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Background: Anxiety and stress have been identified as potential risk factors of cognitive impairment, but research examining this association in midlife has been limited. Method: The current study examined the associations between anxiety and stress symptoms, and cognition in middle‐aged cognitively unimpaired adults (n = 2,463) enrolled in the Healthy Brain Project. Exploratory factor analysis was conducted on items in the Anxiety Subscale of the Hospital Anxiety and Depression Scale, Anxiety and Stress Subscales of the Depression, Anxiety and Stress Scale, and Perceived Stress Scale. Cognition was measured using the Cogstate Brief Battery (CBB). Result: The solution that resulted in the best fit to the data comprised five factors which explained for 48% of the variance: Over‐Reactivity, Panic, Low‐Control, Tension and Intolerance. Panic‐related symptoms were significantly associated with both poorer attention and memory. Having clinically meaningful anxiety symptoms, or both anxiety and stress symptoms, was associated with poorer memory. Conclusion: Anxiety and stress symptoms may be linked to a heightened risk of developing cognitive impairment. Specifically, panic‐related symptoms may play a significant role in the relationship between anxiety symptoms and cognition. Limitations include: 1) cross‐sectional nature of the study limited ability to ascertain direction of causality; 2) individuals with major psychiatric conditions were excluded from the study, thus limiting external validity of the current findings; 3) HBP sample has a higher proportion of individuals with a family history of dementia compared to the general population, hence the sample presents with an increased risk of developing dementia and generalizability of our findings may be limited. [ABSTRACT FROM AUTHOR]

The present research aims to establish the predictive validity of the Test of Memory Malingering (TOMM) in a Singaporean sample with mood and psychotic disorders. Its clinical utility was compared against other performance validity tests: Dot Counting Test (DCT), Rey 15-Item Memory Test II (Rey II), Medical Symptom Validity Test (MSVT), Nonverbal Medical Symptom Validity Test (NV-MSVT), Word Memory Test (WMT) and Victoria Symptom Validity Test (VSVT). Findings revealed that TOMM, MSVT, NV-MSVT, WMT and VSVT preserved the ability to distinguish between Clinical participants' simulation groups, and TOMM outperformed all tests except NVMSVT. Overall, findings supported continued use of TOMM. [ABSTRACT FROM AUTHOR]

Introduction: Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness. Methods: CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS' clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients' function, QOL, and behavioural problems post-intervention. We estimated CARITAS' cost-effectiveness from a patient's perspective, benchmarking it against other dementia treatments and Singapore's Gross Domestic Product (GDP) per capita. Results: CARITAS care significantly improved health utility (p < 0.001), reduced caregiver burden (p < 0.001), and improved PWDs' behavioural problems (p < 0.001) related to "memory" (p < 0.001), "disruption" (p = 0.017), and "depression" (p < 0.001). CARITAS' benefits (dRMBPC = 0.357, dEQ5D index = 0.328, dZBI = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alzheimer's disease and Singapore's GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0-3.0. Discussion: CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers. [ABSTRACT FROM AUTHOR]

Background: The experience of grief in family caregivers as they provide care for persons with dementia is often overlooked. The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) is one among the few scales that capture such experiences. In a recent study, MM-CGI was found to contain three subscales identifying dimensions of loss in caregivers-Personal-Sacrifice Burden (PSB), Heartfelt Sadness, Longing, and Worry (HSLW), and Felt Isolation (FI). We aimed to evaluate the validity and utility of these dimensions in a multiethnic Asian population.Methods: Family caregivers (n = 394) completed MM-CGI and scales assessing caregiver burden, depression, and gains. Internal consistency reliability was examined using Cronbach α; test-retest reliability using intraclass correlation coefficient; and construct validity using Pearson correlation coefficient. The utility of the MM-CGI dimensions was evaluated by comparing caregivers with high subscale scores across dementia stages and caregiving relationship.Results: The three dimensions of MM-CGI exhibited adequate internal consistency, test-retest reliability, construct validity, and known-group validity. PSB correlated most strongly with caregiver burden (r = 0.78); HSLW with caregiver depression (r = 0.75); and FI with caregiver burden and caregiver depression (r = 0.60, respectively). Caregivers with high total grief scores tended to experience most difficulty with HSLW (90.8%), followed by PSB (75.4%) and FI (46.2%). The three dimensions also increased across the dementia stages, with FI higher in mild dementia, PSB higher in moderate dementia, and HSLW higher in severe dementia. Spousal caregivers experienced most difficulty in HSLW, whereas children caregivers experienced similar levels of difficulty across the dimensions.Conclusions: The three dimensions of MM-CGI captured distinct aspects of caregiver grief in a multiethnic Asian population and would enable more individualized assessments and interventions for caregiver grief. [ABSTRACT FROM AUTHOR]