bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying the eHealth Literacy lens to evaluate a virtual assistant to support family carers of people with dementia
Authors: Nguyen Tuan Anh 
Published: January 2025

AbstractBackgroundWe have co‐produced with carers of people with dementia (hereafter carers) a culturally tailored iSupport Virtual Assistant (VA), namely e‐DiVA, to support English‐, Bahasa‐ and Vietnamese‐speaking carers in Australia, Indonesia, New Zealand and Vietnam. The presented research reports qualitative findings from the e‐DiVA user‐testing study.MethodFamily carers and healthcare professionals working in the field of dementia care were given the e‐DiVA to use on their smartphone or handheld device for 1‐2 weeks. They tested all functions and content of the VA and provided feedback in a ‘Think‐aloud’ session, either in person or online. Data was analysed thematically, guided by the eHealth Literacy Framework (eHLF).ResultEighteen family carers and nine staff of aged care providers were recruited. Participants discussed all seven domains of eHLF, which were evidenced in the e‐DiVA. They include: 1) ability to process information, i.e. the VA contains information in a format that can easily be understood, e.g. animations; 2) engagement in own health, i.e. providing tailored lessons through need assessments and ‘chatbot’; 3) ability to engage actively with digital services, i.e. providing user manuals; 4) feeling safe and in control; i.e. secure login; 5) motivation to engage with digital services, i.e. providing quick responses/solutions to carers’ queries; 6) having access to systems that work, i.e. ability to access to the VA anytime anywhere; and 7) digital services that suit individual needs, i.e. available in users’ preferred language. Participants highly ranked domains 1, 2 and 5. They suggested further improvements including making content into audiobooks and messages (domain 1), as well as pointed out some potential barriers to use, especially on domains that require interactions between individuals and the digital system (domains 3, 5 and 7).ConclusionFindings show the high acceptance of the VA by both the carers and aged care providers, as well as a need for enhancement to improve accessibility.
Effectiveness of an intervention program to improve the detection of cognitive impairment in LMIC setting
Authors: Llibre‐Rodriguez Juan J. , Rodriguez‐Velasco Arianne , Gutierrez‐Herrera Raul , Almirall‐Sanchez Arianna , Zayas‐Llerena Tania , Guerra‐Hernandez Milagros , Llibre‐Guerra Jorge J. ,   DAVOS Alzheimer Collaborative
Published: January 2025

AbstractBackgroundWhile two‐thirds of the 57 million people with dementia worldwide live in low‐ and middle‐income countries, research to inform dementia‐related policy in these regions remains scarce. We aimed to increase early dementia diagnosis and the use of standardized cognitive assessment by PCP in primary care settings in CubaMethodWe selected 16 Primary care clinics, with an estimated 160‐200 providers. Clinics were carefully paired based on a number of providers, population demographics, and baseline rates of cognitive impairment diagnosis before being randomized into two groups: one to receive a targeted intervention and the other to continue with usual care practices. The target intervention included a dementia training program and methods for cognitive assessment. A questionnaire about attitudes and practices towards the use of technology‐screening tools, diagnosis, and management of cognitive impairment in primary care was applied to GP at the beginning of the study, 6 months and 12 after training course. The primary endpoint was change in dementia diagnosis rates 12 months after the target intervention.ResultCompared with the usual care group, the intervention group showed significant statistical improvement in the level of confidence in their ability to engage in key aspects of the neurocognitive evaluation, perform memory screening in older people during annual health visits, and confidence during cognitive evaluation. In addition, the intervention group showed significant improvement in interpreting the diagnostic test (χ² = 8.022; p‐value = 0.004), selecting which test is appropriate (χ² = 10.756; p‐value = 0.001) and familiarity with diagnostic criteria for different forms of dementia. In the intervention group, the frequency of PCP cognitive diagnoses (primary outcome) and referrals to memory specialists increase by 141% relative to baseline, and the use of standardized cognitive assessment for annual cognitive evaluation increased by 83%. The overall prevalence of dementia at selected primary care clinics was 10.6% (95% CI, 9.3%‐12.8%).ConclusionThis study confirms the feasibility of training primary care physicians (PCPs) for the early detection, treatment, and support of individuals with dementia and their families.
Dementia Research Priorities in Low‐ and Middle‐income Countries in Southeast Asia: A scoping review of the literature and nominal group technique outcome
Authors: Mattap Siti Maisarah , Mohan Devi , Xi Hoon Jia , Ramachandram Dinesh Sangarran , Turana Yuda , Tan Maw Pin , Nguyen Tuan Anh , Wong Gloria HY , Anlacan Veeda Michelle M. , Suharya DY , Moloney Susan , Robinson Louise 
Published: January 2025

AbstractBackgroundDementia is a global public health concern, that poses daily challenges to the individuals, families, and healthcare systems worldwide. Sixty percent of those affected reside in low‐ and middle‐income countries (LMICs), where 71% of new cases are anticipated by 2025. Most dementia studies focus on high‐income countries, emphasizing the need for region‐specific investigations in areas like Southeast Asia, where diverse cultural, economic, and healthcare settings present unique complexities. Addressing specific challenges and priorities in Southeast Asia will facilitate tailored interventions and effective strategies. We aim to map dementia research priorities in Southeast Asian LMICs and align them with stakeholder‐identified priorities through a consultation process using the nominal group technique.MethodA scoping review was conducted utilizing the Joanna Briggs Institute guidance. Four databases (OvidMedline, Scopus, PsycINFO, and CINAHL) were searched for eligible studies reporting dementia research priorities in LMICs in Southeast Asian. Comparisons were made to a stakeholders’ consultation during a two‐day workshop from the 9th to 10th February 2023 in Kuala Lumpur, Malaysia. Participants included the Southeast Asia‐Dementia (SEA‐Dem) Research Network members key stakeholders from Malaysia, Indonesia, Vietnam, Philippines, Singapore, and Hong Kong (n = 20). Research priorities from each participating country were generated and ranked, harmonized with those from the nominal group technique into tiers of priorities.ResultOnly two studies from Malaysia and Vietnam were eligible, reporting unranked research priorities. Nominal group technique ranked outcomes from Malaysia, Vietnam, Indonesia, and the Philippines were included. Top dementia research priorities were (1) local research and data collection capacity, (2) community awareness and engagement, and (3) health policy. Second‐tier research priorities included harmonizing guidelines and tools standardization, health inequalities, and availability of carer support. The third tier comprised multisectoral collaboration, integration of care, telemedicine, digital approaches, dementia risk reduction, health economics, and sustainable interventions.ConclusionOur ranked and harmonized latest dementia research priorities list can serve as a more nuanced and contextually informed dementia research directional guide for countries with similar backgrounds. Collaborative efforts to increase high‐quality dementia research capacity in Southeast Asian LMICs should be intensified for better dementia care in the region.
Trajectory patterns of behavioral and psychological symptoms of dementia (BPSD) in long‐term care facility residents in Japan and the United States
Authors: Arai Asuna , Katsumata Yuriko 
Published: January 2025

AbstractBackgroundBehavioral and psychological symptoms of people living with dementia (BPSD) are considered to reflect the person’s quality of life and are also risk factors for increased burden on caregivers. Although symptoms of BPSD are known to be diverse and variable, it is unclear whether they show similar longitudinal patterns in different countries. Therefore, this study aimed to clarify the trajectory patterns in BPSD and related factors using data from Japan and the US and compare the results of the two countries.MethodUsing cohort study dataset that were followed up approximately annually in Japan and the US, we extracted data for four waves since 2015. In the US data drawn from the study at National Alzheimer’s Coordinating Center (NACC), long‐term care facilities included two categories such as the assisted living, adult family home, or boarding home, and skilled nursing facility, nursing homes or hospitals. In the Japanese data, long‐term care facilities were categorized into three types including adult group home for people with dementia, long‐term care health facility, and intensive care home for the elderly. A group‐based multi‐trajectory modeling was used to identify the longitudinal patterns of 12 BPSD symptoms over time. We also examined the characteristics of the participants belonging to each trajectory group.ResultThe long‐term care facility residents used for analysis were 480 in Japan and 164 in the US. Three trajectory groups of BPSD were identified among the participants both in Japan and the US. When comparing between two countries, the trajectories of these groups showed similar patterns. Factors associated with the probability of group membership tended to differ by group and also by country.ConclusionWe identified three similar trajectory groups of BPSD in Japan and US long‐term care facility residents. It is suggested that the different backgrounds between countries did not have a great impact on the longitudinal pattern of multiple BPSD symptoms. It would be possible for Japan and the US to consider the BPSD preventive measures for residents in the long‐term care facilities in a common framework.
The role of primary care: An engagement study to improve evaluation of possible Alzheimer’s disease and related disorders at the entry point for patients in a large health system
Authors: Gaster Barak , Raetz Jaqueline G. , McKiddy Sarah , Suchsland Monica Zigman , Hsu Amy P , Fitzpatrick Annette L. , Belza Basia , Liao Joshua M. 
Published: January 2025

AbstractBackgroundThe number of people with Alzheimer’s disease and related disorders (ADRD) is increasing. As a result, the role of primary care providers (PCPs) to detect ADRD is increasingly important. Early detection requires that PCPs are adequately trained to perform clinical evaluations, and health systems will require more knowledgeable PCPs to effectively collaborate with specialists to achieve the capacity needed to diagnose and manage ADRD.MethodWith support of the Davos Alzheimer’s Collaborative, we developed a web‐training curriculum which was paired with tools integrated into the electronic health record (EHR). This intervention was implemented across a network of 14 community‐based primary care clinics from October 2022 to March 2023. PCPs in the network are primarily clinical, spending <5% of their time teaching or doing research. Patients in the network come from diverse backgrounds (41% non‐white). Data was extracted from the EHR to assess PCPs’ use of the tools and the number of cognitive evaluations performed. PCPs also received surveys measuring their confidence subscale for dementia.ResultAll 153 PCPs in the network received access to the EHR tools. Their use of the tools gradually increased, rising to a frequency of 195 patient encounters in the final three‐months of the study period (Figure‐1). The number of cognitive tests entered into the EHR increased from 0.9 to 4.7 per 1000 patient visits >age 50 (p<0.01) (Figure‐2). Fifty PCPs completed the before and after training survey. Their mean reported ADRD‐related clinical confidence subscore increased from 2.54 to 3.74 (p<0.01).ConclusionThis PCP engagement intervention was effective when implemented across a large health system and was associated with more diagnostic cognitive evaluations and increased confidence in ADRD‐related ability by PCPs. As health systems experience growing pressures to meet the needs of patients with ADRD, they will increasingly require programs like this to educate and engage PCPs. This program is designed to be easy to disseminate to other health systems, a process currently underway via recorded trainings and downloaded EHR tools, in order to train PCPs to be both the initial points to begin evaluations and the effective continuity‐collaborators which health systems need.
Activity Diversity and Its Association with Cognitive Function at Baseline in the U.S. POINTER Study
Authors: Leng Xiaoyan , Howard Marjorie , Halloway Shannon , Farias Sarah Tomaszewski , Lee Athene KW , Papp Kathryn V , Baker Laura D , Snyder Heather M , Espeland Mark A. 
Published: January 2025

AbstractBackgroundRecent cross‐sectional and longitudinal studies have shown that higher activity diversity ‐ defined as richness and evenness of daily activities are beneficial to older adults’ cognitive performance. This benefit is independent of frequency or level of cognitive challenge or physical activity.MethodA total of 1688 participants from the U.S. Study to Protect Brain Health through Lifestyle Intervention to Reduce Risk with physical, mental and social activities and cognitive outcomes (global, episodic memory, executive function and processing speed composite scores) measured at the baseline were included in this analysis. The sample was characterized by a mean age of 68.4 (SD: 5.2), 66.9% female, 29.6% less than college education and 33.6% non‐white. A total of 41 activities (11 mental, 21 physical and 10 social activities) are included to evaluate total, mental, social and physical activity diversity based on Shannon’s entropy (0 as no diversity and 1 as full diversity). Walking to do errands (e.g., take children to school or to/from a store) is considered both physical and social. A sequential multiple linear regression models were used to examine associations between activity diversities and cognitive outcomes, adjusted for (model 1) age, sex, race/ethnicity, education, area deprivation index national rank (ADI), and (model 2) additionally self‐reported general health, Framingham cardiovascular disease 10‐year Risk Score, depression (Geriatric Depression Scale total score) and finally (model 3) adding cognitive activity frequency (times/week).ResultHigher total activity diversity is associated with better executive function in models 1 and 2 (p <0.0344) and the association was attenuated when adding cognitive activity frequency as in model 3 (p = 0.0594). Total activity diversity is not associated with global cognition, or episodic memory or processing speed. Higher mental activity diversity is associated with higher global cognition (p<0.0001), episodic memory (p <0.0003) and executive function (p < 0.0001) in all three models, but not processing speed (p >0.2432).ConclusionThese results indicate that cognitive activity diversity is associated with cognitive function in older adults at risk of cognitive decline, which is independent of other risk factors and frequency of cognitive activities.
Implementation of a standardized Video‐based Asynchronous Neurological Examination (VANE) in a multi‐center study of AD/ADRD: Findings from The Diabetes Prevention Program Outcomes Study (DPPOS) AD/ADRD Project
Authors: Noble James M. , Nadkarni Neelesh , Martinez Dianilka , Temprosa Marinella , Bowers Anna , Doherty Lindsay , Febres Gerardo J , Sanchez Danurys , Goldberg Terry E. , Sherif Hanna , Luchsinger Jose A. ,   Diabetes Prevention Program Research Group
Published: January 2025

AbstractBackgroundThe Diabetes Prevention Program Outcomes Study (DPPOS) is an established cohort of aging persons (mean age 72 years) with prediabetes and diabetes with a mean of 23 (range 21‐25) years of follow‐up. DPPOS added neuropsychological testing using the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDSv3) forms. Using the NACC UDS required implementing a standardized neurological examination across 25 US clinical sites, administered by project coordinators (PC).MethodsA video‐based asynchronous neurological examination (VANE) was developed by clinicians with experience in the NACC‐UDS to harmonize with UDSv3 to anticipate common neurological diagnoses aside from dementia including diabetic cranial neuropathy, stroke and Parkinsonism. VANE was designed to be contactless, reproducible, to be administered by non‐clinicians, such as PCs. Using standard iPad software connected to a secure repository, the video exam includes extraocular and facial movements, visual field, speech (“Cookie‐theft”), gross motor strength, pronator drift, praxis and Parkinsonism (i.e. the Unified Parkinson’s Disease Rating Scale modeled examination as in UDSv3, including assessment of tremors, bradykinesia, finger and foot tapping, hand movements, postural stability and gait). Rigidity and pull‐testing were not included. A 10‐minute training video was developed for study staff, which demonstrates the examination step‐by‐step with scripts and video instructions in English and Spanish. Site‐specific performance review, feedback, and staff certification preceded central reading of video recordings by three physicians.ResultsDuring calendar year 2023, 608 neurological examinations occurred at 25 sites, each lasting 10 to 15 minutes. Each site on average completed 24 examinations (SD = 13.0, range 3‐48). Of the initial 442 examinations reviewed, 406 (91%) were completed using the script provided, 421 (95%) were error‐free, and 3 (0.6%) were non‐interpretable. Abnormal findings were noted in 153 participants (2% Parkinsonism, 1% cerebrovascular disease and 31% other neurological abnormalities). Suboptimal exams occurred at 10 of 25 sites (range 1‐4 per site) early in implementation.ConclusionsEngaging research staff across 25 sites, and three physician‐reviewers, this study is the first to implement VANE as an efficient neurological examination model. VANE presents a novel paradigm for large multisite epidemiological studies considering incorporating neurological examinations conducted by non‐clinicians.
Investigation of Brain Signatures Across Diverse Metabolic States in MCI
Authors: Anagnostakis Filippos , Govindarajan Sindhuja Tirumalai , Mamourian Elizabeth , Erus Guray , Melhem Randa , Cui Yuhan , Abdulkadir Ahmed , Tosun Duygu , Shou Haochang , Nasrallah Ilya M. , Davatzikos Christos 
Published: January 2025

AbstractBackgroundLate‐life obesity has been reported to have a negative relationship with risk for dementia and has been associated with lower risk of incident Alzheimer’s disease (AD) in non‐demented individuals. However, associations of obesity and cognition solely in patients with mild cognitive impairment (MCI) is unknown. These associations may be confounded by vascular risk that contributes to metabolic syndrome (MetS). This study investigates the complex interplay between obesity, metabolic syndrome, and neurodegeneration in MCI. We analyze neuroimaging measures, AD biomarkers including amyloid‐beta (Aβ) and tau levels in the cerebrospinal fluid (CSF), and a machine‐learning based imaging signature of AD‐like brain atrophy (the SPARE‐AD index) in distinct metabolic subgroups.MethodsThis study included N = 705 MCI patients (age = 75.3+‐7 years, 61% females) scanned with a median follow‐up interval of 30.3 months from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). N = 139 participants developed dementia. Participants were categorized as metabolic healthy (MH, N = 126) or unhealthy (MU, N = 579) based on MetS criteria, and further as normal weight (NW), overweight (OW), or obese (OB) based on their BMI. Risk of incident dementia among the metabolic states was evaluated using Cox regression. Volumetric brain changes, SPARE‐AD, and CSF total‐tau, p‐tau181, and Aβ1‐42 were analyzed separately using linear models with metabolic state as the predictor, corrected for APOE genotype, age, sex, education, and intracranial volume (volumetric data only). Results were corrected for multiple comparisons using the False Discovery Rate method.ResultsWhen compared to MH‐NW participants, only MU‐OB participants had a significantly lower risk for incident dementia (Hazard Ratio = 0.430, p<0.05), lower (more normal) SPARE‐AD (p = 0.029), total‐tau (p = 0.02) and p‐tau181 (p = 0.006). MU‐OB and MU‐OW participants had significantly higher volumes (p<0.05) of bilateral hippocampi, left temporal white matter, left posterior cingulate gyrus, and the right parahippocampal gyrus, and significantly lower volumes in the right anterior orbital gyrus. A similar pattern of was not observed in other subgroups.ConclusionObese MCI patients with MetS had lower incident dementia, less AD‐like brain shrinkage and more favorable AD biomarkers. Our findings suggest that the cognitive impairment in MU‐high BMI groups might originate from causes unrelated to AD, and might be related to the vascular and metabolic changes.
MIND diet, Cerebrovascular Health, and Cognition among community‐dwelling Older Adults
Authors: Agarwal Puja , Lamar Melissa , Kapasi Alifiya , Evia Arnold M , Aggarwal Neelum T. , Cherian Laurel J , Bennett David A. , Leurgans Sue E. , Arfanakis Konstantions , Schneider Julie A. 
Published: January 2025

AbstractBackgroundWhite matter hyperintensities (WMH) and cerebral arteriosclerosis involving thickening of the vessel wall and stenosis of brain arterioles are common in older adults and associated with poor cognition. The Mediterranean‐DASH Intervention for Neurodegenerative Disease (MIND) diet is associated with better cognition. Little is known about the association of the MIND diet with cerebrovascular outcomes and if this association mediates the link between diet and cognition. This study investigates the association of the MIND diet with WMH volume and arteriolosclerosis, and whether WMH and arteriosclerosis mediate the association between diet and cognition among community‐dwelling older adults.MethodThe study includes 561 participants from an ongoing longitudinal cohort study, the Rush Memory and Aging Project with dietary and neuroimaging data available no more than a year apart. MIND diet scores were obtained using a valid >142‐item food frequency questionnaire. In‐vivo magnetic resonance imaging (MRI) data were collected using a 3T MRI scanner. WMH were segmented using a deep learning model. Arteriolosclerosis was assessed employing a fully automated in‐vivo MRI‐based marker named ARTS (ARTerioloSclerois). An ARTS score was generated for each participant (higher scores indicate a higher likelihood of arteriolosclerosis). Global cognition was assessed using 19‐battery tests. Linear regression models controlled for age, sex, MRI scanner, and education. Mediation analysis was done using structural equation modeling.ResultIn our analytical sample (mean age (81 ± 7.5), 77% female, 16 ± 2.9 years of education a higher MIND diet score was associated with less WMH (β = ‐0.023, SE = 0.009, p = 0.015) and lower ARTS score (β = ‐0.013, SE = 0.004, p = 0.001). The effect estimates were stable when further controlled for BMI and physical activity. The MIND diet was associated with better global cognition (β = 0.0426, SE = 0.012, p = 0.0004), with an indirect association of 10.5% through ARTS score (β = 0.0045, SE = 0.0002, p = 0.038).ConclusionAmong community‐dwelling older adults a higher MIND diet score is associated with less WMH and a lower likelihood of small vessel arteriosclerosis. The association of the MIND diet with cognition is partially mediated by arteriosclerosis. Lifestyle approaches such as adherence to a specific diet may improve cognition by maintaining the cerebrovascular health of older adults.Fundings sources: R01AG054476; R01AG17917; R01AG076143