bluuebunny/crossref_metadata_2025 huggingface dataset:
Crime, Dementia, and Caregivers: Keeping individuals with dementia out of the criminal justice system
Authors: Morgado Lillian , Arias Jalayne J. , Tyler Ana
Published: December 2023

Background

The care and management of justice‐involved persons living with dementia (PLWD) are understudied. Yet emerging data indicate that PLWD may experience symptoms and behaviors which may lead to encounters with the criminal justice system. Consistent with the Sequential Intercept Model (SIM), community and social resources may affect outcomes for justice‐involved PLWD, including formal and informal caregiver resources. This presentation aims to characterize the relevance of community and social resources for criminal justice system outcomes (e.g., risk of arrest, pre‐trial options, and sentencing alternatives for PLWD).

Methods

Synthesis of two semi‐structured interview studies with stakeholders. Study 1: the “Caregiver Study” collected experiences/perspectives from caregivers of persons with frontotemporal lobar degeneration (FTLD) on social and legal decision‐making. Study 2: the “Legal Stakeholder Study” collected experiences/perspectives from legal professionals on managingement of PLWD within the criminal justice system. Transcribed interviews were analyzed applying the Framework Method (an inductive review of transcripts to develop a singular codebook for both studies’ transcripts) before charting data for comparison between participants and studies. Data from both studies were used to uncover potential relationships between social and community resources and justice system outcomes for PLWD.

Result

Caregiver Study: 13 caregivers. Caregivers reported caregiver burden, safety, and patient behaviors that could lead to encounters with law enforcement. Legal Stakeholder Study: 15 participants with a range of experience (5‐25 years). Participants reported the relevance of community and social resources at preventing arrest, pre‐trial release options, and sentencing alternatives. When these data are synthesized with caregivers’ experiences and perspectives the studies generated a fuller narrative of how PLWD experience criminal justice encounters.

Conclusion

Data from the complimentary studies elucidate insight on the relevance of social and community resources for criminal justice related outcomes for PLWD. These data uncover potential relationships between family involvement, financial resources, access to public benefits, and community understanding of dementia as factors relevant to outcomes associated with justice‐involved and potentially justice involved PLWD. These data are consistent with the SIM. These data provide a foundation for research that harnesses the SIM to drive important policy and systemic changes to improve support for PLWD who are justice‐involved.
Multisensory Stimulation Intervention for elderly people with dementia pilot study
Authors: Pilon Gabriella Pereira , Novelli Marcia Maria Pires Camargo
Published: December 2023

Background

Multisensory Stimulation interventions (MSI) are actions that stimulate the senses such as vision, hearing, touch, taste, smell, vestibular and proprioceptive systems. MSI interventions for people with dementia syndromes can offer stimuli that facilitate sensory modulation and capitalize on these individuals' residual sensorimotor skills. There are still few studies that point to the benefits of MSI Interventions in elderly people living in the Brazilian community.

Objective

To evaluate the benefits of an MSI Intervention proposal based on the principles of Snoezelen for elderly people with dementia syndromes.

Materials and Methods

The MSI Intervention will be developed in 12 individual sessions, lasting 45 minutes, with a weekly frequency. Sensory sensations such as vision, hearing, touch, taste, smell and proprioception will be stimulated and will be applied to 10 elderly people with dementia, considering that it is a pilot study. The study will be carried out at the Dementia Care Service (SADe) at the Baixada Santista campus of the Federal University of São Paulo (UNIFESP). The benefits of the MSI Intervention will be evaluated by objective measures (blood pressure and heart rate) and changes in behavior and by subjective measures of perceived benefits of MSI that will be applied before and after the intervention and comparative analysis considering pre‐ and post‐intervention and the effect size of the intervention.

Result: and Conclusion

The study in question is in progress and the reults and conclusions will be presented at the congress.
Race, Purpose and Meaning of Life, and Markers of Brain Health for Alzheimer’s Disease
Authors: Mukundan Aishwarya , Rosso Andrea L , Cisneros Geraldine , Huppert Theodore , Laymon Charles M , Lopresti Brian J. , Potopenko Katey , Reese Alexandria C. , Roush Rebecca E. , Snitz Beth E. , Becker James T , Cohen Ann D. , Shaaban C. Elizabeth
Published: December 2023

Background

Meaning and purpose in life (M&P) represents goal direction and meaning for an individual. Literature has shown associations between higher M&P and better global cognition. However, papers included either predominantly White or Black samples. We aim to replicate these results in a sample with roughly equal Black and White participants and assess racial differences in the association between M&P and markers of brain health (global cognition and amyloid). We hypothesize that higher M&P scores will be associated with better markers of brain health and that the association will be stronger among Black compared to White individuals.

Methods

263 adults aged 50‐89 years (Table 1) from the Pittsburgh Human Connectome Project were included. M&P was measured by the NIH Toolbox questionnaire. Brain health was characterized as general cognitive function by the Montreal Cognitive Assessment (MoCA) and amyloid burden from positron emission tomography with Pittsburgh compound B (PiB) using a global region of interest. Race was self‐reported as either White or Black/African American; individuals of other races (n = 6) were not included in these analyses. The association of M&P with brain outcomes was assessed by linear regression adjusted for years of education, sex, and age. Effect modification by race was assessed with inclusion of an interaction term in the models. Analyses were conducted in the whole sample and then again, in only those considered cognitively normal.

Results

There was no association between M&P and either marker of brain health (global amyloid: β = 0.0008, p = 0.52; cognition: β = 0.019, p = 0.28). There was no statistically significant effect modification by race for either outcome (all p for interaction>0.1). When restricting to those considered cognitively normal, results remained the same.

Conclusion

In contrast to prior findings, we found no association between M&P and markers of brain health in contrast to other studies. This difference is not likely due to racial composition as we found no differences by race but may be due to differences in measurements used. Further research should explore potential differences in associations based on cognitive domain.
The effect of age and years of schooling on CERAD‐MX performance of Mexican preclinical carriers and non‐carriers’ relatives of the V717I APP mutation
Authors: Reyes Angélica Zuno , Pérez‐Rubio Karina , Berumen‐Ocegueda Isaac Enrique , Cornejo‐Loera Geovany , Ringman John M , Flores‐González Martín Alonso , Matute Esmeralda
Published: December 2023

Background

In a previous study in a sample of young neurotypical adults (18 to 59 years), we found that years of schooling (YoS) have a greater effect than age on the tasks included in the neuropsychological protocol of the Mexican adaptation of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD‐MX).

Method

Thirty‐eight participants (Mage = 31.08 years; MYoS = 8.27 years), from Jalisco State in Mexico, identified as first‐degree relatives of symptomatic autosomal dominant Alzheimer’s disease (ADAD) carriers of the V71 7I APP mutation were divided into two groups, MC (n = 15) and NC (n = 23). Eight CERAD‐MX tasks were used: the Mini‐mental State Examination (MMSE), Semantic Verbal Fluency (SVF), Verbal Boston Naming (VBN), Word List Memory (WLM) with delayed recall (WLD) and recognition (WLR), as well as Constructional Praxis copy (CPC) and recall (CPR). We used z‐scores, then defined random vectors with Sklar’s theorem and a Gaussian dome from simulations of new samples obtained by inverse transform sampling.

Result

In both groups, YoS had a greater positive effect on the MMSE, WLM, WLD z‐scores. In the MC group only, this same effect was evident in the SVF and CPR scores, while in the NC group this effect was seen in the VBN, and CPC z‐scores. Age effect was more pronounced that YoS in MC performance on the CPC, while in NC, on SVF performance.

Conclusion

For both groups, YoS has a greater effect than age on several tasks, showing that YoS is a confounding variable when analyzing performance on CERAD‐MX tasks. Moreover, in the MC group, age has a positive effect on CPC task performance suggesting that graphic abilities are not vulnerable to the presence of V717I APP mutation at the preclinical stage.
The prevalence and experience of loneliness in persons with cognitive impairment on an Inpatient Geriatric Unit
Authors: Elmi Sarah
Published: December 2023

Background

Older adults who experience loneliness are at a heightened risk for mortality. There are two distinct types of loneliness: social, in which social interactions and networks are reduced, as can result from social isolation and lack of social integration; and emotional, in which a meaningful attachment bond with another is absent. We examined the prevalence and experience of loneliness in cognitively impaired older adults receiving treatment in a mental healthcare facility.

Method

Fourteen participants with mild cognitive impairment or mild/moderate dementia (mean MoCA 17, range 12‐22; mean age 76, range 65‐92) completed a demographic survey, DeJong Gierveld 6‐Item Loneliness Scale, Montreal Cognitive Assessment (MoCA), and a semi‐structured interview. Basic thematic analysis was used to extract major themes from the interview data. Differences in the prevalence of loneliness between low (MOCA 18 or greater) and high (MOCA 17 or less) cognitive impairment groups and correlations between cognitive impairment and loneliness were examined.

Result

Participants experienced moderate or severe loneliness (86%), emotional (79%) and social (57%) loneliness. Themes emerging from interviews included limited social networks, lack of connection or social engagement, loss of role, need for meaningful activities, missing families, dependency, and stigma. No significant differences were found in loneliness between low vs. high cognitive impairment groups. Correlational analysis suggested a negative association between social loneliness and cognitive impairment, with individuals with lower cognitive impairment scoring higher on social loneliness (r = , p = ).

Conclusion

Loneliness is prevalent and multifactorial in individuals with cognitive impairment receiving care in a mental health care facility.
Cognitive Intervention in Community Older Adults of Rural Nebraska: A Pilot Study
Authors: Saidi Ladan Ghazi , Hill Toni , Kelly Christopher , McKelvey Miechelle
Published: December 2023

Background

Older adults living in rural counties of Nebraska have little access to social and healthcare services to maintain their cognitive health due to geographic limitations, shortage of professional services, and the high cost of such services. The Area Agencies on Aging provide services to underserved older adults in rural areas may lack specialized cognitive health services such as cognitive‐communication interventions.

In this pilot study, we used technology (telepractice) and intergenerational bonding approaches (IGB) to provide an innovative intervention to improve the cognitive health of underserved older adults in rural Nebraska.

Method

We tested the effectiveness of a cognitive communication intervention via telepractice using iPads to support communication, cognitive stimulation, and interaction through an IGB program delivered by students of Speech Language Pathology (SLP) to improve the cognitive health of older adults. Our intervention included eight evidence‐based cognitive communication techniques tested in multiple studies.

Result

The average MoCA scores of the participants was below the cut ‐off (M = 25; SD = 3.9). Pre‐post comparison of cognitive measures (semantic and phonemic fluency, working memory, executive functions) showed a maintenance or improvement of cognitive health, reflecting the effectiveness of our IGB intervention. Precisely, a paired‐t‐test showed a significant increase in some of the measures but not all. However, no measure scores declined. The following measures showed a significant positive difference pre/post intervention: Phonemic fluency: T1 (M = 11, SD = 4.3), and T2 (M = 11, SD = 5); t(8) = 0.508, p = 0.003, semantic fluency: T1 (M = 19.8, SD = 45.8), and T2 (M = 20.2, SD = 5.1); t(8) = ‐0.292, p = 0.004, Stroop test, incongruent trials response time: T1 (M = 1054, SD = 134), and T2 (M = 1057, SD = 147); t(8) = ‐1.191, p = 0.003, Simon task, incongruent trials Accuracy Rate: T1 (M = 65%, SD = 40%), and T2 (M = 74%, SD = 37%); t (8) = ‐0.770, p = 0.05.

Conclusion

Our pilot results are in line with evidence from the literature on positive effects of cognitive stimulation, showing that intergenerational interaction rich with cognitive stimulation can have positive effects on cognitive health.

The preliminary results of this study support the effectiveness of an accessible and cost‐effective approach to promote cognitive health in community older adults in underserved rural areas in the comfort of their homes.
Patients living alone with dementia: course of health‐related quality of life over time and the impact of collaborative care in Germany
Authors: Michalowsky Bernhard , Platen Moritz
Published: December 2023

Background

Little is known about the progression of patient‐reported outcomes in community‐dwelling people living alone with cognitive impairment (PLACI) and the efficacy and cost‐effectiveness of collaborative care models, initiating evidence‐based care and support for this vulnerable subgroup. Thus, this study aims to demonstrate the longitudinal course of patient‐reported outcomes and assess the efficacy and cost‐effectiveness of collaborative care in PLACI compared to those not living alone.

Method

DelpHi‐MV (Dementia: Life‐ and person‐centred help in Mecklenburg‐Western Pomerania) is a German general practitioner‐based, randomized controlled intervention trial. The present analyses are based on longitudinal (24 months) data of 352 patients (≥70 years, community‐dwelling). Patient‐reported outcomes were assessed using the SF‐12, dividing patients' health‐related quality of life (HRQoL) into mental and physical parts. Descriptive statistics were used to demonstrate HRQoL longitudinally. The efficacy and cost‐effectiveness of the collaborative care model were assessed by multivariate regression models and by cost‐effectiveness‐acceptability curves, separately for PLACI vs those living not alone.

Result

N = 178 (51%) patients were living alone and more likely female (73% vs 49%) and older (81 years vs 79 years) than those living not alone. Considering PLACI only, mental and physical HRQoL decreased over time (‐2.4 and ‐2.2) without collaborative care and increased (+1.4 and +2.5) with collaborative care. Multivariate models confirmed the significant positive impact of collaborative care on mental HRQoL (b = +3.1, p = 0.032) over time. The probability of cost‐effectiveness was 96% at a willingness‐to‐pay of 40,000€ /QALY for PLACI, much higher than in those living not alone (26%).

Conclusion

HRQoL would decrease over time in PLACI. Collaborative care could improve patients' everyday lives, especially mental health. Thus, when such models are implemented, health policy could gain the highest cost savings and effects on HRQoL in PLACI.
Rural‐urban disparities in the consumption of fruits and vegetables and cognitive performance in Brazil
Authors: Gonçalves Natalia G , Bertola Laiss , Ferri Cleusa P , Suemoto Claudia Kimie
Published: December 2023

Background

Adherence to a healthy diet has been associated with lower risk of dementia and cognitive decline. Furthermore, low consumption of fruits and vegetables has been associated with lower cognitive performance. Rural Brazilians have several factors related to poor diet quality, such as low education and income.Additionally, rural residents of Latin America face a higher burden of dementia compared to urban residents. However, differences in the association of fruit and vegetable consumption with cognitive performance in urban and rural areas have not been explored. The aim of this study was to investigate the association of fruit and vegetable consumption with cognitive performance in urban and rural areas in a nationally representative sample of Brazilian older adults.

Method

The sample included 9,412 adults 50 years or older from the 2015 wave of the Brazilian Longitudinal Study of Aging. Consumption of fruits and vegetables was measured using a food frequency questionnaire. Cognitive performance was evaluated using the immediate recall, late recall, semantic verbal fluency, prospective memory, semantic memory, and temporal orientation. A global composite z‐score was derived from these tests. Association of consumption of fruits and vegetables with cognitive performance was evaluated using linear regression, adjusted for sociodemographic, lifestyle, and clinical variables.

Result

In 6,743 participants (mean age 61.3±8.9 y, 53% women, 43% White, and 15% from rural areas), the mean intake of fruits and vegetables was 2.0±1.3 portions a day (Table 1). Higher consumption of fruits and vegetables was associated with better episodic (β = 0.021, 95% CI = 0.004;0.037, p = 0.013) and semantic memory (β = 0.037, 95% CI = 0.019;0.055, p<0.001), verbal fluency (β = 0.035, 95% CI = 0.018;0.053, p<0.001), and global cognition (β = 0.032, 95% CI = 0.016;0.048, p<0.001) performances (Table 2). There was a modifying effect of urban/rural area of residency (p for interaction <0.001). Stratified analysis showed that consumption of fruits and vegetables was associated with better episodic and semantic memory, verbal fluency, and global cognition performances in participants who resided in urban, but not rural areas (Table 3).

Conclusion

Consumption of fruits and vegetables was associated with cognitive performance in urban, but not in rural areas in Brazil, possibly due to socioeconomic disadvantages and lower access to healthcare.
Location Dynamics in Northern Rural Minnesota: Barriers and Facilitators for ADRD Diagnosis and Care
Authors: Warry Wayne , Fergen Joshua , Soderlund Patricia R , Cruikshank Kirsten R , Jacklin Kristen
Published: December 2023

Background

The location dynamics of rural northern Minnesota involve shifting economic structures, demographic transitions, and diverse physical environments that affect access to Alzheimer’s Disease and Related Dementias (ADRD) diagnosis, care and health services.

Method

We conducted semi‐structured interviews with 56 key informants including health care providers (n = 7), health leaders and administrators (n = 10), social workers (n = 12), formal and informal caregivers (n = 19), and healthy older adults (n = 8) across northern Minnesota concerning the unique protective and risk factors and the socio‐cultural context of ADRD in the region. Interviews were transcribed and thematically coded in QSR NVivo using a lived experience framework.

Result

Our analysis reveals that winter weather, depopulation trends, and lack of healthcare facilities and services and aspects of rural culture create multi‐faceted challenges to healthy aging and ADRD diagnosis and care. Rural residents often rely on social capital, community institutions, volunteerism, and families to compensate for the lack of medical services. Rural people without social or financial resources may have to relocate to different communities to receive care and services. This lack of access to local care influences stigma and fear of dementia diagnoses in rural areas. These experiences shape cultural understandings of ADRD, and health seeking behaviors, which can be characterized as hesitant and dismissive, creating additional challenges for community interventions.

Conclusion

The location dynamics of rural northern Minnesota shape unique cultural understandings around ADRD diagnosis and care that limits the effectiveness of existing interventions and demands tailored approaches to overcome the lack of local resources, geographic distance, and winter weather constraints. Dense social networks, a culture of volunteerism, and community capacity to develop medical infrastructure are key assets used to overcome these challenges to ADRD care.
Digital and plasma biomarkers for an early diagnosis of Mild Cognitive Impairment and prodromal Alzheimer’s disease
Authors: Tort‐Merino Adrià , Sarto Jordi , Esteller Diana , Tarnanas Ioannis , Bügler Maximilian , Harms Robbert , Iulita M. Florencia , Santuccione Antonella , Ruiz‐García Raquel , Naranjo Laura , Martínez Neus Falgàs , Borrego‐Écija Sergi , Guillén Núria , Fernandez‐Villullas Guadalupe , Val‐Guardiola Andrea , Juncà‐Parella Jordi , Bosch Beatriz , Lladó Albert , Sanchez‐Valle Raquel , Balasa Mircea
Published: December 2023

Background

The application of blood‐based biomarkers for the identification of Alzheimer’s disease (AD) and the development of novel digital technologies as cognitive screening tests are critical to moving toward a reliable, more accessible early diagnosis. Our aim was to evaluate the diagnostic performance of a machine learning‐based cognitive assessment known as Altoida’s digital neuro‐signature (DNS) in patients with non‐degenerative mild cognitive impairment (ndMCI) and MCI due to AD (prodromal AD) and its association with CSF and plasma biomarkers.

Method

Altoida’s MCI‐DNS is a 10‐minute cognitive test battery evaluating activities of daily living via motoric and augmented reality tasks. The test consists of placing and finding virtual objects in a real environment and its final score is obtained by weighting multi‐modal digital data features, such as hands’ micro‐movements, speed, reaction times, or navigation trajectories. We included 81 participants, classified according to their clinical status and CSF AD biomarker profile as: cognitively unimpaired controls, CTR (n = 10; age = 68.5±5.9; MMSE = 29.4±1.1), ndMCI (n = 25; age = 67.6±7.2; MMSE = 26.9±1.9) and prodromal AD (n = 46; age = 70.8±4.9; MMSE = 24.3±3.3). We further investigated a subsample of participants classified according to their plasma pTau181 levels as measured by SiMoA [cutoff = 1.37 pg/mL (Sarto et al., 2022)]: pTau181 negative (n = 27; age = 68.5±5.9; MMSE = 26.9±2.7) or pTau181 positive (n = 30; age = 70.3±5.5; MMSE = 24.1±3.7).

Result

Significant differences were found in MCI‐DNS scores between CTR group and ndMCI (F = 23.5; p<0.001) and prodromal AD (F = 114.4; p<0.001) groups. Also, ndMCI showed higher MCI‐DNS scores than the prodromal AD group (F = 4.53; p<0.05, Fig. 1). ROC curves showed an excellent diagnostic accuracy of the MCI‐DNS in the discrimination between CTR vs. ndMCI (AUC = 0.879) and CTR vs. prodromal AD (AUC = 0.975) (Fig. 1). Further analyses showed differences in MCI‐DNS scores between CSF Aβ42 negative and CSF Aβ42 positive (F = 18.9; p<0.001; Fig. 2), as well as between plasma pTau181 negative and plasma pTau181 positive (F = 6.16; p<0.01; Fig. 2). Finally, MCI DNS scores significantly correlated with CSF Aβ42, CSF Aβ42/pTau ratio, CSF neurofilament‐light chain (NfL) and plasma pTau181 concentrations (Fig. 3).

Conclusion

Altoida’s MCI‐DNS test allows excellent discrimination between CTR and patients with MCI. MCI‐DNS scores significantly correlate with CSF AD core biomarkers, biomarkers of neurodegeneration and blood‐based biomarkers (i.e., plasma pTau181).
Health System Initiatives: Catalysts for Change
Authors: Daven Morgan
Published: December 2023

Health systems hold the key to change for dementia care, representing the primary organizational structures through which meaningful change will occur. The Alzheimer’s Association, the world’s largest nonprofit organization dedicated to Alzheimer’s care, is committed to leading this change. Starting in July 2019, the Alzheimer’s Association launched a Health Systems Initiative to facilitate and enhance dementia care in the clinical setting.

In the three years since its launch, this initiative has made hundreds of connections to health systems across the United States, offering proven solutions for improving health outcomes to more effectively provide care for people living with dementia. Twenty‐two regional health systems directors help increase awareness of resources for clinical training, with a focus on soliciting feedback from providers to better support their work.

The goals of the initiative are to improve health measures, as well as quality of life measures, and promote ways to make it easier for clinicians to provide high quality care. The Alzheimer’s Association Health Systems Initiative provides technical assistance for quality improvement, solutions to advance system and practice changes, and an organizational structure to help disseminate best practices.

Toolkits such as the KAER Model designed by the Gerontological Society of America, quality improvement models such as the Cognition in Primary Program at the University of Washington, and primary care models specialized in dementia care such as the Integrated Memory Care Program at Emory University are helping meet the complex care needs of individuals and families living with Alzheimer’s disease and related dementias.
Examining the reorganization of cognitive networks in subjective cognitive decline: A network analysis approach
Authors: Grunden Nicholas , Phillips Natalie
Published: December 2023

Background

Individuals with subjective cognitive decline (SCD) are at increased risk for developing dementia. However, research is still needed to identify what subtle cognitive changes in SCD might differentiate it from healthy aging. Network analysis has been used to model interrelationships between cognitive measures in healthy and clinically impaired older adults. These multivariate networks can capture a more holistic view of performance within and across cognitive domains, providing further insight into cognitive status. Studies of individuals with Alzheimer’s disease (AD) and mild cognitive impairment (MCI) have revealed distinct network characteristics compared to cognitively normal (CN) older adults. We employed this novel technique to determine whether networks in SCD show evidence of reorganization compared to CN individuals.

Method

This project examined the cognitive network of a sample group with SCD (n = 207, 151 females/56 males, M
Age = 71.6 ± 5.50, M
Education = 15.5 ± 3.40) and compared it with networks of CN (n = 122, 94 females/28 males, M
Age = 71.3 ± 6.08, M
Education = 15.6 ± 3.41), MCI (n = 210, 100 females/110 males, M
Age = 73.7 ± 6.55, M
Education = 15.1 ± 3.81), and AD (n = 79, 32 females/47 males, M
Age = 75.9 ± 7.33, M
Education = 15.3 ± 4.34) participants. Group networks were comprised of performance on various cognitive tests from COMPASS‐ND1 and CIMA‐Q2 aging studies. Networks were constructed as Gaussian graphical models with EBICglasso regularization applied to return sparser networks3.

Result

Strength centrality indices (i.e., the absolute sum of partial correlations with other variables) suggest that measures of executive functioning become less influential while measures of long‐term memory increase their influence in SCD networks compared to CN networks, reflecting a shift from a common decrease in executive processing seen in normal aging to the episodic memory deficits characteristic of AD‐type cognitive decline.

Conclusion

These findings not only differentiate SCD networks from CN networks, but also suggest the beginnings of cognitive reorganization towards MCI, supporting the view of SCD as a preclinical state in the AD continuum.

References:

1. Chertkow et al. (2019), https://doi.org/10.1017/cjn.2019.27

2. Belleville et al. (2019), https://doi.org/10.1016/j.dadm.2019.07.003

3. Epskamp & Fried (2018), https://doi.org/10.1037/met0000167
Virtual Design of the Brain Health Support Program and CAN‐THUMBS UP
Authors: Feldman Howard H. , Belleville Sylvie , Nygaard Haakon B. , Montero‐Odasso Manuel , Chertkow Howard ,   CCNA‐CAN‐THUMBS UP Study Group
Published: December 2023

Background

Modifiable lifestyle factors account for ∼40% of the population attributable risk of dementia. This provides a strong rationale to develop remotely administered, personally tailored, home‐based interventions to reduce these risk factors. CAN‐THUMBS UP (CTU) is a fully remote program that has enrolled a cohort of individuals at risk of dementia, developed an interactive online educational intervention to address personalized risk factors and their modification, and supports an open platform trial to test and compare the efficacy of multidomain interventions. CTU is reaching a broader geography with potential for inclusion of more representative research populations and with an easier and less demanding participant experience.

Method

CTU’s two research intervention programs include: a) The Brain Health Support Program (BHSP) with individuals at increased risk of dementia participating in the Brain Health PRO, a 12‐month online educational program which focuses on lifestyle and dementia risk factors; b) Synchronizing, Exercises and Remedies to Gain Cognition (SYNERGIC), a clinical trial intervention platform whose RCTs are investigating personalized multidomain interventions including those administered fully remotely. In SYNERGIC‐2, the BHPro educational intervention is used as an active control to a more personalized and tailored interventional approach. CTU programs are informed by initial pilot studies, have extensive community input, and incorporate innovative features including an interactive E‐consent platform, remote cognitive testing, wearable technology for sleep and activity monitoring, and home saliva collection for genomics.

Result

Target enrollment of 350 participants in BHSP has been rapidly achieved within 8 months utilizing geotargeted mailing and a coordinated national media campaign. Participants are recruited from all regions of Canada. Pilot studies demonstrated the feasibility of conducting a 100% remote study with high rates of participant satisfaction and completion rates across various virtual outcomes. Results of each of these components of the remote program will be detailed in this FRS.

Conclusion

CTU demonstrates the feasibility and high rate of participant acceptance in fully remote, comprehensive, online programs that include an educational intervention as well as fully remote, multi‐domain lifestyle intervention trials. The adoption of the various technologies has exceeded expectations and supports further clinical trial development with this approach.
Virtual Cognitive Testing‐ Neuropsychology, MyCogHealth and Cogniciti
Authors: Brewster Paul , Hofer Scott M , Jacobs Diane M. , Feldman Howard H. , Belleville Sylvie , Montero‐Odasso Manuel , Nygaard Haakon B. , Chertkow Howard ,   CCNA‐CAN‐THUMBS UP Study Group
Published: December 2023

Background

It is increasingly possible to mobilize technology to more readily evaluate effects of lifestyle interventions. Past research has found virtual administration of neuropsychological testing yields comparable results to in‐person assessments. Self‐administered paradigms using app‐and web‐based assessments have likewise shown promise for measuring cognition longitudinally. The Brain Health Support Program (BHSP) investigates three highly scalable cognitive assessment approaches for use in dementia prevention trials.

Method

The BHSP includes 60‐minute traditional neuropsychological assessments administered remotely via videoconferencing by a study coordinator (baseline & 12‐mos.), 20‐minute self‐administered web‐based cognitive screening assessments with Cogniciti (baseline, 6, and 12‐mos.), and self‐administered ecological momentary assessments using the MyCogHealth app. An intensive measurement protocol is implemented with MyCogHealth whereby participants completed five assessment “bursts” in three‐month intervals. Each “burst” involved five‐minute cognitive testing sessions completed twice daily across seven days. Remote neuropsychological assessments and Cogniciti were completed at home on personal devices. Study phones were provided to those without a smartphone capable of operating MyCogHealth. A three‐month feasibility pilot was completed in early 2022.

Result

The BHSP Pilot found 100% compliance with remote neuropsychological assessments. Participants averaged 85% compliance with the MyCogHealth burst testing schedule. Self‐reported satisfaction with MyCogHealth ranged from 85% (comfort using the app) to 95% (satisfaction with burst testing schedule). During the BHSP Baseline, all participants successfully completed the remote neuropsychological assessment, Cogniciti, and MyCogHealth. 82% had a personal mobile device for operating MyCogHealth and the remainder were provided study phones. Mixed linear regression analyses modeling cognitive trajectories over the first six months of the BHSP in relation to modifiable dementia risk factors and change in health behaviours will be presented. Marginal and conditional R‐Squared values will characterize the relative sensitivity of the three virtual testing paradigms for measuring change.

Conclusion

All three approaches to virtual cognitive testing were feasible for use with the BHSP cohort. Longitudinal results provide an evidence base to inform future applications of virtual testing in dementia prevention trials. Virtual cognitive testing could be stage‐setting by saving clinic visits and lowering trial costs that would in turn expand geographic diversity of participants and enable more interventions to be evaluated.
Using artificial intelligence (AI) to predict the conversion of cognitively unimpaired individuals to mild cognitive impairment
Authors: Rawi Alya AL , Hassan Nehal , Ardle Ríona Mc , Slight Sarah
Published: December 2023

Background

Mild cognitive impairment (MCI) is the objective decline in neurocognitive functioning, but without significant impairment of the individual’s ability to perform the usual instrumental activities of daily living (1). Diagnosing MCI can be done using a combination of different methods such as cognitive testing, structural neuroimaging, nuclear imaging, and cerebrospinal fluids, and plasma biomarkers. Some of these methods are invasive and expensive. Machine learning (ML) algorithms can be trained to predict the onset of MCI, using data from non‐invasive methods.

Method

Four databases (WoS, MEDLINE, EMBASE, and CINAHL) were searched using search string of relevant terms (cognitive decline, artificial intelligence, prediction, and cognitively unimpaired). Articles that reportedtrained ML algorithms using non‐invasive predictors of MCI in cognitively healthy adults (≥ 18 years old) were included. The review was registered with PROSPERO (CRD42022379027) and PRISMA guidelines were followed. The Newcastle‐Ottawa Quality Assessment scale was used to assess the quality of studies.

Result

Of the 1,098 articles identified and screened, 22 studies were included. 373 non‐invasive predictors of MCI were identified. The most prevalent predictors included: demographic information (age, sex, years in education), voice and speech parameters (sentence repeating, semantic fluency), gait parameters (velocity, cadence, step time), performance on cognitive tests (MMSE, K‐MoCA, CDR, AD8), eye‐movements (pupil diameter, saccade orientation) and Instrumental activity of daily livings (medication, finance management). The maximum and minimum number of predictors used to develop a ML algorithm was 121 and 2, respectively. The ML algorithms developed in the included studies had (average sensitivity and specificity of 77.90%±22 and 80.84%±18, respectively) exceeded the performance of algorithms that used invasive and expensive predictors such as nuclear imaging and neuroimaging which achieved accuracy scores (60%‐77%) (2).

Conclusion

Non‐invasive predictors can be used to train ML algorithms to predict the onset of MCI in cognitively healthy individuals with good accuracy scores exceeding 70%. These algorithms may can aid clinician decision making, thus setting early treatment plans, and allowing individuals to be involved in care planning before progression of MCI to dementia AD.
Predictors of decisional capacity in AD biomarker test candidates
Authors: Kim Jeong Eun , Sereika Susan M , Tamres Lisa K , Lingler Jennifer H
Published: December 2023

Background

Deciding to learn one’s Alzheimer’s disease (AD) biomarker status requires comprehending and deliberating about complex and nuanced information. Assessing capacity to consent to AD biomarker testing and disclosure is further complicated when candidates have cognitive impairment and present with family care partners. The objective of this analysis was to identify predictors of decisional capacity for an amyloid PET disclosure study among persons with Mild Cognitive Impairment (PwMCI) and their care partners (CPs).

Method

This investigation was a secondary analysis, using baseline data of a randomized controlled trial of amyloid PET results disclosure. Multiple linear regression modeling was used to examine predictors of decisional capacity, measured by the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC). Focusing on PwMCI (n = 82), the predictor variables of interest were sociodemographic characteristics, and level of knowledge on MCI/AD and normal aging, global cognition measured by Mini Mental Status Exam (MMSE), and neuropsychological tests of language and executive functioning. Dyadic analyses were conducted with CP data (n = 82), using the Actor Partner Interdependence Model (APIM) to assess for presence of partner effects among key variables.

Result

Participants and CPs were mostly White (91.5%, 90.2%), highly educated (16.5, 15.5 years on average), with mean age 72.7 and 66.8 years, respectively. CPs tended to be female, and spouses of the participants (70.7%). MMSE scores (b = 0.215, SE = 0.082, p = 0.011) and MCI/AD knowledge scores (b = 0.241, SE = 0.101, p = 0.020) positively predicted decisional capacity for PwMCI. Dyadic analysis using APIM showed that level of MCI/AD knowledge (p = 0.019) and level of education (p<0.001) were highly correlated within the dyad. Furthermore, analyses revealed significant positive correlations for MCI/AD knowledge for actor relations for decisional capacity for both the participant (a11 = 0.328, p = 0.005) and the CP (a22 = 0.262, p = 0.025). CP’s level of MCI/AD knowledge had a negative association for partner effects for decisional capacity (p21 = ‐0.207, p = 0.043) of the PwMCI.

Conclusion

Assessment of decisional capacity is imperative when considering participation in AD research, including biomarker studies involving results disclosure. Our findings highlight that not only do individual characteristics put PwMCI at risk for lower decisional capacity, but dyadic effects from their CPs may also be present.
Apathy and dysfunction in Lewy Body Disease
Authors: Zhu Carolyn W , Grossman Hillel , Sano Mary
Published: December 2023

Background

Studies in Alzheimer’s disease and frontal temporal lobe dementia have shown high prevalence and persistence of apathy at different disease stages and its strong association with functional decline. Here we use well‐established methods to examine the relationship between apathy and function in a cohort of well‐characterized patients with Lewy Body Disease (LBD) who had regular assessments over time.

Method

Sample includes participants in the National Alzheimer’s Coordinating Center Uniform Data Set (NACC‐UDS, 9/2005‐12/2019) who had at baseline (1) cognitive status of mild cognitive impairment (MCI) or dementia, (2) presumed etiologic diagnosis of LBD, and (3) ≥1 follow‐up. Baseline diagnosis of Parkinson’s disease (PD) was assessed. Apathy was identified using clinician judgment. Participants’ function was measured using the Functional Assessment Questionnaire (FAQ). Multivariable linear mixed model (LMM) was used to estimate relationships between apathy, cognitive status (baseline MCI vs dementia), and function over time.

Result

The sample included 339 participants with MCI and 748 with dementia. Average age = 72.7±8.3, 74% male, 86% non‐Hispanic white, 15.4±3.4 years of education, baseline MMSE = 23.7±5.8, with 3.4±1.7 years of follow‐up. Proportion of participants who reported difficulty with function at baseline ranged according to task complexity from 48% (Heating water, making a cup of coffee, turning off stove after use) to 85% (Assembling tax records, business affairs, or papers); with total FAQ = 13.0±9.1. Presence of apathy increased from 52% at baseline to 60% at visit 4. Across all follow‐ups, 24% of the participants were never apathetic, 13.7% had apathy intermittently (<50% of all visits), 28.3% persistently (≥50% of all visits), and 34.0% were apathetic at all visits. LMM estimation results showed that, compared to participants who were never apathetic, FAQ was 3.8±0.8 points higher, i.e., greater dysfunction, at baseline in participants who were always apathetic, and 3.3±0.7 points higher in those who had intermittent/persistent apathy (both p<0.001). Rate of functional decline was 0.41±0.3 points faster each year in those always apathetic compared to never apathetic (p<0.1).

Conclusion

Apathy is highly prevalent in individuals with LBD. Independent of cognitive status, more persistent apathy was strongly associated with worse function.
A longitudinal study of care‐recipient relationship type on the quality of life in community‐dwelling older adults with dementia
Authors: Lai Aiping , Griffith Lauren E. , Kuspinar Ayse , Smith‐Turchyn Jenna , Richardson Julie
Published: December 2023

Background

With the prolongation of the human lifespan, dementia has become a significant public health issue. In 2050, the number of people living with dementia (PLWD) globally is projected to increase from 50 million in 2018 to 152 million ‐ a 204% increase1. Without a cure or effective treatment for these diseases, maintaining the quality of life (QoL) of PLWD has been identified as the primary goal of care services. In the current study, we used five rounds of National Health and Aging Trends Study (NHATS) data (Round 5 to Round 9) to evaluate how the care‐recipient relationship type influences changes in QoL of PLWD over time.

Method

This was a secondary analysis of longitudinal data. Older adults were categorized into different groups by the type of relationship: (1) spouse/partner; (2) adult child; (3) informal caregiver other than spouse/partner and adult child, such as child‐in‐law, sibling, friend, etc.; (4) If older adults indicated having multiple caregivers, they were assigned to the group of “multiple caregivers.” QoL was assessed in 4 domains: mental health (assessed by Patient Health Questionnaire for Depression and Anxiety, PHQ‐4), self‐reported physical health, pain (Yes/No) and functional limitations (i.e. number of ADLs assistance). Backward and forward stepwise regressions were used to determine the prediction of older adults’ socio‐demographics (age, sex, race, income, education, marital status, living arrangement) and dementia status (probable dementia, possible dementia, and no dementia) on their QoL over 4 years; the generalized estimating equation (GEE) approach was used to examine the prediction of relationship type on QoL across the 4 years.

Result

Older adults cared for by an adult‐child or multiple caregivers predicted increased risk for functional limitations after adjustment for their socio‐demographic and dementia status. The interaction between the type of relationship and education was significant, indicating that the effect of relationship types on functional limitations is not uniform across education levels.

Conclusion

The relationship type between care recipients and caregivers is linked to QoL changes, particularly with functional limitations in PLWD. Socio‐demographics such as education attainment might shape the influence of care‐recipient relationship type on changes in functional limitations over time.
Promoting Workforce for dementia care in India
Authors: Sivakumar Palanimuthu Thangaraju
Published: December 2023

The population of older adults in India is increasing rapidly with the recent population estimate in 2022 indicating the population of older adults aged 60 years and above in India as 142 million. The prevalence of dementia in India is estimated as 8.8 million in 2016. More than 90% of persons with dementia remains undiagnosed and untreated. Majority of those getting diagnosed are likely to do so in the later stages of dementia. Specialized workforce for the care of persons with dementia is not available is most parts of India due to the scarcity of trained human resources as well as lack of specialized services. There is an urgent need to scale up the training of human resources in the public health system for promoting early diagnosis and intervention for persons with dementia as well as for risk reduction and prevention.

Training of Accredited Social Health Activists (ASHA), Community Health Officers and Primary Care Physicians is essential to promote early diagnosis of dementia in the primary care as there is higher prevalence of dementia in rural areas. Expanding the focus of National Mental Health Program (NMHP) and National Program for Health Care of Elderly (NPHCE) to include dementia as an important component is required to enable secondary level care at the district level. The training of the multi‐disciplinary team comprising Psychiatrist, Psychologist, Social Worker in the NMHP and the Physician, Multipurpose Health Worker, Nurse in the NPHCE can augment the workforce for dementia care across the country.

Development of specialized training courses in Geriatric Psychiatry, increase in the postgraduate training opportunities in Psychiatry, Neurology and Geriatric Medicine can also strengthen the human resources in tertiary care. Training of other stakeholders and promoting task sharing approach is essential in the low resource settings like India. This presentation will review the status of workforce development for dementia care in India and discuss the model initiatives implemented in the Geriatric Psychiatry Unit at National Institute of Mental Health and Neurosciences, Bengaluru to promote the workforce for dementia care.