bluuebunny/crossref_metadata_2025 huggingface dataset:
A Scoping Review of the Barriers and Facilitators to Implementing Small‐Scale Residential Dementia Care
Authors: Lewis Robyn A , Gibson Diane , Isbel Stephen , Bail Kasia , D'Cunha Nathan M ,   Centre for Ageing Research and Translation, University of Canberra, Bruce, ACT, 2617
Published: January 2025

Background

There is a need to understand the benefits and limitations of innovative models of dementia care to ensure models meet the needs of people living with dementia, their families and staff. The aim of this scoping review was to explore and synthesise the barriers and facilitators to the widespread implementation of small‐scale residential dementia care.

Method

A scoping review was conducted in 2023 in MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and CENTRAL to identify empirical, peer‐reviewed studies, published in English from database inception to October 2023. Studies of small‐scale residential dementia care with 6‐15 people were included.

Result

Forty‐four studies were identified and synthesised into five focus areas for investigation: People with dementia (n = 19), families (n = 2), staff (n = 12), the built environment (n = 8) and other studies with a focus on a program of care or studies with two or more study populations (n = 3). Studies were published between 1990 and 2023 and included quantitative (n = 29), qualitative (n = 13) and mixed methods (n = 2) approaches. Multiple barriers and facilitators were identified in each focus area that either support or limit the widespread implementation of small‐scale residential dementia care. A key facilitator is the presence of a clear philosophy of small‐scale care that guides the planning of a small‐scale setting or adaptation of a traditional care setting to incorporate principles of small‐scale care. The philosophy should be articulated through policies, communicated to stakeholder groups and implemented consistently in the delivery of care. A key barrier relates to the ability of the care organisation to adjust staff roles to deliver small‐scale care. With broader caring roles and greater decision‐making authority, organisational changes are required to staff ratios, training and education to empower staff to deliver this care.

Conclusion

Small‐scale residential dementia care has the potential to benefit people with dementia, their families, the staff and the wider community. Through the establishment of a clear philosophy of small‐scale care, there is an opportunity to place the person with dementia at the centre of care, provide access to meaningful and appropriate activities of daily living, create a home‐like environment and prioritise relationship building at all levels.
Efficacy and safety evaluation of type‐3 phosphodiesterase inhibitor Cilostazol in mild cognitive impairment
Authors: Saito Satoshi , Yamamoto Haruko , Fukushima Masanori , Ihara Masafumi ,   the COMCID Trial Investigator Group
Published: January 2025

Background

Cilostazol, a selective type‐3 phosphodiesterase inhibitor, ameliorates β‐amyloid accumulation by facilitating intramural periarterial drainage.

Method

Patients with mild cognitive impairment were registered in the COMCID study, an investigator‐initiated, double‐blinded, multi‐center, phase‐II clinical trial. The primary endpoint was the Mini‐Mental State Examination score. Several psychological assessments and circulating β‐amyloid‐albumin complex levels were evaluated as secondary and exploratory endpoints.

Result

Patients were randomly allocated to the Cilostazol (n = 82) or placebo (n = 84) group. There were no serious adverse events caused by the drug intervention. The primary and secondary efficacy endpoints were not different between the two groups. A significant negative correlation between the blood levels of β‐amyloid‐albumin complexes at baseline and the 24‐week visit was observed in the Cilostazol group (P = .005) but not in the placebo group (P = .336).

Conclusion

Cilostazol was well‐tolerated and may have facilitated β‐amyloid clearance from the brain to the blood but did not prevent cognitive decline.
Image‐derived phenotypes in the AMYPAD Prognostic and Natural History Study
Authors: Pieperhoff Leonard , Lorenzini Luigi , Tranfa Mario , Padrela Beatriz E , Ritchie Craig W , Boada Mercè , Marquié Marta , Scheltens Philip , Vandenberghe Rik , Hanseeuw Bernard J , Martinez‐Lage Pablo , Payoux Pierre , Stephens Andrew W. , Buckley Christopher , Farrar Gill , Jessen Frank , Gispert Juan Domingo , García David Vállez , Mutsaerts Henk‐Jan , Collij Lyduine E. , Wink Alle Meije , Barkhof Frederik
Published: January 2025

Background

The Amyloid Imaging to Prevent Alzheimer’s Disease (AMYPAD) Prognostic & Natural History Study (PNHS) is a prospective longitudinal PET cohort of over 1,500 non‐demented individuals from 10 parent cohorts across Europe. We provide an overview of ongoing efforts to curate and integrate magnetic resonance imaging (MRI) multimodal images across sites and to extract biologically meaningful information (i.e., image‐derived phenotypes; IDPs) in this early AD population. Data will be made available on the ADDI platform (fair.addi.ad‐datainitiative.org).

Method

Imaging protocols included core (T1w, T2w, T2*, FLAIR) and advanced (rs‐fMRI, SWI, DWI, and ASL) MRI sequences. Figure 1 provides an overview of the different acquisitions, their corresponding pipelines, and the obtained IDPs. For T1w images, we computed regional volumes and thickness values using FreeSurfer v7.1.1 (surfer.nmr.mgh.harvard.edu/). Morphometric similarity networks were computed using MIND (github.com/isebenius/MIND). White matter hyperintensity volumes were obtained from FLAIR images using Bayesian Model Selection (BaMoS). With rs‐fMRI, mean functional connectivity of canonical networks were extracted using FSL MELODIC and dual‐regression analyses after preprocessing with fMRIPrep v23.0.1 (fmriprep.org). Diffusion MRI scans were processed with QSIprep v0.16 (qsiprep.readthedocs.io) to compute tract‐based spatial statistics and tractograms to build structural connectivity matrices. Finally, cerebral blood flow and the spatial coefficient of variation were computed from ASL images using ExploreASL (github.com/ExploreASL). Statistical harmonization was performed using RELIEF (github.com/junjypark/RELIEF).

Result

Baseline and follow‐up characteristics of the 1537 subjects with available T1w are described in Table 1. Raw and statistically harmonized variants of 380 core and 298 advanced IDPs were calculated. Figure 2 shows the distribution of hippocampal volumes per site before and after statistical harmonization, and their relation with participants' age (R2
raw=0.179, R2
harmonized=0.422). Considering recent developments in the field, the AMYPAD PNHS aims to include additional IDPs associated with vascular health, such as perivascular spaces and other glymphatic system‐related markers.

Conclusion

We present the pipeline built for MRI harmonization and feature extraction of the AMYPAD PNHS dataset. The extracted IDPs can help identify novel imaging outcomes, support the development of disease progression models for the preclinical stages of AD, and provide a reference point for future studies to promote replicability and robustness of findings.
Brain glutathione in vascular mild cognitive impairment and cognitive correlates
Authors: Chen Jinghan Jenny , Herrmann Nathan , Survilla Kate , Mah Ethan , Kang Yejin , Black Sandra E , Ramirez Joel , Andreazza Ana C. , Kiss Alex , Oh Paul I. , Gallagher Damien , Graham Simon J. , Lanctôt Krista L.
Published: January 2025

Background

Oxidative stress (OS) has been implicated in age‐related neurodegeneration and may be important in prodromal states such as vascular mild cognitive impairment (vMCI). Higher peripheral OS is reported in vMCI patients; however, the role of central antioxidant defenses in vMCI and their correlation to cognition is unclear. Glutathione (GSH) is a major brain antioxidant, and the current study assessed brain GSH in possible vMCI vs. controls.

Methods

Possible vMCI patients (1 standard deviation (SD) below population norms in verbal memory, executive function (EF), processing speed, or working memory, age 55‐85, and currently enrolled in a 6‐month exercise rehabilitation program due to having 2 or more vascular risk factors or previous vascular event) and cognitively‐normal (CN) controls were recruited. All participants received 1H magnetic resonance spectroscopy (MEscher–GArwood Point Resolved Spectroscopy) to quantify brain GSH at baseline in the anterior cingulate (AC) and occipital lobe (OL). Spectroscopic analysis was completed using the Gannet toolkit (vers. 3.1) in Matlab (vers. 2020b).

Results

In 43 participants (mVCI n = 22, CN n = 21), AC‐GSH (I.U. ± SD) was higher in mVCI (1.96 ± 0.29) compared to CN (1.64 ± 0.48) (F(1,29.7) = 6.9, p = .01); this difference remained after correcting for cerebrospinal fluid (CSF) volume (F(1,28.4) = 6.5, p = .02), and controlling for age and sex (B [SE] = 0.33 [0.11], p = .007). There was no difference in OL‐GSH before or after correcting for CSF volume. Higher AC‐GSH, but not OL‐GSH, was correlated with poorer global cognition (Montreal Cognitive Assessment ‐Full score, B [SE] = 2.15, p = .03), and poorer EF performance (B [SE] = ‐0.67 [0.25], p < .001). These relationships remained significant after correcting for CSF volume.

Conclusion

The current study suggests an upregulation of AC glutathione in vMCI, which may reflect a compensatory increase in antioxidants as a response to oxidative stress challenges reported in these patients. Higher brain GSH in the AC region is correlated with poorer global cognition and executive function performance, suggesting a link between local brain antioxidant response and disease‐relevant cognitive domains.
“She’s my memory; and he’s my legs!” The experiences of couples living with dementia and multiple health conditions
Authors: Dunn Rosie J , Wolverson Emma , Hilton Andrea
Published: January 2025

Background

Dementia rarely travels alone. People with dementia (PwD) often have multiple other physical diagnoses (multimorbidity) and experience poor quality, fragmented care. Over two thirds of carers of PwD are spouses, over half of which are 85 years old or above. Age is strongly associated with increased multimorbidity; therefore, carers are also likely to experience multimorbidity. Consequently, married or cohabiting couples are likely to experience the dementia journey together as well as live with multimorbidity. However, research has neglected to explore couples’ experiences of living with both dementia and multimorbidity, and the potential challenges they may face. Understanding couples’ experiences collectively will inform the development of appropriate, psychosocial interventions.

Method

Married couples aged 65 or above were asked to keep a photo diary for one month, taking photographs of their experiences of living with dementia and multimorbidity. Couples were given a choice to use either disposable cameras or their own digital device. This was followed by an audio‐recorded interview, using their printed photographs as a photo‐elicitation technique to aid discussion. Interpretative Phenomenological Analysis (IPA) was used to analyse the data.

Results

Six couples participated. IPA revealed couples have to ‘fight for help’, particularly in relation to dementia and stroke care; living with uncertainty was a significant theme. Couples discussed changes in their relationship, and behavioural and practical adaptations they have made in order to support each other. Some couples do not identify as being ‘ill’ or ‘disabled’ despite the multimorbidity they experience. Maintaining hobbies and interests that are important to them both as a couple and individually was vital for them to continue living a good quality of life.

Conclusion

Couples living with dementia and multimorbidity face significant challenges that can pose a threat to their relationship and quality of life. Challenges include inadequate support and healthcare, changes in the relationship and couple identity. However, despite this, couples maintain a positive outlook and ‘work as a team’ in order to adapt to each other’s health conditions and to continue leading a fulfilling life. These findings can be used to develop relationship‐centred interventions to support couples in the community.
Improvements in Usability of MoCA XpressO, a Self‐administered Digital Cognitive Pre‐screening Tool
Authors: Gruber Johanna , Bodenstein Katie , Jansen Richard , Paquette‐Masson Marion , Krieger Joana , Gillies Murray , Nasreddine Ziad
Published: January 2025

Background

XpressO from Montreal Cognitive Assessment (MoCA) is a self‐administered, digital cognitive screening test composed of memory and executive function tasks. Its purpose is to provide a brief pre‐screening of cognition in order to determine whether further cognitive testing is required. A previous validation study comparing the XpressO to the gold standard MoCA test revealed a strong predictive value. However, of the 118 participants recruited, 25% of the participants (n = 30) did not complete the XpressO test due to impaired comprehension (n = 10), requiring assistance (n = 4), skipped or uncompleted tasks (n = 11), and technology difficulties (n = 5). After a qualitative assessment of the users’ experience several improvements were envisioned and implemented in XpressO. This study aims to assess whether these improvements result in a higher completion rate in older adults.

Method

15 older adults that were referred to the MoCA Clinic were recruited to participate in this qualitative study. Each performed the XpressO test while being observed. The observers noted when people experienced difficulty and fed this back to the usability engineer for improvements. As a next step, 30 participants will be recruited from the MoCA Clinic in Greenfield Park, Quebec. Eligibility criteria will include: ability to speak English or French, adults aged 50 years or over, at least 6 years of formal education, and completion of a recent MoCA test within 3 months prior to the start of the study. Participants will complete the XpressO followed by the User Experience Questionnaire (UEQ). The completion rate of XpressO version 1 and version 2 will be compared using a chi‐squared test. To assess whether completion of the XpressO is dependent on MoCA score, an independent t‐test will be used.

Result

Results from the 30 participants will be available by July 2024.

Conclusion

The MoCA XpressO is emerging as an important tool in cognitive pre‐screening and facilitating early detection of cognitive impairment. However, barriers to accessibility need to be addressed in order to optimize the useability of the XpressO for the older population.
Longitudinal gene and protein expression changes associated with Mini‐Mental State Examination (MMSE) score in Hispanic/Latino population
Authors: Roshani Rashedeh , Zhu Wanying , Frankel Elizabeth , Chen Hung‐Hsin , Lee Miryoung , McCormick Joseph B , Fisher‐Hoch Susan P , Highland Heather M , North Kari E , Below Jennifer Elizabeth
Published: January 2025

Background

Studies suggest that approximately 60 to 70 percent of the variability observed in cognitive abilities during aging can be attributed to genetic factors. Therefore, investigating the longitudinal multiomics changes associated with alterations in cognitive measures, such as the Mini‐Mental State Examination (MMSE) score, is of utmost importance.

Method

Longitudinal changes in gene and protein expression related to MMSE scores were examined in the Cameron County Hispanic Cohort (CCHC), an extensively phenotyped, randomly‐recruited, cohort of Mexican Americans residing at the US‐Mexico border. This study focused on 763 CCHC participants with transcriptomics data and 240 participants with proteomics data. We utilized linear mixed‐effect regression models to estimate the effects of MMSE scores on gene and protein expression, incorporating up to 1044 and 415 measures, respectively. The models were adjusted for covariates such as age, sex, level of education, anxiety score, screening measure of depression (CESD) score, cell type proportions (for transcriptomics analysis only), 3 Principal Components (PC), and 10 Probabilistic Estimation of Expression Residuals (PEER) factors.

Result

Our preliminary results identified 834 genes and 192 proteins that exhibited differential expression based on nominal significance. After mapping the significant proteins to gene IDs, one of the common genes found between the two studies is SCG3, which has previously been associated with cognitive performance and general cognitive ability in the GWAS catalog.

Conclusion

Our results provide evidence of the functional effect driving those GWAS signals, including mapping the effector gene.
Pretargeted Imaging for In Vivo Assessment of ASO Therapy Delivery in Alzheimer’s Disease
Authors: Cook Brendon E , Pickel Thomas C , Amatruda Mario , Zhang Qize , Nag Sangram , Bolduc Phillipe , Beshr Rouaa , Morén Anton Forsberg , Muste Cathy , Datta Prodip , Ochniewicz Piotr , Meynaq Yasir Khani , DuBois Jonathan M. , Klein Stephanie K , Halldin Christer , Passamonti Luca , Kaliszczak Maciej
Published: January 2025

Background

Intrathecally (IT) delivered antisense oligonucleotides (ASOs) are promising therapies that can reduce tau pathology in Alzheimer’s Disease (AD). However, current plasma and CSF sampling methods to estimate brain tissue exposure of ASOs are inherently limited, hampering ASO clinical developmental plans. We developed the PET tracer [18F]BIO‐687, which binds ASO conjugates (ASO‐Tz) in vivo, allowing us to image ASO distribution in a living brain using “pretargeted” imaging. Pretargeted imaging proceeds by: 1) intrathecal ASO‐Tz dosing; 2) brain distribution of the ASO‐Tz; 3) intravenous (IV) [18F]BIO‐687 administration, where tracer binds to ASO‐Tz in the brain via ‘click‐chemistry’ reactions, followed by PET imaging. Pretargeting enables longer imaging timepoints while reducing radiation dose to patients. Using pre‐clinical experiments, we demonstrate the feasibility of pretargeted imaging to assess ASO distribution in AD.

Method

A Malat1 ASO tool compound was developed and conjugated as a surrogate for therapeutic ASOs treating AD. ASO distribution was imaged in a non‐human primates (NHP) experiment. ASO‐Tz was IT dosed (20 mg), followed 24 hours later by IV [18F]BIO‐687 injection and PET imaging. Baseline scans of [18F]BIO‐687 with no ASO‐Tz were also performed. In a separate experiment, the Malat1 ASO‐Tz was dosed IT in an AD mouse model expressing hTau (P301S) and age‐matched controls. One week later, mouse brains were stained for hTau (AT8) and ASO distribution using immunofluorescence.

Result

The PET experiment in NHP showed high [18F]BIO‐687 binding in brain regions where ASO‐Tz distributed, indicating successful “pretargeted” imaging. As expected for any IT‐delivered ASO, uptake was higher in hindbrain and cortex. In mice, ASO signal (identified by immunofluorescence) was significantly higher in the hippocampus of P301S than control mice (p<0.05). Unexpectedly, higher ASO concentration was correlated with higher hTau concentration in regions such as the hippocampus and cortex (p<0.05).

Conclusion

The NHP PET imaging data clearly demonstrated the feasibility and utility of pretargeted imaging for assessing Malat1 ASO (or potentially any ASO) distribution. Concurrently, our results from the P301S mice study intriguingly show that Malat1 ASO distributes more in brain regions showing higher tau pathology. Our findings support further pretargeted ASO imaging studies in healthy volunteers and AD patients.
Stakeholder Perspectives on Providing Person‐Centered Dementia Care in Low‐Resource Long‐Term Care Settings
Authors: Holmes Sarah D , Rataj Alison , Kusmaul Nancy , Wang Jing , Kim Yoon Chung , Murray Briana , Davie Laura , Lepore Michael , Corazzini Kirsten
Published: January 2025

Background

There is a growing number of residents living with dementia (RLWD) in long‐term care (LTC) settings, but dementia care access and quality are more limited in communities with fewer health resources and these limitations are exacerbated by current dementia care workforce shortages. Low‐resource LTC settings, including poorer urban and rural settings, serve older adults who are at high risk for health inequities in dementia care. These settings can experience barriers in providing quality dementia care due to their limited ability to capture pertinent information about residents’ needs and preferences and ensuring that information is known by dementia care staff. Although there is evidence about the consequences of care inequities for RLWD in low‐resource LTC settings, less is known about stakeholders’ perspectives about key issues and opportunities for improving dementia care. This study describes stakeholder perspectives regarding the collection and sharing of information about RLWD for supporting quality dementia care in low‐resource LTC settings.

Method

This was a community‐based, participatory research study in four low‐resource LTC settings (two rural, two urban) in the United States. All four settings were in medically underserved areas with two rural settings in New Hampshire and two urban settings in Maryland. In‐depth semi‐structured interviews were conducted with a purposive sample of participants (8 administrators/leaders, 20 care staff, 20 RLWD, and 20 care partners). Interviews were audio recorded, transcribed, and thematically analyzed in NVivo12.

Result

Themes were identified in four core topic areas: 1) identifying information about RLWD to support quality care; 2) finding and accessing information by the care team; 3) sharing information with RLWD; and 4) describing quality measures most relevant for RLWD. Within each theme, subthemes were identified providing greater detail of the process for identifying, collection, and sharing information for supporting quality dementia care.

Conclusion

This study revealed complexities in providing care for RLWD in diverse low‐resource communities and generates directions for addressing dementia care inequities. The findings shed light on practical strategies used by low‐resource LTC settings and motivate future research on measuring dementia care quality and advancing capacity among RLWD, their families, and care staff for inclusive, person‐centered dementia care.
Synergistic cognitive enhancement of repetitive transcranial magnetic stimulation with cognitive training in mild Alzheimer’s disease: preliminary results
Authors: Lee Juyoun , Park Kyung Won , Park Kun‐Woo , Lee Ae Young
Published: January 2025

Background

Repetitive transcranial magnetic stimulation (rTMS) is a non‐invasive emerging tool to modulate brain activities and functional connectivity in various neuropsychiatric disorders. rTMS combined with cognitive training (rTMS‐COG) has been showing cognitive enhancing effects compared to those of placebo in mild Alzheimer’s disease (AD) in some previous studies. However, there is not much research to conclude how much each rTMS or COG contributes to therapeutic cognitive effects. This study aims to investigate the cognitive enhancing effect of rTMS‐COG in patients with mild AD.

Method

This study is a prospective, randomized, double‐blind, placebo‐controlled multicenter study. All recruited patients with the mild stage of AD had amyloid deposition in positron emission tomography. Participants fulfilled the inclusion criteria, including a 21∼26 score on the Mini‐Mental Status Examination (MMSE) and the Clinical Dementia Rating (CDR) scale 1, or the Global Deterioration Scale 3. The treatment group (T) had 30 sessions of rTMS‐COG for 6 weeks. The active control group (S) had digital cognitive training without rTMS for 6 weeks. High frequency (10Hz) rTMS was applied on six cortical areas (bilateral dorsolateral prefrontal cortex, bilateral posterior somatosensory cortex, Broca’s area, and Wernicke’s area). The primary outcome measure of this study was the differences in the ADAS‐cog score changes between groups, and its difference of 24 weeks of treatment from the baseline.

Result

Data from 20 patients (T:S 10:10) were used in the preliminary analysis. The mean values for the participants were 71.7 years of age, 10.5 years of education, and 20.2 ADAS‐cog score. There was no significant difference between the two groups' baseline epidemiological or cognitive characteristics. At 24 weeks, the ADAS‐cog score improved by 1.3 points from the baseline in T and worsened by 1.3 points in S, with a difference of 2.6 points between the two groups. The treatment group showed significantly better cognitive function compared to that of the active control group in the ADAS‐cog scores after 24 weeks from baseline.

Conclusion

This preliminary outcome of the study suggests that rTMS‐COG treatment has significant positive cognitive therapeutic effects, and rTMS might take precedence over COG in terms of cognitive modulation in patients with mild AD.
24‐Hour Optimized Lighting for Persons with Dementia: Technology Development
Authors: White Jonathon David , Ansari MD. Azaharuddin , Al‐Mutawaly Nafia
Published: January 2025

Background

65% of persons with dementia (PWD) suffer from disturbed sleeping patterns and 28% experience vision related falls. Improved lighting has been shown in numerous studies since the 1980s to mitigate these effects.

Method

Computer code was written to optimize the spectra and intensity of light for vision and non‐vision purposes over a 24‐hour cycle based on off‐the‐shelf LEDs. Hardware was developed to implement the lighting scheme. Feedback was received from practitioners and interested parties.

Result

The 24‐hr dynamic white lighting exceeded the CIE specifications for vision for seniors with high CRI and low Duv at all times. The light’s correlated colour temperature (CCT) and intensity increased rapidly in the morning and dropped slowly into the afternoon and evening. The lighting schedule was implemented using a designated microcontroller that controlled the intensity of four 5‐m LED strips. Three strips were placed in an upper cove near the ceiling and 1 LED strip (nighttime) in woodwork a floor level. The resulting light was uniform throughout the room and shadow‐free. The ratio of horizontal to vertical illuminance was 20% higher than typical direct lighting systems. The final system was certified to Canadian standards and installed in 6 bedrooms at Ressam Gardens Memory Care Community, and at a few other facilities. The majority of feedback about the system was favorable.

Conclusion

A practical modular lighting system that delivers 24‐hr dynamic white lighting has been certified to Canadian standards and implemented in a number of locations in Hamilton, ON Canada serving persons with dementia. The majority of feedback has been positive.
Health communication, infodemics and disinformation about dementia related contents during COVID pandemic in Arabic countries: A bibliometric analysis
Authors: Taiebine Mohamed , Marfak Abdelghafour , Nejjari Chakib
Published: January 2025

Background

The spread of fake news may lead to a disparate wave of digital health‐seeking behavior, cyberchondria, anxiety, indecision, and other psychosocial dysfunctions, including collapse in social capital and stigmatization. In this study, we utilized a bibliometric analysis to discern the primary trends associated with health communication and health‐seeking behavior regarding dementia‐related contents in countries within the Middle East and North African (MENA) region.

Method

A literature review was conducted in November 2023. We examined articles published in English from 2020 to 2023 in PubMed, Web of Science, and Scopus databases that addressed health communication, infodemics, and disinformation during the COVID pandemic in Arabic countries. In total, 38 articles were identified. Four studies were selected based on the inclusion criteria. Bibliometric and thematic analysis have been performed by word frequency, geographical position, target population and language (given the diglossic status of Arabic‐speaking countries). The factors that contributed to the successful implementation of the socio‐behavioral and health belief models were described.

Result

There is a dearth of research exploring content related to dementia or Alzheimer’s disease on social media in Arabic‐speaking countries. Several internal and external factors may influence health‐seeking behavior during the pandemic in Arabic‐speaking countries, including low levels of education and literacy, vulnerability to cognitive bias, lack of oversight from authorities, information overload, and an impulsive need to seek immediate responses without engaging in fact‐checking through social media.

Conclusion

It is essential to implement a holistic framework to comprehend the behavior‐seeking attitudes of people with dementia based on socio‐cognitive and sociocultural beliefs during pandemics in order to protect vulnerable persons and provide the community with trustworthy and reliable information.
Protocol for an acceptability and feasibility study of sensor‐instrumented SmartSocks® for use by people with dementia
Authors: Creese Byron , Arnold Jacqui , McDermid Joanne , Medina‐Lara Antonieta , Ismail Zahinoor , Steer Zeke
Published: January 2025

Background

Currently ∼50% of people with dementia experience behavioural symptoms linked to unmanaged distress. Effective and safe management of these symptoms is critical to maintain the quality of life and overall care of people with dementia. Technological solutions have the potential to help with research into these symptoms. Milbotix are a health tech start‐up who are developing ‘SmartSocks®, a sock‐based wearable that provides wellbeing insights: notably by continually monitoring the physiological state of the wearer to recognise early signs of distress. In this study we will assess the acceptability and feasibility of SmartSocks® for clinical research in dementia in a care home environment.

Method

30 people with dementia living in care homes in the UK will be asked to wear the SmartSocks®. We will conduct a survey of care home staff to assess the acceptability of the SmartSocks® so that we can ensure the socks are suitable for the care home environment. We will then carry out a focus group with care home staff to evaluate the integration of the SmartSocks® into care planning so that we can determine how care homes use the socks alongside best practice in care. We will determine the concurrent validity of SmartSocks® data with established measures of agitation and pain so that we can evaluate the potential of the socks to be used to deliver better care and used as objective outcome measures in clinical trials. Finally, we will estimate the cost of providing the socks and will assess if there are differences between the groups in resource use utilization and health related quality of life data.

Result

We present a protocol for feasibility and acceptability study of a novel wearable technology.

Conclusion

The study will start recruiting in July 2024 and finish in December 2024. Results will be used to inform the design of larger substantive studies that will test the efficacy of SmartSocks® in managing and measuring agitation and distress in care homes.
Validation of ICD‐10 diagnosis codes for identification of veterans with intracerebral hemorrhage and subarachnoid hemorrhage using clinical notes in the United States Veterans Affairs Healthcare System
Authors: Aguilar Byron J. , Arasa Vanesa Carlota Andreu , Morin Peter J , Wang Ying , Mittler Brant , Berlowitz Dan , Abdennadher Myriam , Reisman Joel , Querfurth Henry W , Zhang Raymond , Monfared Amir Abbas Tahami , Zhang Quanwu , Xia Weiming
Published: January 2025

Background

Cerebral amyloid angiopathy (CAA) is a significant contributor to hemorrhagic stroke, notably lobar intracerebral hemorrhage (ICH) and convexity subarachnoid hemorrhage (SAH). This study describes the natural occurrence of ICH and SAH events among veterans, including those with AD, within the United States Veterans Affairs Healthcare System (VAHS).

Method

The VAHS database was evaluated to identify ICD‐10 codes for ICH (I61.x) and SAH (I60.x) from 2015‐2023. A subsample of veterans with AD was identified based on 1 qualifier (AD diagnostic code or clinical note); a sensitivity analysis included veterans with ≥2 AD qualifiers, ≥30 days apart. Two‐thousand veterans were randomly selected from the ICH/SAH sample for validation of diagnostic coding using clinical notes. The positive predictive value (PPV) of ICH/SAH diagnostic codes was determined using notes from 100 randomly selected cases.

Result

A total of 23,539 and 7,822 veterans were identified using ICD‐10 codes for ICH and SAH, respectively, out of 4‐5 million veterans receiving care annually. The ICH/SAH sample was 93/95% male, 65/69% white, with a mean age of 70 years. Approximately 14% and 4/5% of veterans with ICH/SAH had AD based on 1 and 2 AD qualifiers, respectively. From 2016‐2023, the yearly prevalence of ICH and SAH was approximately 8‐10 and 3/10,000 patients, respectively (Figure). Approximately 61/68% of veterans in the ICH/SAH sample were identified from outpatient visits only and 39/32% were identified from VAHS inpatient stays with or without outpatient medical records. Among 2,000 randomly selected cases for coding validation, 98% had notes available within ±14 days of the ICD coding; among these, 55/60% carried an ICH/SAH keyword. Brain MRI records were found in one‐third of ICH/SAH cases. Review of 2,000 clinical notes corresponding to 100 randomly selected cases found documentation of ICH in 80% (PPV) of veterans with an ICH diagnostic code and 100% with an SAH diagnostic code.

Conclusion

Yearly prevalence of ICH/SAH (2016‐2023) was 0.08‐0.1%/0.03% in US veterans with 14% of the total cases carrying ≥1 AD identifier. Among cases with clinical notes for ICH and SAH, PPVs were 80% and 100%, respectively.
Facilitating Conversations about Supportive Care Options in the Context of Cognitive Impairment using an Online Visual Elicitation Tool
Authors: Turner Anne M , Chen Annie T. , Child Claire E. , Miller Lyndsey M.
Published: January 2025

Background

Persons with cognitive impairment may experience difficulties with language and cognition that interfere with their ability to make and communicate decisions. We developed an online visual tool to facilitate conversations about their preferences concerning supportive care.

Methods

We conducted Zoom interviews with persons with mild cognitive impairment (MCI) and mild to moderate dementia, using storytelling and a virtual tool designed to facilitate discussion. Each interview sought to discuss decision‐making in the context of three scenarios, one concerning a past decision about supportive care, and two hypothetical scenarios based on decreasing abilities and increasing care needs. Interviewers shared their screen with the visual tool, which used the visual diagramming platform draw.io (https://www.drawio.com/) to create an online “canvas.” Interviewers could drag icons (representing people, places, safety, emotions, activities, and issues) or type text onto the canvas to communicate concepts. We developed the tool with a multidisciplinary team of designers and researchers, and with input from people with cognitive impairment. Key user‐centered design goals for the tool included focusing on simplicity, minimizing cognitive load, and using concepts and images that resonated with participants. We also used pilot interviews to refine interviewers’ techniques for eliciting preferences with the tool. We examined the utility of the tool for engaging participants in dialogic interactions with the interviewer, and the cognitive and communicative processes exhibited by participants.

Results

We conducted fifteen interviews with persons with MCI, and mild or moderate dementia [mean age 77.8 years ± 7.1 (SD), 9 male, 6 female]. With respect to dialogic interactions, interviewers actively used the visualization technique to facilitate the conversation; participants engaged with the interface to varying degrees. Common communicative issues included participants being unresponsive to the question or providing unclear responses. During the sessions participants also exhibited uncertainty, introspection, and self‐awareness.

Conclusion

We present a visual technique to engage persons with cognitive impairment in dialogue about complex decisions. We hope to explore the potential use of this technique in research, clinical, and community settings.
The right to rehabilitation for people with dementia: A co‐design approach to barriers, solutions and strategies
Authors: Layton Natasha , Devanny Catherine , Hill Keith , Swaffer Kate , Russell Grant , Low Lee‐Fay , Lee Angel , Cations Monica , Skouteris Helen , O'Connor Claire , Collyer Taya , Neves Barbara Barbosa , Andrew Nadine , Haines Terry , Srikanth Velandai K , Petersen Alan , Callisaya Michele L
Published: January 2025

Background

People with dementia of all ages have a human right to equal access to quality health care. Despite evidence regarding its effectiveness, many people living with dementia lack access to evidence‐based rehabilitation for promoting function and quality of life. The aims of this study were to 1) explore barriers to access to dementia rehabilitation; and 2) identify solutions which improve access to rehabilitation.

Method

People living with dementia and care partners (n = 13) and health professionals (n = 13) were invited to participate. Experience based co‐design across three virtual workshops was used to understand barriers and solutions to improve access to rehabilitation treatments. Socio‐ecological analyses, using the Levesque Access to Health Care Framework, were applied to findings regarding barriers and to assist selection of solutions.

Result

There was high attendance (92.3%) across the three workshops. Barriers were identified at a person‐level (including lack of knowledge, difficulty navigating the health, aged‐care and disability system, transport, and cost) and health service‐level (including health professional low knowledge and negative attitudes, inequitable funding models and non‐existent or fragmented services). Solutions focused on widespread education and training in the area of dementia rehabilitation, including ensuring people with dementia and their care partners know about rehabilitation therapies and that health professionals, aged care and disability co‐ordinators know how to refer and deliver interventions. Dementia care navigators, changes to Commonwealth aged care and Medicare funding models, and specific dementia rehabilitation programs were also recommended.

Conclusion

Barriers to accessing rehabilitation for people with dementia exist at multiple levels and will require a whole community and systems approach to ensure change.
An RCT assessing the effects of varying exposure times of therapeutic communication robots on dementia in group homes in Japan
Authors: Inoue Kaoru , Kono Mitsunobu , Kobayashi Ryuji , Shibata Takanori , Yatsu Chiyomi , Yao Daryl Patrick Gamboa , Shigeta Masahiro
Published: January 2025

Background

As Japan experiences a super‐ageing society and caregiver manpower decreases, interest in the use of communication robots for active dementia care rises. In the U.S., the communication robot (PARO) has been used as a medical device for psychophysiological biofeedback therapy. We report the effects of varying the exposure time for (PARO) on BPSD severity in people with dementia and on the caregivers' burden of professional caregivers in group homes.

Methods

Cluster randomized controlled trial design. Group homes were randomly assigned to two groups, one using (PARO) once a week and the other thrice a week for one hour per session. For the intervention, (PARO) was placed on a table in a communal area, and participants interacted freely with (PARO). The caregivers provided no encouragement. Changes in BPSD severity and caregivers' burden before and after the intervention were compared using a linear mixed model. The primary outcomes were the severity score and caregivers' burden score of the Neuropsychiatric Inventory brief Questionnaire (NPI‐Q).

Results

Ninety‐one participants were recruited, 85 were included in the analysis. The thrice‐weekly group showed improvement in severity scores before and after the intervention, but there was no statistically significant difference between the once‐weekly and thrice‐weekly groups. The caregivers' burden score was significantly improved in the thrice‐weekly group compared to the once‐weekly group.

Conclusions

Using (PARO) once a week for 1 month did not have a significant effect on either severity or caregivers' burden, whereas thrice a week contributed to reducing caregivers' burden. The effect was better scored on the severity in the thrice‐weekly group than that in the once‐a‐week group, but the difference was not statistically significant, suggesting the need to revisit this issue with a longer intervention period. The impact on caregivers may be evident after a relatively short period. The introduction of (PARO) potentially reduces caregivers’ burden and helps to improve the quality of care, hence providing operational support to group homes.
Icariin Mitigates Cognitive Impairments in Female Rats with Estrogen Deficiency
Authors: Goyal Ahsas , Varshney Vibhav , Aggarwal Kritika
Published: January 2025

Background

Cognitive dysfunction emerges as a manifestation of reduced estrogen levels following ovariectomy in an individual. However, the conventional use of estrogen replacement therapy could increase the risk of breast cancer and thromboembolism. Icariin is a natural compound that has been reported to be a neuroprotective agent against dementia. However, the therapeutic role of the icariin via Nrf‐2‐mediated neuroprotective effect to improve learning and memory is yet to be evaluated in ovariectomized challenged female rats.

Method

Experimentally, dementia was induced by the bilateral ovariectomy of female Wistar rats on the first day (Day‐1) of the experimental protocol of 60 days. Biochemical estimation was done on last day of the protocol to evaluate the cholinergic function using commercially available kits.

Result

Intraperitoneal administration of icariin (Day‐1 to Day‐60) significantly improved the learning and memory activity during the MWM schedule and increased the spontaneous alternation behavior during the performance of the Y maze. Further, icariin increased the activity of ChAT and the level of ACh respectively, and decreased the activity of AChE in HIP, PFC, and AMY. Additionally, the improved level of LPO, SOD and CAT activity have been observed in HIP, PFC and AMY brain regions after the administration of icariin. Moreover, Nrf‐2 antagonist significantly attenuated the therapeutic effect of icariin in ovariectomized‐induced altered behavioral and neurochemical observations in female rodents.

Conclusion

Thus, these above facts suggested that icariin exerts the Nrf‐2‐mediated neuroprotection in ovariectomized rats indicating that icariin also should be taken into consideration as a therapeutic option in the management of estrogen deficit‐induced cognitive dysfunctions.
Distinct Association of Amyloid and Vascular Pathologies with Enhanced Perivascular Spaces
Authors: Kim Woo Sik , Yoo Roh‐Eul , Hwang Yejin , Yang Yelim , Seong Joon‐Kyung , Choi Seung Hong , Lee Wha Jin
Published: January 2025

Background

Glymphatic system dysfunction as characterized by increased MRI‐visible Perivascular Spaces (PVS) is speculated to play a role in the acceleration of amyloid accumulation in Alzheimer’s Disease (AD). However, while PVS is also prevalent amongst Vascular Dementia (VD), the pathological distinctions between regional PVS in AD‐ and VD‐driven cohorts remain largely unknown. Through a mixed dementia cohort, we examined these pathology‐driven localization patterns via automated PVS segmentations from T2‐weighted MRI.

Method

99 cognitively unimpaired (CU) and 190 cognitively impaired (CI) patients’ data were collected from the Seoul National University Dementia cohort. Through visual assessments of individual’s 18F‐Florbetaben PET, FLAIR and SWI images, expert radiologists classified CI patients into 4 groups based on both amyloid and vascular‐damage burden (26 A‐VB‐, 63 A‐VB+, 26 A+VB‐, and 75 A+VB+). PVS segmentation involved masking and thresholding hyperintense vessel structures using slice‐wise Frangi filters applied to T2‐weighted MRIs at the basal ganglia (BG) and cerebral white matter (WM), segmented into 4 major lobes (frontal, parietal, temporal, and occipital). We calculated PVS volume fractions (PVS‐VF) as voxel counts normalized by intracranial volumes. Automated segmentations were validated against manually segmented PVS volumes at BG and whole WM (rank correlation coefficients: 0.634, 0.539). Groupwise differences were calculated through two‐sample t‐tests corrected for multiple comparisons.

Result

For A+ groups, significant increases in PVS‐VF were observed at the temporal and occipital lobes as compared to CU, a finding that agree well with prior visual rating studies. However, VB+ groups showed significant PVS‐VF increases across all lobes as compared to CU. Particularly, BG represented the most pronounced VD‐related PVS, with a significantly greater PVS‐VF in the VB+ groups compared to their VB‐ counterparts. Interestingly, PVS volume ratios of lobar regions and BG showed no significant increases for A‐VB+, while all A+ groups showed significant increases in temporal and occipital regions as compared to CU.

Conclusion

Full utilization of PVS as a core biomarker in discerning glymphatic dysfunctions of AD requires full understanding of their properties in those contexts. Cross‐sectional differentiation of regional PVS localization in AD can become a steppingstone into elucidating those associations within the AD continuum.