in APOE ε4 carriers.Sleep efficiency < 65% is associated with faster brain Aβ accumulation in APOE ε4 non-carriers.Personalized sleep interventions should be studied for potential to slow Aβ accumulation., Competing Interests: L.N.P., B.M.B., K.R.S., J.D.D., V.D., M.W., H.R.S., S.L.G., R.S.B., S.M.L., K.T., and S.R.R.S. report no disclosures. V.L.V. is and has been a consultant or paid speaker at sponsored conference sessions for Eli Lilly, Life Molecular Imaging, ACE Barcelona, and IXICO. P.M. is a full‐time employee of Cogstate Ltd. C.L.M. is an advisor to Prana Biotechnology Ltd and a consultant to Eli Lilly. C.C.R. has served on scientific advisory boards for Bayer Pharma, Elan Corporation, GE Healthcare, and AstraZeneca; has received speaker honoraria from Bayer Pharma and GE Healthcare; and has received research support from Bayer Pharma, GE Healthcare, Piramal Lifesciences, and Avid Radiopharmaceuticals. R.N.M. is founder of, and owns stock in, Alzhyme, and is a co‐founder of the KaRa Institute of Neurological Diseases. Author disclosures are available in the supporting information, (© 2024 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Objectives: Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management., Methods: The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data., Results: Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop ( p = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all p < .02). Participant feedback was positive, with 91% of trainees rating the workshop as "excellent" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep., Conclusions: The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.

Introduction: A rise in premature mortality-defined here as death during the most productive years of life, between adolescence and middle adulthood (15-60 years)-is contributing to stalling life expectancy in high-income countries. Causes of mortality vary, but often include substance misuse, suicide, unintentional injury and non-communicable disease. The development of evidence-informed policy frameworks to guide new approaches to prevention require knowledge of early targets for intervention, and interactions between higher level drivers. Here, we aim to: (1) identify systematic reviews with or without meta-analyses focused on intervention targets for premature mortality (in which intervention targets are causes of mortality that can, at least hypothetically, be modified to reduce risk); (2) evaluate the review quality and risk of bias; (3) compare and evaluate each review's, and their relevant primary studies, findings to identify existing evidence gaps., Methods and Analysis: In May 2023, we searched electronic databases (MEDLINE, PubMed, Embase, Cochrane Library) for peer-reviewed papers published in the English language in the 12 years from 2012 to 2023 that examined intervention targets for mortality. Screening will narrow these papers to focus on systematic reviews with or without meta-analyses, and their primary papers. Our outcome is death between ages 15 and 60 years; with potential intervention targets measured prior to death. A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) will be used to assess quality and risk of bias within included systematic reviews. Results will be synthesised narratively due to anticipated heterogeneity between reviews and between primary studies contained within included reviews., Ethics and Dissemination: This review will synthesise findings from published systematic reviews and meta-analyses, and their primary reviewed studies, meaning ethics committee approval is not required. Our findings will inform cross-cohort consortium development, be published in a peer-reviewed journal, and be presented at national and international conferences., Prospero Registration Number: CRD42022355861., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Study Objectives: Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework., Methods: Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months., Results: Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students' sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency., Conclusions: Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide., (© The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society.)

Background: Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience sleep difficulties such as difficulty initiating and maintaining sleep. Problem sleep may impact children's daily functioning and behaviors and exacerbate ADHD symptoms. Most effective behavioral interventions to improve sleep are conducted in person, limiting accessibility to treatment for individuals in remote or rural communities or those who are unable to attend a clinic. This trial aims to assess the efficacy of delivering an established behavioral intervention online, Sleeping Sound with ADHD © , compared to a face-to-face delivery mode., Methods: This parallel group, non-inferiority, randomized controlled trial (RCT) will include at least 68 children, aged 5-12 years old with ADHD. Families of children will be recruited from private developmental and psychological clinics and social media, within the state of Western Australia (WA). Once written informed consent and baseline questionnaires are completed, families are randomized to receive the behavioral intervention either in-person or online via Telehealth services. The intervention targets the assessment and management of reported sleep problems, through two individual consultations and a follow-up phone call with a trained clinician. The sleep outcomes assessed consist of a parent-reported sleep questionnaire and actigraphy., Discussion: To the best of our knowledge, this is the first RCT to investigate sleep treatment modality for children with ADHD. If effective, clinicians can provide an evidence-based sleep intervention in an accessible manner., Trial Registration: ANZCTR, ACTRN12621001681842 . Registered 9 December 2021-Retrospectively registered., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Study Objectives: There is currently no way to estimate the period of time a person has had obstructive sleep apnoea (OSA). Such information would allow identification of people who have had an extended exposure period and are therefore at greater risk of other medical disorders; and enable consideration of disease chronicity in the study of OSA pathogenesis/treatment., Method: The 'age of OSA Onset' algorithm was developed in the Wisconsin Sleep Cohort (WSC), in participants who had ≥2 sleep studies and not using continuous positive airway pressure (n = 696). The algorithm was tested in a participant subset from the WSC (n = 154) and the Sleep Heart Health Study (SHHS; n = 705), those with an initial sleep study showing no significant OSA (apnea-hypopnea index (AHI) < 15 events/hr) and later sleep study showing moderate to severe OSA (AHI≥15 events/hr)., Results: Regression analyses were performed to identify variables that predicted change in AHI over time (BMI, sex, and AHI; beta weights and intercept used in the algorithm). In the WSC and SHHS subsamples, the observed years with OSA was 3.6 ± 2.6 and 2.7 ± 0.6 years, the algorithm estimated years with OSA was 10.6 ± 8.2 and 9.0 ± 6.2 years., Conclusions: The OSA-Onset algorithm estimated years of exposure to OSA with an accuracy of between 6.6 and 7.8 years (mean absolute error). Future studies are needed to determine whether the years of exposure derived from the OSA-Onset algorithm is related to worse prognosis, poorer cognitive outcomes, and/or poorer response to treatment., Competing Interests: Declaration of competing interest None., (Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.)

Low vitamin D status is linked with poorer cognition in adults while findings in relation to high levels are mixed.We performed a systematic review and meta-analyses to examine dose-response associations between 25-hydroxyvitamin D (25OHD) levelsand cognitive performance in community-dwelling adults. Thirty-eight observational studies were included in dose-response meta-analyses. Positive, nonlinear associations were identified between baseline25OHD levels and global cognition incross-sectional and longitudinal analyses, and for performance in memory and executive function in longitudinal analyses. When restricted to studies involving older adults, thepattern emerged forspecific domains in cross-sectional analyses. Poorer performance was associated with low 25OHD levels, while a sharp improvement was associated withlevels up to 60-70 nM/L. Further improvement was observed only for longitudinal global cognition. Our findings support the association between low vitamin D and poorer cognition and suggest levels of at least 60 nM/L are associated with better cognition during ageing., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Brain reserve, cognitive reserve, and education are thought to protect against late-life cognitive decline, but these variables have not been directly compared to one another in the same model, using future cognitive and functional decline as outcomes. We sought to determine whether the influence of these protective factors on executive function (EF) and daily function decline was dependent upon Alzheimer's disease (AD) pathology severity, as measured by the total tau to beta-amyloid (T-τ/Aβ 1-42 ) ratio in cerebrospinal fluid (CSF)., Method: Participants were 1201 older adult volunteers in the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. Brain reserve was defined using a composite index of structural brain volumes (total brain matter, hippocampus, and white matter hyperintensity). Cognitive reserve was defined as the variance in episodic memory performance not explained by brain integrity and demographics., Results: At higher levels of T-τ/Aβ 1-42 , brain and cognitive reserve predicted slower decline in EF. Only brain reserve attenuated decline at lower levels of T-τ/Aβ 1-42 . Education had no independent association with cognitive decline., Conclusions: These results point to a hierarchy of protection against aging- and disease-associated cognitive decline. When pathology is low, only structural brain integrity predicts rate of future EF decline. The ability of cognitive reserve to predict future EF decline becomes stronger as CSF biomarker evidence of AD increases. Although education is typically thought of as a proxy for cognitive reserve, it did not show any protective effects on cognition after accounting for brain integrity and the residual cognitive reserve index.

Objective: To explore the barriers and facilitators faced by hearing healthcare clinicians (HHCs) with respect to asking adults with hearing loss (HL) about their emotional well-being., Design: This qualitative study was conducted using semi-structured individual interviews and focus groups. The interview topic guide was developed based on the COM-B model., Study Sample: Fifteen HHCs of a single hearing services organisation in Western Australia across 13 clinic locations participated., Results: Barriers and facilitators that may influence HHCs' behaviour of routinely asking adults about their emotional well-being include having the knowledge and skills to ask about emotional well-being, forgetting to ask, awareness of the emotional impacts of HL, time and tools for asking, clients' reactions to being asked, supportive peers, normalisation of discussions relating to emotional well-being, presence of significant others, emotions associated with asking, being in the habit of asking, reminders, beliefs about consequences and confidence or capabilities, and scope of audiology practice., Conclusions: Application of the COM-B model identified barriers in capabilities (e.g. knowledge), opportunities (e.g. tools), and motivation (e.g. beliefs about benefits of asking about emotions) that need to be addressed for HHCs to ask their clients about their emotional well-being.

Objective: This study describes the development of an intervention to increase the frequency of audiologists' asking about and providing information regarding mental wellbeing within adult audiology services., Design: The Behaviour Change Wheel (BCW), an eight-step systematic process, was followed to develop the intervention. Reports describing the first four steps are published elsewhere. This report describes the final four steps and details the intervention developed., Results: A multifaceted intervention was developed to change audiologists' behaviours relating to providing mental wellbeing support to adults with hearing loss. Specifically, three behaviours were targeted: (1) asking clients about their mental wellbeing, (2) providing general information on the mental wellbeing impacts of hearing loss, and (3) providing personalised information on managing the mental wellbeing impacts of hearing loss. A variety of intervention functions and behaviour change techniques were incorporated into the intervention, including instruction and demonstration, information about others approval, adding objects to the environment, use of prompts/cues, and endorsement from credible sources., Conclusion: This study is the first to use the Behaviour Change Wheel to develop an intervention targeting mental wellbeing support behaviours in audiologists and confirms the usability and usefulness of the approach in a complex area of clinical care. The systematic development of the Ask, Inform, Manage, Encourage, Refer (AIMER) intervention will facilitate a thorough evaluation of its effectiveness in the next phase of this work., (© 2023. The Author(s).)

Introduction: The short version of the Conners' Adult ADHD Rating Scales (CAARS-S:S) is a self-report measure used to identify symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) during adulthood. However, its psychometric properties specifically in emerging adults, or the transitional age group between adolescence and adulthood, remain understudied. This study aimed to validate the factor structure of the CAARS-S:S in a sample of emerging adults., Method: The CAARS-S:S measure was completed by adults (n = 591) aged 18 to 29 located in English-speaking countries, including Australia, Canada and the United States. Confirmatory factor analysis was used to test a four-factor model of Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability and Problems with Self-Concept, as well as the model's invariance by sex. Sex was also included as a covariate in the model to examine differences in males' and females' scores on each factor., Results: Overall, the four-factor structure fit the data and was invariant across males and females. All factors demonstrated high internal reliability (average ω t and α = .86). It was observed that males tended to score higher on Inattention/Memory Problems while females scored higher on Problems with Self-Concept., Conclusion: This research establishes the psychometric properties of the CAARS-S:S, placing greater confidence in using it to screen for ADHD symptoms in emerging adults living in a Westernized cultural context. The detailed findings of this research, implications for the use of the CAARS-S:S in this age group and potential future directions for examining the properties of the measure are discussed.

Introduction: Obstructive sleep apnoea (OSA) is a multisystem, debilitating, chronic disorder of breathing during sleep, resulting in a relatively consistent pattern of cognitive deficits. More recently, it has been argued that those cognitive deficits, especially in middle-aged patients, may be driven by cardiovascular and metabolic comorbidities, rather than by distinct OSA-processes, such as are for example ensuing nocturnal intermittent hypoxaemia, oxidative stress, neuroinflammation, and sleep fragmentation., Methods: Thus, we undertook to define cognitive performance in a group of 27 middle-aged male patients with untreated OSA, who had no concomitant comorbidities, compared with seven matched controls (AHI mean ± S.D.: 1.9 ± 1.4 events/h; mean age 34.0 ± 9.3 years; mean BMI 23.8 ± 2.3 kg/m 2 ). Of the 27 patients, 16 had mild OSA (AHI mean ± S.D.:11.7 ± 4.0 events/h; mean age 42.6 ± 8.2 years; mean BMI 26.7 ± 4.1 kg/m 2 ), and 11 severe OSA (AHI 41.8 ± 20.7 events/h; age: 46.9 ± 10.9 years, BMI: 28.0 ± 3.2 kg/m 2 )., Results: In our patient cohort, we demonstrate poorer executive-functioning, visuospatial memory, and deficits in vigilance sustained attention, psychomotor and impulse control. Remarkably, we also report, for the first time, effects on social cognition in this group of male, middle-aged OSA patients., Conclusion: Our findings suggest that distinct, OSA-driven processes may be sufficient for cognitive changes to occur as early as in middle age, in otherwise healthy individuals., Competing Interests: Conflict of interest MM was employed by L&M Data Science Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Objective: To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being., Design: A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change)., Study Sample: Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3)., Results: Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss., Conclusion: Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.

Introduction: Anomalous perceptions are characterised by the subjective experience of a range of distorted and/or hallucinatory percepts. Whilst considerable attention has been paid to the neurocognitive processes contributing to anomalous perceptions amongst older adults, less is known about the social factors (e.g. social isolation, loneliness). Furthermore, it is unknown whether loneliness and social isolation are associated with different types of anomalous perceptions, including anomalous body-centred self-experiences and anomalous external experiences., Methods: This study examined the cross-sectional relationships between loneliness, objective social isolation, and anomalous perceptions in a sample of community-dwelling older adults ( N  = 242, M age  = 71.87 ± 7.73, range = 52-91, 67.8% female) using structural equation modelling., Results: Higher levels of loneliness were associated with more anomalous body-centred self-experiences and anomalous external experiences. Those reporting more loneliness also reported higher levels of anxiety and depression; however, the relationship between loneliness and anomalous perceptions was not mediated by these factors. Social disconnection from a religious group was associated with more anomalous external experiences and being married/living with a partner was associated with more anomalous body-centred self-experiences., Conclusions: These findings suggest that loneliness and social isolation have differential associations with anomalous perceptions in older adults and provide additional evidence that attending to loneliness in older adults is important.

Objective: To evaluate intervention characteristics and components within behavioral sleep interventions in school-aged children with ADHD and examine evidence related to effectiveness., Method: A systematic review was conducted using PsycINFO, Embase, MEDLINE, PubMed, and OpenGray. The subsequent meta-analysis used sleep outcomes to produce comparable effect sizes (Hedges' g ) and compare intervention effects between randomized controlled trials and pre-post studies., Results: Eleven articles satisfied the inclusion criteria (562 children, across all groups, aged 5-14 years, M  = 8.71). Studies reported improvements in sleep although there was marked heterogeneity between studies and limited use of objective sleep measures within them. On average, intervention groups improved more than control groups in the five randomized controlled trials (-0.46, 95% CI = [-0.58, -0.35], k  = 4)., Conclusion: The findings support the use of behavioral sleep interventions for school-aged children with ADHD. Findings suggest that brief, individualized intervention may be more effective than standardized.

Background: The residual approach to measuring cognitive reserve (using the residual reserve index) aims to capture cognitive resilience conferred by cognitive reserve, but may be confounded by factors representing brain resilience. We sought to distinguish between brain and cognitive resilience by comparing interactions between the residual reserve index and amyloid, tau, and neurodegeneration ["AT(N)"] biomarkers when predicting executive function. We hypothesized that the residual reserve index would moderate at least one path from an AT(N) biomarker to executive function (consistent with cognitive resilience), as opposed to moderating a path between two AT(N) biomarkers (suggestive of brain resilience)., Methods: Participants ( N = 332) were from the Alzheimer's Disease Neuroimaging Initiative. The residual reserve index represented the difference between observed and predicted memory performance (a positive residual reserve index suggests higher cognitive reserve). AT(N) biomarkers were: CSF β-amyloid 1-42 /β-amyloid 1-40 (A), plasma phosphorylated tau-181 (T), and FDG metabolism in AD-specific regions ([N]). AT(N) biomarkers (measured at consecutive time points) were entered in a sequential mediation model testing the indirect effects from baseline amyloid to executive function intercept (third annual follow-up) and slope (baseline to seventh follow-up), via tau and/or FDG metabolism. The baseline residual reserve index was entered as a moderator of paths between AT(N) biomarkers (e.g., amyloid-tau), and paths between AT(N) biomarkers and executive function., Results: The residual reserve index interacted with amyloid pathology when predicting FDG metabolism: the indirect effect of amyloid → FDG metabolism → executive function intercept and slope varied as a function of the residual reserve index. With lower amyloid pathology, executive function performance was comparable at different levels of the residual reserve index, but a higher residual reserve index was associated with lower FDG metabolism. With higher amyloid pathology, a higher residual reserve index predicted better executive function via higher FDG metabolism., Conclusion: The effect of the residual reserve index on executive function performance via FDG metabolism was consistent with cognitive resilience. This suggests the residual reserve index captures variation in cognitive reserve; specifically, neural efficiency, and neural capacity to upregulate metabolism to enhance cognitive resilience in the face of greater amyloid pathology. Implications for future research include the potential bidirectionality between neural efficiency and amyloid accumulation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 McKenzie, Bucks, Weinborn, Bourgeat, Salvado and Gavett.)

Objective: The Memory for Intentions Test (MIsT) is a clinical measure of prospective memory that has strong evidence for convergent, discriminative, and ecological validity. This study uses a conceptual replication design to evaluate the latent structure of the MIsT in two parallel samples who commonly experience prospective memory deficits: older adults and people living with HIV disease., Participants and Methods: Study participants included 303 people with HIV disease (ages 18-67) and 267 community-dwelling older adults (ages 50-91). Confirmatory factor analyses of the MIsT were conducted separately in each sample. We evaluated a one-factor model, as well as three two-factor models with the MIsT items loading onto each factor based on cue type, delay interval, or response modality., Results: The one-factor model provided the best (and most parsimonious) fit to the data in both study samples. All two-factor models also demonstrated good fit statistics, although correlations between the two factors in each model were high and none of the two-factor models provided a significantly better fit than the one-factor model., Conclusions: Results of this conceptual replication study provide support for a robust factor structure of the MIsT across older adults and people with HIV disease. A total score for the MIsT provides the most parsimonious solution, although available evidence and theory also support the potential use of subscales (e.g., cue type). Future studies of the MIsT would be useful to determine its psychometrics in different clinical populations and across demographic factors (e.g., race/ethnicity).

Obstructive sleep apnea (OSA) is a highly prevalent condition in people living with schizophrenia or other psychotic disorder. Its treatment with continuous positive airway pressure therapy (CPAP) can dramatically improve daytime and physical health function. People with a psychotic disorder, however, are rarely diagnosed and treated and there are no large-scale studies showing evidence of successful treatment with CPAP. Using a retrospective case-control study approach (N = 554), we examined adherence to and effectiveness of a CPAP trial in individuals with comorbid psychotic disorder and OSA (psychosis group, n = 165) referred for a CPAP trial at the West Australian Sleep Disorders Research Institute. Given that antipsychotic medication is an important confounder, we included a psychiatric (non-psychosis) comparison group taking antipsychotic medication (antipsychotic group, n = 82), as well as a nonpsychiatric control group (OSA control group, n = 307) also diagnosed with OSA and referred for CPAP. Variables included OSA symptom response, CPAP engagement, and usage at 3 months. The Psychosis group had the most severe OSA at baseline and they attended fewer clinic appointments overall. However, there were no other group differences either in CPAP adherence or treatment response. CPAP was equally effective in normalizing OSA symptoms and daytime sleepiness in all groups. CPAP usage was longer per night in the Psychosis and Antipsychotic groups, perhaps suggesting a role of sedation from antipsychotic medications. In conclusion, OSA is treatable and CPAP feasible in people with severe mental illness and antipsychotic medications are not a barrier to treatment response., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: There are few Arabic language functional scales for patients with dementia. The Bristol Activity of Daily Living Scale (BADLS) was designed and validated for use in patients with dementia., Objective: Our study aimed to translate, cross-culturally adapt, and validate the BADLS to the Arabic language for people with neurocognitive decline and dementia., Methods: The original BADLS scale was translated to the Arabic language followed by face validity assessment through a pilot testing in five Arabic countries. The Arabic BADLS was assessed in a sample of 139 participants and their caregivers for concurrent and convergent validity., Results: The Arabic BADLS had excellent internal consistency, Cronbach's alpha 0.95 (95% CI 0.93-0.96). Likewise, the Arabic BADLS had strong convergent validity with the Montreal Cognitive Assessment (r = -0.82, p < 0.001)., Conclusion: The Arabic BADLS is a valid scale that can used to assess the functional performance of people living with dementia.

Age-related deficits in prospective memory (PM) are well established, but it is not known whether PM is stable over time among older adults. In this study, 271 community-dwelling older adults underwent abaseline neuropsychological evaluation and up to three follow-up visits, approximately 2.4 years apart. Mixed effects linear longitudinal models revealed small, but significant linear declines and between-subjects variability in event-based PM performance. There were no changes in performance on measures of time-based PM, retrospective memory, or executive functions. Changes in event-based PM were not associated with age, retrospective memory, executive functions, or everyday functioning. Among older adults, event-based PM appears to be more susceptible to linear declines than does time-based PM, which future research might examine with regard to the possible underlying cognitive mechanisms of cue encoding, monitoring, detection, and retrieval processes.

Low vitamin D status has been linked to adverse cognitive outcomes in older adults. However, relationships at higher levels remain uncertain. We aimed to clarify patterns of association between vitamin D status and cognitive performance, using flexible regression methods, in 4872 middle- to older-aged adults (2678 females) from the Busselton Healthy Ageing Study. Cross-sectional associations of serum levels of 25-hydroxyvitamin D (25OHD) and performance in cognitive domains were modelled using linear regression and restricted cubic splines, controlling for demographic, lifestyle, and health factors. Mean ± SD serum 25OHD levels were 78 ± 24 nM/L for women and 85 ± 25 nM/L for men. Increasing levels in women were associated with better global cognition (linear trend, p = 0.023) and attention accuracy (continuity of attention), with improvement in the latter plateauing around levels of 80 nM/L (nonlinear trend, p = 0.035). In men, increasing levels of serum 25OHD were associated with better attention accuracy (linear trend, p = 0.022), but poorer semantic verbal fluency (linear trend, p = 0.025) and global cognition (nonlinear trend, p = 0.015). We identified patterns of association between serum 25OHD levels and cognitive performance that may reflect early dose-response relationships, particularly in women. Longitudinal analyses extending through to older ages may help to clarify the nature, strength, and temporality of these relationships.

Purpose: Hearing loss causes emotional distress and can contribute to the development of psychological difficulties, yet emotional and psychological issues are not addressed within current audiology services. The purpose of this study was to use focus groups with consumer and community representatives to explore how we might improve the provision of support for clients experiencing emotional and psychological issues in relation to their hearing loss., Participants: Adults with hearing loss ( n = 19) and their significant others ( n = 9), as well as 10 hearing health care professionals ( n = 4 hearing health care clinicians, n = 4 reception staff, and n = 2 clinical managers), participated in consumer and community engagement focus groups., Method: Consumer and community representatives were tasked with (a) identifying the stakeholders involved in supporting adults experiencing emotional or psychological difficulties on account of their hearing loss, (b) describing the behaviors undertaken by each stakeholder group, and (c) selecting target behavior(s) that could optimally form the basis of an intervention program to improve the quality and frequency of support provided to people experiencing emotional and psychological problems in the audiology setting., Results: Participants identified 12 stakeholder groups involved in supporting adults with hearing loss experiencing emotional and psychological problems. The three behaviors voted by participants to be the most promising for a behavioral intervention included the clinician (a) asking about, (b) providing information on, and (c) delivering therapeutic intervention for emotional and psychological well-being within audiological service provision., Conclusion: Consumer and community stakeholder representatives indicate a general desire for hearing health care clinicians to deliver support for the emotional and psychological issues that arise relating to hearing loss.

Importance: The prevalence of hyperacusis and its relationship with mental and general health is unknown in a nonclinical sample. Therefore, we aimed to determine the prevalence of hyperacusis and its relation with hearing, general and mental health in a population-based study., Study Design: Prospective population-based study., Material and Methods: This study uses data from the Busselton Healthy Ageing Study (BHAS). A sample of 5,107 eligible inhabitants aged 45 to 70 years completed a detailed questionnaire and a clinical assessment. A positive answer to "Do you consider yourself sensitive or intolerant to everyday sounds" was used to indicate hyperacusis. Logistic regression was used to examine the association between hearing, mental and general health factors, and hyperacusis., Results: Of 5,107 participants, 775 (15.2%) reported hyperacusis. The majority of participants with hyperacusis reported an occasional effect on daily life (72.0%). Being female, older in age, having a lower income, physical or mental health difficulties, more severe hearing loss, and tinnitus were all associated with the presence of hyperacusis. Individuals who experience hearing impairment, poorer general or mental health have a higher possibility of hyperacusis having an effect on their daily life., Conclusions: In this community population-based cohort study, we found a prevalence of hyperacusis of 15.2%. Individuals with hearing loss, mental health problems, and lower physical health have a higher possibility of experiencing effects on their daily life associated with their hyperacusis. Unravelling the relationship between hyperacusis hearing, general and mental health can be of major importance for a better understanding of the condition and its consequences., Level of Evidence: 2 Laryngoscope, 131:E2887-E2896, 2021., (© 2021 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Aim: The present study tested a compensatory executive intervention for prospective memory (goal management training) for the first time in older adults. Prospective memory (the ability to remember and execute a task in the future) declines with age, with significant implications for older adults' activities of daily living and quality of life. Prospective memory interventions have focused primarily on the retrospective component of prospective memory (e.g., implementation intentions). However, executive dysfunction is also implicated in age-related prospective memory decline. Methods: Community-dwelling older adults were randomly allocated to receive goal management training, implementation intentions or no intervention. Prospective memory was assessed before and after the intervention with a well-validated laboratory-based prospective memory measure.  Results: Contrary to predictions, neither goal management training nor implementation intentions were successful at improving prospective memory in healthy older adults. Participants who received goal management training were more likely to have difficulty comprehending the intervention. Post-hoc analyses suggested implementation intentions improved prospective memory specifically for participants with poorer baseline prospective memory.  Conclusions: These results represent important cautionary findings about the possible limitations of goal management training to improve prospective memory in older adults. Future research should also consider the role of baseline prospective memory ability in affecting response to compensatory intervention.

Despite the strong evidence on circadian rhythm disruption in shift workers and consequent increased vulnerability for infection, longitudinal association between shift work and COVID-19 infection is unexplored. In this study, data from UK Biobank participants who were tested for COVID-19 infection (16 March to 7 September 2020) were used to explore the link between shift work and COVID-19 infection. Using the baseline occupational information, participants were categorised as non-shift workers, day shift workers, mixed shift workers and night shift workers. Multivariable regression models were used to assess the association between shift work and COVID-19 infection. Among the 18,221 participants (9.4% positive cases), 11.2% were health workers, and 16.4% were involved in shift-work-based jobs. Ethnic minorities (18%) and people in night-shift-based jobs (18.1%) had a significantly higher prevalence of COVID-19 infection than others. Adjusted logistics regression model suggest that, compared with their counterparts, people employed in a night-shift-based job were 1.85-fold (95% CI: 1.42-2.41) more likely to have COVID-19 infection. Sensitivity analysis focusing on people working in a non-healthcare setting suggests that people in shift-work-based jobs had 1.81-fold (95% CI: 1.04%-3.18%) higher odds of COVID-19 infection than their counterparts. Shift workers, particularly night shift workers, irrespective of their occupational group, seem to be at high risk of COVID-19 infection. If similar results are obtained from other studies, then it would mandate to revisit the criteria for defining high-risk groups for COVID-19 and implementing appropriate interventions to protect people in shift-based jobs., (© 2021 European Sleep Research Society.)

Objective: Intraindividual variability (IIV)-variance in an individual's cognitive performance-may be associated with subsequent cognitive decline and/or conversion to dementia in older adults. This novel measure of cognition encompasses two main operationalizations: inconsistency (IIV-I) and dispersion (IIV-D), referring to variance within or across tasks, respectively. Each operationalization can also be measured with or without covariates. This meta-analytic study explores the association between IIV and subsequent cognitive outcomes regardless of operational definition and measurement approach., Method: Longitudinal studies ( N = 13) that have examined IIV in association with later cognitive decline and/or conversation to MCI/dementia were analyzed. The effect of IIV operationalization was explored. Additional subgroup analysis of measurement approaches could not be examined due to the limited number of appropriate studies available for inclusion., Results: Meta-analytic estimates suggest IIV is associated with subsequent cognitive decline and/or conversion to MCI/dementia ( r = .20, 95% CI [.09, .31]) with no significant difference between the two operationalisations observed ( Q = 3.41, p = .065)., Conclusion: Cognitive IIV, including both IIV-I and IIV-D operationalizations, appears to be associated with subsequent cognitive decline and/or dementia and may offer a novel indicator of incipient dementia in both clinical and research settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background and Objective: Chronic medical conditions accumulate within individuals with age. However, knowledge concerning the trends, patterns and determinants of multimorbidity remains limited. This study assessed the prevalence and patterns of multimorbidity using extensive individual phenotyping in a general population of Australian middle-aged adults., Methods: Participants (n = 5029, 55% female), born between 1946 and 1964 and attending the cross-sectional phase of the Busselton Healthy Ageing Study (BHAS) between 2010 and 2015, were studied. Prevalence of 21 chronic conditions was estimated using clinical measurement, validated instrument scores and/or self-reported doctor-diagnosis. Non-random patterns of multimorbidity were explored using observed/expected (O/E) prevalence ratios and latent class analysis (LCA). Variables associated with numbers of conditions and class of multimorbidity were investigated., Results: The individual prevalence of 21 chronic conditions ranged from 2 to 54% and multimorbidity was common with 73% of the cohort having 2 or more chronic conditions. (mean ± SD 2.75 ± 1.84, median = 2.00, range 0-13). The prevalence of multimorbidity increased with age, obesity, physical inactivity, tobacco smoking and family history of asthma, diabetes, myocardial infarct or cancer. There were 13 pairs and 27 triplets of conditions identified with a prevalence > 1.5% and O/E > 1.5. Of the triplets, arthritis (> 50%), bowel disease (> 33%) and depression-anxiety (> 33%) were observed most commonly. LCA modelling identified 4 statistically and clinically distinct classes of multimorbidity labelled as: 1) "Healthy" (70%) with average of 1.95 conditions; 2) "Respiratory and Atopy" (11%, 3.65 conditions); 3) "Non-cardiometabolic" (14%, 4.77 conditions), and 4) "Cardiometabolic" (5%, 6.32 conditions). Predictors of multimorbidity class membership differed between classes and differed from predictors of number of co-occurring conditions., Conclusion: Multimorbidity is common among middle-aged adults from a general population. Some conditions associated with ageing such as arthritis, bowel disease and depression-anxiety co-occur in clinically distinct patterns and at higher prevalence than expected by chance. These findings may inform further studies into shared biological and environmental causes of co-occurring conditions of ageing. Recognition of distinct patterns of multimorbidity may aid in a holistic approach to care management in individuals presenting with multiple chronic conditions, while also guiding health resource allocation in ageing populations., (© 2021. The Author(s).)

Objective: Sleep quantity and quality are associated with executive function (EF) in experimental studies, and in individuals with sleep disorders. With advancing age, sleep quantity and quality decline, as does the ability to perform EF tasks, suggesting that sleep disruption may contribute to age-related EF declines. This cross-sectional cohort study tested the hypothesis that poorer sleep quality (i.e., the frequency and duration of awakenings) and/or quantity may partly account for age-related EF deficits., Method: Community-dwelling older adults (N = 184) completed actigraphic sleep monitoring then a range of EF tasks. Two EF factors were extracted using exploratory structural equation modeling. Sleep variables did not mediate the relationship between age and EF factors. Post hoc moderated mediation analyses were conducted to test whether cognitive reserve compensates for sleep-related EF deficits, using years of education as a proxy measure of cognitive reserve., Results: We found a significant interaction between cognitive reserve and the number and frequency of awakenings, explaining a small (approximately 3%), but significant amount of variance in EF. Specifically, in individuals with fewer than 11 years of education, greater sleep disturbance was associated with poorer EF, but sleep did not impact EF in those with more education. There was no association between age and sleep quantity., Conclusions: This study highlights the role of cognitive reserve in the sleep-EF relationship, suggesting individuals with greater cognitive reserve may be able to counter the impact of disturbed sleep on EF. Therefore, improving sleep may confer some protection against EF deficits in vulnerable older adults.

Study Objectives: To determine cognitive profiles in individuals with short sleep duration insomnia (SSDI) and normal sleep duration insomnia (NSDI; also, paradoxical insomnia), compared to healthy sleepers. Method: Polysomnographic (PSG) and neuropsychological data were analysed from 902 community-based Raine Study participants aged 22 ± 0.6 years of whom 124 met criteria for insomnia (53 with NSDI and 71 with or SSDI) and 246 were classified as healthy with normal sleep (i.e., without insomnia or other sleep disorders). Measurements of self- report (attention and memory) and laboratory-assessed (attention, episodic memory, working memory, learning, and psychomotor function) cognition and mood, and PSG-based sleep stages (% total sleep time; %TST) were compared between these 3 groups. Results: In comparison to the healthy sleeper group, both insomnia groups had poorer self-reported attention, memory, mood, and sleep, and poorer laboratory-assessed attention (inconsistency). The NSDI group had less consistent working memory reaction time than healthy-sleepers or those with SSDI. The SSDI group had more inconsistency in executive function (shifting), and showed greater %TST in stage N1 and N3, and less REM sleep than either healthy-sleepers or those with NSDI. Conclusions: Individuals with NSDI demonstrated greater working memory inconsistency, despite no laboratory assessed sleep problems, implicating early signs of pathophysiology other than disturbed sleep. Those with SSDI demonstrated different sleep architecture, poorer attention (inconsistency), and greater executive function (inconsistency) compared to healthy-sleepers and those with NSDI, implicating sleep disturbance in the disease process of this phenotype., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Olaithe, Ree, McArdle, Donaldson, Pushpanathan, Eastwood and Bucks.)