Dementia In Old Age Research Articles

Efficacy of Immersive Virtual Reality-Based Cognitive Training in Older Adults with Hearing Impairment: Three Case Reports

The purpose of this study was to investigate the effects of immersive virtual reality (VR)-based cognitive training in older adults with hearing impairment. Participants were three older adults with hearing impairment. Three assessment tools, audiometric, neuropsychological, and outcome measurements of the subjective hearing handicap inventory for the elderly, were examined before and after the VR cognitive training. The VR cognitive training was conducted once per week for 6 weeks and consisted of five different VR games classified into three specific cognitive domains (attention, memory, and executive function). The improved VR game performances were constantly observed across the training sessions in all three participants. After the VR cognitive training, first, the scores on the forward digit span test (attention), immediate recall on the SVLT-E (memory), and word reading and color reading on the K-CWST (executive function) were improved for all participants. In addition, the reaction time on the K-TMT-E (executive function) was shortened. Second, the sentence recognition scores in adverse listening conditions (SNR 0 dB and -5 dB) were improved. Third, the Korean version of hearing handicap inventory for the elderly (K-HHIE) scores which are reflective of subjective hearing handicap were decreased. Preventive intervention for cognitive deficits in older adults with hearing impairment is needed because hearing impairment is one of the major risk factors for dementia in older age. In this respect, the present case study demonstrates that VR cognitive training could improve cognitive function, speech-in-noise perception, and subjective hearing handicap in the hearing-impaired elderly.

Do Personality Traits Influence the Association Between Depression and Dementia in Old Age?

Depression and personality traits are independent predictors of dementia or cognitive impairment. Despite the well-established relationship between these two psychosocial factors and dementia, no research has been documented on how personality traits can influence dementia in older adults exhibiting depressive symptoms. This study explores the influence of personality traits on the association between change in depression and dementia in old age. A population-based longitudinal cohort study involving two waves of data collected 5 years apart, containing 2210 American older adults, from the National Social Life, Health, and Aging Project to explore if personality traits influence how change in depression predicts the development of dementia. We assessed these relationships while adjusting for sociodemographic characteristics. Change in depression increased the likelihood of dementia at T2 by 4.2% (AOR = 1.04, p = 0.019) in the co-variate adjusted model. Personality traits, overall, did not influence how depression predicts the development of dementia. However, agreeableness individually nullified the effect of depression on the development of dementia, whereas extraversion was the only personality trait that significantly predicted dementia. Prosocial behaviors should be promoted in old age as these appear to be protective. In addition, early life education and a strong social support can keep the depression–dementia spectrum at bay in old age.

Association of Systolic Blood Pressure With Dementia Risk and the Role of Age, U-Shaped Associations, and Mortality

The optimal systolic blood pressure (SBP) to minimize the risk of dementia in older age is unknown. To investigate whether the association between SBP and dementia risk is U-shaped and whether age and comorbidity play a role in this association. This cohort study used an individual participant data approach to analyze 7 prospective, observational, population-based cohort studies that were designed to evaluate incident dementia in older adults. These studies started between 1987 and 2006 in Europe and the US. Participants had no dementia diagnosis and had SBP and/or diastolic blood pressure (BP) data at baseline and incident dementia status during follow-up. Data analysis was conducted from November 7, 2019, to October 3, 2021. Baseline systolic BP. All-cause dementia (defined using Diagnostic and Statistical Manual of Mental Disorders [Third Edition Revised] or Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] and established at follow-up measurements or in clinical practice), mortality, and combined dementia and mortality were the outcomes. Covariates included baseline antihypertensive medication use, sex, educational level, body mass index, smoking status, diabetes, stroke history, myocardial infarction history, and polypharmacy. Cox proportional hazards regression models were used, and nonlinear associations were explored using natural splines. The study analyzed 7 cohort studies with a total of 17 286 participants, among whom 10 393 were women (60.1%) and the mean (SD) baseline age was 74.5 (7.3) years. Overall, dementia risk was lower for individuals with higher SBP, with the lowest risk associated with an SBP of approximately 185 mm Hg (95% CI, 161-230 mm Hg; P = .001). Stratified by overlapping 10-year baseline age groups, the lowest dementia risk was observed at somewhat lower systolic BP levels in those older than 75 years (158 [95% CI, 152-178] mm Hg to 170 [95% CI, 160-260] mm Hg). For mortality, there was a clear U-shaped association, with the lowest risk at 160 mm Hg (95% CI, 154-181 mm Hg; P < .001). This U-shape occurred across all age groups, with the lowest dementia risk associated with an SBP of 134 mm Hg (95% CI, 102-149 mm Hg; P = .03) in those aged 60 to 70 years and increasing to between 155 mm Hg (95% CI, 150-166 mm Hg; P < .001) and 166 mm Hg (95% CI, 154-260 mm Hg; P = .02) for age groups between 70 and 95 years. Combined dementia and mortality risk curves closely resembled those for mortality. Associations of diastolic BP with dementia risk were generally similar but were less distinct. This cohort study found that dementia risk was lower for older individuals with higher SBP levels and that more distinctly U-shaped associations appeared for those older than 75 years, but these associations cannot be explained by SBP-associated changes in mortality risk. The findings may warrant future trials on tailored BP management in older age groups that take life expectancy and health context into consideration.

Excess costs of dementia in old age (85+) in Germany: Results from the AgeCoDe-AgeQualiDe study

Dementia is a major economic challenge for societies worldwide. One approach of cost-of-illness studies focuses on the excess costs of people with dementia compared to costs in people without dementia. Yet, excess costs of dementia have rarely been examined. To contribute to the existing evidence on excess costs of dementia by adding information regarding the oldest-old. We used cross-sectional data from the AgeQualiDe study. This multicenter cohort study considers exclusively participants with a minimum age of 85 years. We included 856 primary care patients with (n = 154) and without (n = 702) dementia into the analysis. By using the reweighting method of entropy balancing, excess costs from the societal perspective were estimated as mean cost differences between both groups for each cost category of different healthcare sectors. In our primary analysis, total costs were 2.5 times higher for people with dementia (n = 154) compared with people without dementia (n = 702). People with dementia showed significant total excess costs of € 11,789 (95% CI € 8,343–15,234) compared with people without the disease in a 6-month period. Excess costs of informal care represented the highest cost category in both primary and sensitivity analyses. Our results emphasize the economic and practical value of informal carers in dementia care, as it is generally unpaid care provision saving expenditures for formal care. Health policy strategies are needed to foster community-based dementia care in order to relieve social security systems and to support informal carers of people with dementia.

Cognitive stimulation in the workplace, plasma proteins, and risk of dementia: three analyses of population cohort studies

ObjectivesTo examine the association between cognitively stimulating work and subsequent risk of dementia and to identify protein pathways for this association.DesignMulticohort study with three sets of analyses.SettingUnited Kingdom, Europe, and...

Law and Dementia: Family Context and the Experience of Dementia in Old Age

Not all older persons will experience dementia but dementia is, by a wide margin, most likely to be experienced by persons age 65 and older. This chapter examines how characteristic relationship patterns and family dynamics of later life intersect with the experience of dementia in old age, and the ways in which law has responded to those intersections to create a distinct subgenre of family law focused on the older parent/adult child and late-life spousal relationships. At a historical moment when family members are normatively independent, no longer defined in relation to one another by traditional socially defined roles, family caregiving of older parents/spouses with dementia remains the expectation (despite decreased availability of the “free” female labour provided by daughters and daughters in law in the past). Concerns about capacity, undue influence, caregiving expectations, exploitation, and abuse may arise in the context of both old and new spousal relationships (with distinctive causes and implications). The older parent/adult child dynamic is multifaceted and complex, as old resentments and sensitivities about intra-familial fairness mix with new obligations and concerns about parental vulnerability to exploitation and harm (of which adult children may also be a source).

Alzheimer's disease: classification and diagnosis criteria

In recent years, the intensity of population aging has increased and the incidence of senile diseases, including dementia, has significantly increased. With the aging of populations in Europe, knowledge about the detection and diagnosis of dementia has increased in the last decade. Due to the increase in the number of patients, new therapies and precise diagnostic criteria have been introduced, contributing to faster diagnosis of the disease. Alzheimer's disease (AD) is the biggest cause of dementia in old age. It is characterized by progressive cognitive deficits, especially memory, and disorders such as: apathy, agitation and psychotic symptoms. Alzhaimer's disease is a degenerative brain disease caused by the deposition of pathological B-amyloid protein tau and alpha-synuclein in the brain, causing atrophy of neurons and their connections. The basis for diagnosis of dementia in the course of Alzheimer's disease are ICD-10 or DSM-IV criteria. The clinical course and symptoms in the course of AD are defined by the Global Deterioration Scale (GDS), the scale also determines the stage of the disease. Acetylcholinesterase inhibitor drugs and memantine are used to treat the symptoms of Alzheimer's disease. Prompt diagnosis and treatment significantly delays the progression of the disease and helps to prolong normal functioning of the patient.

Toward the development of a vibrant, super-aged society: The future of medicine and society in Japan.

Toward the development of a vibrant, super-aged society: The future of medicine and society in Japan.

Multimorbidity in old age and its impact on life results.

BackgroundHigh prevalence diseases, such as high blood pressure, dementia and depression in old age can lead to multimorbidity, which is often defined as the presence of more than one health condition in an individual. Multimorbidity has negative consequences on health-related quality of life and healthcare utilization. As many age-associated diseases are not curable, therapeutic goals like preservation of autonomy, functioning, and life satisfaction become more important in old age patients.ObjectiveThe prevalence of multimorbidity dementia and depressive symptoms and the consequences of multimorbidity on autonomy, functioning, and life satisfaction among the oldest old were examined.Material and methodsIn personal computer-assisted interviews, participants of the representative study NRW80+ were asked for which health issues they received medical treatment.ResultsOn average, people above the age of 80 years were treated for 3.62 diseases and 31.4% of older people received medical treatment for 5 or more diseases. A connection between multimorbidity and age group could not be shown. Autonomy, functioning, and life satisfaction are reduced in association with multimorbidity.ConclusionMultimorbidity is a frequent phenomenon among old people. A lack of diagnostic procedures and medical treatment can be a reason for the missing age trends. The results illustrate the importance of multimorbidity for patient-relevant outcomes and reveal the need to identify patients with multimorbidity.

Targeting γ-Secretase for Familial Alzheimer's Disease.

Familial Alzheimer's disease (FAD) is a rare early-onset genetic form of a common dementia of old age. Striking in middle age, FAD is caused by missense mutations in three genes: APP (encoding the amyloid precursor protein) and PSEN1 and PSEN2 (encoding presenilin-1 and presenilin-2). APP is proteolytically processed successively by β-secretase and γ-secretase to produce the amyloid β-peptide (Aβ). Presenilin is the catalytic component of γ-secretase, a membrane-embedded aspartyl protease complex that cleaves APP within its single transmembrane domain to produce Aβ of varying lengths. Thus, all FAD mutations are found in the substrate and the enzyme that produce Aβ. The 42-residue variant Aβ42 has been the primary focus of Alzheimer drug discovery for over two decades, as this particular peptide is highly prone to aggregation, is the major protein deposited in the characteristic cerebral plaques of Alzheimer's disease, and is proportionately elevated in FAD. Despite extensive efforts, all agents targeting Aβ and Aβ42 have failed in the clinic, including γ-secretase inhibitors, leading to questioning of the amyloid hypothesis of Alzheimer pathogenesis. However, processing of the APP transmembrane domain by γ-secretase is complex, involving initial endoproteolysis followed by successive carboxypeptidase trimming steps to secreted Aβ peptides such as Aβ42. Recent findings reveal that FAD mutations in PSEN1 and in APP result in deficient trimming of initially formed long Aβ peptides. A logical drug discovery strategy for FAD could therefore involve the search for compounds that rescue this deficient carboxypeptidase activity. The rare early-onset FAD arguably presents a simpler path to developing effective therapeutics compared to the much more complex heterogeneous sporadic Alzheimer's disease.

Mitigating the negative impacts of aging on cognitive function; modifiable factors associated with increasing cognitive reserve

Research suggests that social, physical, and cognitively challenging activities during lifetime, could mitigate the negative effects of aging on cognitive function. This effect is explained by the increased cognitive reserve (CR) resulting from such factors; in fact, such activities, by altering structural and functional properties of the human brain, equip one with more effective compensatory mechanisms to resist brain damage before the presentation of severe clinical symptoms. Therefore, applying appropriate modifications in one's lifestyle and activities may be effective in lowering the risk of developing dementia and cognitive dysfunction in old age, especially in brain areas that are susceptible to aging. In this paper, we are going to review relevant studies discussing the association between important modifiable factors, known as CR proxies (i.e., educational attainment, occupational complexity, physical activity, social engagement, bilingualism, leisure activities, and Mediterranean diet), and different domains of cognitive function, which are affected either in the process of healthy aging or neurodegenerative diseases.

Childhood Abuse and Cognitive Function in a Large Cohort of Middle-Aged Women.

Cognitive function at middle age is of particular public health interest, as it strongly predicts later dementia. Children who have experienced abuse subsequently have worse cognitive function than those who have not. However, it remains unclear whether the association of abuse with cognitive function persists into middle age. In 2014-2016, 14,151 women ages 49-69 years who had previously responded to a childhood abuse questionnaire completed a cognitive battery. In models adjusted for childhood socioeconomic status and head trauma, combined physical, emotional, and sexual abuse was associated with lower scores on both Learning/Working Memory (severe abuse, lower scores similar to that observed in women 4.8 years older in our data) and Psychomotor Speed/Attention (severe abuse, lower scores similar to that observed in women to 2.9 years older in our data). Adjustment for adulthood socioeconomic status and health factors (e.g., smoking, hypertension) slightly attenuated associations. In exploratory analyses further adjusted for psychological distress, associations were attenuated. Women exposed versus unexposed to childhood abuse had poorer cognitive function at mid-life. Associations were particularly strong for learning and working memory and were not accounted for by adulthood health factors. Childhood abuse should be investigated as a potential risk factor for cognitive decline and dementia in old age.

Dementia in old age: from diagnosis to fatal outcome

Background: It is well known, that old age dementias steadily grow progressively worse and inevitably lead to fatal outcome. Mortality indices in foreign research largely vary, they are practically absent in domestic scientific studies, and official statistical data on the prevalence of dementia and the cause of death do not reflect the real situation. The Objective of the study was to perform the analysis of completed cases of late age dementias from the materials of observations in Alzheimer’s disease center of the Mental Health Research Center.Patients and Methods: Observational study, using prospective method of out-patient observation of subjects with dementias, who consulted Alzheimer’s disease center in 2007-2016 for the first time, made it possible to obtain reliable data on 217 patients, who died during this period.Results: More than one third of such cases (39%) referred to nosologically various dementias with an early onset of the disease. In more than half of the cases (58%) the cause of death was medical pathology. In the rest of the patients severe or terminal stage of the basic disease was noticed toward the end of life under conditions of home care.Conclusions: Holistic view of the clinical picture of old age dementias (from the onset of the disease till the fatal outcome) is necessary for creation of incidence registers and obtaining of science-based statistical indices of survival, mortality and causes of death. It is necessary to develop measures of assistance to families of patients with the most severe stage of dementias, creation of out-patient and in-patient network of hospices for this contingent of patients.

How to prevent the malignant progression of bipolar disorder.

There is increasing recognition that, in a high percentage of cases, bipolar disorder is a progressive illness. Multiple types of sensitization (or increased reactivity to repetition of the same stimulus) drive illness progression. One of the clearest is that of episode sensitization, where increased numbers of prior episodes are associated with: faster recurrences; more dysfunction; disability; social, educational, and employment deficits; suicide; medical comorbidities; cognitive dysfunction; and an increased incidence of dementia in old age. Repetition of stressors and bouts of substance abuse can also result in sensitization. Each type of sensitization appears to have an epigenetic basis, such that preventing sensitization should minimize the accumulation of adverse epigenetic chemical marks on DNA, histones, and microRNA. New data emphasize the importance of early, consistent intervention after an initial manic episode. The cognitive dysfunction associated with a first episode improves only if there are no further episode recurrences during the next year. A randomized study has also shown that comprehensive multimodal prophylactic intervention for 2 years leads to improvements in illness course extending over a total of 6 years. Intensive treatment of the earliest stages of bipolar disorder can thus exert lasting positive effects on the course of illness.

Neuron-glia interactions: Molecular basis of alzheimer's disease and applications of neuroproteomics.

Neurodegenerative disorders present with progressive and irreversible degeneration of the neurons. Alzheimer's disease (AD) is one of the most common neurodegenerative disorders affecting 50 million people worldwide (2017), expected to be doubled every 20years. Primarily affected by age, AD is the cause for old-age dementia, progressive memory loss, dysfunctional thoughts, confusion, cognitive impairment and personality changes. Neuroglia formerly understood as "glue" of the brain neurons consists of macroglia (astrocytes and oligodendrocyte), microglia and progenitors NG2-glia, and constitute a large fraction of the mammalian brain. The primary functions of glial cells are to provide neurons with metabolic and structural support in the healthy brain; however, they attain a "reactive" state from the "resting" state upon challenged with a pathological insult such as a neurodegenerative cascade. Failure or defects in their homoeostatic functions (i.e. concentration of ions, neurotransmitters) ultimately jeopardize neurons with excitotoxicity and oxidative stress. Moreover, the most common clinical outcome of AD is the cognitive impairment and memory loss, which are attributed mainly by the accumulation of Aβ. Failure of glial cells to remove the Aβ toxic proteins accelerates the AD progression. The rapidly emerging proteomic techniques such as mass spectrometry (MS), cross-linking mass spectrometry, hydrogen deuterium trade mass spectrometry, protein foot printing and 2-DGE combined withLC-MS/MS present wide array of possibilities for the identification of differentially expressed proteins in AD.

The Other Within Oneself: Understanding Care for a Family Member with Early‐Onset Dementia Through the Lens of Dividuality

AbstractIn this article, I use the concept of the dividual to analyze the dynamics at stake in a family caring for a member with early‐onset dementia. Drawing on anthropological fieldwork in the Netherlands, I argue that using a dividual framework reveals family dynamics that are overlooked when using an individual framework, and it allows one to better understand the emotional pain that family members experience during the care process. Approaching family members as fractal persons shows how their identity is composed of other family members and how this can lead to dilemmas and conflicts in the care situation. The majority of articles on dementia focus on dyadic relationships. This article advocates a systemic approach encompassing the whole family. Moreover, it underlines the importance of taking the historicity of family relations into account and not limiting the analysis to situational dynamics.

Late-life depression and the risk of dementia in 14 countries: a 10-year follow-up study from the Survey of Health, Ageing and Retirement in Europe

BackgroundDepression is the most common mental health problem and often co-occurs with dementia in old age. This study investigates the influence of late-life depression on risk of dementia. MethodsA total of 16210 dementia-free participants aged 60+ from the Survey of Health, Aging, and Retirement in Europe were followed up for 10 years to detect incident dementia. Depression was assessed by a 12-item Europe-depression scale, dementia was determined by physician diagnosis reported by the participants and their informants. Fine and Gray model was performed to explore the association between depression and incident dementia taking into account competing risk of death. ResultsDuring an average of 8 years follow-up, 1030 (6.35%) incident dementia were identified. Late-life depression was related to higher subdistribution hazard ratio (sHR) of dementia (sHR=1.52, 95%CI: 1.32-1.75) after adjusting for age, gender, country, education, smoking, drinking, living arrangement, BMI, chronic disease, and physical activity. Further, the risk was only existed in those below age of 80 (sHR=1.75, 95%CI: 1.47-2.07). In addition, a dose-response association was observed between the severity of depression and dementia risk (p for trend<0.001). LimitationThe ascertainment of depression and dementia was based on information reported by the participants and/or their informants, which might result in information bias. The causal relationship could not be determined because limited follow-up time. ConclusionsLate-life depression is associated with higher incidence of dementia in a dose-response fashion. Interventions targeting depression patients aged 60-79 years and those with severe depression may be effective strategies to prevent dementia.

Midlife socioeconomic position and old-age dementia mortality: a large prospective register-based study from Finland

ObjectivesTo assess the association between multiple indicators of socioeconomic position and dementia-related death, and to estimate the contribution of dementia to socioeconomic differences in overall mortality at older ages.DesignProspective population-based...

Determinants of incident dementia in different old age groups: results of the prospective AgeCoDe/AgeQualiDe study.

To examine the impact of determinants of incident dementia in three different old age groups (75-79, 80-84, 85+years) in Germany. Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals. Primary care medical record registry sample. General practitioners' (GPs) patients aged 75+years at baseline. Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset. Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups. This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.

The Impact of an Educational Support Program on Formal Caregivers of Elderly People with Dementia in the Institutional Context

With the aging of the population and the increase of social services tackling their needs, it has been increasing the concern about the qualifications of formal caregivers, with the aim of continuous improvement of the quality of the services they provide to the elderly. The goal of this study is to evaluate the impact of an educational support program on formal caregivers of elderly people with dementia in an institutional context. It follows a quasi-experimental design where the 97 formal caregivers that have participated in the study came from two different institutions. They were randomly selected to participate in an educational support program on dementia, with two groups formed: a control group and an experimental group. Pre and post-training tests were used to evaluate knowledge and perceptions about dementia in old age. Findings suggest that the impact of the educational support program has improved knowledge and perceptions about dementia in old age among formal caregivers.