bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insights from Alzheimer’s Disease Multimodal Screening and Prevention Strategies in Egyptian Healthcare Institutions: A Systematic Literature Review
Authors: Haitham Youssef , Ismail Youssef A. , Walid Mohammad , Mohamed Hazim , El‐Satar Youssef M. Abd 
Published: January 2025

AbstractBackgroundAlzheimer’s Disease (AD) is a progressive, incurable neurological condition that is the most common cause of dementia. Five percent of people aged 65 to 74, 13.1% of people aged 75 to 84, and 33.3% of people aged 85 or older have AD, according to 2023 statistics. Due to the lack of scientific data comparing the success and cost‐effectiveness of screening programs and trial recruiting strategies, the main goal of this paper is to determine the existence and quality of AD screening (if existed) in Egypt, including how often it’s done, how common it is and how much information is known about the importance of AD screening among both healthcare professionals and the general public.MethodsWe reviewed database searches through November 2023 in MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials; and additional searches for ongoing trials through ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and Current Controlled Trials (ISRCTN Register). We also investigated healthcare units in Port Said, Ismailia and some units in Cairo about typical AD screening programs that have been established or scheduled to be initiated in the future.ResultsHealthcare units investigations show that the AD screening program has not been established yet and isn’t scheduled for any future dates. There was no previous history of screening programs being held in Egypt in any digital database. AD screening programs are a crucial part of regular public health awareness, especially for elderly individuals that are particularly vulnerable to its effects and are affected by it at a disproportionately high level compared to other people.ConclusionWe could not find any solid evidence on the previous existence of any AD screening programs in Egypt. Further investigations are required to drive conclusive decisions about the quality of screening programs in Egypt.
Dementia, Mild Cognitive Impairment and Ambulatory Care Utilization
Authors: Chen Yi , James Bryan D , Capuano Ana W. , Banerjee Mousumi , Springer Mellanie , Bynum Julie , Grodstein Francine 
Published: January 2025

AbstractBackgroundDementia is underdiagnosed by the healthcare system, and MCI is rarely identified. Thus, while interventions to reduce cognitive decline are becoming increasingly available, it is not clear how appropriate individuals will be evaluated for treatment opportunities. A first step to improving diagnosis is understanding how older individuals with dementia or MCI interact with the healthcare system, especially ambulatory evaluation and management (E&M) visits, the backbone of healthcare.MethodWe investigated 2,116 community‐dwelling participants in four cohorts at the Rush Alzheimer’s Disease Center, all with linked Medicare Fee‐for‐Service claims. Each year from 2011‐19, we classified participants as no cognitive impairment (NCI), MCI, or dementia, based on their annual cohort evaluation; we then compared number of ambulatory E&M visits in claims over the next year across groups, controlled for demographics and comorbidities, using repeated measures generalized Poisson mixed effect models. We also considered annual likelihood of visiting different provider specialties, using logistic mixed effect models.ResultWe included 8,672 person‐years (PY) of followup: 76% with NCI, 17% with MCI, and 7% with dementia. Average age over followup was 82 years, and 24% of PY was among Black participants; mean number of ambulatory E&M visits was 9.7/year (SD 6.9). Dementia was strongly associated with fewer E&M visits (23% fewer visits/year, p<0.001) but changes began even in MCI, which was associated with about 5% fewer visits (p = 0.02), compared to NCI. Participants with dementia and MCI were more likely to visit a dementia‐related specialist (odds ratio [OR] = 1.9, p<0.0001 for MCI; OR = 1.8, p = 0.009 for dementia) than those with NCI, although only a small minority (<30%) saw these specialists. Further, both dementia (OR = 0.2, p<0.0001) and MCI (OR = 0.6, p = 0.0001) were related to substantially lower likelihood of seeing any other medical specialist, indicating that even those with MCI were not receiving the full spectrum of healthcare.ConclusionImpaired cognition was associated with fewer ambulatory E&M visits, and less complexity in healthcare; while these results were strongest for dementia, alterations appeared even with MCI. Finding ways to improve ambulatory care utilization for those with cognitive impairment is critical to identifying and supporting individuals who can benefit from treatment interventions.
The Effect of Upward Educational Mobility on Cognitive Performance Among Older Adults: A Comparison Between Mexico and South Africa
Authors: Meza Erika 
Published: January 2025

AbstractBackgroundUpward socioeconomic trajectories across the life course have been protectively associated with late‐life cognitive outcomes. However, few studies have explored this association in low‐ and middle‐income countries (LMICs). Our study examines how upward educational mobility affects cognitive performance in nationally representative samples of older adults in Mexico and South Africa, two LMICs with a history of social and economic disadvantages and different educational transformations.MethodData were from two nationally representative samples of adults 50 years and older, the Mexican Health and Aging Study (MHAS), the Health and Aging in Africa Longitudinal Study in South Africa (HAALSI), and their harmonized cognitive aging ancillary studies, Mex‐Cog and HAALSI‐Dementia. We used linear regression models to evaluate the relationship between upward educational mobility in adjacent generations (i.e., first‐generation to receive a formal education) and cognitive performance (i.e., orientation, executive function, language, memory, and global cognitive domains).ResultOur study included 1,031 participants whose parents did not receive any formal education; most were female (58%), and on average Mex‐Cog participants (n = 584) were slightly younger (mean: 69; sd: 9.3) than HAALSI‐dementia participants (n = 447; mean: 72; sd: 11.3). Among individuals whose parents did not receive a formal education, participants who received some education (i.e., upwardly mobile) had higher cognitive performance scores at baseline. Adjusting for age and sex, upwardly mobile individuals had 0.52 (95% CI: 0.42, 0.63) higher orientation, 0.39 (95% CI: 0.29, 0.48) higher language, and 0.37 (95% CI: 0.29, 0.46) higher memory performance in both cohorts. Greater benefits of upward educational mobility on executive function and global cognitive performance were observed for Mex‐Cog participants (B: 0.79; 95% CI: 0.67, 0.92 and B: 0.66; 95% CI: 0.54, 0.78, respectively) compared to their HAALSI‐dementia counterparts (B: 0.44; 95% CI: 0.33, 0.56 and B: 0.51; 95% CI: 0.39, 0.62).ConclusionOur findings emphasize the impact of greater access to educational opportunities on late‐life cognitive performance and the importance of contextualizing educational transformational benefits in different settings.
Recruitment Strategies and Preliminary Results from the IPAT Study
Authors: Zaenglein Jordan , Hall Tristyn , McGregor Margaret , Tomlinson Anna , Reagin Christopher , Mathison Stephen , Rivera‐Torres Solymar , Zhang Rong 
Published: January 2025

AbstractBackgroundThe Impact of Intensive Treatment of Systolic Blood Pressure on Brain Perfusion, Amyloid and Tau in Older Adults (IPAT) is an ongoing randomized control trial (RCT) for prevention of Alzheimer’s disease (AD) (NCT05331144). The primary outcome of the trial is to assess the impact of intensive lowering of high systolic blood pressure (SBP) on the accumulation of brain amyloid in older adults for a study duration of 2 years. Study recruitment started on October 25th of 2022 and will end in September of 2025. The goal is to enroll 180 participants. Inclusionary criteria include participants who are between the ages of 60 and 85 and have a systolic blood pressure (SPB) of 130mmHg or greater. Exclusionary criteria include those who have a history of major cerebrovascular disease, a diagnosis of Alzheimer’s disease and related dementias (ADRD), other major neurologic diseases, or cannot perform MRI.MethodsA multimodal recruitment approach was implemented which includes hospital databases, virtual sources, referrals, and community outreach activities (Table 1). The recruitment response yield, scheduled consent visit yield, and randomization yield from October 2022 to December 2023 were analyzed across the recruitment source subgroups.ResultsThe total recruitment response was 718 potential participants. Out of 718 potential participants, 77 individuals had an informed consent appointment scheduled (10.7%) and 23 of the 718 individuals were randomized (3.2%). The source subset that produced the highest yield for total recruitment response was hospital databases (67%). The source subset that produced the highest yield for consent visits scheduled was hospital databases (68%). The source subset that produced the highest yield for randomizations was hospital databases (56%) (Figure 1).ConclusionsThe IPAT Study had a success with total recruitment yield from the hospital database sources, but less success with virtual resources, referrals, and community outreach activities. However, a multimodal recruitment approach is essential to meet the overall enrollment goal of the project.
Association of moderate and vigorous physical activity with cognitive performance: results from the ELSI‐Brasil Study
Authors: Martins‐Pais Ingryd Mayara Nascimento , Rabelo Wendell Lima , Vidal‐Ferreira Naomi , Ferri Cleusa P , Suemoto Claudia Kimie , Gonçalves Natalia G 
Published: January 2025

AbstractBackgroundModerate physical activity (PA) is considered one of the main protective factors for the risk of dementia. It is estimated that 1.6% of dementia cases worldwide could be prevented with increases in physical activity. However, there is little evidence of the association between vigorous physical activity and cognitive performance. Therefore, this study aimed to investigate the association between moderate and vigorous physical activity and cognitive performance in older adults from the Brazilian Longitudinal Study of Aging (ELSI‐Brasil).MethodThe sample included 9,412 adults 50 years or older from the Brazilian Longitudinal Study of Aging. Cognitive performance evaluated the memory, temporal orientation, and verbal fluency domains. A global composite z‐score was derived from the tests. PA was assessed using the International Physical Activity Questionnaire. We used linear regression models to verify the association of moderate and vigorous physical activity with cognitive performance.ResultAfter exclusions, a total of 7,954 participants remained. Mean age was 61.8±9,2 years, 61.8% were women, 44.3% were mixed, 36.4% practiced at least 150 minutes of moderate physical activity, and 21.1% practiced at least 75 minutes of vigorous physical activity (Table 1). Compared to participants who did not meet the guideline for moderate PA (less than 150 minutes/week), those who met the guidelines (150 to 299 min/week) and those who performed more than 2x the recommended amount of moderate PA (300 minutes or more/week) had better global cognitive performance (β = 0.174, 95% CI = 0.097;0.250, p<0.001; β = 0.196, 95% CI = 0.124;0.268, p<0.001, respectively) (Figure 1). We found no association between vigorous PA and cognitive performance (Figure 1).ConclusionWhile performing 150 minutes/week or more of moderate PA was associated with better cognitive performance, there was no additional benefit of vigorous PA for cognitive performance.
Long‐term cost‐effectiveness of collaborative dementia care for persons living alone versus those living with a caregiver in Germany
Authors: Michalowsky Bernhard , Platen Moritz , Blotenberg Iris , Teipel Stefan , Thyrian Jochen René , Hoffmann Wolfgang 
Published: January 2025

AbstractBackgroundPrevious trials reported that collaborative Dementia Care Management (cDCM) could be cost‐effective in the short term, especially for those living alone. However, long‐term evidence is lacking. Therefore, the study’s objective was to determine the long‐term efficacy and cost‐effectiveness of cDCM in those living alone compared to those living with a caregiver. compared with usual care.MethodA General Practitioner (GP)‐based, cluster‐randomized‐controlled intervention trial (DelpHi‐MV) was conducted. Participating GP practices were randomly allocated to one of two arms (care as usual or cDCM). Participants were included if they were 70 years or older, living at home, and screened positive for dementia. Participants of the intervention group received a comprehensive needs assessment and individualized interventions by nurses specifically qualified for dementia collaborating with GPs and healthcare stakeholders over six months. Controls received usual care. We conducted a subgroup analyses separating the sample into those living alone versus those living not alone. Health‐Related Quality of Life (SF‐6D), Quality‐adjusted life years, and resource used were assessed at baseline, 12, 24 and 36 months.Result428 (n = 303 cDCM, n = 125 usual care) participants were included in the analysis. Based on multivariate regression models adjusted for baseline scores, cDCM was more cost‐effective in PlwD living alone. Compared to controls, the gain in QALY (alone: +0.224 [95% CI 0.03 to 0.42], p = 0.027; not alone: 0.079 [95% CI ‐0.11 to 0.27], p<0.417), savings in costs (alone: ‐3,815 [‐12,573 to 5,982], p = 0.485; not alone: 3,283 [‐3,514 to 11,121], p = 0.307), and the probability of cost‐effectiveness at WTP 40.000€/QALY was significantly higher in PlwD living alone (92% vs 32%). Differences in costs were especially due to a trend for delayed institutionalization in the first and second year for those living alone.ConclusioncDCM is cost‐effective in the long term beyond the intervention or short‐term periods, improving patients HRQoL and reducing costs in those living alone. Therefore, should become a health policy priority and translated into routine care practice. Whether cDCM more likely leads to better‐prepared institutionalization should be investigated in future research to support the community‐dwelling living situation as long as possible and make institutionalizations as smooth as possible.
Living alone with dementia in Japan: challenges and policies
Authors: Awata Shuichi 
Published: January 2025

AbstractBackgroundDue to declining birthrate and increasing longevity, the number of older people living alone with cognitive impairment is rapidly increasing in Japan. They have a lot of challenges in terms of health, housing, finance, daily life and protection of rights, all of which should be clarified to create inclusive, equitable, and sustainable super‐aged societies.MethodsA series of factual investigation was conducted using existing statical materials, community‐based epidemiological studies, clinic‐based case studies, and literature reviews.ResultsAccording to the national prevalence rate of dementia and the future population estimate by household type, the percentage of older people living alone with dementia were estimated to increase with age, particularly in female; those in oldest‐old population aged 85 years and more were estimated to be 7% in male and 14% in female in 2025 and rapidly increase during the first half of 21th century. A series of factual investigations suggested that older people living alone with cognitive impairment were more likely to feel lonely, have poor nutritional status, become victims of fraud and natural disasters, die after missing, and experience disruption of continuous living in a community. “Community Space”, the places where older people are able to stay freely and comfortably in a community, may contribute to improve accessibility to health and social care services. In addition to public advocacy systems such as the adult gurdian system, every service provider, prticularly health and social care service providers, should learn the skill for decision support. Public‐private partnership should be promoted to prevail rational accommodation in social environment.ConclusionThe national and local governments should formulate comprehensive policies to ensure human rights of older people living alone with cognitive impairment in a community. The first version of the guidance to create social environment to support the lives of older people living alone with cognitive impairment was published in Japan.
An intervention to support persons living alone with cognitive impairment in the United States
Authors: Gibson Allison 
Published: January 2025

AbstractBackgroundAlthough most individuals experiencing cognitive impairment reside with another, as many as one third may live alone. Such individuals may have difficulty managing their health and wellbeing. Further, they may be more isolated from healthcare and social services. Developing strategies to circumvent premature institutional placement and reduce use of emergency services is vital to keeping healthcare expenditures lower, and also recognizes the needs of individual’s safety, autonomy, and quality‐of‐life.MethodsThis study utilized a single‐arm, non‐randomized trial design. This proof‐of‐concept study aimed to establish feasibility of Services To Age in Your Home (STAY Home) service utilization and care management intervention to improve utilization of healthcare and social support services for persons living alone with cognitive impairment. The intervention implemented one session weekly for twelve weeks through in‐person visits by a team of social workers and student interns of approximately one hour. Potential participants underwent cognitive screenings, the Adapted Informed Consent Questionnaire, and the informed consent process was repeated every 30 days to try to ensure that participants were appropriate to participate. The primary outcome was to increase healthcare and social service utilization. Exploratory outcomes examined social support and biopsychosocial needs.ResultsOf the 12 participants, individuals reported limited, non‐traditional forms of social support. Analyses of the data demonstrate a significant need for this population to link those living alone with cognitive impairment to healthcare and social services (pre‐intervention only 42% had been seen by a social serivce provider in the last year; only 33% had seen a healthcare provider in the last year). Analyses demonstrate the intervention is feasible with high adherence to weekly visits (75%). While the study was not powered to compare secondary outcomes, quality‐of‐life increased for participants from pre‐ to post‐intervention (pre‐intervention x̄ = 2.7; post‐intervention x̄ = 3.3; p‐value = 0.01).ConclusionWhile many participants were willing to engage in the pilot program, additional barriers contributed to utilizing health and social services. Future studies must continue to explore potential solutions for this difficult‐to‐support population. In addition to increasing access to healthcare and support services, participants may also benefit from a medication adherence component to the intervention.
Effect of intentional weight loss through dietary intervention on cognition: The MIND Trial Study
Authors: Dhana Klodian , Ventrelle Jennifer , Carey Vincent J , Aggarwal Neelum T. , Arfanakis Konstantions , Sacks Frank , Barnes Lisa L. 
Published: January 2025

AbstractBackgroundWith the increasing prevalence of obesity and its negative consequences on health, weight management has emerged as a priority for public health. We conducted a study to investigate the association of intentional weight loss through dietary intervention on cognition among older adults participating in the MIND trial.MethodMIND trial enrolled overweight older adults aged 65‐85 years with a family history of dementia but without cognitive impairment and self‐reporting a suboptimal diet. Participants were randomized to the MIND diet or a control (usual) diet for 3 years; both diets promoted weight loss through mild caloric restriction. Of 604 individuals enrolled in the MIND trial, 520 had measured weight at the baseline and year 3 visit and were included in the analysis. We computed the percentage of weight loss based on baseline and last assessment and grouped individuals into 4 categories: weight gainers, <5% weight loss, 5‐10% weight loss, and >10% weight loss. Linear mixed‐effect models were used to estimate the 3‐year change in global cognitive scores. Models were adjusted by age, sex, race, apolipoprotein E (APOE) e4 allele, baseline BMI, and dietary assignment.ResultThe mean age was 70 years, 65% were women, and the mean BMI was 34 kg/m2. During 3 years of dietary intervention, 78.5% of participants lost weight. The average weight loss ranged from 2.3 kg to 15kg. Compared to people who gained weight, those with >10% weight loss significantly improved their cognitive scores by 0.103 SD/units (95%CI 0.008, 0.199) at year 3 visit. In addition, individuals who lost weight had improved plasma levels of inflammation, lipids, and glucose during the trial period. Among people in the MIND diet group, those with >10% weight loss significantly improved their cognitive scores by 0.171 SD/units (95%CI 0.028, 0.314) compared to people who gained weight; there was no significant association in the control diet group.ConclusionAmong overweight and cognitively unimpaired individuals at the baseline with a family history of dementia, a weight loss of 10% (average 15 kg) or more during 3 years of dietary interventions was associated with improved cognitive scores when compared to people who gained weight.