bluuebunny/crossref_metadata_2025 huggingface dataset:
Advancing Dementia Care: AI Simulations in Managing Everyday Challenges
Authors: Yuan Fengpei , Bible Bryce , Zhao Xiaopeng
Published: January 2025

Background

The prevalence of Alzheimer’s disease and related dementias (ADRD) presents a growing public health challenge. This study introduces an innovative approach to dementia care through the development of AI agents that simulate the interactions between people living with dementia (PLWD) and their caregivers during activities of daily living (ADLs).

Method

The study employs ChatGPT (GPT4) large language models to create AI agents representing both PLWD and interventionists. These agents are designed to mimic real‐world verbal and nonverbal interactions in a simulated environment. A key component of the research is the development of a reinforcement learning (RL) framework. This framework is instrumental in formulating optimal assistive strategies that are personalized for PLWD. The performance of the RL‐guided interventionists is compared with that of naive interventionists across various scenarios. The focus is on tasks such as grocery shopping, highlighting the potential challenges and assistance required in such daily activities.

Result

The AI agents successfully replicated the nuanced dynamics of dementia care. The RL framework demonstrated its potential in optimizing personalized care strategies, highlighting the significant role of AI in dementia management. Comparisons revealed that RL‐guided interventionists outperformed their naive counterparts, indicating the effectiveness of AI in enhancing caregiving approaches. The study also emphasizes the need for future research to include more complex scenarios and integrate real‐world data to further enhance the simulation’s accuracy and relevance.

Conclusion

This research represents a groundbreaking step in applying AI to dementia care. It showcases the capability of AI agents in understanding and replicating complex human interactions within the context of caregiving. The study opens new pathways for research in AI’s role in healthcare, especially in addressing the challenges of eldercare and dementia management. It suggests a future where AI can not only assist in understanding and managing dementia but also support caregivers, thereby improving the quality of life for both PLWD and those who care for them. The integration of professional expertise and real‐world data in future studies could further refine these AI‐based care strategies, making them more effective and personalized.
Positive Tau and Amyloid Burden as Potential Predictors for Financial Capacity in Pre‐ Dementia Stages of Alzheimer’s Disease
Authors: Le Kayla , Bieger Andrei , Schlickmann Thomas Hugentobler , Gehres Sarah Wehle , de Bastiani Marco Antônio , Borelli Wyllians Vendramini , Zimmer Eduardo R. ,   ADNI
Published: January 2025

Background

Amyloid and tau pathologies are the hallmarks of Alzheimer’s disease (AD). Previous research indicated notable connections between financial capacity and AD biomarkers. Here, we aimed to understand whether financial capacity is affected by the cerebral accumulation of tau and amyloid. We hypothesized that amyloid and tau positivity will lead to a lower FCI‐Score.

Method

CU and MCI participants who had completed Financial Capacity Instrument ‐ Short Form (FCI‐SF) assessment, amyloid‐ and tau‐PET scans were selected from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Linear regression analysis was employed to investigate associations between Amyloid and Tau positivity with FCI‐Score, adjusted for age, gender, education and race (Table 1). Finally, a stepwise regression analysis was conducted to identify the predictors of financial capacity.

Result

Upon conducting a linear regression model on the positive amyloid and tau burden (a+t+), a highly significant negative association between a+t+ and FCI Score was observed (Figure 1). Stepwise regression analysis reiterated these results and both positive amyloid and tau burden (p < 0.01) demonstrated a significant predictive value of the FCI‐Score.

Conclusion

Our results align with previous studies on neurocognitive factors of financial capacity in pre‐ dementia stages, lending additional support for the significant influence of both amyloid and tau positivity in the decline of financial capacity. A decline in financial capacity may indicate pathological buildup and serve as an early warning sign for Alzheimer’s disease. Therefore, future research should continue to investigate the longitudinal relationship between tau, amyloid, financial capacity and other instrumental activities of daily living.
Your Beautiful Brain: Art Workshops for Ethnic Diversity in Dementia Research
Authors: Bauermeister Sarah
Published: January 2025

Background

Ethnic diversity communities are frequently underrepresented in dementia research. Reasons include lack of identification with dementia research studies, promotional material for dementia prevention and accessibility. The result of this underrepresentation means that new developments for dementia treatments will be not be trialled on these communities. This means that any ethnic differences in dementia or dementia progression will not be taken into account. It is, however, important to understand outreach and education and not to assume that ‘one size fits all’ when it comes to providing information on maintaining a healthy lifestyle for dementia prevention. The aim of Your Beautiful Brain art workshops was to provide a fun activity which was culturally appropriate, for teaching about brain health and dementia prevention. Using art as a medium has a two fold benefit. Firstly, art is fun and secondly, art is a creative activity which is good for the brain, and in the context of the workshops, is also sociable.

Method

The workshops were held and consisted of:

1. A brief talk on healthy lifestyle for a healthy brain

2. Provision of colouring sheets showing Black African and Caribbean community members taking part in healthy activities (e.g., jogging, walking, eating healthy food).

3. Art stationery was provided and included: Art workbook, colouring pencils, pens and pastels, and stickers.

4. A ‘free art’ session was facilitated where participants created any art piece which depicted their understanding of the talk in the morning.

5. Refreshments were provided and the workshops were open to adults aged 50 years and over, both with and without dementia.

Result

6 workshops were held across the United Kingdom, attended by over 50 participants and carers. Feedback from the attendees was that the workshops were very enjoyable and they had learned things about the brain and keeping healthy that they did not know before. Requests to return to provide more workshops were received.

Conclusion

The Your Beautiful Brain art workshops funded by Alzheimer’s Research UK (ARUK) and supported by Dementias Platform UK (DPUK) showed that ethnic communities can be reached through the medium of a fun workshop activity.
Exploring Mild Cognitive Impairment and Cognitive Rehabilitation in a cohort from the Alzheimer Center of the School of Medicine of the University of Buenos Aires
Authors: Olivar Natividad , Barreto Maria Dolores , Mendez Vanesa Roxana , Pasqua Patricia Alejandra , Estigarribia Karina Irene , Brusco Luis Ignacio
Published: January 2025

Background

Mild cognitive impairment (MCI) is a condition that affects a growing number of individuals worldwide, representing a transition between normal aging and dementia. As the world’s population ages, understanding and addressing MCI becomes increasingly crucial for both patients and healthcare professionals.

Method

15 participants (13 women and 2 men) with MCI with an MMSE score of 24/30 were included in a cognitive rehabilitation workshop. The workshop was held during the year 2023, with a frequency of twice a week. A neuropsychological battery was applied to each participant at the beginning and at the end of the workshop with the following tests: semantic and phonological verbal fluency, Trail A and B tasks, Boston test, Digit‐symbol test and the Rey’s verbal test. The Beck Depression Inventory and the Katz and Lawton and Brody scales were also administered to evaluate activities of daily and instrumental living.

Result

73% of patients showed an improvement in MMSE scores. They also showed similar but significantly better performance in the neuropsychological tests administered. 66% showed a reduction in abnormally high Beck Depression Inventory scores, while activities of daily living and instrumental living improved.

Conclusion

Early and group intervention can help mitigate the effects of MCI and promote healthy cognitive aging by improving sociability, mood, and quality of life.
Loneliness, social isolation in older adults and their association with incident dementia in men and women: 3 years of follow‐up on population‐based study
Authors: Sánchez Brenda Sarai Miranda , Acosta‐Castillo Isaac , Sosa Ana Luisa
Published: January 2025

Background

Dementia is a syndrome highly prevalent in elderly. Genetic and health factors have been reported to be associated with their onset. There is evidence that some psychosocial factors may have a differential effect by sex, beyond biological or hormonal explanations, as loneliness and social isolation(SI). Loneliness is defined as the feeling of being alone and can be reported as persistent, unavoidable, unpleasant or bothersome. SI is understood as limited or no contact with family or social networks, as well as low social contact, which may include friendly, religious or recreational activities

Objective

to analyze the association between loneliness and social isolation with the risk of incident dementia in older adults, men and women from a population‐based sample.

Method

The analytical sample include 1,517 participants aged ≥65 years evaluated within Dementia Research Group 10/66 in Mexico, between 2006‐2010, from urban and rural areas. Loneliness was assessed based on three items: admits to feeling lonely, with or without emotional discomfort. SI was identified by: friends, relatives and neighbors contacts; living alone and social gatherings attendance. All participants had information for incident dementia, sex, age, education, marital status, residence, occupation, household assets, income, mild cognitive impairment(MCI), neuropsychiatric symptoms(NPS), diabetes, disability, hypertension, cerebral vascular accident(CVA), hearing and visual difficulties, falls and use of health services.

Result

Total prevalence of loneliness and SI were 33.6% and 39.1%, respectively. Women were lonelier, older, not married, without own income, with more hypertension and NPS, than men (see table 1).

In multivariable competing risk models (with death and disability as competing events), loneliness with or without emotional discomfort (RR = 1.63 95% CI:1.03‐2.57) and with emotional discomfort (RR = 1.65 95% CI:1.05‐2.59) showed to be a risk factor for incident dementia in women. Social isolation did not show this effect as well any model for men (see table 2).

Conclusion

Loneliness was shown as a risk factor only in women, effect that was maintained with and without emotional discomfort. We believe that expanding the study of psychosocial factors as well as their usefulness in predicting incident dementia is important, also considering that some of these factors play a different role between men and women.
Detection of presymptomatic cerebral amyloid angiopathy, CAA, using diffusion MRI analysis of cortical grey matter in hereditary mutation carriers
Authors: Chance Steven A , Hardingham Ian , Valotti Michele , van Rooden Sanneke , van der Grond Jeroen
Published: January 2025

Background

HCHWA‐D mutation carriers experience highly heritable early onset of cerebral amyloid angiopathy (CAA). Diffusion MRI appears to be sensitive to CAA and detects punctate cortical lesions in CAA cases post‐mortem. DTI of white matter tracts was found to be sensitive to alterations in symptomatic HCHWA‐D carriers but did not show alterations in presymptomatic carriers (Schouten et al. DOI: 10.1161/JAHA.118.011288.). The diffusion signal from cortical grey matter microstructure may yet detect presymptomatic cases.

Method

CDM (cortical disarray measurement) quantifies DTI parameters related to the vertical minicolumnar microstructure of cortical grey matter that is disrupted in neurodegeneration. AngleR is the angle between the principal diffusion direction and the cortical minicolumn axis. PerpPD+ and ParlPD are the components parallel and perendicular to the minicolumn axis.

Participants from an existing dataset (Schouten et al.), included 12 symptomatic and 11 asymptomatic HCHWA‐D mutation carriers and 24 non‐carrier controls (based on: genotype, clinical status, and age). Diffusion MRI had been acquired at a single time point from a Philips Achieva 3T scanner at Leiden University Medical Center.

Statistical GLM used multivariate ANOVA, classifying patients by Mutation status (carrier vs non‐carrier) and Clinical status (non‐carrier control, asymptomatic carrier, symptomatic carrier), covarying for age.

Result

For the whole brain cortical average PerpPD+ was significantly increased in mutation carriers (p<0.05) driven by a significantly increased PerpPD+ in symptomatic carriers compared to both asymptomatic groups (controls and carriers) (p<0.05).

At the regional level some measures in prespecified regions of interest were significantly altered in symptomatic carriers and, notably, significantly different in mutation carriers (p<0.05), both symptomatic and asymptomatic groups, compared to controls.

Conclusion

Diffusion MRI analysis of cerebral cortex detects microstructural differences related to clinical symptoms of CAA in HCHWA‐D mutation carriers and particular measures of the microstructure organisation differentiate the CAA group, including presymptomatic, from controls.
The association of cardiovascular disease risk and renal function to cognition in middle‐aged to older adult Black Americans: Findings from the African Americans Fighting Alzheimer’s in Midlife (AA‐FAIM) study
Authors: Ennis Gilda E. , Norton Derek L. , Salazar Hector , Carter Fabu P. , Jonaitis Erin M. , Langhough Rebecca E. , Chin Nathaniel A. , Zuelsdorff Megan L. , Asthana Sanjay , Johnson Sterling C. , Gleason Carey E.
Published: January 2025

Background

Non‐Hispanic Black Americans (BA) have increased prevalence of cardiovascular disease (CVD) risk factors and elevated risk for end‐stage renal disease (ESRD). CVD risk factors, and potentially ESRD, heighten dementia risk; however, the association of CVD risk and kidney function to cognition in cognitively unimpaired (CU) BA adults remains understudied. We tested whether global CVD risk, individual CVD risk factors, and less healthy kidney function moderated associations between age and cognitive performance in middle‐aged to older adult BAs who were CU at baseline.

Method

BAs were enrolled in AA‐FAIM, an ancillary study of the Wisconsin Alzheimer’s Disease Research Center (WI‐ADRC) and Wisconsin Registry for Alzheimer’s Prevention (WRAP) (longitudinal N = 192; cross‐sectional N = 323; Table 1). Exclusion criteria included baseline MCI/dementia, stroke, heart attack, or heart failure history. Baseline CVD risk measures were tested as moderators of age‐related cognitive change in mixed models: Framingham Heart Study (FHS) 10‐year CVD risk, systolic blood pressure (SBP), American College of Cardiology/American Heart Association BP classification (normal, elevated, stage 1 and 2 hypertension), waist circumference, and triglyceride/HDL ratio. Cognitive outcomes included processing speed, fluency, executive function, language, episodic memory, attention, working memory, and non‐verbal learning/memory. Regression tested whether average prior SBP and estimated glomerular filtration rate (eGFR) moderated the association between age and cognition. See Table 2 for models. Benjamini Hochberg (BH) correction applied.

Result

24.1% had high CVD risk (FHS CVD > .20). Results suggested a relationship between elevated (vs. normal) BP and greater aging‐related decline in processing speed, and in older adults, an association between higher average prior SBP and lower language scores (Figure 1). Tested without age x risk interaction, results suggested relationships between FHS CVD risk and worse attention and working memory and relationships between lower eGFR and worse fluency, processing speed, and working memory. Latter two eGFR results survived comparisons’ correction but all others did not (Table 2).

Conclusion

Results suggest elevated BP and CVD risk and less healthy kidney function had deleterious effects on cognition in the AA‐FAIM sample; however, most findings did not survive comparisons’ correction, perhaps due to insufficient power. The impact of kidney function on neural structure requires further investigation.
International Practices of Speech‐Language Pathologists Working with Bilingual Speakers with Primary Progressive Aphasia
Authors: Grasso Stephanie M , Gallée Jeanne , Cartwright Jade , Jokel Regina , Lavoie Monica , McGowan Ellen , Pozzebon Margaret , Beber Bárbara Costa , Duboisdindien Guillaume , Montagut Núria , Norvik Monica , Sugimoto Taiki , Townsend Rosemary , Unger Nina , Wisnes Ingvild E. Wisnes E. , Volkmer Anna
Published: January 2025

Background

Although primary progressive aphasia (PPA) is considered a rarer form of dementia, individuals living with PPA are increasingly identified by healthcare professionals. Research investigating speech‐language assessment and intervention in PPA has been conducted primarily in monolingual speakers and little is known about clinical decision‐making of speech‐language pathologists (SLPs) working with bilinguals with PPA.

Methods

A comprehensive survey containing questions regarding clinician confidence, prioritization, and ratings of basic competency for Volkmer, Cartwright, Ruggero et al.’s (2023) best practice principles was constructed with questions that also queried practices pertaining to working with bilingual populations. Data was collected anonymously, via the Qualtrics survey platform and the survey was disseminated via social media and through social networks of study team members.

Results

A total of 185 participants responded with representation from 27 countries. In total, bilingual participants spoke a total of 39 different languages. The average number of languages spoken by respondents was 1.86 (SD = 1.08). Twenty‐three percent of respondents reported that they provided clinical services bilingually and 28% identified as bicultural. Respondents indicated that coursework in their training to become SLPs related to bilingual neurogenic communication disorders was covered for less than two hours (39%), less than five hours (33%), or more than five hours (28%). The majority of respondents indicated that they sometimes or typically worked with an interpreter or translator for conducting bilingual assessments (43%) or performed them independently (18%). When asked which language respondents typically assess participants in, 5% indicated the maternal language, 39% indicated the dominant/most functional language(s), and 54% indicated the language(s) the clinician felt comfortable speaking.

Conclusion

This study reports, for the first time, the practices of speech‐language pathologists working with bilingual speakers with PPA. Results indicate that SLPs are likely to receive some exposure to bilingual adult neurogenic communication disorders in their training. SLPs are more likely to assess bilingual individuals with PPA in the languages clinicians speak, or in the participant’s most functional/dominant language(s). Additional international forums are needed to extend core principles and philosophies of SLP practices, particularly when individuals living with PPA speak more than one language.
The Temporal Relationship Between Physical Activity, Mood, and Sleep in Older Adults: Lead‐Lag Discovery and Replication Analyses
Authors: Kara Ryan , de la Colina Adrian Noriega , Ai Meishan , Bao Shania Fock Ka , Kramer Arthur , Tremblay‐Mercier Jennifer , Villeneuve Sylvia , Li Linda , Walker Caitlin , Geddes Maiya R.
Published: January 2025

Background

Alzheimer’s disease (AD) affects about 416 million individuals across the disease continuum. An estimated 40% of dementia cases can be prevented or delayed in onset by addressing modifiable risk factors like sleep time, physical activity (PA), and mood. These three behaviors (sleep time, physical inactivity, and mood) are linked to cognitive decline, and their tridirectional link has been shown by prior research work. However, their longitudinal and potential temporal interrelatedness remain unclear.

Method

Thirty cognitively unimpaired (CU) sedentary older adults participating in the Daily Activity Study of Health (DASH) (Clinicaltrials.gov:NCT04315363) underwent objective PA measurement using a wrist‐worn accelerometer to monitor 24‐hour daily activity (discovery sample). Participants also completed a daily morning mood scale; through an Ecological Momentary Assessment and daily activity data, we performed a 10‐day lead‐lag analysis using moderate‐to‐vigorous PA (MVPA) time, mood, and sleep time. The temporal patterns were derived by assessing the rank order of the lead‐lag coefficients. The relationship between different time points of the variables were examined through cross‐correlations. We replicated the results in a sample of 25 CU, physically inactive older adults from the Healthy Aging Brain Study (HABS) (Clinical trials.gov:NCT06038643) with familial risk of AD. An identical methodological and analytic approach was applied to this replication sample.

Result

The lead‐lag analysis in the DASH cohort (mean age in years: 69.39±5.14, 26 female, mean education years 16.60 ± 3.03) determined positive mood change preceded increase in sleep time, and was then followed by an increase in MVPA. The relationship between positive mood change and increased MVPA was replicated in the HABS lead‐lag analysis (mean age = 69.71±3.54 years; 20 females; mean education years = 16.12±2.99).

Conclusion

In this study, we found that (1) improved mood precedes the increase in physical activity and sleep time in CU sedentary older adults. We confirmed that MVPA and mood precede sleep time. We also found that (2) mood precedes MVPA time, which in turn precedes sleep time. Understanding temporal dynamics between mood, sleep time, and MVPA, can help develop better interventions targeting an increase in physical inactivity in older adults, a major risk factor of AD.
Do dual cognitive and motor impairments signal cognitive decline in stroke?
Authors: Tiwari Anjali
Published: January 2025

Background

Approximately 30% of individuals with stroke experience impending cognitive decline, often leading to dementia over the subsequent years. Despite an increased risk of dementia among individuals with stroke, there is no predictive tool to identify stroke individuals who are at higher risk of future cognitive decline. The purpose of the Come‐Drive study is to identify whether dual impairments in cognitive and motor function may provide behavioral biomarkers to predict future cognitive decline in stroke.

Method

Thirty‐two stroke survivors (cognitively impaired; N = 16 and cognitively normal; N = 16) participated. All participants performed (1) Cognitive tasks: A divided attention task provided mean processing time. A simple reaction time task with the unaffected upper extremity provided an index of variability in processing time. (2) Motor tasks: Overground walking to provide gait speed and gait (stride time) variability measurements. Hierarchical logistic regression analyses were performed to determine whether processing speed and/or gait performance predicted participants’ cognitive status.

Result

The cognitively impaired stroke group showed significantly increased mean processing time (p = 0.001), and increased variability in processing time (p = 0.005), compared to the cognitively normal stroke group. The cognitively impaired stroke group showed slower gait speed and amplified gait variability, but these differences failed to reach statistical significance (p > 0.05). The logistic regression showed that the mean and variability of processing time significantly predicted the cognitive status in the individuals with stroke (X2 (4) = 17.29, p = 0.002). Gait speed and gait variability did not emerge as significant predictors of cognitive status in individuals with stroke. The regression model accounted for 58% of the variance in determining the cognitive status post‐stroke with 83% accuracy.

Conclusion

Dual decline in processing speed and gait did not emerge to be better predictors of cognitive status in individuals with stroke than the decline in processing speed alone. Perhaps a more complex motor task may serve as a better predictor of cognitive decline than a simple overground walking task. Overall, unique impairments in cognitive processing speed may serve as indicators of poor cognitive status in individuals with stroke.
Attitudes, Beliefs and Knowledge About Brain Donation Among Black Americans; Focus Group Feedback Results
Authors: Caban‐Holt Allison M , Cuccaro Michael L. , Starks Takiyah D. , Gregory Ashley , Adams Larry D. , Chavez Jenny , Pryor‐Banks Paris , Lloyd Shawnta' , Haines Jonathan L. , Reitz Christiane , Vance Jeffery M. , Duke Tina , Douglas Mary E , Pericak‐Vance Margaret A. , Byrd Goldie S.
Published: January 2025

Background

African Americans (AA) are underrepresented in Alzheimer’s disease (AD) brain donation research, making up approximately 2% of brain donations to the National Alzheimer’s Coordinating Center (NACC). Focus groups were conducted to obtain qualitative information to expand upon survey data that was collected previously to gain additional insights into the attitudes of Black∖AA individuals toward brain donation and perceptions of medical research.

Method

A brain donation focus group facilitator guide was created based upon earlier survey findings. Three focus groups of Black/AA adults were conducted in each of the following states: Florida, New York, North Carolina, and Ohio, United States between September and December, 2023. Sessions were audio recorded and written notes were also produced. Discussion topics posed to focus group participants included their preferred sources of health information, knowledge about AD, brain donation processes, motivations for and barriers to research participation

Result

Across all locations, 83 Black∖AAs participated in focus groups, females = 80.72%, with an average age = 66.13 years, and average education = 13.88 years. Preliminary review of focus group responses suggest that 1) awareness of brain donation research procedures and processes is low in the general population that is not involved in research, 2) most participants did not know that brain donation was not covered by organ donation through one’s driver’s license, 3) most assumed that brain donation would be disfiguring and would preclude having an open casket funeral, 4) few participants had been approached about brain donation for themselves or a family member, 5) most participants were open to learning more about brain donation, 6) participants expressed interest in the research being focused on and conducted by AAs, which they suggested was progress from the past, 7) religion was not expressed as a significant factor in consideration of brain donation, however, 8) family agreement was voiced as important in this decision‐making process.

Conclusion

These insights will be used to create a community‐informed educational program for AA∖Black communities about AD research and brain donation that will focus on increasing knowledge of brain donation procedures, focus on family engagement in research, and provide opportunities for participation.
Effective Communication of Stroke Signs in Spanish to Patients in Cognitive Impairment
Authors: Singh Neeraj
Published: January 2025

Background

Strokes affect 15 million people worldwide annually, including 5% of patients over the age of 75, making them a leading cause of death and disability, especially in elderly patients with cognitive impairment. Mnemonics have been developed in multiple languages to inform the public how to recognize stroke signs, including the English “BEFAST.” For Spanish‐speaking populations, the mnemonics “AHORA” and “RAPIDO” are both circulated with pictorial brochures. This study compares the effectiveness of both mnemonics in helping patients with cognitive impairment recognize stroke signs.

Method

Between January and December 2023, 50 Spanish‐speaking patients with cognitive impairment or any type of dementia were interviewed in the Northwell Health Neurosciences clinic in New York. Each participant was shown the AHORA and RAPIDO brochures and asked to identify for each handout its purpose, favorable features, and ranking of quality (0‐5). To mitigate presentation bias, half of the participants viewed the AHORA brochure first, while the other half viewed the RAPIDO brochure first. A paired t‐test was conducted to determine the statistical significance of the difference in average ranking of each brochure.

Result

The AHORA brochure received an average ranking of 3.66/5.00, significantly higher than the average ranking of 3.36/5.00 for the RAPIDO brochure (p = 0.0096). Positive comments about the AHORA brochure included the brochure appearing concise, the mnemonic being shorter, and the emphasis on calling 911 when stroke signs are recognized. Comments about the RAPIDO brochure included the brochure containing excessive information and the mnemonic being longer and more difficult to understand.

Conclusion

Participants preferred the AHORA brochure over the RAPIDO brochure for its concise appearance and descriptions of each stroke sign, and emphasis on calling 911 when stroke signs are recognized. These findings provide valuable guidance for physicians in selecting brochures for Spanish‐speaking patients and patients with cognitive impairment, and offer insights into the elements necessary to develop effective mnemonics in other languages.
AT(N), neuronal and glial biomarkers in young‐onset neurodegenerative disorders and psychiatric disorders and their associations with neuropsychiatric symptoms and cognition
Authors: Chiu Wei‐Hsuan , Goh Anita M Y , Eratne Dhamidhu , Velakoulis Dennis , Loi Samantha M
Published: January 2025

Background

It is clinically a challenging task to accurately differentiate complex young‐onset neurodegenerative disorders from psychiatric disorders which often present with similar neuropsychiatric symptoms (NPS) in their early stages. The aim of this study is to provide a more nuanced understanding of the interplay between NPS, cognition and multiple pathologies that may drive these disorders.

Method

This study was conducted at the Neuropsychiatry Centre, the Royal Melbourne Hospital, Melbourne, Australia, as part of a large, multi‐site research study, the Markers in Neuropsychiatric Disorders Study. Sixty participants, including people with Alzheimer’s disease, Huntington’s disease, frontotemporal dementia, major depressive disorder and generalised anxiety disorder and together with healthy controls, were recruited and assessed for plasma biomarkers, NPS and cognition. Their plasma levels of amyloid‐beta, total‐tau (t‐tau), phosphorylated‐tau (p‐tau), neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAP) were measured. The severity of multiple common NPS such as depression, anxiety and apathy were also measured. Cognitive functions were measured by a combination of cognitive screening tool and standardised neuropsychological assessments. General linear regressions were used to investigate the associations between biomarkers, NPS and cognition in these disorders and the differences between the two clinical groups.

Result

The analysis of the collected data is ongoing. However, results from a pilot study suggest that memory recall was related to an interplay between AT(N) pathologies, and executive function was related to a neuronal pathology. The severity of NPS may moderate these relationships.

Conclusion

Young‐onset neuropsychiatric disorders, presenting with overlapping symptoms, pose a diagnostic dilemma. The results of this study provide a more nuanced understanding of the intricate interplay between NPS, cognition and biomarkers that may shed light into the differentiation between young‐onset neurodegenerative disorders and psychiatric disorders.
Interaction between Education and Alzheimer’s Disease Biomarkers in Longitudinal Clinical Impairment
Authors: Schlickmann Thomas Hugentobler , Borelli Wyllians Vendramini , da Ros João Pedro Uglione , Machado Luiza Santos , Lussier Firoza Z , Macedo Arthur C. , Rahmouni Nesrine , Therriault Joseph , Servaes Stijn , Stevenson Jenna , Chamoun Mira , Bezgin Gleb , Benedet Andrea L. , Rosa‐Neto Pedro , Zimmer Eduardo R.
Published: January 2025

Background

Higher education is often associated with reduced risk of cognitive decline. These findings fueled the conceptualization of cognitive reserve to explain individual variabilities in clinical trajectory. However, our understanding of the biological basis for this phenomenon is still not precise. In this sense, we assessed the interaction between Alzheimer’s biomarkers and cognitive reserve.

Method

We included 85 individuals from the Translational Biomarkers of Aging and Dementia (TRIAD) cohort presenting normal cognition or mild cognitive impairment with global Clinical Dementia Rating (CDR) ≤ 0.5. All individuals underwent positron emission tomography (PET) for amyloid‐β (A) and tau (T) assessed with [18F]AZD4694‐PET and [18F]MK6240‐PET, respectively. A positivity was defined as neocortical Aβ‐PET SUVR ≥ 1.55. T positivity was defined as temporal meta‐ROI tau‐PET SUVR ≥ 1.24. We calculated a change in CDR sum of boxes (CDR‐SB) by subtracting baseline from their scores after 2 years of follow‐up. Analysis were conducted with the CDR sum of boxes (CDRSB) as well as within specific domains, always correcting for age, sex, APOEε4 carriership and baseline score.

Result

Demographics information is described in Table 1. Linear regression analysis showed that years of education interacted with A+T+ status to reduce cognitive decline (β = ‐0.19, p < 0.001) but did not interact with any other pathological status as shown in Figure 1. We also found that communication, a specific domain of the CDR scale, had a longitudinal association with education in the A+T+ group (β = ‐0.09, p = 0.0303, Figure 2).

Conclusion

The protective effect of education, as measure of cognitive reserve, occurred specifically in A+T+ individuals. Moreover, this effect was mostly on the communication domain. These results contribute to our understanding of cognitive reserve as they may suggest that education protects communication from the synergistic damage of amyloid and tau pathologies. Further investigations in additional cohorts with longer follow‐up is warranted.
Frontal Memory‐related Brainwaves Differentially Correlate with AD and Astrocyte Plasma Biomarkers
Authors: Jiang Yang , Wu Xian , Katsumata Yuriko , Clark Maria F , Foley Kate E. , Wang Baoxi , Sudduth Tiffany L. , Wilcock Donna M. , Jicha Gregory A , Norris Christopher M.
Published: January 2025

Background

We currently lack in the dementia field accurate, noninvasive, quick, and affordable screening tools for brain dysfunctions associated with early subtle risk of mild cognitive impairment (MCI). Our Kentucky aging cohort demonstrates that asymptomatic older individuals with MCI‐like frontal memory‐related brainwave patterns convert to MCI within a short 5‐year period, as opposed to individuals with NC‐like patterns (1) that remain normal 10 years later (2). Astrocyte reactivity influences amyloid‐ß effects on tau pathology in preclinical Alzheimer’s disease (3). Leveraging blood‐based AD and astrocyte biomarkers and the cognitive electroencephalogram (EEG) signatures (4), we test the hypothesis that predictive frontal memory‐related EEG changes correlate with preclinical and early AD plasma biomarkers.

Method

34 (19 women) older volunteers with or without MCI, average age 79 (SD 8.53) years old, from a longitudinal cohort followed by University of Kentucky ADRC participated. Each participant’s EEG was recorded (64‐ or 14‐channels) during a working memory (modified delayed match‐to‐sample) task. Principal component analysis (PCA) was performed on 64‐channel EEG data to create PC scores (PC1 & PC2). For multiple linear regression of EEG PC scores on multiple neurodegenerative plasma biomarkers including Aß42/40, pTau181, total Tau, and GFAP (Astrocyte reactivity), we adjusted age, sex, education, and gap years between collection dates.

Result

The 61% of variance in frontal signals can be explained by PC1 in normal cognition (NC) and MCI individuals, and PC2 counts for 35% of variance (Figure 1). The decreased brainwaves (MCI‐like) seen in left frontal sites significantly correlate with increased pTau181, GFAP, and PC2 (Figure 2). Curiously, right frontal EEG relations with pTau181, GFAP showed the opposite trend. Bilateral frontal signals showed negative correlations with Aß42/40 and positive correlations with total Tau.

Conclusion

Our results indicate that GFAP & pTau181 trend in similar asymmetry ways with frontal cognitive brainwaves, but Aß42/40 & total Tau correlate to a different component of frontal EEG. That is, distinct cognitive brainwaves correlate with astrocyte reactivity differentially that influence pathologies of beta‐amyloid accumulations and Tau development. Cognitive pathophysiological signatures and AD–Astrocyte plasma biomarkers have great potential for predicting subtle cognitive decline and specific dementia risk in healthy normal individuals.
Disrupted Sleep at Night is Associated with a Higher Level of Agitation Throughout the Week in People Living with Cognitive Decline
Authors: Au‐Yeung Wan‐Tai M. , Miller Lyndsey M. , Lindauer Allison , Beattie Zachary T , Mattek Nora , Steele Joel S. , Kaye Jeffrey A
Published: January 2025

Background

Agitation is one of the most challenging behaviors exhibited by people with cognitive decline, causing distress in caregivers, earlier placement into long‐term care and faster disease progression. In order to better manage agitated behaviors in people with cognitive decline, it is important to identify associated factors. The MODERATE (Monitoring Dementia‐Related Agitation Using Technology Evaluation) study aims to characterize agitation using technology and identify precipitants (behavioral or environmental) of agitation.

Method

People living in the greater Portland, Oregon, USA area were recruited into the study. The inclusion criteria were a diagnosis of mild cognitive impairment or dementia, currently residing with a family caregiver within their own home, and caregiver endorsement of symptom(s) of agitation, irritability/lability, motor disturbance, nighttime behaviors and/or disinhibition in the Neuropsychiatric Inventory‐Questionnaire (NPI‐Q). Bed pressure mats (Emfit) were deployed as part of the ORCATECH platform in their homes, which measure participants' sleep behaviors and their physiological signals through ballistocardiography. The weekly agitation levels of the participants were reported by their family caregivers through modified Cohen‐Mansfield Agitation Inventory‐Short Form questionnaires as part of weekly online surveys.

Result

Data from the first 8 participants (mean age(SD) = 70 (10)) with bed pressure mats were analyzed. A subset of bed pressure mat outputs was selected to provide a holistic picture of participants' sleep behaviors and their physiology while avoiding multicollinearity. Monitoring period was for a mean (SD) of 315 (190) nights. An individual mixed linear model was built with each included bed pressure mat output and week as the predictors and total agitation level as the model output. After false discovery rate correction, higher duration of wake after sleep onset was a significant predictor of their weekly total level of agitation. The caveats of these results include small sample and varied follow‐up time ranging from 4‐85 weeks of observations per participant.

Conclusion

Disrupted sleep (measured objectively by bed pressure mat) are positively associated with participants' weekly level of agitation. Future work with larger sample sizes is needed to confirm findings. Unobtrusive identification of behavioral factors associated with agitation can potentially help manage this challenging behavioral symptom.
Comparing the Brief Assessment of Cognitive Health and Montreal Cognitive Assessment: Test‐retest reliability and sensitivity to cognitive change in older adults
Authors: Floden Darlene P , Curran Kelsey , Hogue Olivia , Krishnan Kamini , Saxena Saket A , Sonneborn Claire , Rothberg Michael B , Misra‐Hebert Anita D , Milinovich Alex P , Pfoh Elizabeth R , Fox Robert J , Kattan Michael W , Busch Robyn M
Published: January 2025

Background

Test‐retest reliability for existing cognitive screening tests is typically poor and most have ceiling effects and restricted score ranges that mask the presence of subtle decline. The Brief Assessment of Cognitive Health (BACH) is a computerized cognitive screening tool that patients complete independently. It includes a complex memory test without ceiling effects and brief mood and history questions. The BACH generates a probability score for cognitive impairment that is highly accurate at predicting impairment on neuropsychological testing. The goal of this study was to determine if the psychometric characteristics of BACH (i.e., test‐retest reliability and sensitivity to cognitive change) are superior compared to a commonly used screening test, the Montreal Cognitive Assessment (MoCA).

Method

Ninety‐seven participants completed the BACH and MoCA at two timepoints. A mixed effects model was fit to derive between‐ and within‐subjects variability to calculate the intraclass correlation coefficient (ICC) to assess test‐retest reliability of the screening tools. A subset of 52 participants completed the same neuropsychological battery at both timepoints and individual composite cognitive change scores were calculated. Pearson correlations were used to determine the strength of relationships between the composite cognitive change score and change scores on the MoCA and BACH.

Result

On average, the ICC sample was 68 years‐old with 15 years education, and 56% were female. The median time between test sessions was 384 days (range 246‐1211). ICC for the BACH probability of impairment score was 0.59 (moderate reliability) whereas the ICC for the MoCA was 0.48 (poor reliability). For the cognitive testing sample (average age = 72 years, 16 years ed, 54% female), median time between test sessions was 336 days (range 263‐426). Composite cognitive change score was moderately related to BACH probability change (r = ‐0.49; CI = [‐0.68, ‐0.26]) and strongly related to BACH memory score change (r = 0.55; CI = [0.32, 0.71]). Composite cognitive change score was weakly associated with MoCA change score (r = 0.12; CI = [‐0.17, 0.38]).

Conclusion

The BACH demonstrated moderate to strong test‐retest reliability and sensitivity to cognitive change, while observed MoCA psychometrics were below the cutoffs recommended for clinical practice. The BACH is a more accurate tool for cognitive surveillance in older adults.
Remote App‐Based Cognitive Assessment in Aging and Pre‐Clinical Alzheimer’s Disease in a Diverse Sample of Older Adults
Authors: Mechanic‐Hamilton Dawn , Humphreys Valerie , Prusky Alex , Halberstadter Kimberly , Wolk David A
Published: January 2025

Background

Mobile, valid and engaging cognitive assessments are essential for detecting and tracking change in research participants and patients at risk for Alzheimer’s Disease and Related Dementias (ADRDs). This pilot study aims to determine the feasibility and generalizability of an at‐home, app‐based cognitive assessment, the mobile cognitive app performance platform (mCAPP), to detect cognitive changes associated with aging and preclinical AD.

Method

mCAPP includes three gamified tasks (Figure 1): (1) a “concentration” memory task that includes learning and matching hidden card pairs with increasing memory load, pattern separation features (lure vs. non‐lure), and spatial memory (2) a stroop‐like task (“brick drop”) with speeded word and color identification and response inhibition components and (3) a digit‐symbol coding‐like task (“space imposters”) with increasing pairs. Participants used mCAPP at home for two weeks and completed the NACC UDS3 and additional paper and pencil tests. Participants included ninety‐three adults (72% female; age = 72.5±5.5, education = 16.4±2.6; 49.5% White, 49.5% Black/African American, 1% Multiracial) without cognitive impairment enrolled in the Penn ADRC cohort. A subgroup also completed longitudinal mCAPP testing and amyloid PET imaging.

Result

Participants played 11±4 sessions over two weeks, with 61% playing more than the assigned sessions. Most participants (97%) used a smartphone. Usability rating was 6.3±0.8 (1‐7 scale). Most participants rated the difficulty of the tasks as “just right” for Concentration (93%), Brick Drop (84%), and Space Imposters (87%) after playing the games for the first time. 70% reported preferring mobile device cognitive assessment to standard in‐person cognitive batteries. All tasks showed lower performance with increasing cognitive load (p’s<.05). mCAPP measures correlated with paper and pencil tests from analogous domains on paper and pencil measures (p’s<.01). Participants with a positive amyloid PET scan showed a trend toward slower and less accurate performance on some mCAPP measures.

Conclusion

This pilot study shows mCAPP usability for at‐home use in a diverse cohort of older adults. Performance across measures indicate initial reliability and validity of mCAPP. Future work will include the evaluation of mCAPP performance relationships with biomarkers and longitudinal data analysis. Remote, accessible, and reliable cognitive assessment has the potential to reduce barriers to research participation and clinical care.