bluuebunny/crossref_metadata_2025_split huggingface dataset:
EEG‐guided anesthetic titration and perioperative cognitive disorders
Authors: Evered Lisbeth Anne 
Published: January 2025

AbstractBackgroundPostoperative delirium (POD) is a serious complication of surgery associated with prolonged hospitalisation, long‐term cognitive decline, dementia and mortality. There is increasing evidence that electroencephalography (EEG) monitoring may reduce the incidence of POD, however, the best method for achieving this is unclear.MethodThis presentation will present the results of a multicentre randomised clinical trial of 515 at‐risk patients undergoing major surgery from 8 centres in 3 countries who were assessed for POD for 5 days postoperatively. They also underwent cognitive screening at baseline, discharge, 30 days and one year postoperatively. Patients were assigned to light or deep anaesthesia. Additionally, this presentation will consider a meta‐analysis of available studies investigating EEG monitoring to prevent delirium and outline the importance of EEG spectrogram interpretation as part of EEG monitoring and consequent anesthetic titration when using this technique to reduce or prevent POD.ResultThe incidence of POD was lower (19%) in the light anesthesia group compared with the deep anesthesia group (28%) (OR 0.58 (95% CI 0.38 to 0.88), P=0.010). Meta‐analysis results were fragile and depended on inclusion criteria of studies. Interpretation of EEG spectrograms is a developing field, but adds significant, critical information.ConclusionEEG monitoring is a possible method for preventing POD and long‐term complications. EEG spectrogram interpretation will likely add critical information to enhance this technique.
Real‐World Data on the diagnosis of Alzheimer’s Disease in routine clinical practice: Insights from the Australian Dementia Network “ADNeT” Registry
Authors: Ward Stephanie Alison , Lin Xiaoping , Wallis Kasey , Brodaty Henry , Rowe Christopher C. , Masters Colin L. , Naismith Sharon L , Ahern Susannah 
Published: January 2025

AbstractReal‐world data on the uptake, effectiveness and safety of new diagnostics and disease‐modifying (DMT) treatments for Alzheimer’s Disease (AD) are imperative. This can be achieved through patient registries. A major challenge is how to embed registry data capture into routine clinical practice. To optimize coverage and maintain data contribution over time, registry participation needs to create maximal benefits, yet impose minimal burdens, on clinical sites.In the experience of the Australian Dementia Network (ADNeT) Registry, it has been the unique insights that clinicians obtain into their own diagnostic practices that has incentivised ongoing participation. The ADNeT Registry collects data primarily to measure the quality of diagnosis and clinical care provided to people with either mild cognitive impairment or dementia and was pragmatically designed to be utilized in multiple diagnostic settings and by different clinical craft groups. Clinicians enter a brief minimum dataset, based upon routine clinical data, at the time of diagnosis. These data are augmented by the ADNeT Registry’s collection of patients and/or carer‐reported experience and outcome measures and will be further augmented by planned linkage with administrative datasets.By January 2024, the ADNeT Registry had collected data on over 4000 participants, from 66 sites, had issued 4 benchmarked site reports, and published 2 annual reports. Of this cohort, 75% of people with dementia had an AD subtype. At the national level, considerable variation exists in diagnostic time intervals, and in the use of functional neuroimaging and biomarkers. At the individual site level, clinicians report regularly comparing their individual data against Registry benchmarked data to review, and if some cases, improve, their diagnostic approaches.The Registry’s explicit focus on supporting clinicians is further enhanced by broader achievements of ADNeT, including the publication of memory clinic guidelines, streamlined processes for accessing clinical trials, and appropriate use recommendations for DMTs. Collectively, ADNeT and the ADNeT Registry provides a strong foundation for additional data capture on DMT prescription, safety, and outcome measures, with a design that helps ensure that collected data are truly reflective of the “real‐world”.
Unravelling the challenges of dementia home care in India
Authors: Dasgupta Jayashree 
Published: January 2025

AbstractBackgroundIndia has a mixed public‐private healthcare system however most care is out‐of‐pocket. Despite projections that the older population is expected to rise from current 138 million to 194 million by 2031, services catering to the needs of people living with dementia remain limited. Ailing family members and older adults have traditionally been cared for in an intergenerational joint family system where members reside together. However, social transitions, including more women entering the workforce and migration, both within India and international migration, for better job opportunities, have led to changes in this traditional family system. This presents significant challenges for families as they end up providing majority of dementia care with limited professional support, limited knowledge and virtually no access to training, counseling and other support services.MethodsUsing a case study approach we describe the complexity of issues faced by Indian families. Cases were retrospectively sampled from families that availed services from an eldercare organization providing a range of services in Gurugram India, between Jan 2018 to March 2023. Using this approach, we specifically draw attention to 1) challenges faced by transnational Indian families when parents struggle to live independently 2) challenges faced by an only child due to limited dementia specific services 3) Dynamics within families as they navigate various aspects of decision making, finances and family relocation for dementia care.ResultsThis presentation will highlight important themes that emerge and focus on areas which need to be addressed whilst developing homecare services for dementia in India. In particular, we highlight the need for professionally delivered family support, eldercare services tailored to dementia, training for a dementia ready work force in India, and the role that technology plays in supporting dementia care.ConclusionsThis qualitative and experiential account provides impetus for further work to develop culturally appropriate strategies to support dementia care in India.
The long‐term impact of rugby, soccer and boxing participation on brain health in older adults from the general population: insights from the 1946 British birth cohort
Authors: Parker Thomas D , James Sarah‐Naomi , Keuss Sarah E , Keshavan Ashvini , Coath William , Cash David M , Lu Kirsty , Nicholas Jennifer M , Sudre Carole H , Crutch Sebastian J , Fox Nick C , Richards Marcus , Schott Jonathan M 
Published: January 2025

AbstractBackgroundIn elite athletes, participation in sports associated with repetitive head injury exposure has been linked to an increased risk of neurodegeneration later in life. However, there has been limited study in more general populations. We aimed to investigate whether participation in such sports impacted outcomes relevant to brain health in a cohort of British‐born older adults.Methods441 participants from Insight 46 (a sub‐study of the 1946 British Birth Cohort) were asked whether they participated in rugby, soccer, or boxing, consistently for at least a year (yes/no) at various epochs of life (<20, 20‐49 and 50+ years). Individuals underwent baseline florbetapir‐PET, serial brain MRI and cognitive assessments (mean age at baseline assessment 70.6 years, mean interval between visits = 2.4 years). A range of life course data were included in analyses, including attitudes to sports, education, engagement in physical activity and self‐reported symptomatic head injury.ResultAs only one female identified as participating in rugby, soccer, or boxing, only males were included in analyses: 101/232 males (43.5%) stated they participated in at least one of these sports, 46 of whom participated for more than one epoch. Univariate analyses revealed participation was associated with a range of demographic factors including: a preference “to play rough sports” aged 13 (p<0.001); a higher level of education (p = 0.007); engagement in physical activity aged 36 (p<0.001); and 43 (p = 0.017); and greater risk of self‐reported symptomatic head injury (35.3% vs 14.7%, p<0.001).There were no significant associations between participation in these sports and baseline cognitive function or decline, beta‐amyloid deposition, white matter hypertintensity volume, or baseline/longitudinal change in total brain or hippocampal volume (table 1).Longer duration of participation (≥ two epochs vs one) was associated with lower hippocampal volume at baseline (p = 0.006) but did not predict subsequent atrophy or any other outcome examined (table 2).ConclusionPrevious exposure to sports associated with repetitive head injuries is common amongst British‐born older adults and associated with a range of demographic factors relevant to brain health. Longer duration of exposure predicted lower hippocampal volume age 70 years, but there was no evidence of significantly accelerated atrophy or cognitive decline beyond this.
Diversity, Equity and Inclusivity‐ Low and Middle Income countries and the Lancet commission
Authors: Livingston Gill , Huntley Jonathan D , Liu Kathy Y , Gonzalez Sergi Costafreda , Selbaek Geir , Alladi Suvarna , Ames David , Banerjee Sube , Burns Alistair , Brayne Carol , Fox Nick C , Ferri Cleusa P , Gitlin Laura N. , Howard Robert J , Kales Helen C , Kivimäki Mika , Larson Eric B , Nakasujja Noeline , Rockwood Kenneth , Samus Quincy M , Shirai Kokoro , Singh‐Manoux Archana , Schneider Lon S. S. , Walsh Sebastian , Yao Yao , Sommerlad Andrew , Mukadam Naaheed 
Published: January 2025

AbstractBackgroundData from high‐income countries (HICs) suggest a decline in age‐specific incidence rates of dementia. However, this has happened primarily in HICs, with low‐ and middle‐ income countries (LMICs) facing two main challenges: a higher burden of risk factors and, in general, a faster ageing population. Most people with dementia live in LMICs, and this is set to increase, thus requiring urgent and robust action to prevent, treat and support people with dementia and their families.MethodsWe, in the Lancet Commission, reviewed the most recent literature, and conducted a new metanalysis on worldwide dementia risk. We have calculated worldwide figures, although there may be variation in different ethnic and socioeconomic groups.ResultsDementia studies are overwhelmingly from HICs, and there is a tendency to recruit people of European origin with higher education and socioeconomic status, with few people from ethnic minority groups. The same applies in respect of worldwide clinical trials, including multicomponent interventions to reduce risk, biomarker research and pharmacological/non‐pharmacological interventions.Although most interventions are developed in HICs, culturally adapted interventions seem to be as effective in LMICs as in their original context, as long as the interventions’ core components are not compromised in the adaptation process.ConclusionPolicy interventions can improve dementia prevention, particularly in LMICs and in minority and lower level socio‐economic groups ‐ precisely the people who have the greatest burden of modifiable risk and are more likely to develop dementia.Dementia prevention efforts should be tailored to the needs of the different countries and different groups within countries. Trials and research databases should aim for sociodemographic diversity to reflect real life populations.Although evidence‐based interventions developed in HICs can be effective in LMICs, there is often a lack of healthcare infrastructure and resources to deliver them. Moreover, cultural differences can make them inappropriate or less effective. Interventions should be developed in partnership with local communities to ensure their appropriateness in respect of the culture, beliefs and practises which vary within and between countries.
Interventions for cognitive symptoms of dementia ‐ and the Lancet commission view on anti‐amyloid antibodies
Authors: Selbaek Geir 
Published: January 2025

AbstractBackgroundWhile symptomatic treatment for Alzheimer’s disease has been available for three decades disease modifying treatment does not exist. New drug treatments, known as immunotherapies, which remove amyloid from the brain offer hope, but the clinical significance remains uncertain.MethodSystematic reviews of the literature, expert consensus, and information from clinical environments.ResultCholinesterase inhibitors (ChEI) and memantine have repeatedly demonstrated a modest symptomatic effect on cognition and function in clinical trials and long‐term observational studies indicate that these drugs may lower mortality. They are readily available, relatively affordable, have few side‐effects and should be offered to patients with Alzheimer’s disease or Lewy Body dementias.Treatment with the monoclonal antibodies lecanemab and donanemab consistently shows an effect on clinical measures, such as cognition, function, and quality of life. However, the effect size is small, and the results may not generalize to groups that are poorly represented in the clinical trials. Risk of serious adverse events, such as brain haemorrhages, may restrict the population eligible for treatment. Lecanemab has been granted marketing approval in USA, Japan and China and awaits decision in European countries, expected first half of 2024. Before implementation several issues need to be addressed. More people will need a more precise and biomarker‐based diagnosis at an earlier disease stage. The total treatment cost is huge. In addition to medication cost more resources will be needed for diagnostic testing, treatment administration and surveillance/monitoring of side effects. At present, very few countries can meet these requirements.ConclusionThe advent of monoclonal antibodies represents a major scientific breakthrough in the quest to combat Alzheimer’s disease and might offer hope to people with the disease and their closest caregivers. Unfortunately, so far, the limited clinical gain may not offset treatment cost and risk of adverse events. Long‐term efficacy data and results from trials with treatment initiated at an earlier disease stage are needed to determine the meaningfulness of these new treatments. In parallel, other treatment options targeting tau protein, inflammatory pathways or metabolic dysfunction should be investigated further to offer people with Alzheimer’s disease and related dementias a personalized treatment regimen.
Combining plasma biomarkers for β‐amyloid diagnosis and cognitive prognosis across the clinical spectrum: normal, amnestic, and non‐amnestic
Authors: Cousins Katheryn A Q , Phillips Jeffrey S , Das Sandhitsu R. , O’Brien Kyra , Tropea Thomas F. , Chen‐Plotkin Alice , Shaw Leslie M. , Nasrallah Ilya M. , Mechanic‐Hamilton Dawn , McMillan Corey T , Irwin David J , Lee Eddie B , Wolk David A 
Published: January 2025

AbstractBackgroundAlzheimer’s disease (AD) is clinically heterogeneous, and can manifest as amnestic or non‐amnestic dementia, or be pre‐manifest in persons with normal cognition (NormCog). Utility of plasma biomarkers to diagnose AD and prognose cognitive decline must be evaluated in a clinically heterogeneous population representative of the AD spectrum. We investigate pathological and cognitive correlates of plasma phosphorylated tau 181 (p‐tau181), glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL) across AD and AD‐related dementias (ADRD). We test 1.) if combing biomarkers improves diagnostic accuracy for β‐amyloid (Aβ) in NormCog and impaired cognition (ImpCog), 2.) if Aβ diagnostic accuracy in ImpCog differs by clinical syndrome (amnestic dementia vs. non‐amnestic dementia vs. mild cognitive impairment [MCI]), and 3.) how biomarkers predict future cognitive decline in Aβ+ and Aβ‐.MethodsParticipants were NormCog (n=132) and ImpCog (n=461; 130 MCI/impairment without MCI; 61 amnestic; 270 non‐amnestic), with confirmed Aβ status (247 Aβ+; 346 Aβ‐; cerebrospinal fluid/positron emission tomography/autopsy) and single molecule array plasma measurements. Logistic regression and receiver operating characteristic (ROC) area under the curve (AUC) tested discrimination of Aβ+ from Aβ‐; K‐folds cross‐validation and exhaustive selection determined optimal biomarker combinations. Chi‐square tests compared correct classifications to errors of the multivariable model and plasma p‐tau181 across phenotype. Survival analyses tested time to global clinical dementia rating (CDR) progression.ResultsMultivariable models (p‐tau+GFAP+NfL) had the best performance to detect Aβ+ in NormCog (ROCAUC=0.87) and were significantly better in Impaired (ROCAUC=0.87) compared to single analytes (all p<0.018) (Table 1; Figure 1). In ImpCog, multivariable model classification differed by phenotype (χ2=7, p=0.032), with highest accuracy in amnestic dementia (Accuracy: 92%), followed by MCI/impaired not MCI (81%), and non‐amnestic dementia (76%). Likewise, plasma p‐tau181 performance significantly differed by phenotype (χ2=6.8, p=0.035) (Accuracy: amnestic=90%; MCI/impairment without MCI=80%; non‐amnestic=74%). Survival analyses demonstrated that higher NfL best predicted faster CDR progression for both Aβ+ (HR=2.94, p=8.1e‐06) and Aβ‐ individuals (HR=3.11, p=2.6e‐09) (Figure 2).ConclusionCombining plasma biomarkers can optimize detection of AD pathology across cognitively normal and clinically diverse neurodegenerative disease. Still, diagnostic accuracy may be lower for non‐amnestic AD. Plasma NfL showed the most accurate prognosis across neurodegenerative spectrum.
Transition to hospice: how it impacts the mental health of caregivers of persons with dementia
Authors: Oh Oonjee , Oliver Debra Parker , Washington Karla , Demiris George 
Published: January 2025

AbstractBackgroundWithin the dementia space, many caregivers lack understanding of hospice care and may not be well prepared for transition to hospice. Nonetheless, few studies have explored hospice transition specifically from the perspective of caregivers for persons with dementia and how it impacts their mental health. In this study, we aimed to examine caregivers’ mental health indicators and their correlation structure based on the timing of hospice transition.MethodWe conducted a secondary data analysis using the pre‐intervention data from an ongoing randomized clinical trial of a problem‐solving therapy intervention for hospice caregivers labeled ENCODE (Empowering Caregivers of Patients with Dementia), focusing on a sample recruited between December 2021 and mid‐January 2024. Recent transition to hospice was defined as enrollment in hospice for less than 14 days at baseline. We conducted two‐sample T‐tests and χ² tests to compare the demographics, caregiving characteristics, hospice setting, and mental health indicators (i.e., depressive and anxiety symptoms, perceived change in wellbeing, the mental component of health‐related quality of life (HrQoL)) between caregivers who recently transitioned to hospice and those who had been in hospice longer. Additionally, we compared the Pearson correlation matrices across mental health indicators based on the caregivers’ hospice transition.ResultAmong 156 caregivers (mean age = 59.63, female 82.05%, spouse/partner 16.03%), 62 (39.74%) caregivers recently transitioned to hospice. Compared to other hospice caregivers, we found that caregivers who recently entered hospice had significantly higher levels of depressive symptoms (p value = 0.031), higher levels of anxiety symptoms (p value = 0.001), and worse trends in overall changes in wellbeing (p value = 0.012). There were no significant differences in the mental component of HrQoL. The association patterns between each pair of mental health indicators were consistent across different timings of hospice transition.ConclusionIn the context of dementia care, our results highlight that caregivers who just entered hospice are undergoing a challenging transition that often finds them in a mentally vulnerable position. To develop and implement effective strategies for caregivers of persons with dementia, we need to understand the needs and vulnerabilities of caregivers during hospice transition and identify the best timing for the delivery of supportive tools.
Psychological Contributors to Purpose in Life among a Culturally Diverse Aging Cohort
Authors: Vu Uyen TM , Farias Sarah Tomaszewski , Weakley Alyssa , Harvey Danielle J. , Meyer Oanh L. 
Published: January 2025

AbstractBackgroundPurpose in life (PIL) refers to individuals’ derivation of meaning from life experiences, possession of a sense of direction and intentionality, and striving towards goals. PIL is associated with many positive health outcomes and reduced risk of cognitive decline and dementia in older adults. Importantly, PIL is potentially modifiable through intervention to reduce risk of Alzheimer’s disease and related disorders. However, it is a complex construct likely influenced by psychological, lifestyle, and demographic factors. This study examines factors contributing to PIL, with the long‐range goal to inform the development of intervention approaches.MethodsThis was a cross‐sectional study of participants from the University of California Davis Alzheimer’s Disease Research Center Longitudinal Cohort with a PIL score (N = 191). The mean age was 76.3 (SD = 7.2). Most were female (65%) and cognitively normal (85.3%). A substantial percentage were from underrepresented groups (45%). Independent variables of interest were grit, positive affect, emotional support, self‐efficacy, loneliness, and participation in physical and recreational activities. Covariates included age, sex, race, and education. Individual and joint linear regression models were run to examine associations.ResultsAll variables were significantly associated with PIL in bivariate models, but only positive affect was associated with higher PIL in the joint model including all independent variables and covariates (B = 0.478, 95% CI [0.362, 0.655], p < .001). Loneliness was associated with lower PIL (B = ‐0.18, 95% CI [‐0.384, ‐0.053], p = .01).ConclusionsPsychological, lifestyle, and demographic factors are important to consider in their association with PIL. Our findings showed that positive affect was associated with higher PIL and loneliness with lower PIL. These results have implications for future prevention and interventions to increase PIL in older adults, which may improve cognition and health. There are currently limited interventions that explicitly target PIL, and they are mostly in the cancer population. Conversely there are several evidence‐based approaches to increase positive affect that may also increase sense of PIL. Additionally, the association between loneliness and PIL suggests that increasing social connection may also bolster PIL.