Different Stages Of Dementia Research Articles

Comparative Characteristics of Inflammatory Markers in Alzheimer’s Disease in Males and Females

Background: the role of the sex factor in the differences between the manifestations of normality and pathology is not limited to the phenomenon of sexual dimorphism. It is known that the prevalence of certain diseases in males and females is different, in particular, there is a multiple increase in the incidence of dementia in females compared to males in Alzheimer’s disease (AD). Taking into account the role of neuroinflammation in the pathogenesis of neurodegenerative diseases, there is reason to assume gender differences in inflammation indicators at different stages of dementia in AD. The aim of the study was to conduct comparative analysis of indicators of the inflammatory system in the blood plasma of males and females at different stages of Alzheimer’s disease. Patients, control group and methods: a total of 210 patients with AD (101 males and 109 females) aged 49 to 94 years (average age 72.3 ± 8.2) with varying degrees of dementia severity, i.e. mild, moderate, severe, were examined. In peripheral blood plasma, the enzymatic activity of leukocyte elastase (LE) and the functional activity of α1-proteinase inhibitor (α1-PI) were determined by the spectrophotometric method, and the level of C-reactive protein (CRP) and IL-6 were determined by the enzyme-linked immunosorbent method (ELISA). The control group consisted of 52 healthy people, who did not differ from the patients in age and gender. Results and discussion: in the blood of patients with varying severity of dementia in AD, a statistically significant increase in α1-PI activity was observed compared to controls (p < 0.0001), regardless of gender. For all subgroups of patients with AD, the indicators of LE enzymatic activity were within the control range or beyond its lower limit. Low LE activity was observed in males compared to females both in the general group and in moderate dementia (p = 0.005105, p = 0.028672, respectively). In severe dementia, a significant decrease in LE activity compared to the controls did not depend on gender. Low LE activity in the blood of patients with AD, along with elevated levels of other inflammatory markers, may reflect a critical violation of the permeability of the blood-brain barrier and/or functional exhaustion of neutrophils due to a long-term inflammatory process. In males, compared with females, an increase in the level of the pro-inflammatory cytokine IL-6 was detected in the general group and in moderate dementia (p = 0.021238, p = 0.027894, respectively). A highly significant increase in CRP levels was only detected in males in subgroups with different severity of dementia. CRP levels in males were significantly higher than in females at the stage of moderate and severe dementia (p = 0.000906, p = 0.000049, respectively). Conclusion: distinctive features of inflammatory markers spectrum were identified, depending on gender and severity of dementia in AD. These results can be used to develop sex-specific preventive or therapeutic strategies for patients with mild cognitive impairment to determine risk and resistance to developing dementia.

Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study.

Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout. This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden. In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs. Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65%; t15=2.430; P=.03; d=0.61 [medium effect size]). COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions.

Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights.

Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.

Impact of Pain and Neuropsychiatric Symptoms on Activities in Nursing Home Residents (COSMOS Trial)

ObjectiveThis study aims to identify whether pain and dementia-related behavior are associated with different types of activities in nursing home residents, controlled for dementia severity. DesignCross-sectional baseline data from the multicomponent cluster randomized controlled COSMOS trial (acronym for Communication, Systematic pain treatment, Medication review, Organization of activities, and Safety). Setting and ParticipantsA total of 723 patients from 33 Norwegian nursing homes with 67 units (clusters). Participants aged ≥65 years, with a life expectancy of >6 months, and with valid data on activity were eligible for inclusion. MethodsActivity was operationalized in time (hours per week) and type (cognitive, social, physical, and no activity). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), pain with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and behavior with the Neuropsychiatric Inventory Nursing Home version (NPI-NH). Analyses were performed using linear and logistic regression. Sensitivity analyses for dementia severity were performed to account for effect modification. ResultsA total of 289 participants were included (mean age 86.2 [SD 7.6]; 74% female). A higher pain score was associated with less time spent on activity in participants with severe dementia (estimate 0.897, P = .043). A higher score for the NPI-NH mood cluster (depression and anxiety) was associated with a higher likelihood of participation in cognitive activities (odds ratio [OR], 1.073; P = .039). Apathy (OR, 0.884; P = .041) and lack of inhibition (OR, 0.904; P = .042) were associated with a lower likelihood of participation in social activities as well as no engagement in activities (apathy OR, 0.880; P = .042; lack of inhibition OR, 0.894; P = .034). Conclusion and ImplicationsPain and dementia-related behavior may influence the participation in activities in the nursing home. There is an urgent need to investigate what type of activity stimulates people in different stages of dementia.

New Convolutional Neural Network and Graph Convolutional Network-Based Architecture for AI Applications in Alzheimer’s Disease and Dementia-Stage Classification

Neuroimaging experts in biotech industries can benefit from using cutting-edge artificial intelligence techniques for Alzheimer’s disease (AD)- and dementia-stage prediction, even though it is difficult to anticipate the precise stage of dementia and AD. Therefore, we propose a cutting-edge, computer-assisted method based on an advanced deep learning algorithm to differentiate between people with varying degrees of dementia, including healthy, very mild dementia, mild dementia, and moderate dementia classes. In this paper, four separate models were developed for classifying different dementia stages: convolutional neural networks (CNNs) built from scratch, pre-trained VGG16 with additional convolutional layers, graph convolutional networks (GCNs), and CNN-GCN models. The CNNs were implemented, and then the flattened layer output was fed to the GCN classifier, resulting in the proposed CNN-GCN architecture. A total of 6400 whole-brain magnetic resonance imaging scans were obtained from the Alzheimer’s Disease Neuroimaging Initiative database to train and evaluate the proposed methods. We applied the 5-fold cross-validation (CV) technique for all the models. We presented the results from the best fold out of the five folds in assessing the performance of the models developed in this study. Hence, for the best fold of the 5-fold CV, the above-mentioned models achieved an overall accuracy of 43.83%, 71.17%, 99.06%, and 100%, respectively. The CNN-GCN model, in particular, demonstrates excellent performance in classifying different stages of dementia. Understanding the stages of dementia can assist biotech industry researchers in uncovering molecular markers and pathways connected with each stage.

LONGITUDINAL CHANGE IN PERFORMANCE ON THE MONTREAL COGNITIVE ASSESSMENT IN THE PEOPLE WITH DEMENTIA

Abstract The Montreal Cognitive Assessment (MoCA), a widely employed cognitive screening tool, is designed to identify mild cognitive impairment and diverse forms of dementia. Through its multidimensional evaluation of cognitive domains, MoCA supports clinicians in precise assessment and intervention planning for individuals manifesting cognitive deficits. Despite MoCA’s prevalence, limited research has explored its temporal dynamics in individuals experiencing memory loss, particularly across different stages of dementia. This study examined the MoCA changes of a longitudinal study analyzing the conversational speech in 8 older adults (5 males 3 females) with mild- to moderate-stage of dementia. Repeated biweekly measures at 12 intervals over six months were employed to gauge changes in total MoCA scores and its sub-tasks. Our findings reveal: 1) a significant negative correlation (r=-0.22, p=0.03) between the total MoCA score and the total time spent in tests; 2) most participants present a positive correlation (r=0.03 to 0.6) in their first memory trial session and a negative correlation (r=-0.1 to -0.8)in the second trial between words recalled and the time spent; 3) over 60% of participants demonstrating a declining trend in naming sessions, while orientation sessions exhibit no clear trend. These outcomes imply MoCA’s susceptibility to a “learning effect” with repeated measurements in people with dementia. Future longitudinal studies should consider alternate MoCA versions or extended assessment intervals to mitigate this effect.

P63: Best Practice Guidance on Human Interaction with Technology in Dementia Update June 2023 – Recommendations from the INDUCT and DISTINCT Networks

Objective:INDUCT (Interdisciplinary Network for Dementia Using Current Technology), and DISTINCT (Dementia Inter-sectorial strategy for training and innovation network for current technology) are two Marie Sklodowska-Curie funded International Training Networks that aimed to develop a multi-disciplinary, inter-sectorial educational research framework for Europe to improve technology and care for people with dementia, and to provide the evidence to show how technology can improve the lives of people with dementia.Methods:In INDUCT (2016-2020) 15 Early Stage Researchers worked on projects in the areas of Technology to support everyday life; technology to promote meaningful activities; and healthcare technology. In DISTINCT (2019-2023) 15 Early Stage Researchers worked on technology to promote Social health in three domains: fulfilling ones potential and obligations in society, managing one’s own life, and participation in social and other meaningful activities.Both networks adopted three transversal objectives: 1) To determine practical, cognitive and social factors needed to make technology more useable for people with dementia; 2) To evaluate the effectiveness of specific contemporary technology; 3) To trace facilitators and barriers for implementation of technology in dementia care.Results:The main recommendations resulting from all research projects are integrated in a web-based digital Best Practice Guidance on Human Interaction with Technology in Dementia which was recently updated (Dec 2022 and June 2023) and will be presented at the congress. The recommendations are meant for different target groups, i.e. people in different stages of dementia, their (in)formal carers, policy makers, designers and researchers, who can easily find the recommendations relevant to them in the Best Practice Guidance by means of a digital selection tool.Conclusions:The INDUCT/DISTINCT Best Practice Guidance informs on how to improve the development, usage, impact and implementation of technology for people with dementia in various technology areas. This Best Practice Guidance is the result of intensive collaborative partnership of INDUCT and DISTINCT with academic and non-academic partners as well as the involvement of representatives of the different target groups throughout the projects.

Clinical Manifestations.

Patterns of cognitive performance associated with different stages of dementia have been primarily studied in Non-Hispanic White (NHW) populations. This study compares patterns of cognitive performance, on a brief neuropsychological battery, in Caribbean Hispanic (CH) and NHW individuals with mild cognitive impairment, based on Clinical Dementia Rating (CDR) staging scores. Our data included 427 individuals including 299 self-identified CH (mean age = 76.0; 69.6% female; mean education = 11.9) and 128 NHW (mean age = 72.9; 61.7% female; mean education = 13.8) who completed the CDR and a brief neuropsychological battery. Participants with other medical conditions known to impact cognition were excluded. Sex-, age-, and education-adjusted Z-scores were calculated for all cognitive tests (Logical Memory (Immediate and Delayed recall), Digit Span (Forward and Backward), and Verbal Fluency (Animals and Vegetables)). ANOVAs were used to examine the effects of ethnicity (NHW, CH) and CDR Global Score (0.5, 1.0) on the adjusted Z-scores for all cognitive tests. CDR score distribution was adjusted through factorial ANOVA (ethnicity x CDR). Descriptive analyses included independent t-tests to examine differences between ethnicity groups on age, sex, education, percent AD, percent Unclear, and CDR Global Score. There was a main effect of ethnicity on Digit Span Forward (p < 0.001), Digit Span Backward (p < 0.001), and Verbal Fluency - Vegetables (p < 0.01), where CH individuals showed greater impairment regardless of Global CDR score. We found a main effect of Global CDR score on all cognitive tests, where individuals with Global CDR score of 1.0 demonstrated more impairment than individuals with a Global CDR score of 0.5. No ethnicity x CDR interactions were significant. Our sample of older CH and NHW individuals, presumed to have mild cognitive impairments based on CDR staging, did not differ in memory abilities. However, the CH group scored significantly lower on measures of attention and working memory. Finally, semantic fluency performance was variable and possibly influenced by cultural familiarity with different semantic categories. Among older CH individuals with mild dementia, cognitive difficulties may extend beyond memory problems and include attentional and executive function difficulties. These findings have clinical implications for diagnosis and management of CH patients.

Vascular Risks, Aging, and Late-Onset Dementia: Overlapping Etiologies Point to 'Scavenger Receptor'-Mediated Therapeutics

Early changes in systemic vascular stiffness and endothelial function can contribute to altered cerebrovascular hemodynamics and impaired cognitive function; additionally, these vascular changes point to potential targets for prevention and treatment strategies in people with mild cognitive impairment. Although the pathogenic mechanisms underlying these vascular changes are heterogeneous and complex, one common feature is the development of cerebral blood flow (CBF) dysregulation, resulting in chronic cerebral hypoperfusion (CCH) and subsequently an insufficient blood supply to the brain. However, the incorporation of drugs, or other bioactive molecules, into specifically a "high density lipoprotein-like" ("HDL-like") lipid nanocarrier can result in the production of a multitasking "combination therapeutic" – capable of targeting cell-surface scavenger receptors (mainly SR-BI). Such targeting behavior of this proposed (biomimetic-nanocarrier) therapeutic vehicle can facilitate the nanocarrier's enhanced endocytosis into various target cells which, in turn, increases the likelihood that this multitasking "combination therapeutic" provides some enhanced efficacy at different stages of dementia.

Inter-rating reliability of the Swiss easy-read integrated palliative care outcome scale for people with dementia.

The Integrated Palliative Care Outcome Scale for People with Dementia is a promising instrument for nursing home quality improvement and research in dementia care. It enables frontline staff in nursing homes to understand and rate the needs and concerns of people with dementia. We recently adapted the measure to include easy language for users from various educational backgrounds. In this study, we examine the inter-rating reliability of the Integrated Palliative Care Outcome Scale for People with Dementia for frontline staff in nursing homes. In this secondary analysis of an experimental study, 317 frontline staff members in 23 Swiss nursing homes assessed 240 people with dementia from a convenience sample. Reliability for individual items was computed using Fleiss Kappa. Because of the nested nature of the primary data, a generalisability and dependability study was performed for an experimental IPOS-Dem sum score. The individual Integrated Palliative Care Outcome Scale for People with Dementia items showed kappa values between .38 (95% CI .3-.48) and .15 (95% CI .08-.22). For the experimental IPOS-Dem sum score, a dependability index of .57 was found. The different ratings and time between ratings explain less than 2% of the variance in the sum score. The different nursing homes make up 12% and the people with dementia make up 43% of the sum score variance. The dependability study indicates that an experimental IPOS-Dem sum score could be acceptable for research by averaging two ratings. Limited research has been conducted on the measurement error and reliability of patient-centred outcome measures for people with dementia who are living in nursing homes. The Swiss Easy-Read IPOS-Dem is a promising instrument but requires further improvement to be reliable for research or decision making. Future studies may look at its measurement properties for different rater populations or at different stages of dementia. Furthermore, there is a need to establish the construct validity and internal consistency of the easy-read IPOS-Dem.

Care management needs of family caregivers at different stages of dementia

AbstractBackgroundIn Taiwan, more than 90% of persons with dementia who live at home are cared for by family caregivers. According to previous researches, family caregivers of dementia have a higher level of burden than almost all other diseases of old age. In addition, due to the different courses of dementia in each stage, coupled with the complexity of its problems, persons with different stages of dementia have different care demands. Therefore, this study aimed to explore the care management needs of family caregivers caring for persons with dementia at different stages.MethodA cross‐sectional study was conducted. Of the 250 family caregivers of persons with dementia were included. The Care Management Needs Scale (CMNS) was used to measure the care management needs of family caregivers, which is divided into six dimensions of needs (care service, psychological support, immediate information, anticipated information, referral and tracking of long‐term care resources, and individual case management service). The severity of dementia was determined by a neurologist using the Clinical Dementia Rating (CDR) scale.ResultFrom very mild dementia to severe dementia, the dimension with the highest needs at each stage are individual case management service, immediate information, referral and tracking of long‐term care resources, and care service, respectively. The overall needs, care service and psychological support in moderate dementia are significantly higher than very mild dementia. According to the needs of each item, the three highest needs are related to the dimension of immediate information and individual case management service in very mild dementia and mild dementia; in the case of moderate to severe dementia, care service began to appear in the three highest needs.ConclusionThe study concluded that different stages of dementia have different care management needs. When moderate dementia (CDR = 2.0), the need for care services will begin to increase. The findings suggest that care management should be provided for different stages of dementia. This study’s results provide a knowledge base for designing dementia stage‐specific care management in clinical practice and developing community‐based, long‐term care systems for family caregivers of persons with dementia.

Wearable devices: underrepresentation in the ageing society

Wearable devices: underrepresentation in the ageing society

Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care.

Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care.

Pathophysiological Linkage between Aging and Cognitive Decline: Implications for Dementia Treatment

The cardiovascular risk factors for dementia trigger widespread inflammation and oxidative stress. These two interacting processes lead to neurodegeneration, gradual cognitive/memory decline, and eventually (late-onset) dementia. In addition, there is supporting evidence pointing to elevated pulse pressure as a clear risk factor for cognitive decline. Accordingly, an effective therapeutic strategy to delay dementia could be based upon nanotargeting bioactive molecules, using lipid nanocarriers, toward cell-surface scavenger receptors. The resulting nanocarrier therapeutic is likely to be "multitasking", i.e., be capable of entering various target cells. Such targeting behavior of this proposed therapeutic appears likely to provide enhanced efficacy at different stages of dementia.

An AI‐based approach to detect cognitive impairment from digital voice recordings of neuropsychological assessments

AbstractBackgroundReliable cognitive impairment screening tools that are easy to administer and minimally time consuming are greatly needed. Given the high sensitivity of neuropsychological (NP) exams in detection of cognitive decline, we seek to develop an automated screening tool to detect dementia and mild cognitive impairment (MCI) based on digital voice recordings of NP assessments. This could enable wide‐spread screening for dementia and accelerate preventative efforts.MethodWe used natural language processing methods to create a screening tool that identifies different stages of dementia based on automated transcription of digital voice recordings. The transcribed sentences were classified into 8 main sub‐tests including memory assessment, naming and language skill, verbal fluency, general questions, etc. Using the idea of transfer learning, we encoded the participants' sentences into quantitative data. This data and the participants’ demographic variables such as age, sex, Apoe gene, and education were employed to train and test three binary classification tasks, (I) Normal cognition versus Dementia, (II) Normal/MCI versus Dementia, and (III) Normal versus MCI.ResultWe evaluated the performance of the classification tasks using the digital voice recordings of NP assessments, collected from the Framingham Heart Study, containing 410 cognitively intact subjects, 387 MCI, and 287 subjects with dementia. The average Area Under the Curve (AUC) on the held‐out test data reached 92.6%, 88.0%, and 74.4% for differentiating Normal from Dementia, Normal or MCI from Dementia, and Normal from MCI, respectively. Looking at the importance of the sub‐tests in differentiating MCI from Normal, we note that general questions can be more useful for assessment of MCI, whereas verbal fluency would not be as useful in this task.ConclusionThe proposed approach offers a fully automated identification of MCI and dementia based on a recorded NP test, providing an opportunity to develop a remote screening tool that could be easily adapted to any language.

Automated detection of mild cognitive impairment and dementia from voice recordings: A natural language processing approach.

Automated computational assessment of neuropsychological tests would enable widespread, cost-effective screening for dementia. A novel natural language processing approach is developed and validated to identify different stages of dementia based on automated transcription of digital voice recordings of subjects' neuropsychological tests conducted by the Framingham Heart Study (n = 1084). Transcribed sentences from the test were encoded into quantitative data and several models were trained and tested using these data and the participants' demographic characteristics. Average area under the curve (AUC) on the held-out test data reached 92.6%, 88.0%, and 74.4% for differentiating Normal cognition from Dementia, Normal or Mild Cognitive Impairment (MCI) from Dementia, and Normal from MCI, respectively. The proposed approach offers a fully automated identification of MCI and dementia based on a recorded neuropsychological test, providing an opportunity to develop a remote screening tool that could be adapted easily to any language.

Are Smart Homes Adequate for Older Adults with Dementia?

Smart home technologies can enable older adults, including those with dementia, to live more independently in their homes for a longer time. Activity recognition, in combination with anomaly detection, has shown the potential to recognise users’ daily activities and detect deviations. However, activity recognition and anomaly detection are not sufficient, as they lack the capacity to capture the progression of patients’ habits across the different stages of dementia. To achieve this, smart homes should be enabled to recognise patients’ habits and changes in habits, including the loss of some habits. In this study, we first present an overview of the stages that characterise dementia, alongside real-world personas that depict users’ behaviours at each stage. Then, we survey the state of the art on activity recognition in smart homes for older adults with dementia, including the literature that combines activity recognition and anomaly detection. We categorise the literature based on goals, stages of dementia, and targeted users. Finally, we justify the necessity for habit recognition in smart homes for older adults with dementia, and we discuss the research challenges related to its implementation.

Exploratory pilot study on resource allocation along the dementia continuum under constrained and unconstrained budget scenarios

BackgroundPeople with dementia and their carers have a wide range of health and social care needs which vary along the dementia continuum. The government response to events and transitions at various stages of the continuum can have a substantial impact on the lived experience of dementia and to resource allocation decision-making. Hearing what practitioners have to say about need at various points of transition along the dementia continuum is very important, especially for the resource allocation process.MethodsThe paper uses an innovative longitudinal balance of care (BoC) methodology to identify the impact of changes along the dementia care continuum for care recipients and practitioners throughout the course of the condition. Participatory workshops were held with five Health and Social Care Professionals (HSCPs) to pilot a mixed methods approach to resource allocation decision-making along the dementia continuum. In these workshops, these practitioner participants were asked to generate a set of services and supports for a person with dementia with changing and evolving needs over a five year period under two budget scenarios: no budget constraint (NBC); and a budget constraint (BC). Participants were asked to recommend services for short, post event, transition periods and for longer steady state periods.ResultsParticipants were able to allocate different packages of services and supports for different stages of dementia under different budgetary conditions. The total cost for the five year period under the NBC scenario is €200,000 on average, reducing to €133,000 under the BC scenario. Under the BC (NBC) scenarios, participants spent on average 85% (90%) of their budget on community services and 15% (10%) on nursing home services.ConclusionThe methodology used in this paper is a valuable complement to cross-sectional BoC studies through its identification of the importance of events, transitions and staging along the dementia care continuum. The desire of participants to keep people with dementia living in their own home is strong, even in the later stages of dementia, as evident by their recommendation to spend €400 per week more on home care provision compared to the alternative residential care, albeit in the absence of any budget constraints.

Brain dysmorphologies associated with Alzheimer disease in Down syndrome

Down syndrome (DS) is a genetic disorder occurring in 1 out of every 700 to 1,000 live births caused by trisomy of chromosome 21. The overexpression of the Amyloid Precursor Protein (APP) gene located on this chromosome leads to an early onset and rapid accumulation of ß‐amyloid (Aß) in the brain that invariably results in Alzheimer Disease (AD) in people with DS. Therefore, AD, the most common form of dementia, is currently one of the most relevant medical issues in people with DS. In this study, we assessed brain morphological patterns to quantify dysmorphologies associated with AD in Down syndrome.Brain shape and size analyses were performed using Geometric Morphometrics in a sample of 243 adults, including 153 euploid healthy controls (EU) and 90 individuals with DS at different stages of dementia: asymptomatic DS with no signs of AD‐related cognitive impairment (N=58), individuals with DS and prodromal AD (N=21) and individuals diagnosed with AD dementia (N=11). A set of 38 3D brain landmarks representing the overall shape of the brain and internal brain structures (ventricles, corpus callosum, cerebellum and pons) were located on magnetic resonance images of the head.Results showed a significant separation between EU and DS populations based on both global and local brain shape and size analyses. Individuals with DS displayed a smaller cerebellum, a protruding posterior midbody in the corpus callosum, a frontally projected brain and expanded ventricles. Significant brain shape differences were detected in individuals diagnosed with AD, which mainly affected the shape of enlarged brain ventricles. Remarkably, individuals at advanced stages of the disease displayed more severe dysmorphologies as compared to those individuals at prodromal stages and individuals with no signs of dementia, confirming a phenotypic continuum associated with the severity of dementia that highlights the impact of this neurodegenerative disorder in brain morphology.

Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study

BackgroundThe objective was to describe the prevalence and intensity of neuropsychiatric symptoms (NPSs) isolated and grouped into subsyndromes in patients with dementia in primary care (PC) to analyse their distribution based on stages of dementia and the relationship between them and the intensity of symptoms.MethodsDesign: Cross-sectional study. Setting and population: Patients with dementia, not institutionalized, in a PC follow-up. Variables: Sociodemographic and clinical variables. Assessment instruments: The frequency and intensity of NPSs were measured with the Neuropsychiatric Inventory (NPI), and the stages of dementia with the Global Deterioration Scale (GDS). Statistical analysis: The number of NPSs per patient, the mean NPI value, and the prevalence and intensity of NPSs isolated and grouped into subsyndromes were calculated, as were their 95% confidence intervals (CIs). The analyses were performed on an overall basis and by GDS scores. To analyse the association between the NPI and GDS scores, multivariate analysis was performed with a generalized linear model.ResultsOverall, 98.4% (95% CI 94.5;99.8) of the patients presented some type of NPS, with an average of five symptoms per patient. The most frequent symptoms were apathy [69.8% (95% CI 61.1;77.5)], agitation [55.8% (95% CI 46.8;64.5)] and irritability [48.8% (95% CI 39.9;57.8)]. The more intense NPSs were apathy [NPI 3.2 (95% CI 2.5;3.8)] and agitation [NPI 3.2 (95% CI 2.5;4.0)]. For subsyndromes, hyperactivity predominated [86.0% (95% CI 78.8;91.5)], followed by apathy [77.5% (95% CI 69.3;84.4]). By phase of dementia, the most common isolated symptom was apathy (60.7–75.0%). Affective symptoms and irritability predominated in the initial stages, and psychotic symptoms predominated in advanced stages. The mean NPI score was 24.9 (95% CI 21.5;28.4) and increased from 15.6 (95% CI 8.2;23.1) for GDS 3 to 28.9 (95% CI 12.6;45.1) for GDS 7. Patients with in the most advanced stages of dementia presented an NPI score 7.6 (95% CI 6.8;8.3) points higher than the score for mild dementia with adjustment for the other variables.ConclusionsA high prevalence of NPSs was found among patients with dementia treated in PC. Symptoms change and increase in intensity as the disease progresses. Scales such as the NPI allow these symptoms to be identified, which may facilitate more stage-appropriate management.