Stages Of Dementia Research Articles

Leveraging Vision Transformers for Early Detection of Alzheimer's disease Through MRI Image Analysis

Alzheimer's disease (AD) poses challenges for early recognition due to subtle and overlapping symptoms, making timely care and intervention difficult. This work presents a new method for identifying Alzheimer's disease by combining magnetic resonance imaging (MRI) data with a Vision Transformer (ViT) model. In this research, we develop a method that leverages MRI scans to classify Alzheimer's disease (AD) into four distinct stages: Non-Demented, Very Mild Demented, Mild Demented, and Moderate Demented. To improve the identification of clinical and structural alterations in the brain linked to AD, sophisticated characteristics are retrieved, including voxel-intensity patterns, grey matter volume, and cortical thickness. These characteristics allow for a more accurate representation of MRI data when paired with sophisticated processing methods. Additionally, even in situations where data is scarce, transfer learning is used to maximize the Vision Transformer (ViT) model's classification accuracy, especially when it comes to differentiating between neighboring stages of dementia. The ViT model, a cutting-edge deep learning technique, shows strong performance and dependability in identifying AD phases. Our findings highlight its effectiveness, showcasing a significant improvement in diagnostic accuracy compared to existing methods. The accuracy with which the ViT model can distinguish between different phases of AD emphasizes both its suitability for handling complicated MRI data and its promise for early diagnosis and detection.This paper offers a promising method for enhancing MRI image processing for Alzheimer's disease diagnosis through sophisticated feature extraction, transfer learning, and the use of Vision Transformers (ViTs). Present authors believe this method successfully tackles the difficulties of early and precise detection, making it essential for appropriate medical image analysis.

The Implementation of Infant Anoesis and Adult Autonoesis in the Retrogenesis and Staging System of the Neurocognitive Disorders: A Proposal for a Multidimensional Person-Centered Model

Background: Retrogenesis is the process by which the degenerative and vascular mechanisms of dementia reverse the order of acquisition in the normal development. Objective. The development of memory/knowledge after birth may help to know the biopsychosocial and functional characteristics (biosphere) of the retrogenesis. Methods. A literature review was performed in the PubMed, Google Scholar, and Scopus databases using 43 keywords related to retrogenesis: 234 eligible records were selected. Results. The infantile amnesia, characterized from anoesis, was described along the infant/child’s biosphere in which the limbic system progressively develops the acquisition of the body knowledge (Anoetic Body Consciousness, AnBC). Anoesis is the infant memory state characterized by the absence of long-term memories of the many stressful/painful experiences that accompany the acquisition under the long-life voluntary control of the long-term memories fundamental for the body growth and survival (mainly chewing/swallowing and walking). At the age of 3–4 years, usually, the AnBC evolves, as a continuum, into the adulthood autonoesis with the emergence, in the child/adolescent, of the consciousness of “self” trough the development of the Episodic Autobiographic Memory (EAM) and the Autonoetic Mind Consciousness (AuMC). The development of cognition and knowledge is due to the progressive maturation of the whole limbic system and not only of the hippocampus. In the biopsychosocial retrogenesis, the EAM/AuMC vanishes progressively along the mild, moderate, and severe stages of dementia when the infant AnBC resurfaces, losing progressively the basic activities of daily living in a retrogenetic order of acquisition where the last functions to disappear are chewing/swallowing. Conclusion. The transition from the adult EAM-AuMC to the infant AnBC, as a continuum in the individual biosphere, adds a contribution to the assessment of the retrogenesis in dementia from a multidimensional person-centered model.

Deprescribing in cognitively vulnerable older people: development and validation of STOPPCog criteria.

To validate STOPPCog, a list of explicit criteria for potentially inappropriate medication use in cognitively vulnerable older adults. A Delphi consensus survey of an expert panel comprising academic geriatricians, old age psychiatrists, general practitioners, and clinical pharmacists. Ireland. Nine panellists. STOPPCog criteria were initially created by the authors based on clinical experience and literature appraisal. Criteria were organised according to drug/drug class. Using Delphi consensus methodology, panellists ranked their agreement with each criterion on a 5-point Likert scale and provided written feedback. Criteria with a median value of 1 or 2 (strongly agree/agree) and a 25th centile value of ≤2 were included in the final list. All panellists completed two Delphi consensus validation rounds. Twenty-five criteria were proposed initially, twenty were accepted. One criterion was rejected (multi-vitamin supplements), and four criteria were rephrased (two of these were combined to one criterion for greater clarity). The final list comprised 23 criteria that are arranged in six subgroups i.e. (i) drugs with anticholinergic properties taken daily; (ii) drugs with sedative properties taken daily; (iii) drugs that may exacerbate psychotic symptoms in patients with alpha-synuclein pathology; (iv) drugs used for chronic pain; (v) drugs without proven efficacy for dementia taken daily; (vi) drugs that are of no proven benefit in advanced stage dementia i.e. clinical dementia rating of 3.0 where palliation may be appropriate. STOPPCog comprises 23 criteria relating to medications that are potentially inappropriate in cognitively vulnerable older adults. STOPPCog may assist physicians in deprescribing medications in this patient population.

Adults living with dementia and chronic wounds, wound types, care challenges, and impact across dementia stages: A scoping review protocol.

The objective of this scoping review is to map the existing evidence on the epidemiology, care challenges, and impacts of various wound types among individuals living with dementia across different stages of the disease. Dementia is a growing global health concern, projected to rise significantly as the population ages. This condition not only affects cognitive function but also increases the risk of chronic wounds in part due to impairments in mobility, self-care, and communication. Current wound care guidelines inadequately address the specific needs of individuals with dementia. This scoping review seeks to fill this gap by comprehensively exploring the intersection between dementia and wound care. This review will include studies involving adults aged 18 and older diagnosed with dementia or cognitive impairment who are experiencing alterations in skin integrity, such as pressure injuries, venous and arterial ulcers, and diabetic ulcers. Both qualitative and quantitative studies will be considered, as well as studies focusing on the challenges faced by caregivers in managing wounds in this population. Excluded are studies such as editorials and opinion articles. A comprehensive search strategy will be employed across multiple electronic databases, including MEDLINE, CINAHL, PsycINFO, EMBASE, and PubMed, as well as grey literature sources like ProQuest Dissertations & Theses Global and OpenGrey. The search will include studies published in English and French without date restrictions. Data will be extracted using a pilot-tested tool and presented in graphical, diagrammatic, and tabular formats. A narrative summary will accompany these visuals, providing context and insights into the data in relation to the review's objectives.

Detecting mild cognitive impairment by applying integrated random forest to finger tapping.

Early detection of dementia is essential to reduce the decline in quality of life (QoL) and the increase in medical and nursing care costs associated with dementia in an aging society. In this study, we aimed to develop a simple screening test for mild cognitive impairment (MCI), a preliminary stage of dementia, by creating an analytical method to accurately detect MCI through finger-tapping measurement. We extracted 248 characteristics from the finger-tapping waveforms of 182 MCI patients and 352 normal controls, applying five conventional classification methods along with an improved Random Forest (RF) method proposed in this study (Integrated RF). In the proposed method, the RF classification model for the MCI and normal control groups is supplementally integrated with the RF classification model for the Alzheimer's disease and normal control groups to generate a new classification model. When comparing the discrimination accuracy of each method, the proposed method achieved the highest accuracy, with an F1-score of 0.795 (recall = 0.778 and precision = 0.814). These results demonstrate the potential of finger-tapping measurement as a highly accurate screening test for MCI.

The Turkish validity and reliability of Addenbrooke's Cognitive Examination III.

Addenbrooke's Cognitive Examination III (ACE-III) was developed as a screening tool for cognitive disorders. Many countries have proven the cultural adaptation, reliability and validity of ACE-III. To make cultural adaptations of ACE-III for the Turkish population and to examine its validity and reliability. First, ACE-III was translated and adapted into Turkish (ACE-III-TR), then its validity and reliability were examined. The study included 234 people: 93 with dementia (78 Alzheimer's disease (AD) and 15 frontotemporal dementia (FTD)), 46 with mild cognitive impairment (MCI) and 95 healthy. Two blinded speech and language therapists rated the ACE-III-TR simultaneously for interrater validity. The same practitioner retested the same participants 2 weeks later for test-retest reliability. The construct validity of the culturally adapted test was assessed by analysing subsection correlations with the ACE-III-TR total score. The association between the Mini-Mental State Examination (MMSE) total score, relevant subsections and ACE-III-TR total score was examined for criterion validity. Intergroup differences for healthy, MCI and dementia were studied for ACE-III-TR subsections and total score, and cut-off scores were calculated for total score with sensitivity and specificity in differential diagnosis. Attention, memory and ACE-III-TR total scores showed a statistically significant difference between the three groups of dementia, MCI and healthy (p<0.001). Statistically significant positive correlations ranging from 0.571 to 0.929 were found between ACE-III-TR subsections and total scores (p<0.05). A highly significant positive correlation was found between MMSE total score and ACE-III-TR total score (r=0.870). Between the second and first measurements, positive, moderately significant correlations were found for all subsections and ACE-III-TR total (ICC=0.508-0.784, r=0.477-0.646). A high level of agreement was found between two raters for all ACE-III-TR subsections and the ACE-III-TR total score (alpha=0.9296-0.99995). The total ACE-III-TR cut-off score was 79.5 for healthy and MCI and 69.5 for MCI and mild stage dementia. This study found that ACE-III-TR is a sensitive and specific screening test for the diagnosis of MCI and dementia that has high validity and reliability. ACE-III-TR was found to be a valid and reliable tool in dementia, including AD and FTD, and in mild, moderate and advanced dementia. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes. What is already known on the subject ACE was used as a screening tool to detect MCI and to differentiate AD from FTD. ACE was revised by Hsieh etal. in 2013 and updated as ACE-III, which has the advantages of assessing five cognitive domains, not requiring the use of additional materials, and providing an effective and sensitive measurement in a short time. However, the validity and reliability study of the ACE-III in Turkish has not been conducted. What this study adds to the existing knowledge This study demonstrates the validity and reliability of the Turkish ACE-III (ACE-III-TR), which is a sensitive and specific screening test for the diagnosis of MCI and dementia. What are the practical and clinical implications of this work? The ACE-III-TR can provide clinicians and patients with a quick and brief general cognitive screening, indicating both the patient's overall cognitive profile and the measures of each of the assessed domains. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes.

Use of lecanemab and donanemab in the Canadian healthcare system: Evidence, challenges, and areas for future research.

Lecanemab and donanemab are monoclonal antibody therapies that remove amyloid-beta from the brain. They are the first therapies that alter a fundamental mechanism, amyloid-beta deposition, in Alzheimer disease (AD). To inform Canadian decisions on approval and use of these drugs, the Canadian Consortium on Neurodegeneration in Aging commissioned Work Groups to review evidence on the efficacy and safety of these new therapies, as well as their projected impacts on Canadian dementia systems of care. We included persons with lived experience with Alzheimer disease in the discussion about the benefits and harms. Our review of the trial publications found high quality evidence of statistically significant group differences, but also recognized that there are mixed views on the clinical relevance of the observed differences and the value of therapy for individual patients. The drugs are intended for persons with early AD, at a stage of mild cognitive impairment or mild dementia. If patients are treated, then confirmation of AD by positron emission tomography or cerebrospinal fluid analysis and monitoring for risk of amyloid-related imaging abnormalities was recommended, as done in the clinical trials, although it would strain Canadian resource capacity. More data are needed to determine the size of the potentially eligible treatment population in Canada.

Diagnostic utility of the MTA-Score depending on age and cerebral microangiopathy in times of automated volumetry

To investigate the diagnostic value of the MTA score according to age, cerebral small vessel disease and in times of automated volumetry. Retrospective analysis of patients with subjective cognitive decline (SCD), amnestic mild cognitive impairment (aMCI), Alzheimer's disease (AD) and mixed dementia (MD) who presented to our outpatient dementia clinic between February 2018 and October 2020. Patients underwent cranial magnetic resonance imaging (MRI) including specific MRI sequences needed for automated volumetry. MRI data sets were analyzed regarding MTA score, Fazekas score, hippocampal und temporal lobe percentile and total white matter lesion volume. Within the study period, 242 patients (100 male, 142 female, mean age 74.7±9.9 years) with SCD (n=20), aMCI (n=110), AD (n=62) and MD (n=50) were analyzed. MTA score strongly correlated with age (ρ=0.545; p<0.001), especially regarding the aMCI and AD group. MTA score differentiated only between prodromal and dementia stages (aMCI vs. AD: p=0.005), whereas hippocampal percentile also showed a trend in differentiating between SCD and aMCI. There was a correlation between MTA score and hippocampal percentile (ρ=-0.385; p<0.001), which, on a single group level, could only be shown for the aMCI and AD group. There was significant correlation between MTA score with hippocampal and temporal lobe percentile. MTA score also correlated with Fazekas score (ρ=0.451; p<0.001) which again could only be detected within the aMCI and AD group. But there was no correlation between hippocampal percentile and total white matter lesion volume. When interpreting the MTA score, patient's age needs to be taken into consideration. Especially, in early dementia diagnostics, automated volumetric procedures might be advantageous, but due to the strong correlation of MTA score with hippocampal percentile, the MTA score still is a valid diagnostic marker. Whether hippocampal atrophy is modulated by cerebral small vessel disease still needs to be elucidated.

Palliative Care Program for Community-Dwelling Individuals With Dementia and Caregivers: The IN-PEACE Randomized Clinical Trial.

Care management benefits community-dwelling patients with dementia, but studies include few patients with moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, and seldom reduce health care utilization. To determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia. A randomized clinical trial of community-dwelling patients with moderate to severe dementia and their caregivers enrolled from March 2019 to December 2020 from 2 sites in central Indiana (2-year follow-up completed on January 7, 2023). Electronic health record screening identified patients with dementia; caregivers confirmed eligibility, including dementia stage. The intervention consisted of monthly calls from a trained nurse or social worker and evidence-based protocols to help caregivers manage patients' neuropsychiatric symptoms, caregiver distress, and palliative care issues (eg, advance care planning, symptoms, and hospice) (n = 99). Usual care caregivers received written dementia resource information and patients received care from usual clinicians (n = 102). The primary outcome was Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score (scores range from 0-36, with higher scores indicating worse patient symptoms). Secondary outcomes included Symptom Management in End-of-Life Dementia scores, caregiver depression (Patient Health Questionnaire-8) scores, caregiver distress (NPI-Q distress) scores, and combined ED and hospitalization events. Outcomes were assessed quarterly for 24 months or until patient death. A total of 201 dyads were enrolled (patients were 67.7% female; 43.3% African American; mean [SD] age, 83.6 [7.9] years); 3 dyads withdrew and 83 patients died over the course of the study, with at least 90% of eligible dyads in both groups completing each of the quarterly assessments. For the dementia palliative care vs usual care groups, mean NPI-Q severity scores were 9.92 vs 9.41 at baseline and 9.15 vs 9.39 at 24 months, respectively (between-group difference at 24 months, -0.24 [95% CI, -2.33 to 1.84]). There was no significant difference in the rate of change in NPI-Q severity from baseline between groups over time (P = .87 for the group and time interaction). There were no significant differences in the secondary outcomes, except that there were fewer combined ED and hospitalization events in the dementia palliative care group (mean events/patient, 1.06 in dementia palliative care vs 2.37 in usual care; between-group difference, -1.31 [95% CI, -1.93 to -0.69]; relative risk, 0.45 [95% CI, 0.31 to 0.65]). Among community-dwelling patients with moderate to severe dementia and their caregivers, dementia palliative care, compared with usual care, did not significantly improve patients' neuropsychiatric symptoms through 24 months. ClinicalTrials.gov Identifier: NCT03773757.

Studying Alzheimer’s disease through an integrative serum metabolomic and lipoproteomic approach

BackgroundAlzheimer’s disease (AD) is the most frequent neurodegenerative disorder worldwide. The great variability in disease evolution and the incomplete understanding of the molecular mechanisms underlying AD make it difficult to predict when a patient will convert from prodromal stage to dementia. We hypothesize that metabolic alterations present at the level of the brain could be reflected at a systemic level in blood serum of patients, and that these alterations could be used as prognostic biomarkers.MethodsThis pilot study proposes a serum investigation via nuclear magnetic resonance (NMR) spectroscopy in a consecutive series of AD patients including 57 patients affected by Alzheimer’s disease at dementia stage (AD-dem) and 45 patients with mild cognitive impairment (MCI) due to AD (MCI-AD). As control group, we considered 31 subjects with mild cognitive impairment in whom AD and other neurodegenerative disorders were excluded (MCI). A panel of 26 metabolites and 112 lipoprotein-related parameters was quantified and the logistic LASSO regression algorithm was employed to identify the optimal combination of metabolites-lipoproteins and their ratios to discriminate the groups of interest.ResultsIn the training set, our model classified AD-dem and MCI with an accuracy of 81.7%. These results were reproduced in the validation set (accuracy 75.0%). Evolution of MCI-AD patients was evaluated over time. Patients who displayed a decrease in MMSE < 1.5 point per year were considered at lower progression rate: we obtained a division in 18 MCI-AD at lower progression rate (MCI-AD LR) and 27 at higher progression rate (MCI-AD HR). The model calculated using 4 metabolic features identified MCI-AD LR and MCI-AD HR with an accuracy of 73.3%.ConclusionsThe identification of potential novel peripheral biomarkers of Alzheimer’s disease, as proposed in this study, opens a new prospect for an innovative and minimally invasive method to identify AD in its very early stages. We proposed a novel approach able to sub-stratify MCI-AD patients identifying those associated with a faster rate of clinical progression.

The Effects of Exergaming on the Depressive Symptoms of People With Dementia: A Systematic Review and Meta-Analysis.

Depressive symptoms are common among people with dementia (PWD). Exergaming consisting of combined cognitive and physical training in gaming is increasingly used to alleviate their depressive symptoms in research. With its potential synergistic neurobiological and psychosocial effects on reducing depressive symptoms among PWD, this review aimed to understand its effectiveness and contents. This is a systematic review of the effectiveness of exergames on depressive symptoms among older adults with dementia. A search was conducted on 7 May 2024 of the online databases CINAHL, Embase, PsycINFO, PubMed and the China Academic Journal Network Publishing Database (CNKI). The methodological quality of randomised controlled trials (RCT) and quasi-experimental studies was assessed with RoB2 and ROBINS-I, respectively. A meta-analysis of the included RCTs was conducted. Six studies consisting of four RCTs and two quasi-experimental studies involving 235 participants with various stages of dementia were included. The meta-analysis showed a significant overall improvement in depression with a large effect size (SMD = 1.46, 95% CI = -2.50, -0.43; p = 0.006). Despite high heterogeneity (I2 = 91%), all studies demonstrated a trend of improvement in depression after the intervention. The exergames adopted in the included trials had the following elements: simultaneous motor-cognitive training, a scoring mechanism and a social play. The dose of exergames ranged from 15 to 60 min per session for at least 8 weeks, with a minimum of two sessions weekly. However, the included studies had a moderate-to-serious risk of bias. The certainty of the evidence was very low. Exergames could be effective at improving the depressive symptoms of older adults with dementia. Yet, a moderate-to-severe risk of bias shows a rigorous study should be conducted in the future. This study provides evidence for healthcare professionals and informal caregivers to use exergames to address depressive symptoms in PWD. The review was registered on PROSPERO with the reference CRD42022372762.

Novel Monoclonal Antibodies for the Treatment of Alzheimers Disease using KISUNLA Drug

For persons with early-stage sympathetic Alzheimer's disease (AD), including those with mild cognitive impairment and mild congitive dementia stages of the disease with confirmed amyloid pathology, KISUNLA (donanemab-azbt) is a disease-modifying treatment. Nearly half of research participants finished their course of treatment with Kisunla within a year, making it the first and only amyloid plaque targeting medication that uses a limited duration treatment regimen based on amyloid plaque elimination. For those with early-stage sympathetic Alzheimer's disease who desperately require an efficient therapeutic alternative, Kisunla shows extremely significant results

Machine Learning-Based Alzheimer's Disease Stage Diagnosis Utilizing Blood Gene Expression and Clinical Data: A Comparative Investigation.

Background/Objectives: This study presents a comparative analysis of the multistage diagnosis of Alzheimer's disease (AD), including mild cognitive impairment (MCI), utilizing two distinct types of biomarkers: blood gene expression and clinical biomarker samples. Both of these samples, obtained from participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI), were independently analyzed utilizing machine learning (ML)-based multiclassifiers. This study applied novel machine learning-based data augmentation techniques to gene expression profile data that are high-dimensional, low-sample-size (HDLSS) and inherently highly imbalanced. The investigation obtained the highest multiclassification performance to date in the multistage diagnosis of Alzheimer's disease utilizing the blood gene expression profiles of Alzheimer's Disease Neuroimaging Initiative (ADNI) participants. Based on the performance results obtained, and other factors such as early prediction capabilities, this study compares the efficacies of the two types of biomarkers for multistage diagnosis. This study presents the sole investigation in which multiclassification-based AD stage diagnosis was conducted utilizing blood gene expression data. We obtained the best multiclassification result in both modalities of the ADNI data in terms of F1-score and were able to identify new genetic biomarkers. Methods: The combination of the XGBoost and SFBS (Sequential Floating Backward Selection) methods was used to select the features. We were able to select the 95 most effective gene probe sets out of 49,386. For the clinical study data, eight of the most effective biomarkers were selected using SFBS. A deep learning (DL) classifier was used to identify the stages-cognitive normal (CN), mild cognitive impairment (MCI), and Alzheimer's disease (AD)/dementia. DL, support vector machine (SVM), gradient boosting (GB), and random forest (RF) classifiers were used for the AD stage detection from gene expression profile data. Because of the high data imbalance in genomic data, borderline oversampling/data augmentation was applied in the model training and original samples for validation. Results: Utilizing clinical data, the highest ROC AUC scores attained were 0.989, 0.927, and 0.907 for the identification of the CN, MCI, and dementia stages, respectively. The highest F1 scores achieved were 0.971, 0.939, and 0.886. Employing gene expression data, we obtained ROC AUC scores of 0.763, 0.761, and 0.706 for the CN, MCI, and dementia stages, respectively, and F1 scores of 0.71, 0.77, and 0.53 for CN, MCI, and dementia, respectively. Conclusions: This represents the best outcome to date for AD stage diagnosis from ADNI blood gene expression profile data utilizing multiclassification techniques. The results indicated that our multiclassification model effectively manages the imbalanced data of a high-dimension, low-sample-size (HDLSS) nature to identify samples of the minority class. MAPK14, PLG, FZD2, FXYD6, and TEP1 are among the novel genes identified as being associated with AD risk.

Neuropsychiatric symptoms and neuroimaging-based brain age in mild cognitive impairment and early dementia: A multicenter study.

Despite the clinical importance and significant social burden of neuropsychiatric symptoms (NPS) in dementia, the underlying neurobiological mechanism remains poorly understood. Recently, neuroimaging-derived brain-age estimation by machine-learning analysis has shown promise as an individual-level biomarker. We investigated the relationship between NPS and brain-age in amnestic mild cognitive impairment (MCI) and early dementia. In this cross-sectional study, clinical data, including neuropsychiatric inventory (NPI), and structural brain MRI of 499 individuals with clinical diagnoses of amnestic MCI (n = 185), early Alzheimer's disease (AD) (n = 258) or dementia with Lewy bodies (DLB) (n = 56) were analyzed. We established a brain-age prediction model using 694 healthy brain MRIs and a support vector regression model and applied it to the participants' data. Finally, the brain-predicted age difference (brain-PAD: predicted age minus chronological age) was calculated. All groups showed significantly increased brain-PAD, and the median (IQR) brain-PAD was 4.3 (5.4) years in MCI, 6.3 (6.2) years in AD, and 5.0 (6.5) years in DLB. The NPI scores were subdivided into the following four categories: (i) Agitation and Irritability, (ii) Depression and Apathy, (iii) Delusions and Hallucinations, and (iv) Euphoria and Disinhibition. We found a significantly positive correlation between brain-PAD and the depression/apathy factor (Spearman's rs = 0.156, FDR-corrected P = 0.002), whereas no significance was shown for the other NPS factors. Higher brain-age may be associated with depression and apathy symptoms presented in MCI to early dementia stages, and brain-age analysis may be useful as a novel biomarker for the assessment or monitoring of NPS.

How Dementia Stages Influence the Impact of Stressors and Caregiving Appraisals on Caregiver Well-being

How Dementia Stages Influence the Impact of Stressors and Caregiving Appraisals on Caregiver Well-being

The effect of apathy on quality of life and caregiver burden in patients with dementia

ABSTRACT Introduction Apathy is one of the common neuropsychiatric symptoms in people with dementia (PwD). The aim of this study is to determine the impact of apathy on the patient's quality of life (QoL) and caregiver's burden among PwD. Methods Sample of this cross-sectional descriptive study consisted of 88 PwD attending the outpatient clinic of a university hospital in Istanbul and their family caregivers. The evaluation battery included Apathy Evaluation Scale (AES), Caregiver Burden Inventory (CBI) and Quality of Life in Alzheimer's Disease Scale (QoL-AD). Results The mean age of the patients was 73.1 ± 11.7, and the time since diagnosis was 3.9 ± 3.1 years; 64.8% had Alzheimer's type dementia, and 53.4% (n = 47) had mild dementia. The mean AES-C score was 52.9 ± 10.2, QoL-AD score was 28.4 ± 5.6 and CBI score 32.6 ± 25.9. Apathy was associated with medical comorbidity, stage of dementia, neuropsychiatric symptoms, functional status and depression. Apathy was found to be predictor of the QoL-AD and also related with CBI. Conclusions In dementia patients, apathy was associated with patients’ functional status, quality of life, and caregiver burden. It is recommended that patients be evaluated for apathy and its impact on activities of daily living, quality of life and caregiver burden.

The value of privacy for people with dementia.

The concept of privacy marks an astonishing gap in the discussion about care for people with dementia (PwD). In general, questions of privacy play an important role and attract much attention in the ethics of nursing care. Yet, when it comes to dementia care, there is hardly any systematic ethical debate on the topic at all. It almost seems as though PwD lost any plausible interest in privacy and no longer had a private sphere that needed to be considered or protected. However, this not only contradicts widespread moral intuitions but also ignores the views and needs of those affected. This conceptual analysis sets out to explore the value of privacy for PwD. We first outline the origins and dimensions of the concept of privacy itself and point out problems and limitations in the context of dementia. Especially the prevalent liberal conceptions' dependence on the idea of individual autonomy poses considerable challenges to an adequate understanding of the moral significance of privacy for PwD. Therefore, we subsequently examine alternative ways of conceptualizing the value of privacy in the context of dementia care. We argue that autonomy-based concepts of privacy may still apply in the early stages of dementia. In the further course of the syndrome, however, the relevance of other normative aspects comes to the fore, especially respect for remaining personal preferences as well as objective criteria of dignity and well-being. Thus, we outline in a differentiated way how and to what extent privacy can be of normative importance even beyond the purview of autonomy and should consequently be considered in dementia care.

Revealing hidden knowledge in amnestic mice.

Alzheimer's disease (AD) is a form of dementia in which memory and cognitive decline is thought to arise from underlying neurodegeneration. These cognitive impairments, however, are transient when they first appear and can fluctuate across disease progression. Here, we investigate the neural mechanisms underlying fluctuations of performance in amnestic mice. We trained APP/PS1+ mice on an auditory go/no-go task that dissociated learning of task contingencies (knowledge) from its more variable expression under reinforcement (performance). APP/PS1+ exhibited significant performance deficits compared to control mice. Using large-scale two-photon imaging of 6,216 excitatory neurons in 8 mice, we found that auditory cortical networks were more suppressed, less selective to the sensory cues, and exhibited aberrant higher-order encoding of reward prediction compared to control mice. A small sub-population of neurons, however, displayed the opposite phenotype, reflecting a potential compensatory mechanism. Volumetric analysis demonstrated that deficits were concentrated near Aβ plaques. Strikingly, we found that these cortical deficits were reversed almost instantaneously on probe (non-reinforced) trials when APP/PS1+ performed as well as control mice, providing neural evidence for intact stimulus-action knowledge despite variable ongoing performance. A biologically-plausible reinforcement learning model recapitulated these results and showed that synaptic weights from sensory-to-decision neurons were preserved (i.e. intact stimulus-action knowledge) despite poor performance that was due to inadequate contextual scaling (i.e. impaired performance). Our results suggest that the amnestic phenotype is transient, contextual, and endogenously reversible, with the underlying neural circuits retaining the underlying stimulus-action associations. Thus, memory deficits commonly observed in amnestic mouse models, and potentially at early stages of dementia in humans, relate more to contextual drivers of performance rather than degeneration of the underlying memory traces.

Music moves: Ettlingen dementia study – a pragmatic randomised controlled trial

Objectives Due to the limited effectiveness of pharmacological treatment, there is a growing need to explore non-pharmacological psychosocial interventions such as music therapy when treating the behavioural and psychological symptoms of dementia (BPSD). Method We randomised 57 nursing home residents into individual active music therapy plus standard care (aMT), individual receptive music therapy with tactile sound vibration plus standard care (rMT), or the standard care control group (CG). A trained music therapist provided 12 sessions over 6 weeks. The outcomes (BPSD; depression; quality of life; medical system usage; activities of daily living; music therapy engagement) were measured at baseline (0 week), post-intervention (6 weeks), and follow-up (12 weeks). Results The results indicated small beneficial effects for BPSD in aMT and rMT at follow-up, a small beneficial effect for total musical engagement in aMT and rMT, a small negative effect for verbal communication in rMT, and a small beneficial effect for medical usage in the CG. Conclusion Both aMT and rMT methods showed promise for managing BPSD and increasing engagement during music therapy. rMT may be more suited for advanced stages of dementia. Future studies should evaluate the appropriateness and effectiveness of each intervention according to disease severity.

Effects of clinical stage, behavioral and psychological symptoms of dementia, and living arrangement on social distance towards people with dementia.

Dementia presents significant challenges, including social exclusion, which can be exacerbated by public stigma. This study aimed to clarify how social distances, a common measure of public stigma, towards people living with dementia and its associated factors vary with clinical stage, presence of behavioral and psychological symptoms of dementia (BPSD), and living arrangements. The study involved 2,589 Japanese participants aged 40 to 90 years. They were exposed to one of four vignettes depicting an 80-year-old woman progressing from normal ageing to mild, moderate, and severe dementia: Vignette A (living with husband, without BPSD); Vignette B (living with husband, with BPSD); Vignette C (living alone, without BPSD); and Vignette D (living alone, with BPSD). Social distance showed no significant differences in the normal aging and mild stage of dementia across all vignettes. At the moderate stage, social distance was higher for individuals exhibiting BPSD, regardless of living arrangement. At the severe stage, the lowest social distance was observed towards individuals living with their family without BPSD, whereas the highest was towards those living alone, exhibiting BPSD. For Vignette A, possession of social capital (p<0.001) and having experience of social contact with people living with dementia (PLWD) (p = 0.001-0.007) were independently associated with lower social distance across all dementia stages. In addition, in the mild stage of dementia, high perceived social support (p = 0.005) and having knowledge about dementia (p = 0.036) were associated with lower social distance, but not in the moderate or severe stage of dementia. For Vignette D, possession of social capital (p≤0.001) and having experience of social contact with PLWD (p<0.001 to p = 0.006) were independently associated with lower social distance across all dementia stages. In mild dementia, female sex (p = 0.004) and knowledge about dementia (p = 0.026) were associated with lower social distance. Furthermore, in mild and moderate dementia, living in rural area (p = 0.003-0.048) was associated with lower social distance. Social distance is higher toward PLWD who live alone and exhibit BPSD than toward those who live with family and/or do not show BPSD, indicating a higher risk of exclusion for the former. Moreover, factors affecting social distance towards PLWD vary across different clinical stages of dementia. While greater knowledge about dementia is associated with lower social distance toward PLWD, this effect appears to be most pronounced in the mild stage. In contrast, opportunities for social contact with PLWD are crucial for achieving lower social distance across all stages of dementia. The findings underscore the need for stage-specific interventions to address stigma, with a focus on education and opportunities for social contact. Targeted efforts are especially important for promoting the inclusion of PLWD who live alone and exhibit BPSD.