Dementia In Population Research Articles

B vitamins and prevention of cognitive decline and incident dementia: A systematic review and meta‐analysis

AbstractBackgroundElevation of homocysteine levels is a well‐established risk factor for dementia, yet controversy exists regarding whether B‐vitamin‐mediated reduction of homocysteine levels can benefit cognitive function. We aimed to investigate whether B vitamins can reduce the risk of cognitive decline and incident dementia.MethodPubMed, EMBASE, Cochrane Library, and Web of Science were searched for articles published from the inception dates to March 1, 2020. Studies were eligible if the endpoints included MMSE changes and risk of cognitive decline and/or dementia. Random‐effect or fixed‐effect models, depending on the degree of heterogeneity, were performed to calculate mean differences (MDs), hazard ratios (HRs), and odds ratios (ORs).ResultA total of 95 studies with 46175 participants (25 RCTs, 20 cohorts, and 50 cross‐sectional studies) were included. B vitamins can benefit cognitive function as measured by MMSE changes (MD, 0.13, 95% CI 0.04‐0.23), and this result was also significant in studies where placebo groups developed cognitive decline, suggesting that B vitamins slow cognitive decline. For the > 12 months interventional period stratum, B vitamins decreased cognitive decline (MD, 0.15, 95% CI 0.05‐0.25) compared to placebo; no such outcome was detected for the shorter interventional stratum. In the non‐dementia population, B vitamins slowed cognitive decline (MD, 0.15, 95% CI 0.04‐0.25) compared to placebo; this outcome was not found for the dementia population. Lower folate levels (but not B12 or B6) were associated with higher risk of dementia (OR, 1.76, 95% CI 1.24‐2.50) and cognitive decline (OR, 1.26, 95% CI 1.02‐1.55). Among the population without dementia aged 50 years and above, the risk of incident dementia was significantly decreased among individuals with higher intake of folate (HR, 0.61, 95% CI 0.47‐0.78) (but not B12 or B6).ConclusionOur meta‐analysis suggests that B vitamin supplementation is associated with slowing of cognitive decline, especially in populations who received early and long‐term intervention; higher intake of dietary folate is associated with a reduced risk of incident dementia in non‐dementia aged population.

Caring for behavioral symptoms of dementia (CBD): A new investigation into cannabidiol for the treatment of anxiety and agitation in Alzheimer’s dementia

AbstractBackgroundAnxiety and agitation symptoms affect 25‐70% of the dementia population, though there are no FDA‐approved medications that treat the behavioral symptoms of AD. Thus, the need for developing safe and efficacious treatments for anxiety and agitation in AD is dire. One potential treatment is cannabidiol (CBD), the major non‐intoxicating constituent of cannabis sativa, a variety of the cannabis plant that contains <0.3% delta9‐tetrahydrocannabinol (THC), the main intoxicating constituent in cannabis, by weight. The present open‐label clinical trial seeks to address this gap in knowledge by assessing the efficacy and tolerability of a high‐CBD/low‐THC sublingual solution as a treatment for anxiety and agitation in older adults with Alzheimer’s disease.MethodAn 8‐week open‐label clinical trial of an industrial hemp‐derived high‐CBD/low‐THC sublingual solution. This includes 12 research participants with AD and symptoms of anxiety with or without agitation. Our primary efficacy outcome measures include the anxiety domain of the Neuropsychiatric Inventory‐Clinician Version (NPI‐C) and the Generalized Anxiety Disorder‐7 Item Scale (GAD‐7). Our secondary safety outcome measures include monitoring for serious adverse events and medication side effects, cognitive decline estimates from the Mini Mental Status Exam (MMSE), and the emergence of possible delirium from the Confusion Assessment Method (CAM). Scores on the NPI‐C, the Cohen‐Mansfield Agitation Inventory (CMAI), and caregiver burden estimates from the Zarit Caregiver Burden Interview will be included as additional exploratory measures.ResultsWe hypothesize that twice daily treatment with a high‐CBD/low‐THC solution in older adults with AD for 8 weeks will be associated with a statistically significant reduction in anxiety and agitation symptoms compared to baseline, as measured by our efficacy outcome measurements. We predict that the solution will be well‐tolerated by the study population, as measured by our safety outcome measurements.ConclusionWith no current FDA‐approved treatments for these behavioral symptoms, patients with AD risk ineffective therapies or mortality‐associated antipsychotic treatments to address their NPS. Treating anxiety and agitation in these patients not only alleviates their symptoms but could also reduce caregiver burden and lengthen the time to institutionalization. CBD is a promising anxiolytic treatment that could advance our available treatment options for anxiety and agitation in AD.

Written Discourse Task Helps to Identify Progression from Mild Cognitive Impairment to Dementia

Purpose: We aimed to investigate: (1) the clinical, diagnostic value of a written discourse task, and (2) the relationship between executive functions and written discourse within the spectrum of individuals with mild cognitive impairment (MCI). Method: To determine whether written discourse performance predicts clinical course among individuals with MCI, we retrospectively classified individuals with MCI as converters (N = 26) who were later diagnosed with dementia or as a stable MCI group (N = 45). We quantified core word measures from written discourse samples obtained from the Cookie Theft picture description task. Result: Written discourse measures differentiated converters from the stable MCI group. Converters produced a fewer number of core words than the stable MCI group. A measure of executive function significantly predicted performance on the production of core words in written discourse for the converters. In a multivariable regression, production of core words remained the only explanatory variable closely associated with the progression to dementia in MCI. Conclusion: Written discourse tasks can predict the likelihood of MCI progressing to dementia, independently of recall and an executive function measure. Correlational results suggest that written discourse performance was associated with executive function as measured by the Trail Making Test. Our findings emphasize the usefulness of including written discourse tasks in language assessment batteries targeting preclinical dementia populations.

Future projections of the prevalence of dementia in Japan: results from the Toyama Dementia Survey

BackgroundThis study aimed to make future projections of the nationwide prevalence of dementia in Japan using the prevalence of dementia from the Toyama Dementia Survey and population projections.MethodsWe performed linear regression analysis using the prevalence of dementia by sex and age in 1985, 1990, 1996, 2001, and 2014 from the Toyama Dementia Survey to calculate the estimated future prevalence by sex and age. The estimated prevalence was then multiplied by the estimated future population of people aged 65 years and older by sex and age in each of the 47 prefectures from 2020 to 2045 and added together to calculate the total number of people with dementia. The estimated future prevalence of dementia was calculated by dividing the calculated number of people with dementia by the estimated future population of people aged 65 years and older in each of the 47 prefectures. In addition, the estimated future prevalence of dementia in each of the 47 prefectures from 2020 to 2045 was presented on a map of Japan and grayscale-coded in four levels.ResultsIn 2020, the estimated future prevalence of dementia did not exceed 20% in any prefecture, but in 2025, five prefectures, mainly rural prefectures, had projected rates exceeding 20%. In 2030, the prevalence rate is projected to exceed 20% nationwide, and by 2035, the rate will exceed 25% in 42 prefectures. In 2045, all prefectures excluding Tokyo are projected to have a dementia prevalence rate exceeding 25%, and the rate will exceed 30% in 12 of 47 prefectures.ConclusionsOver the next 25 years, the prevalence of dementia in people older than 65 years is projected to exceed 25% nationwide, including metropolitan areas.

Japanese National Dementia Plan Is Associated with a Small Shift in Location of Death: An Interrupted Time Series Analysis.

Background:Japan has one of the highest percentages of persons with dementia and hospital deaths in the world. Hospitals are often not equipped to handle the care complexity required for persons with dementia at the end of life. The National Dementia Orange plan aimed to decrease hospital deaths by expanding time in the community.Objective:The aim of this study is to evaluate whether the National Dementia Orange Plan is associated with a decrease in hospitals deaths for persons with dementia.Methods:We used quarterly, cross-sectional, national death certificate data consisting of the total Japanese dementia population 65 years and older, spanning a period from 2009 to 2016. The primary outcome was quarterly adjusted relative risk rates (aRRR) of dying in hospital, nursing home, home, or elsewhere. An interrupted time series analysis was performed to study the slope change over time. Analyses were adjusted for sex and seasonality.Results:149,638 died with dementia. With the implementation of the Orange Plan, death in nursing home (aRRR 1.08, [1.07–1.08], p < 0.001) and elsewhere (aRRR 1.05, [1.05–1.06], p < 0.001) increased over time compared to hospital death. No changes were found in death at home.Conclusion:This study provides evidence that the National Dementia Orange plan was associated with a small increase in death in nursing home and elsewhere. Hospital death remained the primary location of death. End-of-life strategies should be expanded in national dementia policies to increase aging in the community until death.

B vitamins and prevention of cognitive decline and incident dementia: a systematic review and meta-analysis.

Elevation of homocysteine (Hcy) levels is well-established as a risk factor for dementia, yet controversy exists regarding whether B-vitamin-mediated reduction of homocysteine levels can benefit cognitive function. To investigate whether B vitamin supplementation can reduce the risk of cognitive decline and incident dementia. The PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched for articles published from the inception dates to March 1, 2020. Randomized controlled trials (RCT) were included if B vitamins were supplied to investigate their effect on the rate of cognitive decline. Cohort studies investigating dietary intake of B vitamins and the risk of incident dementia were eligible. Cross-sectional studies comparing differences in levels of B vitamins and Hcy were included. Two reviewers independently performed data extraction and assessed the study quality. Random-effect or fixed-effect models, depending on the degree of heterogeneity, were performed to calculate mean differences (MDs), hazard ratios (HRs), and odds ratios (ORs). A total of 95 studies with 46175 participants (25 RCTs, 20 cohort studies, and 50 cross-sectional studies) were included in this meta-analysis. This meta-analysis supports that B vitamins can benefit cognitive function as measured by Mini-Mental State Examination score changes (6155 participants; MD, 0.14, 95%CI 0.04 to 0.23), and this result was also significant in studies where placebo groups developed cognitive decline (4211 participants; MD, 0.16, 95%CI 0.05 to 0.26), suggesting that B vitamins slow cognitive decline. For the > 12 months interventional period stratum, B vitamin supplementation decreased cognitive decline (3814 participants; MD, 0.15, 95%CI 0.05 to 0.26) compared to placebo; no such outcome was detected for the shorter interventional stratum (806 participants; MD, 0.18, 95%CI -0.25 to 0.61). In the non-dementia population, B vitamin supplementation slowed cognitive decline (3431 participants; MD, 0.15, 95%CI 0.04 to 0.25) compared to placebo; this outcome was not found for the dementia population (642 participants; MD, 0.20, 95%CI -0.35 to 0.75). Lower folate levels (but not B12 or B6 deficiency) and higher Hcy levels were significantly associated with higher risks of dementia (folate: 6654 participants; OR, 1.76, 95%CI 1.24 to 2.50; Hcy: 12665 participants; OR, 2.09, 95%CI 1.60 to 2.74) and cognitive decline (folate: 4336 participants; OR, 1.26, 95%CI 1.02 to 1.55; Hcy: 6149 participants; OR, 1.19, 95%CI 1.05 to 1.34). Among the population without dementia aged 50 years and above, the risk of incident dementia was significantly decreased among individuals with higher intake of folate (13529 participants; HR, 0.61, 95%CI 0.47 to 0.78), whereas higher intake of B12 or B6 was not associated with lower dementia risk. This meta-analysis suggests that B vitamin supplementation is associated with slowing of cognitive decline, especially in populations who received early intervention and intervention of long duration; the study also indicates that higher intake of dietary folate, but not B12 or B6, is associated with a reduced risk of incident dementia in non-dementia aged population. Given the prevalence of dementia cases in many countries with aging populations, public health policies should be introduced to ensure that subgroups of the population at risk have an adequate B vitamin status.

Global Perspectives on Brief Cognitive Assessments for Dementia Diagnosis.

Timely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected. To investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs. This is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach. Four domains with subthemes emerged illustrating participants' perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate. BCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population.

Exploring dementia family carers’ self-initiated strategies in managing behavioural and psychological symptoms in dementia: a qualitative study

ObjectivesCarer’s self-initiated management strategies of behavioural and psychological symptoms of dementia (BPSD) can inform intervention development. These strategies are affected by cultural values. Little is known about non-Western dementia carers’...

Living well with dementia: The role volunteer-based social recreational programs in promoting social connectedness of people with dementia and their caregivers

Objectives: This evaluation study was designed to examine the factors that contribute the promotion of social connectedness among people with dementia and their caregivers through social recreational programs; develop an understanding of volunteer’s impact on program success; and identify the barriers and facilitators to improve the volunteer-based programs to promote social connectedness. Method: A qualitative descriptive research design was used to explore the study participants’ lived experiences of social recreational programs from Alzheimer’s Society of Durham Region (ASDR) in Ontario, Canada. A final sample of 31 participants was recruited including people with dementia, informal caregivers, and community volunteers. Qualitative data was collected through face-to-face semi-structured interviews. Emerging themes were derived from the qualitative descriptive data using thematic analysis. Results: The qualitative interviews highlighted the impact of social recreational programs on people with dementia, caregivers and volunteers in the promotion of social connectedness, as well as the examination of barriers and facilitators to identify opportunities for the future improvement of ASDR programs that would benefit the dementia populations. The study findings revealed that the project ‘Living Well with Dementia’ has been able to successfully foster social connectedness through its volunteer-led social recreational programs by promoting the physical and mental well-being of people with dementia and their caregivers. Conclusion: Our study findings underscored the critical roles of volunteers who contributed to the success of community-based programs. Future research is needed to identify the opportunities to address current gaps in services and to strengthen the social recreational programs using evidence-based practices and client-centered approaches. Supplemental data for this article can be accessed online at http://doi.org/10.1080/13607863.2021.1950614.

A probability formula derived from serum indicators, age, and comorbidities as an early predictor of dementia in elderly Chinese people.

IntroductionBlood‐based indicators are potentially economical and a safe method for screening a population for dementia, although their predictive values have not been unequivocally confirmed. The present study proposes a dementia prediction formula based on serum indicators and patient characteristics.MethodsFrom January 2016 to December 2018, the data of elderly patients older than 60 years admitted to the Department of Neurology and Geriatrics in our hospital were retrospectively reviewed. A multivariate logistic regression model was applied to verify the patients’ characteristics and serum indicators associated with the risk of dementia. After receiver‐operating characteristic (ROC) curve and area under the ROC curve (AUC) analyses, we propose a dementia prediction formula and cutoff values for the predictive ability of early dementia.ResultsFour thousand seven hundred twenty two elderly patients were enrolled, and the incidence of dementia was 12.0% (565). When patients had ≥8 comorbidities, their risk of developing dementia was 20 times higher than those without comorbidities. After multivariate regression analysis, age (OR: 1.086, p < .001) and homocysteine (HCY) concentrations (OR: 1.017, p = .003) were proven to be linked to the risk of developing dementia, while total cholesterol (TC) (OR: 0.674, p = .005) was a protective factor for dementia. We developed a formula of age + low‐density lipoprotein cholesterol (LDL‐C) + TC + HCY + number of comorbidities as a good predictor of dementia (AUC: 0.79), with a probability (cutoff) value of 0.112 (sensitivity 87.4%, specificity 55.8%, and accuracy 60.5%).ConclusionsHigh‐serum HCY and low TC were risk factors for developing dementia. A cutoff value > 0.112 derived from our formula was an excellent predictor for people at a high risk of developing dementia, and may be a potentially useful diagnostic tool for identifying patients at risk for dementia in routine clinical practice.

Development and validation of a predictive algorithm for risk of dementia in the community setting

BackgroundMost dementia algorithms are unsuitable for population-level assessment and planning as they are designed for use in the clinical setting. A predictive risk algorithm to estimate 5-year dementia risk in...

Structural volume and cortical thickness differences between males and females in cognitively normal, cognitively impaired and Alzheimer’s dementia population

We investigated differences due to sex in brain structural volume and cortical thickness in older cognitively normal (N=742), cognitively impaired (MCI; N=540) and Alzheimer’s Dementia (AD; N=402) individuals from the ADNI and AIBL datasets (861 Males and 823 Females). General linear models were used to control the effect of relevant covariates including age, intracranial volume, magnetic resonance imaging (MRI) scanner field strength and scanner types. Significant volumetric differences due to sex were observed within different cortical and subcortical regions of the cognitively normal group. The number of significantly different regions was reduced in the MCI group, and no region remained different in the AD group. Cortical thickness was overall thinner in males than females in the cognitively normal group, and likewise, the differences due to sex were reduced in the MCI and AD groups. These findings were sustained after including cerebrospinal fluid (CSF) Tau and phosphorylated tau (pTau) as additional covariates.

Sex differences in a murine model of Cerebral Amyloid Angiopathy

Cerebral amyloid angiopathy (CAA) is one of the common causes of lobar intracerebral hemorrhage and vascular cognitive impairment (VCI) in the aging population. Increased amyloid plaque deposition within cerebral blood vessels, specifically the smooth muscle layer, is linked to increased cerebral microbleeds (CMBs) and impaired cognition in CAA. Studies in Alzheimer’s disease (AD) have shown that amyloid plaque pathology is more prevalent in the brains of elderly women (2/3rd of the dementia population) compared with men, however, there is a paucity of studies on sex differences in CAA. The objective of this study was to discern the sexual dichotomies in CAA. We utilized male and female Tg-SwDI mice (mouse model of CAA) at 12–14 months of age for this study. We evaluated sex differences in CMBs, cognitive function and inflammation. Cognition was assessed using Y-maze (spatial working memory) and Fear Conditioning (contextual memory). CMBs were quantified by ex vivo brain MRI scans. Inflammatory cytokines in brain were quantified using ELISA. Our results demonstrated that aging Tg-SwDI female mice had a significantly higher burden of CMBs on MRI as compared to males. Interestingly, these aging Tg-SwDI female mice also had significantly impaired spatial and contextual memory on Y maze and Fear Conditioning respectively. Furthermore, female mice had significantly lower circulating inflammatory cytokines, IL-1α, IL-2, IL-9, and IFN-γ, as compared to males. Our results demonstrate that aging female Tg-SwDI mice are more cognitively impaired and have higher number of CMBs, as compared to males at 12–14 months of age. This may be secondary to reduced levels of neural repair cytokines (IL-1α, IL-2, IL-9 and IFN-γ) involved in sex specific inflammatory signaling in CAA.

Alcohol-related dementia – an overlooked entity?

IntroductionThe relationship between alcohol use and dementia is complex. There is a J-shaped relationship between alcohol use and cognitive impairment and evidence shows that one-quarter of the dementia population have alcohol related problems. It is estimated that alcohol-related dementia (ARD) contributes for about 10% of all cases of dementia, especially early-onset dementia, but is largely overlooked or seen as a comorbid factor.ObjectivesTo clarify the relationship between alcohol use, alcohol-related brain damage and dementia; to review the clinical features, neuropathology, nosology and neuropsychology of ARD and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome- WKS).MethodsWe performed a review of systematic reviews from the last 10 years. A total of 28 systematic reviews were identified.ResultsHeavy alcohol use has been shown to be a contributory factor and necessary factor in the development of multiple brain diseases. It may cause brain damage in multiple ways: direct neurotoxic effect of acetaldehyde; thiamine deficiency. It is also a risk factor for other conditions, such as hepatic encephalopathy, epilepsy and head injury.ConclusionsClinical observation favors the diagnosis of ADR as a distinct entity, but broader evidence reflects significant commonality between ARD and WKS, tough neuropsychological studies have largely attempted to differentiate these syndromes. Repeated episodes of WKS may cause cognitive deterioration. In contrast to other common causes of dementia, the decline in cognitive functioning in ARD is relatively non-progressive if abstinence is maintained, or even partially reversible, as supported by neuroimaging evidence. Given the increase in per capita consumption, it is expected a disproportionate increase in ARD.

Components of Empowerment Among Family Caregivers of Community-Dwelling People With Dementia in Japan: A Qualitative Research Study.

ABSTRACTBackgroundFamily caregivers of people with dementia (PWDs) experience significant physical, psychological, and social burdens. Empowerment, which refers to the process of gaining power in society through behavioral change, is important to coping successfully with care-related burdens. The high burden of care faced by family caregivers in Japan often makes accepting social support difficult for caregivers of PWDs, resulting in feelings of isolation. Clarifying what components constitute empowering experiences for family caregivers of PWDs is necessary to gain a better understanding of their empowerment experiences and to develop relevant support schemes.PurposeThis study was developed to describe the components of empowerment experienced by family caregivers of community-dwelling PWDs in Japan.MethodsThis qualitative descriptive study used semistructured in-depth interviews to explore components of empowerment experienced by family caregivers of adults/older adults with dementia. Purposive sampling was used to recruit 20 family caregivers (age range: 50–87 years) from four self-help groups. A qualitative content analysis method was used to analyze the data. The components derived from the interviews were reviewed by three nursing researchers not directly involved in this study who are specialists in qualitative research and geriatric nursing.ResultsFour categories and 12 subcategories were derived to illuminate the components of empowerment among family caregivers of PWDs. Specifically, these categories were as follows: (a) proactive aspects of dementia care that were acquired through the caregiving experience, (b) creating a relationship that respects PWDs, (c) Building relationships based on mutual understanding of one's surroundings, and (d) understanding the social aspects of dementia care.Conclusions/Implications for PracticeThe findings of this study provide additional understanding of the components of the empowerment experiences of family caregivers of PWDs in Japan and in other East Asian countries experiencing increasing dementia diagnoses and population aging. In addition, the structural components of empowerment offer a useful perspective for health professionals on assessment and intervention that is framed on the cultural characteristics of East Asia. Ultimately, the results suggest that healthcare professionals should develop intervention programs that are tailored to the needs of caregivers at different levels of empowerment.

A systematic review of the novel applications of cannabinoids in dementia care: food refusal and neuropsychiatric symptoms

<h3>Introduction</h3> In recent years, there has been increased research interest investigating the novel use of cannabinoids in the treatment of patients living with dementia. Early clinical research suggests that cannabinoids may be beneficial in a variety of areas, including pain, sleep, weight loss, and behavioral aggression. In particular, cannabinoids may be especially valuable in dementia care in areas where there are currently limited therapies, including food refusal and neuropsychiatric symptoms (NPS) such as agitation and sleep disruption. Pharmacologic interventions for disordered eating in dementia are limited. And although atypical antipsychotics are commonly used to treat NPS, they are associated with an increased risk of serious adverse events and all-cause mortality in older patients. Thus, this study aims to review the current literature on the potential applications of cannabinoids in the treatment of food refusal and neuropsychiatric symptoms in dementia populations. <h3>Methods</h3> A systematic literature review was performed utilizing six major electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, Google Scholar, Cochrane CENTRAL) for articles published from database inception to November 2020. Search strings including keywords and Medical Subject Headings (MeSH terms) related to cannabinoids, dementia, food refusal, weight loss, agitation, and neuropsychiatric symptoms were used to identify relevant articles. <h3>Results</h3> A total of 23 relevant articles were identified that examined the use of cannabinoids including tetrahydrocannabinol, dronabinol, and nabilone in dementia patients. Regarding treatment of NPS in dementia, numerous studies found that use of cannabinoids was associated with potential benefits including reduced nighttime motor activity, improved sleep duration, reduced agitation, and lower Neuropsychiatric Inventory scores. With regards to food refusal, multiple articles documented use of cannabinoids being associated with increased percentage of meals consumed, with one crossover placebo-controlled trial finding increased overall body weight in dementia patients on dronabinol. Documented potential side effects include possible worsening of psychosis and anxiety, although overall, the literature appears to show cannabinoids to be generally well-tolerated. <h3>Conclusions</h3> Use of cannabinoids as potential treatments for food refusal and neuropsychiatric symptoms in dementia populations is an ongoing area of research. Completed clinical studies done on the subject to date have been small in scale, but have shown cannabinoids to be relatively well-tolerated and have yielded positive results. Thus, cannabinoids may have potential as a therapeutic intervention in dementia care, and these findings warrant further investigation. <h3>Funding</h3> Not applicable

Caring for Behavioral Symptoms of Dementia (CBD): A New Investigation into Cannabidiol for the Treatment of Anxiety and Agitation in Alzheimer's Dementia

<h3>Introduction</h3> Alzheimer's disease (AD) is a debilitating neurodegenerative disease accounting for 60-80% of dementia cases worldwide. In the United States alone, 13.8 million Americans are predicted to develop AD by 2050. The neuropsychiatric symptoms (NPS) of dementia affect up to 97% of AD patients over the course of their disease. A common NPS is agitation, characterized by problem behaviors that include combativeness and restlessness. Agitation is commonly associated with greater caregiver burden, shorter time to institutionalization, and anxiety. Anxiety symptoms affect 25-70% of the dementia population, and this wide range speaks to the inability to discern anxiety from agitation. Despite the pervasiveness of anxiety and agitation in the AD population, there are no FDA-approved medications that treat the behavioral symptoms of AD. Current treatments for these symptoms include time-intensive behavioral therapies and prescription of off-label antipsychotic medications that include an FDA warning of increased mortality in this population. Thus, the need for developing safe and efficacious treatments for anxiety and agitation in AD is dire. One potential treatment is cannabidiol (CBD), the major non-intoxicating constituent of cannabis sativa and industrial hemp, a variety of the cannabis plant that contains <0.3% delta9-tetrahydrocannabinol (THC), the main intoxicating constituent in cannabis, by weight. CBD modifies the endocannabinoid system and is thought to modulate effects via the 5-HT serotonergic system, μ-opioid receptors, and TRPV1/TRPV2 receptors. These interactions seem to result in an anxiolytic effect, as studies demonstrate CBD's ability to attenuate acute responses to stress in rats, act as a panicolytic in rats, and attenuate anxiety in humans. The utilization of CBD may extend beyond its role as an anxiolytic, as preclinical studies suggest widespread therapeutic impacts of CBD, including its ability to offer neuroprotective properties and inhibit tau hyperphosphorylation. Despite pre-clinical and animal evidence that CBD could modify neurodegeneration and behavioral symptoms in AD, no human clinical trials have investigated the impact of CBD on anxiety or agitation in AD. The present open-label clinical trial seeks to address this gap in knowledge by assessing the efficacy and tolerability of a high-CBD/low-THC sublingual solution as a treatment for anxiety and agitation in older adults with Alzheimer's disease. <h3>Methods</h3> An 8-week open-label clinical trial of an industrial hemp-derived custom-formulated high-CBD/low-THC sublingual solution developed by Dr. Staci Gruber, PhD, at McLean Hospital. We will recruit 12 research participants with mild to moderate Alzheimer's dementia and behavioral symptoms of anxiety with or without agitation. Our primary efficacy outcome measures are the anxiety domain of the Neuropsychiatric Inventory-Clinician Version (NPI-C) and the Generalized Anxiety Disorder-7 Item Scale (GAD-7). Our secondary safety outcome measures include continuous monitoring for serious adverse events and medication side effects, cognitive decline estimates from the Mini Mental Status Exam (MMSE), and the emergence of possible delirium from the 3D-Confusion Assessment Method (3D-CAM). Agitation and aggression domains on the NPI-C, scores on the Cohen-Mansfield Agitation Inventory (CMAI), and caregiver burden estimates from the Zarit Caregiver Burden Interview will be included as additional exploratory measures. <h3>Results</h3> Dr. Gruber's team is currently conducting a clinical trial for the treatment of anxiety in adults with moderate to severe anxiety using a similar custom-formulated high-CBD/low-THC sublingual solution. Preliminary analyses of Dr. Gruber's ongoing trial reveal that subjects experience significant reduction in anxiety symptoms along with improvements in mood, quality of life, and executive function over 4 weeks of treatment. Given these data and evidence of CBD's anxiolytic effects, we hypothesize that twice daily treatment with a high-CBD/low-THC solution in older adults with AD for 8 weeks will be associated with a statistically significant reduction in anxiety and agitation symptoms compared to baseline, as measured by our efficacy outcome measurements. We predict that the solution will be well-tolerated by the study population, as measured by our safety outcome measurements. <h3>Conclusions</h3> We seek a safe and effective treatment for the neuropsychiatric symptoms of anxiety and agitation in older adults with AD. With no current FDA-approved treatments for these behavioral symptoms, patients with AD risk ineffective therapies or mortality-associated antipsychotic treatments to address their NPS. Treating anxiety and agitation in these patients not only alleviates their symptoms but could also reduce caregiver burden and lengthen the time to institutionalization. CBD is a promising anxiolytic treatment that could advance our available treatment options for anxiety and agitation in AD. <h3>Funding</h3> The Spier Family Foundation

Clinical Features and Outcomes of Patients with Dementia Compared to an Aging Cohort Hospitalized During the Initial New York City COVID-19 Wave.

Background:Patients with dementia are vulnerable during the coronavirus disease 2019 (COVID-19) pandemic, yet few studies describe their hospital course and outcomes.Objective:To describe and compare the hospital course for COVID-19 patients with dementia to an aging cohort without dementia in a large New York City academic medical center.Methods:This was a single-center retrospective cohort study describing all consecutive patients age 65 or older with confirmed COVID-19 who presented to the emergency department or were hospitalized at New York-Presbyterian/Columbia University Irving Medical Center between March 6 and April 7, 2020.Results:A total of 531 patients were evaluated, including 116 (21.8%) with previously diagnosed dementia, and 415 without dementia. Patients with dementia had higher mortality (50.0%versus 35.4%, p = 0.006); despite similar comorbidities and complications, multivariate analysis indicated the association was dependent on age, sex, comorbidities, and code status. Patients with dementia more often presented with delirium (36.2%versus 11.6%, p < 0.001) but less often presented with multiple other COVID-19 symptoms, and these findings remained after adjusting for age and sex.Conclusion:Hospitalized COVID-19 patients with dementia had higher mortality, but dementia was not an independent risk factor for death. These patients were approximately 3 times more likely to present with delirium but less often manifested or communicated other common COVID-19 symptoms. For this high-risk population in a worsening pandemic, understanding the unique manifestations and course in dementia and aging populations may help guide earlier diagnosis and optimize medical management.

Knowledge, Attitudes, and Stigma Related to Dementia Among Illiterate and Literate Older Adults in Shanghai.

BackgroundChina has the largest population of patients with dementia worldwide, no assessment of illiterate old population’s dementia knowledge, attitudes, stigma have been conducted so far in China.AimThis study focused on the impact of education on knowledge, attitudes, and stigma related to dementia.MethodsThe community-based sample used in this study was recruited using multi-stage random sampling from residents aged ≥60 years registered in Shanghai. We used the Geriatric Depression Scale (GDS-30) to identify depression, and the Ascertain Dementia 8 questionnaire (AD8) for evaluating participants’ cognitive impairment. Knowledge, Attitude, Belief, and Practice scale, Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) were used for measuring dementia knowledge, attitudes, stigma. We separated the population into illiterate and literate group, propensity score matching based on age, sex, depression, and cognitive impairment. We calculated the difference of knowledge, attitudes, and stigma related to dementia between illiterate and literate groups.ResultsTwo thousand five hundred and eighteen participants completed the survey. After propensity score matching, 186 pairs of matched participants left. The overall correct rate of dementia knowledge was 70.34%. The illiterate group had a lower percentage of correct answers for each knowledge item. The item “Dementia is not a disease, it is forgetfulness due to aging” had the lowest accuracy rate in both groups (38.71% vs. 50.54%, p=0.022). Illiterate older adults were less accepting of dementia than literate older adults. The majority of participants did not agree that: “There is no need to visit a doctor when older people have memory loss, difficulty communicating, or finding words” (56.99% vs. 68.28%). Illiterate older adults had higher scores for the items assessing stigma toward dementia than literate older adults.ConclusionDementia-related knowledge and attitudes among community-dwelling older adults in Shanghai may be related to literacy.

Older Chinese Adults’ Knowledge, Beliefs, Attitudes and Behaviour on Cognitive Health and Ageing: An Exploratory Study in Singapore

Introduction: In recent years there has been increasing strategies to delay onset or progression of dementia, and identification of its modifiable risk factors. Given the collective emphasis on dementia prevention, an in-depth exploratory study is needed to enrich previous research and provide insights on current behaviours and attitudes towards dementia prevention. We aim to investigate the knowledge, beliefs, attitude and behaviour of older Chinese adults on cognitive health and ageing to identify motivators and barriers towards activities of dementia risk reduction. Methods &amp; Materials: In-depth interviews were conducted with 25 older Chinese adults between 50-75 years. The COM-B Framework from the Behavioural Change Wheel was used in the discussion guide design, and to identify themes to cover a. knowledge on brain health; b. perceptions of people with cognitive decline, impairment, and related conditions; and c. habits of maintaining a healthy lifestyle. Results: Four common insights identified were: a. Overall understanding of dementia remained low even as the word dementia was particularly recognizable among informants; b. Mental health was instinctively perceived to be integral to cognitive health; c. Presence of stigma towards the at-risk population of dementia and its support services; d. There was a basic knowledge of modifiable risk factors of dementia, but the knowledge did not always translate into preventive and health-seeking behaviour for brain health. Conclusion: The study has adopted an innovative approach in using the COM-B Framework of Behaviour Change to unveil motivators and barriers that would influence perceptions of older Chinese adults towards cognitive health and ageing. Elements of behaviour change identified in our research can be used to support older adults and their communities to gain more awareness about dementia, reduce risks and address challenges experienced, creating a supportive community for those at risk and having dementia.