Ascertain Dementia Research Articles

Health beliefs model to explore older adults' dementia prevention and health promotion from 2021 to 2022 in Taiwan: A cross-sectional survey study.

One person suffers from dementia every 3 seconds globally. Thirteen older adults aged 65 and older will have dementia, and 1 in 5 older adults over the age of 80 years will have dementia in Taiwan. Older adults should be equipped with demonstrated health beliefs regarding dementia prevention and health promotion about Ascertain Dementia 8-item Questionnaire (AD8), cues to action, health beliefs, self-efficacy, and behavioral intention in daily life. The purpose of this study was to survey older adults' demographic background, AD8, cues to action, health beliefs, self-efficacy, and behavioral intention for dementia prevention and health promotion. A cross-sectional survey design was used. Convenience sampling was performed. A total of 330 older adults participated in the study. The questionnaire used in this study included questions on older adults' demographic background, AD8, cues to action, health beliefs, self-efficacy, and behavioral intention. The researcher collected complete data by receiving the sampling on paper or by interview from October 8, 2021, to February 12, 2022. The SPSS 23.0 statistical package was employed for quantitative analysis. Data analysis included frequency, percentage, mean, standard deviation (SD), Spearman's rho correlation, and simple regression analysis. The findings showed that older adults had the following mean scores on health beliefs (perceived susceptibility 13.45 ± SD 2.34, perceived severity 13.54 ± SD 2.69, perceived benefits 16.57 ± SD 2.84, perceived barriers 8.20 ± SD 3.69), self-efficacy 16.96 ± SD3.52, and behavioral intention 19.56 ± SD 3.51. Older adults' demographic background, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy explained 56.1% of the variance in behavioral intention. The conclusions of the study indicated that older adults' demographic background, AD8, cues to action, health beliefs, self-efficacy, and behavioral intention constituted the main factors for effective dementia prevention and health promotion. In the future, the research team will continue to explore older adults' dementia prevention and develop many strategies on health promotion, as well as slowing the aging brain process.

The Relationship Between Poor Sleep and Memory Impairment Among Shift Nurses in China: A Cross-Sectional Study.

Many shift nurses experience poor sleep quality, and the effect on nurses' cognitive function remains unclear. The study aims to investigate sleep status and explore its association with cognitive function. This descriptive cross-sectional study was conducted in a tertiary care hospital in Fujian, China between March and September 2022. By convenience sampling method, 588 shift nurses participated in this study. The Pittsburgh Sleep Quality Index (PSQI) and Bergen Shift Work Sleep Questionnaire (BSWSQ) were used to assess sleep quality, while the Chinese version of Ascertain Dementia-8 (AD-8) was used to evaluate cognitive function. A PSQI score ≤7 is classified as good sleep quality, and a score >7 indicates poor sleep quality. An AD-8 score≥ 2 is considered indicative of memory impairment. Multivariate logistic regression analysis was conducted to explore the association between sleep status and memory impairment. A total of 310 (52.6%) participants presented poor sleep quality. Among them, 52.2% of participants had day shift-related sleep problems, 45.9% had evening shift-related sleep problems, 61.9% had night shift-related sleep problems, and 15.0% reported rest-day/vacation-related sleep problems. The prevalence of poor sleep quality and each shift-related sleep problem in the memory impairment group were higher than in the normalmemory group (P<0.05). Multivariate logistic regression analysis indicated that poor sleep quality (OR=2.073, 95% CI: 1.398~3.072), evening shift-related sleep problems (OR=1.707, 95% CI: 1.028~2.835), night shift-related sleep problems (OR=1.859, 95% CI:1.104~3.129), and rest-day/vacation-related sleep problems (OR=2.069, 95% CI:1.170~3.659) was significantly associated with memory impairment. This study highlights the prevalence of poor sleep quality among clinical nurses and identifies poor sleep quality and shift-related sleep problems (excluding day shift) as risk factors for memory impairment. Nurse managers should prioritize sleep quality and focus on cognitive function to enhance nurses' occupational health.

Endocrine-Disrupting Chemicals Exposure and Neurocognitive Function in the General Population: A Community-Based Study.

Endocrine-disrupting chemicals (EDCs) are pervasive in everyday environments. The impacts of these chemicals, along with EDC-related lifestyle and dietary habits on neurocognitive function, are not well understood. The Chang Gung Community Medicine Research Center conducted a cross-sectional study involving 887 participants. From this initial cohort, 120 individuals were selected based on their EDC exposure scores for detailed analysis. Among these, 67 participants aged 55 years or older were further chosen to undergo cognitive impairment assessments using the Ascertain Dementia-8 (AD-8) questionnaire. These 67 older participants did not significantly differ in age, albuminuria, or estimated glomerular filtration rate compared to those with lower impairment scores. This study revealed that mono-(2-ethylhexyl) phthalate (MEHP) levels (8.511 vs. 6.432 µg/g creatinine, p = 0.038) were associated with greater risk of cognitive impairment (AD-8 ≥ 2). Statistical models adjusting for age, gender, and diabetes indicated that MEHP levels positively correlated with AD-8 scores, achieving statistical significance in more comprehensive models (β ± SE: 0.160 ± 0.076, p = 0.042). Logistic regression analysis underscored a significant positive association between high MEHP levels and higher AD-8 scores (odds ratio: 1.217, p = 0.006). Receiver operating characteristic curves highlighted the association of high MEHP levels and EDC exposure scores for significant cognitive impairment, with areas under the curve of 66.3% and 66.6%, respectively. Exposure to EDCs, specifically di-(2-ethylhexyl) phthalate, the precursor to MEHP, may be associated with neurocognitive impairment in middle-aged and older adults.

Exploring the interplay of psychiatric symptoms, antipsychotic medications, side effects, employment status, and quality of life in Chronic Schizophrenia

BackgroundMany factors contribute to quality of life (QoL) in patients with schizophrenia, yet limited research examined these factors in patients in China. This cross-sectional study explores subjective QoL and its associated factors in patients.MethodsThe QoL was assessed using the Schizophrenia Quality of Life Scale (SQLS). Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS) and seven factors were extracted. Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety. Cognitive impairment was assessed using the Ascertain Dementia 8 (AD8). The Treatment Emergent Symptom Scale (TESS) and Rating Scale for Extrapyramidal Side Effects (RSESE) were used to evaluate the side effects of medications.ResultsWe recruited 270 patients (male:142,52.6%, mean age:41.9 ± 9.4 years). Positive correlations were observed between SQLS and its subdomains with the total score of BPRS, PHQ-9, GAD-7, AD8, TESS, and RSESE (all P < 0.005). Patients who were taking activating second-generation antipsychotics (SGAs) had lower scores on total SQLS, Motivation/ Energy domain of SQLS (SQLS-ME) as well as Symptoms/ Side effects domain of SQLS (SQLS-SS) compared to those taking non-activating SGAs (all P < 0.005). Multiple regression analysis showed that depressive/ anxiety symptoms and cognitive impairment had significant negative effects on QoL (P ≤ 0.001), while activating SGAs had a positive effect (P < 0.005). Blunted affect and unemployment were inversely associated with the motivation/energy domain (P < 0.001).ConclusionOur findings emphasize the important role of depression/anxiety symptoms and cognitive impairment in the QoL of patients with chronic schizophrenia. Activating SGAs and employment may improve the QoL of these individuals.Trial registrationThis protocol was registered at chictr.org.cn (Identifier: ChiCTR2100043537).

Combining the AD8 and MMSE for community-based dementia screening

BackgroundThis study aimed to determine whether a cognitive test the Mini-Mental State Examination (MMSE) and the Ascertain Dementia 8 (AD8) instrument applied in combination could improve the accuracy of dementia detection in a community setting. MethodsStudy participants were recruited from a community-based integrated screening program in Tainan, Taiwan. Participants completed the AD8 and were administered the Chinese version of the MMSE by psychologists. In addition, the presence of dementia was determined by neurologists based on the 2011 National Institute on Aging–Alzheimer's Association guidelines. Logistic regression analysis determined whether the combination of these two tests provided any additional information for dementia detection than either test alone. Receiver operating characteristic (ROC) curve analyses were conducted to explore the performances of different screening modalities in detecting dementia. ResultIn total, 282 participants with an average age of 69.31 ± 10.27 years were enrolled. The prevalence of dementia among participants aged ≥65 years was 9.29 %. The sensitivity and specificity of the AD8 applied alone for detecting dementia were 64.71 % and 87.89 %, respectively, and of the MMSE applied alone, after adjusting for education level, were 41.18 % and 84.50 %, respectively. Using a cutoff score of 21 for the MMSE resulted in sensitivity of 77.78 % and specificity of 73.58 %. The AD8 and MMSE when combined in parallel yielded 88.89 % sensitivity and 70.16 % specificity. The serial use of the AD8 followed by the MMSE yielded 50 % sensitivity and 93.02 % specificity. Except for when an MMSE cutoff value of 26 was applied, the sensitivity of all examined modalities was poor and specificity was moderate for detecting mild cognitive impairment. ROC curve analysis revealed that the parallel application of the MMSE and AD8 (area under the ROC curve [AUC]: 82.3 % [75.1 %–89.4 %]) resulted in better dementia detection accuracy than the AD8 alone (AUC: 73.3 % [60.7 %–85.9 %]), the MMSE alone (AUC: 77.4 % [67.6 %–87.3 %]), or serial test administration (AUC: 67.6 % [53.4 %–81.8 %]). ConclusionThis study successfully demonstrated that the MMSE and AD8 combination for dementia screening could improve detection accuracy in a community setting.

Cognitive Impairment and Social Determinants of Health Among Indigenous Women.

Cognitive impairment and Alzheimer's disease and related dementias (ADRD) pose significant challenges for Indigenous populations, necessitating urgent research. Limited evidence suggests that high rates of ADRD among Indigenous peoples are associated with social determinants of health (SDOH), such as education, income, health literacy, religion, and social engagement. Collaborating with a Northern Plains tribe, participants were recruited 123 self-identified Indigenous women aged 40-70 through a comprehensive recruitment strategy. Employing the SDOH framework, the research assessed cognitive impairment and Alzheimer's disease knowledge (ADK), utilizing the Ascertain Dementia 8 and Alzheimer's disease knowledge scales (ADK-30). The investigation examined the relationships between selected SDOH variables and cognitive impairment status. More than half of the participants showed signs of cognitive impairment, which correlated with lower income and education levels. Increased knowledge about Alzheimer's disease, particularly in terms of treatment management and its life impact subscales, was associated with lower odds of cognitive impairment. Conversely, higher levels of depressive symptoms and participation in religious activities were linked to increased odds of cognitive impairment. The findings underscore the importance of culturally grounded tools and SDOH frameworks tailored to Indigenous contexts in addressing ADRD disparities. Future research should integrate historical and cultural factors to advance health equity within Indigenous communities, ultimately mitigating the impact of ADRD and promoting overall well-being.

Screening for dementia and associated factors in older adults from low socioeconomic communities in iLembe, KwaZulu-Natal.

Dementia is one of the leading non-communicable causes of disability and mortality in older adults, with recent research showing that it is increasing in low-middle-income countries compared to high-income countries. As such, multidisciplinary efforts are needed to effectively reduce the prevalence and risk of dementia through quick screening, diagnosis, and management of those with dementia and those at risk. The study's objectives were to estimate the prevalence of dementia and measure the sociodemographic and clinical risks in older adults in low socioeconomic communities. The study was conducted among older adults aged ≥ 60 years from the iLembe district in South Africa. This cross-sectional, one-phased, household study was conducted to screen for dementia over 8 months between October 2018 and October 2019. Demographic and clinical data were collected using a semi-structured questionnaire. In addition, the Mini-Mental Status Exam, Ascertain Dementia Eight-item questionnaire and Instrumental Activities of Daily Living Scale were administered to a multi-stage cluster sample of 320 participants to ascertain dementia prevalence. Frequencies and multivariate logistic regression were conducted to determine risk factors correlated with dementia. The prevalence of dementia was 13.4%. Participants aged 80 years and above were 2.73 times more likely to develop dementia than participants younger than 80 years. Those with an education level of Grade 1-7 had a 69% less chance of developing dementia than those without formal education. Single participants showed an almost seven-fold increase in dementia. Lastly, depression increased the risk of dementia by two-fold. Dementia was probable in over one-sixth of the sample. Dementia risk factors were both modifiable and non-modifiable. Dementia prevalence in South Africa is increasing and therefore it is crucial to develop a dementia plan that is specific to the South African context which will include strategies for early identification of the disease, reducing modifiable risks and strategic management of dementia associated medical conditions such as depression and vascular diseases.

General cognitive ability in high school, attained education, occupational complexity, and dementia risk.

We address the extent to which adolescent cognition predicts dementia risk in later life, mediated by educational attainment and occupational complexity. Using data from Project Talent Aging Study (PTAS), we fitted two structural equation models to test whether adolescent cognition predicts cognitive impairment (CI) and Ascertain Dementia 8 (AD8) status simultaneously (NCognitive Assessment=2477) and AD8 alone (NQuestionnaire=6491) 60 years later, mediated by education and occupational complexity. Co-twin control analysis examined 82discordant pairs for CI/AD8. Education partially mediated the effect of adolescent cognition on CI in the cognitive assessment aample and AD8 inthe questionnaire sample (Ps<0.001). Within twin pairs, differences in adolescent cognition were small, but intrapair differences in education predicted CI status. Adolescent cognition predicted dementia risk 60 years later, partially mediated through education. Educational attainment, but not occupational complexity, contributes to CI risk beyond its role as a mediator of adolescent cognition, further supported by the co-twin analyses. Project Talent Aging Study follows enrollees from high school for nearly 60 years. General cognitive ability in high school predicts later-life cognitive impairment. Low education is a risk partially due to its association with cognitive ability.

A cross-sectional study on the prevalence of depression and dementia among the geriatric population residing in the rural field practice area of Medical College, Kolkata

Background: A healthy mental adjustment to life is associated with a higher life expectancy than emotional disorders and stress. Age-related depression and dementia are major global public health issues that contribute to significant morbidity and disability among the elderly. Aims and Objectives: The aim of this study was to estimate the prevalence of depression and dementia among the elderly population residing in the rural field practice area of Medical College, Kolkata. Materials and Methods: This cross-sectional study was conducted among 110 elderly populations obtained through multistage random sampling, in the villages under ROHANDA health and wellness center using pre-tested, validated questionnaires called the short version of Geriatric depression scale -15, and Ascertain Dementia 8 to screen and estimate the prevalence of depression and dementia among the elderly. Results: The prevalence of depression and dementia among the elderly (mean age ± SD = 62.5 ± 6.69 years) was 18.2% and 17.3%, respectively. Increasing age, low socioeconomic status, low education, and nucleation of families were found to have significance in developing both dementia and depressive symptoms among the elderly. Binary logistic regression analysis was performed with the risk factors that found to be significantly associated with the development of depression and dementia. For depression type of family (adjusted odds ratio [AOR] 0.11; 95% confidence interval [CI] [0.013–0.983]), body mass index (AOR 7.07; 95% CI [2.104–23.755]) were found to be independent risk factors and for dementia age (AOR 13.60; 95% CI [3.168–58.375]), socioeconomic status (AOR 0.063; 95% CI [0.007–0.563]), marital status (AOR 7.83; 95% CI [1.767–34.696]) were found to be significant after controlling other relevant factors. Conclusion: As aging-related changes take place, depression and cognitive impairment in the elderly go undiagnosed. Therefore, early screening in primary care can aid in early diagnosis and the implementation of suitable interventions to lessen the severity and burden of the condition and enhance the quality of life.

Air particulate pollution exposure associated with impaired cognition via microbiota gut-brain axis: an evidence from rural elderly female in northwest China.

This study aimed to reveal harm of exposure to indoor air pollution to cognitive function through "gut-brain-axis" among rural elderly residents. There were 120 participants recruited in rural villages of northwest China from December 2021 to February 2022. The cognitive level was assessed by eight-item ascertain dementia (AD) questionnaire, and indoor air pollution exposure was measured by air quality sensor. Inflammatory cytokines and oxidative stress-related index were detected in blood serum. Fecal samples were collected for gut microbiota analysis. The 120 participants were divided into impaired cognition (AD8) (81/67.5%) and cognition normal (NG) (39/32.5%). And there had more female in AD8 (FAD) (55/67.9%) than NG (FNG) (18/46.2%) (P = 0.003). Exposure of air pollution in FAD was higher than FNG (PM1, PM2.5, PM10, P < 0.001; NO2, P < 0.001; CO, P = 0.014; O3, P = 0.002). The risk of cognitive impairment increases 6.8%, 3.6%, 2.6%, 11%, and 2.4% in female for every 1 μg/m3 increased in exposure of PM1, PM2.5, PM10, NO2, and O3, separately. And GSH-Px and T-SOD in FAD were significantly lower than the FNG group (P = 0.011, P = 0.019). Gut microbiota in FAD is disordered with lower richness and diversity. Relative abundance of core bacteria Faecalibacterium (top 1 genus) in FAD was reduced (13.65% vs 19.81%, P = 0.0235), while Escherichia_Shigella and Akkermansia was increased. Correlation analysis showed Faecalibacterium was negatively correlated with age, and exposure of O3, PM1, PM2.5, and PM10; Akkermansia and Monoglobus were positively correlated with exposure of PM1, PM2.5 and PM10; Escherichia_Shigella was significantly positively correlated with NO2. Indoor air pollution exposure impaired cognitive function in elderly people, especially female, which may cause systemic inflammation, dysbiosis of the gut microbiota, and ultimately leading to early cognitive impairment through the gut-brain axis.

Diagnostic accuracy of Ascertain Dementia 8-item Questionnaire by participant and informant-A systematic review and meta-analysis.

The Ascertain Dementia 8-item Questionnaire (AD8) is a screening tool for cognitive impairment that can be administered to older persons and/or their informants. To evaluate the diagnostic accuracy and compare the predictive parameters of the informant and participant-completed Ascertain Dementia 8-item Questionnaire (iAD8 and pAD8, respectively) in older adults with cognitive impairment. We searched ten electronic databases (including MEDLINE (Ovid), Embase) from tool inception to March 2022. We included studies with patients ≥60 years old that were screened for cognitive impairment using AD8 in any healthcare setting. Predictive parameters were assessed against reference standards to estimate accuracy and diagnostic ability using bivariate random-effects meta-analyses. We used QUADAS-2 criteria to assess risk of bias. A cut-off of ≥2/8 was used to classify mild cognitive impairment (MCI), dementia, and cognitive impairment (MCI or dementia). Seven studies using the iAD8 (n = 794) showed a sensitivity of 80% and specificity of 79% to detect MCI. Nine studies using the iAD8 (n = 2393) established 91% sensitivity and 64% specificity to detect dementia. To detect MCI using the pAD8, four studies (n = 836) showed 57% sensitivity and 71% specificity. To detect dementia using the pAD8, four studies (n = 3015) demonstrated 82% sensitivity and 75% specificity. Recurring high or unclear risk of bias was noted in the domains of "Index test" and "reference standard". The diagnostic accuracy of iAD8 is superior to that of pAD8 when screening for cognitive impairment. The AD8 may be an acceptable alternative to screen for cognitive impairment in older adults when there are limitations to formal testing.

Presence and Persistence of Perceived Subjective Cognitive Complaints and Incident Mild Cognitive Impairments Among Community-Residing Older Adults

ObjectivesTo examine whether Subjective Cognitive Complaints (SCCs) predicted incident mild cognitive impairment (MCI). DesignProspective Study. SettingCentral Control of Mobility and Aging (CCMA), a cohort study of community-residing older adults. ParticipantsParticipants were dementia-free community-residing older adults. MeasurementsSCCs were assessed at the baseline and via bi-monthly structured phone interviews during the first year using the Ascertain Dementia 8 (AD8). Nonpersistent status required one or two SCCs endorsements and Persistent status required three or more SCCs endorsements. Outcome, presence of mild cognitive impairments (MCI) was determined by established case conference diagnostic procedures. Participants were followed annually. Generalized estimating equations (GEE), logistic model type, were used to determine the odds of developing MCI during follow-up. SCCs served as the three-level predictor (no/nonpersistent/persistent) and cognitive status (MCI versus normal) as the binary outcome. Analyses were adjusted for age, sex, education, race, health status, depressive symptoms, and global cognition. ResultsThe sample (n=454; mean age=75.67 ± 6.43; %female=55.3) included 245 participants who reported no SCCs, 156 who reported 1–2 SCCs, and 53 who reported 3 or more SCCs. Sixty-eight participants developed MCI during follow-up. Results showed that compared to no SCCs, persistent SCCs, and nonpersistent SCCs were significantly associated with increased odds of developing MCI during follow-up. ConclusionsThe presence of SCCs regardless of their persistence was associated with increased odds of developing MCI even when adjusting for objectively-assessed cognitive performance.

Prevalence and Progression of Subjective Cognitive Decline Among Rural Chinese Older Adults: A Population-Based Study.

Few community-based studies have examined occurrence and progression of subjective cognitive decline (SCD). To investigate prevalence and progression of SCD among rural-dwelling Chinese elderly people. This cohort study included 2,488 cognitively unimpaired adults (age≥65 years) who were examined at baseline (2014-2015) and followed in 2018. Demographic, epidemiological, clinical, and neuropsychological data were collected via in-person interviews and clinical examinations following a structured questionnaire. At baseline, SCD was assessed using the self-rated Ascertain Dementia 8-item Questionnaire. At follow-up, Alzheimer's disease (AD) and vascular dementia (VaD) were clinically diagnosed following the international criteria. Data were analyzed using logistic regression models. The prevalence of SCD was 40.07%. SCD at baseline was associated with the multivariable-adjusted odds ratio (OR) of 1.51 (95% confidence interval 1.10-2.07) for incident cognitive impairment, no dementia (CIND) and 3.11 (1.64-5.93) for incident AD. Among people with SCD at baseline, the multivariable-adjusted OR of incident CIND was 0.55(0.32-0.96) for hyperlipidemia; the multivariable-adjusted OR of incident AD was 1.21 (1.14-1.30) for older age, 0.32 (0.12-0.88) for high education, 2.60 (1.11-6.08) for carrying APOEɛ4 allele, and 0.34 (0.13-0.86) for high social support, whereas the multivariable-adjusted OR of incident VaD was 6.30 (1.71-23.18) for obesity. SCD affects over 40% of rural-dwelling cognitively unimpaired older adults in China. SCD is associated with accelerated progression to CIND and AD. Older age, lack of school education, APOEɛ4 allele, and low social support are associated with an increased risk of progression from SCD to AD, whereas obesity is related to accelerated progression to VaD.

Prevalence and progression of subjective cognitive decline among rural Chinese older adults: A Population‐based follow‐up study

AbstractBackgroundFew studies have examined occurrence and progression of subjective cognitive decline (SCD) in rural China. We aimed to investigate the prevalence of SCD and explore factors associated with progression from SCD to cognitive impairment, no dementia (CIND) and Alzheimer’s disease (AD).MethodThis community‐based study included 2488 cognitively unimpaired participants (age ≥65 years; 55.18% women; and 39.87% illiterate) in the Shandong Yanggu Study of Aging and Dementia who were examined at baseline (2014‐2015), of these, 1843 were followed in 2018. Demographic, epidemiological, clinical, and neuropsychological data were collected following a structured questionnaire. SCD was defined based on the Chinese version of the self‐rated Ascertain Dementia 8‐item Questionnaire (AD8) score. CIND and AD were diagnosed following the international criteria. Data were analyzed with the multivariate logistic regression models.ResultAt baseline, 997 of the 2488 participants were defined to have SCD. The prevalence of SCD was 40.07%, and the prevalence was increased with age. Of the 1843 participants in the follow‐up examination in 2018, 189 were diagnosed with CIND and 58 with AD. Having SCD at baseline was significantly associated with the multi‐adjusted odds ratio (OR) of 1.55 (95% confidence interval = 1.14‐2.12) for incident CIND and 2.91 (1.56‐5.42) for incident AD. Of 745 participants with SCD at baseline, 97 progressed to CIND and 43 to AD during the average 3.79 years of follow‐up. Multivariable logistic regressions showed that the multi‐adjusted OR of incident CIND was 0.51 (0.26‐0.98) for high social support, whereas the multi‐adjusted OR of incident AD was 1.22 (1.14‐1.31) for older age (per 1‐year increment), 0.31 (0.11‐0.85) for high education, 2.77 (1.17‐6.57) for carrying the apolipoprotein E (APOE) ε4 allele, 0.29 (0.11‐0.75) for high social support, and 3.98 (1.37‐11.52) for mild depressive symptoms.ConclusionSCD affects over 40% of rural‐dwelling older adults in China who are free of cognitive impairment. Older people with SCD are more likely to develop CIND and AD. Older age, illiteracy, APOE ε4 allele, low social support, and depressive symptoms are associated with accelerated progression from SCD to CIND or AD.

Validity and reliability of the Farsi version of the ascertain dementia 8-item (AD8-F) informant interview in Iranian patients with mild neurocognitive disorder

BackgroundFor screening and distinguishing between mild neurocognitive disorder (mNCD) and normal cognitive age-related changes in primary care centers, a simple and practical tool is necessary. Therefore, this study aims to determine the validity and reliability of the Farsi version of the Ascertain Dementia 8-item (AD8-F) informant interview in patients with mNCD.MethodsThis is a study of the psychometric properties of the Farsi AD8. The participants include sixty informant-patient dyads with mNCD and sixty controls with normal cognition. The AD8 was compared to the mini-mental state examination (MMSE) and the Mini-Cog. As a gold standard, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for mNCD was used. The reliability was measured using internal consistency and test-retest. Validity was assessed by evaluating the content, concurrent, and construct validity. Data were analyzed via Cronbach’s α, Pearson correlation, independent t-test, and analysis of variance (ANOVA) and area under the curve (AUC) by statistical package for the social sciences (SPSS) v.23.ResultsCronbach’s α was 0.71. Test-retest reproducibility was 0.8. The AD8 had inverse correlations with the Mini-Cog (r = − 0.70, P < 0.01) and MMSE (r = − 0.56, P < 0.01). The area under the curve was 0.88. The optimal cutoff score was > 2. Sensitivity and specificity were 80 and 83%, respectively. The positive predictive value was 83%. The negative predictive value was 81%.ConclusionOur results suggest that this tool can be used as a screening tool to detect a mild neurocognitive disorder in primary care centers.

Validation of the Informant Quick Dementia Rating System (QDRS) among Older Adults in Singapore.

The Quick Dementia Rating System (QDRS) is a brief and rapid tool that can be administered by an informant without the need for a trained assessor. Our objective was to examine the validity, reliability, and cost-effectiveness of the informant QDRS in a Singapore memory clinic sample. We assessed a total of 177 older adults, among whom, 32 had no cognitive impairment (NCI), 61 had mild cognitive impairment (MCI), and 84 had dementia. Elderly underwent 1) the informant QDRS, 2) the Clinical Dementia Rating (CDR) as the gold standard diagnosis, 3) the Mini-Mental State Examination (MMSE), and 4) the Ascertain Dementia 8 (AD8) as comparisons to the QDRS. The extent to which the QDRS may reduce the recruitment cost (time) of clinical trials was also calculated. The QDRS had excellent internal consistency (Cronbach alpha = 0.939). It correlated highly with the CDR-global (R = 0.897), CDR Sum-of-Boxes (R = 0.915), MMSE (R = -0.848), and the AD8 (R = 0.747), showing good concurrent validity. With an optimal cut-off of 1.5 for MCI (sensitivity 85.2%, specificity 96.3%) and 6 for dementia (sensitivity 90.1%, specificity 89.2%), the QDRS achieved a higher overall accuracy of 85.0%, as compared to MMSE (71.2%) and AD8 (73.4%). A simulated clinical trial recruitment scenario demonstrated that pre-screening with the QDRS followed by a confirmatory CDR would reduce the time needed to identify NCI subjects by 23.3% and MCI subjects by 75.3%. The QDRS is a reliable cognitive impairment screening tool which is suitable for informant-administration, especially for identification of MCI.

A-106 Diagnostic Predictive Utility of Perceived Subjective Cognitive Complaints Measured by Ascertain Dementia 8 (AD8)

Abstract Objective: Literature regarding the association between the presence and persistence of subjective cognitive complaints (SCCs) and cognitive impairments is inconsistent. Therefore, we examined whether SCCs status (no/non-persistent/persistent SCCs), predicted the risk of developing incident Mild Cognitive Impairment (MCI). Methods: Participants were dementia-free community-residing older adults. We assessed SCCs at the baseline visit and via bi-monthly structured phone interviews during the first study year using the Ascertain Dementia 8 (AD8). Non-persistent status required one SCCs endorsement and Persistent status required two or more SCCs endorsements. Cognitive status was determined by established case conference diagnostic procedures. Participants were followed annually up to 5 years. Generalized Estimating Equations (GEE), logistic model type, were used to determine the odds of developing MCI during follow-up. The presence and persistence of SCCs served as the three-level predictor. Analyses adjusted for age, sex, education, ethnicity, and health status. Results: The sample (n = 454; mean age = 75.67 ± 6.43; %female = 55.3) included 245 participants who reported no SCCs, 105 who reported 1 SCCs and 104 who reported 2 or more SCCs. 59 participants developed MCI during follow-up. GEE results showed that compared to no SCCs, persistent SCCs (OR = 3.004, 95% CI = 1.503–6.003, p = 0.002), and non-persistent endorsements of SCCs (OR = 3.760, 95%CI = 1.946–7.265, p &amp;lt; 0.001) were significantly associated with increased odds of developing MCI during follow-up. Conclusions: The presence of SCCs regardless of its persistence was associated with increased odds of developing MCI among older adults.

The discriminant validity of single-question assessments of subjective cognitive complaints in an Asian older adult population.

ObjectiveTo compare the discriminant validity of three different single-question assessments of subjective cognitive complaints (SCC) for dementia in a community-based older adult population in Singapore.MethodsEligible older adults aged ≥60 were recruited into phase I for identifying those who require further assessment using the Abbreviated Mental Test (AMT) and progressive forgetfulness question (PFQ). Participants who failed either tests entered phase II and were administered various single-question assessments of SCC, such as the 8th question on the patient Ascertain Dementia 8 (AD8-8pt), informant AD8 (AD8-8info), and the 10th item on the Geriatric Depression Scale (GDS-10), followed by the Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery to identify the participant’s cognitive status by a research diagnosis and DSM-IV criteria. Differences in characteristics among diagnostic groups were compared. All discriminatory indices (sensitivity, specificity, positive, and negative predictive values, overall accuracy) for these single-question assessments and their combinations with the MoCA were calculated and reported to confirm their discriminant validity in identifying the existence of subjective complaints and objective impairment.ResultsA total of 3,780 participants were assessed at phase I, of which 957 entered and completed phase II. Of whom, 911 were dementia-free and 46 had dementia. The MoCA (13/14) displayed good sensitivity (95.6%), specificity (81.5%), and overall accuracy (82.1%) for dementia detection. The GDS-10 and AD8-8pt showed poor discriminant validity, while the AD8-8info had the highest specificity (83.2%) and the greatest overall accuracy (82.5%) for dementia. Compensatory combination of the AD8-8info with MoCA, the sensitivity and positive predictive values were optimized (100%), while the conjunctive combination of two tools achieved excellent specificity (96.3%) and overall accuracy (94.8%) in discriminating dementia patients.Conclusion and implicationsCombining a reliable single-question SCC assessment with an objective tool can efficiently discriminate dementia patients from healthy older adults in the community.

Development and validation of the Ascertain Dementia 8 (AD8) Thai version.

The Ascertain Dementia 8 (AD8) is a brief informant-based questionnaire which reliably distinguishes patients with neurocognitive disorder (NCD) and normal cognition. Our objective was to translate the AD8 into Thai and test its validity as a potentially useful measure to detect patients with the mild stage of major NCD due to Alzheimer disease (major NCD-AD). Evaluations of 144 informant-patient dyads were made. Participants were patients who attended the memory clinic at Ramathibodi Hospital and non-patient volunteers. The AD8-Thai version was administered separately from doctor's interviews and neuropsychological assessments. Diagnostic workups included a complete medical history, physical and neurological examinations, neuropsychological testing, the Clinical Dementia Rating Scale-Sum of Boxes (CDR-SOB), Montreal Cognitive Assessment (MoCA), blood tests and brain imaging, preferably with magnetic resonance imaging. All researchers were blinded to the AD8 results. An AD8 score ≥3 had a sensitivity of 95.5%, a specificity of 89.5%, a positive predictive value of 84%, and a negative predictive value of 97.1% for screening major NCD-AD and those with normal cognition. A subgroup analysis with participants aged ≥65 years and with ≥12 years of education revealed comparable ability to the whole group. AD8 scores had a moderate negative relationship with MoCA scores (r= -0.470) and a strong positive relationship with CDR-SOB scores (r= 0.547). The performance of AD8 scores in differentiating mild NCD from normal cognition was not as good as for major NCD-AD. AD8-Thai version is an acceptable screening tool for major NCD-AD. For patients aged 65 years or older, with at least 12 years of education, and with cognitive complaints in memory clinic, an AD8-Thai score of 3 or more would be sufficient to work on major NCD diagnosis. The performance of the AD8-Thai in mild NCD needs further investigation.

The causal association between empty nest and depressive symptoms with cognitive impairments in China

BackgroundIn the context of rapid aging, “empty nest syndrome” is becoming a major public health concern. The causal effects of empty nest on depressive symptoms have been studied in developed countries, but the mediating mechanism of depressive symptoms in the association between empty nest and cognitive impairments has not been studied. This study estimated the causal association of empty nest with depressive symptoms and cognitive impairments in China, and then estimated how depression mediates the association between empty nest and cognitive impairments. MethodsUsing data of 23,614 urban older adults (65+) obtained from the Shandong Province Aging and Mental Health Survey in 2020, a weighted linear regression model combined with instrumental variable was applied to explore the causal effects of empty nest, and a four-step mediation model was run to test the mediator of depressive symptoms. The Ascertain Dementia 8-item Questionnaire and Patient Health Questionnaire-9 were used to measure cognitive impairments and depressive symptoms. ResultsEmpty nest was associated with 0.13 (95%CI: 0.04–0.23) and 0.23 (95%CI: 0.14–0.33) increases in the Ascertain Dementia 8-item Questionnaire and the Patient Health Questionnaire-9 scores, respectively. The association between empty nest and the Ascertain Dementia 8-item Questionnaire scores was mediated by the Patient Health Questionnaire-9 scores. ConclusionsEmpty nest affected depression in adulthood with cognitive impairments. A focus on integrative intervention for empty nesters is recommended, taking depression and cognition into account. LimitationsIt is a cross-sectional study and the data is not nationally representative.