Early Stages Of Dementia Research Articles

Distinct neurophysiology during nonword repetition in logopenic and non-fluent variants of primary progressive aphasia.

Overlapping clinical presentations in primary progressive aphasia (PPA) variants present challenges for diagnosis and understanding pathophysiology, particularly in the early stages of the disease when behavioral (speech) symptoms are not clearly evident. Divergent atrophy patterns (temporoparietal degeneration in logopenic variant lvPPA, frontal degeneration in nonfluent variant nfvPPA) can partially account for differential speech production errors in the two groups in the later stages of the disease. While the existing dogma states that neurodegeneration is the root cause of compromised behavior and cortical activity in PPA, the extent to which neurophysiological signatures of speech dysfunction manifest independent of their divergent atrophy patterns remain unknown. We test the hypothesis that nonword deficits in lvPPA and nfvPPA arise from distinct patterns of neural oscillations that are unrelated to atrophy. We use a novel structure-function imaging approach integrating magnetoencephalographic imaging of neural oscillations during a non-word repetition task with voxel-based morphometry-derived measures of gray matter volume to isolate neural oscillation abnormalities independent of atrophy. We find reduced beta band neural activity in left temporal regions associated with the late stages of auditory encoding unique to patients with lvPPA and reduced high-gamma neural activity over left frontal regions associated with the early stages of motor preparation in patients with nfvPPA. Neither of these patterns of reduced cortical oscillations was explained by cortical atrophy in our statistical model. These findings highlight the importance of structure-function imaging in revealing neurophysiological sequelae in early stages of dementia when neither structural atrophy nor behavioral deficits are clinically distinct.

Identification of eating, drinking and swallowing difficulties for people living with early-stage dementia: A systematic review.

The prevalence of dementia is increasing, bringing a range of challenges, such as eating, drinking and swallowing (EDS) difficulties, that are associated with aspiration, which can be fatal. Early identification of EDS difficulty in early-stage dementia could prevent complications, but reliable indicators are needed to help develop pathways to support the diagnosis. Previous reviews of this area require updating. To identify reliable and clinically measurable indicators of EDS difficulty used in early-stage dementia. A systematic search was conducted using common databases (MEDLINE, EMBASE and PsychInfo). Articles reporting indicators of EDS difficulty in early-stage dementia or mild cognitive impairment were included. The reliability of included studies was critically appraised using the risk of bias tools. Study outcomes were narratively reviewed by considering the reliability, clinical measurability and applicability of EDS indicators to early-stage dementia. Initial searches returned 2443 articles. After removing duplicates, limiting to English language and human studies, 1589 articles remained. After reviewing titles, 60 abstracts were reviewed, yielding 18 full-text articles. A total of 12 articles were excluded that did not report at least one indicator of EDS difficulty in early-stage dementia, or where the reported association was not strong. Six included studies that reported eight indicators of EDS difficulty in early-stage dementia (four studies including people with Alzheimer's disease). On the balance of measurability, reliability and applicability, the most promising indicators of EDS difficulty were: delayed oral transit, rinsing ability, sarcopenia and polypharmacy. Additional, less reliable and applicable indicators included: always opened lips and non-amnestic mild cognitive impairment, especially in men. The delayed pharyngeal response is subjectively measured when instrumental assessment is not available and the 'candy sucking test' cannot be recommended because there is an inherent choking risk. EDS difficulty in early-stage dementia can be highlighted by indicators that could be combined to create enhanced pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration. Exploring the experiences of people living with dementia and their families' perspectives on potential indicators of EDS difficulty may add to the existing evidence base. What is already known on the subject Early identification of EDS difficulty in early-stage dementia may prevent complications, but more reliable and clinically measurable indicators of EDS difficulty are needed to help develop pathways to support diagnosis. What this paper adds to existing knowledge A comprehensive range of studies related to EDS identification in early-stage dementia have been selected and reviewed. Across six included studies, the most promising indicators of EDS difficulty in early-stage dementia included delayed oral transit, poor rinsing ability, presence of sarcopenia and polypharmacy. What are the potential or actual clinical implications of this work? This study could help to develop pathways to support the early identification of EDS difficulties for people living with early-stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration.

Association of Unhealthy Lifestyle and Genetic Risk Factors With Mild Cognitive Impairment in Chinese Older Adults

Apolipoprotein E polymorphism ε4 (APOE ε4) and methylenetetrahydrofolate reductase (MTHFR) TT genotype are genetic risk factors of mild cognitive impairment (MCI), but whether this risk can be changed by modifiable lifestyle factors is unknown. To explore whether unhealthy lifestyle (unhealthy dietary intake, current smoking, nonlimited alcohol consumption, and irregular physical activities) is associated with a higher risk of age-related MCI considering genetic risk. This population-based cohort study used data from Tianjin Elderly Nutrition and Cognition (TENC) study participants, recruited from March 1, 2018, through June 30, 2021, and followed up until November 30, 2022. Participants were Chinese adults aged 60 years or older who completed the neuropsychological assessments, general physical examinations, and a personal interview. Healthy lifestyle was defined according to the Chinese Dietary Guidelines 2022, including healthy diet, regular physical activity, limited alcohol consumption, and no current smoking, categorized into healthy and unhealthy lifestyles according to weighted standardized lifestyle score. Genetic risk was defined by MTHFR TT genotype and APOE ε4, categorized into low and high genetic risk according to weighted standardized genetic risk score. The main outcome was newly diagnosed MCI as identified using a modified version of Petersen criteria. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazard regression models. A total of 4665 participants were included (mean [SD] age, 67.9 [4.9] years; 2546 female [54.6%] and 2119 male [45.4%]); 653 participants with new-onset MCI (mean [SD] age, 68.4 [5.4] years; 267 female [40.9%] and 386 male [59.1%]) were identified after a median follow-up of 3.11 years (range, 0.82-4.61 years). Individuals with a low genetic risk and an unhealthy lifestyle (HR, 3.01; 95% CI, 2.38-3.79), a high genetic risk and a healthy lifestyle (HR, 2.65; 95% CI, 2.03-3.44), and a high genetic risk and an unhealthy lifestyle (HR, 3.58; 95% CI, 2.73-4.69) had a higher risk of MCI compared with participants with a low genetic risk and a healthy lifestyle. There was a synergistic interaction between lifestyle categories and genetic risk (β = 3.58; 95% CI, 2.73-4.69). In this cohort study of TENC participants, the findings show that unhealthy lifestyle and high genetic risk were significantly associated with a higher risk of MCI among Chinese older adults. Unhealthy lifestyle factors were associated with a higher risk of MCI regardless of genetic risk, and lifestyle and genetic risk had synergistic interactions. These findings could contribute to the development of dietary guidelines and the prevention of early-stage dementia.

Exploring the occurrence and the risk factors of the desire for hastened death and depression in people with early-stage dementia in Greece.

To assess the factors associated with desire for hastened death and depression in early-stage dementia as well as the association between them. Also, to explore the mediator and moderator role of age in the relationship between depression and desire for hasten death. A prospective cross-sectional study including 100 patients diagnosed with early-stage dementia from a rehabilitation center between December 2018 and July 2019. Measurement tools used were the Mini-Mental State Examination, the Greek Montreal Cognitive Assessment, the Greek Schedule of Attitudes toward Hastened Death, and the Geriatric Depression Scale-15 item. Patients diagnosed with dementia as a result of Stroke history were excluded. Factors of multifactorial analysis significantly associated with desire for hastened death were as follows: age (p=0.009), marital status (p=0.001), and depression (p<0.001). The factor significantly associated with depression was age (p=0.001). Also, a mediation/moderation analysis has shown that depression and age are significant predictors of desire for hasten death. The desire for hastened death and depression in people diagnosed with early-stage dementia includes many components. Younger patients, men, higher educated patients, single, childless, and those with higher depression scores had higher desire for hastened death, while men and older patients had higher scores of desire for depression. Our study provides important information about the desire for hastened death and depression in early-stage dementia, their risk factors, and their association.

Daily time management in dementia: qualitative interviews with persons with dementia and their significant others

BackgroundPersons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life.MethodSemi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis.ResultsA main category “Support by significant others is always part of daily time management”, and three categories “Facing new challenges”, “Using strategies to handle changes”, and “Time assistive technology in daily life” illustrated that significant others provided support for daily time management in all phases of dementia. This support was often embedded in other kinds of support for emerging challenges. Support in time management was needed from an early stage in dementia, and responsibility for time management was gradually transferred to significant others. Time AT could support time orientation and were important for sharing the time management conducted by others but did not enable independent time management.ConclusionsTime-related assessments and interventions should be offered at an early stage of dementia to increase the possibility of maintaining daily time management skills. Using time AT to communicate time might increase agency and participation in daily occupations for persons with dementia. Given the central role of significant others for daily time management, the society needs to adequately support persons with dementia lacking support from significant others.

Intergenerational Reminiscence Approach in Improving Emotional Well-Being of Older Asian Americans in Early-Stage Dementia Using Virtual Reality: Protocol for an Explanatory Sequential Mixed Methods Study.

After a dementia diagnosis, Asian Americans experience anxiety, feelings of shame, and other negative effects. Emotional well-being is not only an important aspect of mental health, but also a quality of resilience that helps people bounce back faster from difficulties. However, few studies have addressed issues in developing, implementing, and testing intervention strategies to promote emotional well-being among older adults. Intergenerational solidarity between grandparents and grandchildren has been emphasized in Asian families and is beneficial for the health of persons with dementia. Reminiscence and life review have been identified as potentially effective intervention strategies for helping depression and emotional well-being for older adults. This proposed study aims to develop and implement an intergenerational reminiscence approach and evaluate its potential feasibility and effectiveness in improving the emotional well-being of older Asian American adults who have a recent dementia diagnosis. An explanatory sequential mixed methods design will be used in which quantitative data will first be collected and analyzed to identify subsamples of participants who report the greatest and least change in emotional well-being; then, these subsamples will be interviewed to further understand why or why not this intervention works for them. Older adults will receive 6 sessions of life review with grandchildren in virtual reality (VR; 1-1.5 hours each week for 6 weeks), aided by pictures and virtually traveling to important places in their life using Google Earth to look around at those places and remember important times. Quantitative survey data will be collected pre- and postintervention and at a 3-month follow-up. Qualitative interviews with selected participants will also be integrated into the study design. The quantitative data from the surveys will be entered into SPSS (IBM Corp) and analyzed using descriptive analyses, Pearson chi-square tests, nonparametric Friedman tests, or nonparametric Wilcox signed-rank tests (2-tailed). The qualitative data will be transcribed by research assistants, coded by the investigators independently, and analyzed with guidance from content analysis software (Atlas.ti; Atlas.ti Scientific Software Development GmbH). The project was delayed due to the COVID-19 pandemic. Data collection started in late 2021, and 26 participants were recruited as of December 2022. While we are still cleaning and analyzing the quantitative data, the qualitative interviews showed promising results of this intergenerational reminiscence approach in improving emotional well-being among older Asian American adults who have cognitive impairment. Intergenerational reminiscence provided by grandchildren is promising in improving the emotional well-being of grandparents. VR technology is likely to be accepted by older adults. Future research may consider scaling up this pilot into a trackable, replicable model that includes more participants and develops a more rigorous study design with control groups to test the effectiveness of this intervention for older adults with dementia. DERR1-10.2196/48927.

The effectiveness and health-economic evaluation of “Partner in Balance,” a blended self-management program for early-stage dementia caregivers: study protocol for a cluster-randomized controlled trial

BackgroundInformal caregivers of people with dementia are crucial in dementia care. However, they are insufficiently supported and report caregiver burdens, which urges the need for cost-effective interventions aimed at supporting caregivers. This paper presents the design of a study evaluating the effectiveness, cost-effectiveness, and cost-utility of a blended self-management program for early-stage dementia caregivers.Methods/designA pragmatic, cluster randomized controlled trial with a shared control group will be conducted. Participants will be informal caregivers of people with early-stage dementia and will be recruited by local care professionals. Randomization will be carried out at the level of the care professional level in a ratio of 35% to 65% (control arm vs. intervention arm). Participants in the control arm will receive care as usual and the intervention arm will receive the blended care self-management program “Partner in Balance” within a usual care setting in the Netherlands. Data will be collected at baseline and at 3-, 6-, 12-, and 24-month follow-ups. The primary outcome for effectiveness (part 1) is care management self-efficacy. For the health-economic evaluation (part 2) total care costs and the quality of life for individuals with dementia (cost-effectiveness) and quality-adjusted life years (cost-utility) will be the base case analysis. Secondary outcomes (parts 1 and 2) will include depression, anxiety, perceived informal caregiving stress, service-use self-efficacy, quality of life, caregivers’ gain, and perseverance time. A process evaluation (part 3) will investigate the internal and external validity of the intervention.DiscussionIn this trial, we plan to evaluate the effectiveness, cost-effectiveness, and cost-utility of “Partner in Balance” among informal caregivers of people with dementia. We expect to find a significant increase in care management self-efficacy, and the program to be cost-effective, and provide valuable insights to stakeholders of “Partner in Balance.”Trial registrationClinicalTrials.gov, NCT05450146. Registered on 4 November 2022.

Effectiveness of vortioxetine in patients with major depressive disorder and early-stage dementia: The MEMORY study

BackgroundDepression and dementia are highly prevalent in older adults and often co-occur. This Phase IV study investigated the effectiveness and tolerability of vortioxetine in improving depressive symptoms, cognitive performance, daily and global functioning and health-related quality of life (HRQoL) in patients with major depressive disorder (MDD) and comorbid early-stage dementia. MethodsPatients (n = 82) aged 55–85 years with a primary diagnosis of MDD (onset before age 55 years) and comorbid early-stage dementia (diagnosed ≥6 months before screening and after onset of MDD; Mini-Mental State Examination-2 total score, 20–24) received vortioxetine for 12 weeks (initiated at 5 mg/day and up-titrated to 10 mg/day at day 8, with flexible dosing thereafter [5–20 mg/day]). The primary endpoint was change from baseline in Montgomery–Åsberg Depression Rating Scale (MADRS) total score at week 12. ResultsSignificant improvement in depressive symptom severity was seen from week 1 onwards (P < 0.0001). At week 12, the least-square mean (standard error) change in MADRS total score from baseline was −12.4 (0.78). Significant improvements in cognitive performance were observed (from week 1 for the Digit Symbol Substitution Test and week 4 for the Rey Auditory Verbal Learning Test). Patients also experienced significant improvements in daily and global functioning, and HRQoL. Vortioxetine was well tolerated. From week 4 onwards, more than 50 % of patients were receiving 20 mg/day. LimitationsOpen-label study. ConclusionsVortioxetine demonstrated effectiveness in clinically significantly improving depressive symptoms, cognitive performance, daily and global functioning, and HRQoL in patients with MDD and comorbid early-stage dementia treated for 12 weeks. Trial registrationClinicalTrials.gov/ct2/show/NCT04294654.

APOE4 carrier status determines association between white matter disease and grey matter atrophy in early-stage dementia

BackgroundWhite matter hyperintensities, a neuroimaging marker of small-vessel cerebrovascular disease and apolipoprotein ε4 (APOE4) allele, are important dementia risk factors. However, APOE4 as a key effect modifier in the relationship between white matter hyperintensities and grey matter volume needs further exploration.MethodsOne hundred ninety-two early-stage dementia (including mild cognitive impairment and mild dementia) and 259 cognitively unimpaired participants from a neurocognitive research cohort with neuroimaging data, APOE genotyping, and neuropsychological assessments were studied. We investigated independent and interactive effects of white matter hyperintensities and APOE4 on whole-brain voxel-wise grey matter volume using voxel-based morphometry (uncorrected p < 0.001; minimum cluster size = 100 voxels). We further assessed interactive effects between APOE4 and white matter hyperintensities on global cognition, memory, and executive function in early-stage dementia and cognitively unimpaired participants.ResultsIndependent of APOE4 status, higher white matter hyperintensity load was associated with greater grey matter atrophy across frontal, parietal, temporal, and occipital lobes in cognitively unimpaired and early-stage dementia subjects. However, interaction analyses and independent sample analyses revealed that APOE4 non-carriers demonstrated greater white matter hyperintensity-associated grey matter atrophy compared to APOE4 carriers in both cognitively unimpaired and early-stage dementia groups. Additional confirmatory analyses among APOE4 non-carriers demonstrated that white matter hyperintensities resulted in widespread grey matter loss. Analyses of cognitive function demonstrated that higher white matter hyperintensity load was associated with worse global (Mini-Mental State Examination, Montreal Cognitive Assessment) and executive function (Color Trails 2) in APOE4 non-carriers compared to APOE4 carriers in early-stage dementia but not cognitively unimpaired participants.ConclusionsThe association between white matter hyperintensities and grey matter loss is more pronounced in APOE4 non-carriers than APOE4 carriers in the cognitively unimpaired and early-stage dementia stages. Furthermore, white matter hyperintensity presence results in poorer executive function in APOE4 non-carriers compared to APOE4 carriers. This finding may have significant impact on the design of clinical trials with disease modifying therapies.

Tau‐PET imaging with 18F‐PI‐2620 reveals lateralized distribution of tau pathology in critical language regions in patients with early onset of Alzheimer’s Disease and patients with primary progressive aphasia

AbstractBackgroundLanguage disorders are frequent in patients in advanced and early stages of dementia (Goth &amp; Strøm, 2018) together with the deterioration of other cognitive domains (e.g., memory) (Taler &amp; Phillips, 2008). The first complaint in people with dementia often is language impairment, even preceding other cognitive declines (Ferris &amp; Farlow, 2013). Logopenic variant primary progressive aphasia (lvPPA) and non‐fluent/agrammatic variant PPA (nf/avPPA) are rare neurodegenerative disorders being language impairment the main feature (Gono‐Tempini, 2011). Both β‐amyloid (Aβ) and tau appear to occur in Alzheimer disease (AD). Moreover, Aβ and tau aggregates also represent the underlying pathology in lvPPA (Montembeault et al. 2018) while nf/avPPA resembles a pure tau‐pathology. The purpose of this study is to explore the distribution of tau‐pathology in critical language regions in patients with early‐onset AD (EOAD) and patients diagnosed with primary progressive aphasia (PPA).MethodEight participants (55‐77y): 4 with EOAD, 3 with lvPPA (these first seven patients additionally had a positive 18F‐Florbetaben Amyloid PET), 1 with nf/avPPA, and 14 healthy controls (HC) (age range 54‐76y) underwent dynamic PET scans with 18F‐PI‐2620 to examine the distribution of tau‐pathology in the following cortical language regions: inferior frontal gyrus (IFG), superior temporal gyrus (STG), supramarginal and angular gyrus (PL). Group differences in language regions were examined using standardized uptake value ratios (SUVRs) normalized to the inferior gray matter of the cerebellum.ResultCompared to HC, 3/4 patients with EOAD showed elevated levels of 18F‐PI‐2620 binding, mainly in the right IFG and IPL and left STG, while 3/4 patients with PPA (2 lvPPA and 1 nf/avPPA) showed left lateralized elevated uptake of 18F‐PI‐2620 in all language regions. All PPA patients showed increased binding of 18F‐PI‐2620 predominantly in the left parietal regions.ConclusionOur preliminary results reveal a lateralized distribution pattern of 18F‐PI‐2620 in language regions in patients with EOAD and particularly in those with PPA. These findings suggest that 18F‐PI‐2620 PET imaging is a promising tool to visualize tau aggregations in patients with EOAD and PPA. However, further studies are needed to confirm these preliminary results.

Decreased activities of prefrontal and temporal lobes in patients with mild cognitive impairment and mild Alzheimer’s disease on a clock drawing task via functional near‐infrared spectroscopy imaging

AbstractBackgroundStudies have shown that changes in cerebral blood flow occur in the early stage of dementia, including Alzheimer’s disease (AD), and decreased cerebral blood flow contributes to impairment of brain activities, then affects cognitive function. To diagnose AD in very early stage, such as mild cognitive impairment (MCI), it is therefore necessary to find a new way to detect early activities of brain, such as functional near‐infrared spectroscopy (fNIRS).MethodsThe clock drawing task (CLOX) is one of the widely used neurocognitive function scoring test for dementia. In this study, brain activities were examined in patients with MCI (n = 8) and mild AD (n = 8) during an unprompted CLOX drawing using functional near‐infrared spectroscopy (fNIRS). The concentration changes of oxyhemoglobin (HbO), reflecting brain activities indirectly, were tested in each group via fNIRS.ResultsActivation in the right hemisphere was significantly attenuated in mild AD compared with MCI. With the development of disease severity from MCI to mild AD, the reductions of HbO2 concentrations in the right prefrontal and right temporal lobe were observed greater and steeper. The HbO2 in mild AD was significantly lower than that in MCI (false discovery rate corrected, p &lt;0.025). In addition, HbO2 concentration was positively associated with the clinical score of MMSE (MCI group, p&lt;0.05; mild AD group, p&lt;0.05).ConclusionThis study suggests that activity in the frontal and temporal lobes of mild AD is reduced compared to MCI. Those results reflects that CLOX is an effective tool for extracting fNIRS signal features. In addition, fNIRS‐based analysis has great promise for exploring the mechanisms of changes in the sensory‐spatial function of MCI and mild AD.

Community-based early dementia advance care planning in the United States: A scoping review

• Advance care planning conversations empower shared decision-making among persons living with dementia. • Community-based advance care planning during the early stages of dementia may prevent avoidable care and promote quality of life. • Standard and skillful communication by providers with consideration of social determinants of health may support early dementia advance care planning. • Nurses are ideally situated to facilitate caregiver engagement and promote community-based early dementia goals of care conversations.

Discrepancies in dyadic coping: associations with distress and quality of life in couples facing early stage dementia.

Due to an aging population, the number of persons living with dementia (PWDs) is increasing worldwide. Romantic partners, as informal caregivers (IC) of PWDs, are often adopting additional tasks. The concept of dyadic coping (DC) addresses how couples cope with stress together. For dyadic coping to be successful, efforts of both partners should be equal. The current study examines how discrepancies in PWDs and ICs perspectives on DC relate to distress and quality of life in each partner within couples facing early stage dementia (ESD). A total of 37 mixed-sex couples including one partner with ESD completed self-report questionnaires. Discrepancies in reciprocity (comparing provided or received levels of DC between partners), equity (each partner balancing own levels received and provided), and congruence (the agreement about levels of DC exchanged between partners) and their covariation with distress and quality of life (QoL) of each partner were measured. Both partners indicated a discrepancy in reciprocity: PWDs reported receiving more DC than ICs reported receiving, which was associated with higher QoL in PWDs and lower QoL in ICs. Inequities were found in ICs only, who reported receiving less DC, than providing. No relation between inequities and distress or QoL was found. ICs reported more incongruencies than PWDs did, which was associated with higher QoL and less depression in partners. A redivision of tasks and roles in the early stage of dementia is associated with different experiences and views between partners. Whereas ICs take over most household and care tasks within the couple, their effort was considered less helpful by PWDs than by ICs. A high care burden is associated with a compromised quality of ICs' social life and living conditions. The clinical implications of the results are discussed.

Factors influencing access to nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia: An integrative review.

Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self-efficacy and quality of life for persons with mild-to-moderate dementia (PWDs). These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions. To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision. PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments. The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence-informed decision-making and access to desired nonpharmacological treatments. Involvement of patients and families in care-planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare. INTRODUCTION: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it remains unclear in the literature how persons with mild-to-moderate dementia (PWDs) view, understand and access nonpharmacological interventions. The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community-dwelling seniors with mild-to-moderate dementia. An integrative review was undertaken following Toronto and Remington (A step-by-step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance. The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences. The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour-oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours. The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild-to-moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management.

A Study on the Transformations of the Relationship between Married Daughters Who Cared for Their Demented Fathers and Her Families with the Systems Perspective

&lt;p&gt;&amp;quot;本研究以系統觀點探討已婚女兒成為失智父親照顧者之脈絡、已婚女兒與失智父親、以及與其他家人的關係變化。採用敘事研究法進行本研究,共訪談兩位已婚女兒。研究發現在父親失智初期,家庭延續過去因應模式,因此與母親關係親近的已婚女兒處理失智相關事務。當失智加劇,已婚女兒與母親一同照顧父親,形成緊密的父親-母親-女兒三角照顧關係。已婚女兒同時照顧父親,也安撫母親的情緒。整體而言,不論早期父女關係如何,與母親關係親近,則已婚女兒容易成為失智父親的照顧者。在已婚女兒成為照顧者之後,原本疏遠的父女關係也轉為親近,但在入住長照機構後父女關係可能出現再次轉折。已婚女兒也與極少分擔照顧責任、無提供經濟資源的兒子,關係疏離。過去探討失智照顧的文獻多聚焦在照顧者個人觀點或是照顧者-被照顧者兩人關係。不同於過去研究,本研究的獨特之處在於發現失智照顧歷程的父親-母親-女兒之三角照顧關係,並針對已婚女兒成為照顧者的家庭脈絡與文化脈絡進行討論。最後,依據研究結果對實務工作與未來研究提出相關建議。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The research, from the Systems perspective, explored the contextualization of married daughters who cared for their demented fathers, the change in the relationships between married daughters and the demented fathers, and the change in relationships between married daughters and the other family members. This study was conducted with narrative research. A total of 2 married daughters were interviewed. This study found that in the early stage of dementia, the family continued with the previous coping strategies and these married daughters who had close relationships with their mothers took on the dementia-related affairs. As dementia exacerbated, these married daughters and mothers took care of the father together, forming a close father-mother-daughter triangulation. These daughters were taking care of the fathers with dementia, while also soothing their mother’s mood. Regardless of the father-daughter relationships before the onset of dementia, the closer the mother-daughter relationship, the more likely these married daughters were to become caregivers for their fathers. Subsequently, after these daughters becoming caregivers, the father-daughter relationships transformed from distant to close, but there may be another turning point after those fathers moving into the long-term care institutions. Prior studies on the care of dementia have focused on the personal perspective of the family caregiver or the relationship between the caregiver and the family member with dementia. Unlike previous studies, the unique finding of this study is the father-mother-daughter triangulation in the care process. Finally, based on the research findings, some suggestions were made for practical work and future research.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Outcomes of use of the quality outcome measure for individuals with dementia (QOMID) with people with Down’s syndrome and dementia

PurposeThis paper aims to describe the outcomes of the use of the Quality Outcome Measure for individuals with dementia (QOMID) within a dementia pathway for people with Down’s syndrome (DS). The QOMID is a tool for clinicians to use with 17 outcome domains, each with descriptors for early, mid and late stage dementia, rated on a four point scale from rarely achieved for the person (1) to consistently and completely achieved for the person (4).Design/methodology/approachData from first time use of the QOMID with 49 people with DS and dementia was analysed to determine if specific outcome domains are more achievable than others, if this differs by stage of dementia and what recommendations are suggested.FindingsResults suggest that there were significant differences in achievability across the domains but that achievability did not vary between early and mid-stages of dementia. The themes with most recommendations were: quality of paperwork and documentation; improving communication with the person with DS and dementia; and working together with health and social care professionals.Practical implicationsResults suggest that outcomes which fall outside of the typical learning disabilities skillset and are dementia specific are being achieved less often. Primarily, recommendations focused on practical solutions such as using visual timetables to communicate with the person and adapting their environment. Further work on integrating the QOMID and stage-related team training for care staff is underway.Originality/valueTo the best of the authors’ knowledge, this is the first detailed analysis of the use of the QOMID in clinical practice with people with DS and dementia.

Real-world driving digital data reliably index MCI over time (S15.008)

<h3>Objective:</h3> Our objective is to detect age-related cognitive decline from driver behavior. The overarching goal is to develop real-world, digital biomarkers of early dementia, including Alzheimer’s disease (AD), to inform clinical care and intervention. <h3>Background:</h3> Cognitive decline affects driving abilities. Driver behavior patterns, in turn, index cognitive abilities. Roadway environments present varying challenges, revealing driver strategies accommodating challenges. Strategies map to cognitive decline, even in transitional dementia stages like mild cognitive impairment (MCI). <h3>Design/Methods:</h3> Real-world driving data (249,104 miles) were collected for 2, 3-month periods across 2 years (baseline/longitudinal) using sensors installed in participants’ vehicles. 74 participants (mean age = 75.1, 44 females) self-reported demographics and completed neuropsychological assessments relevant to aging, driving, and AD. Neuropsychological data were used to classify MCI at baseline (MCI: N = 14; Peterson, 2004). Mixed-effect linear regressions assessed changes in speed limit compliance (difference between vehicle speed and posted speed limit) across MCI class and roadway environment (residential/commercial/interstate roads [20–30/35–45/≥ 55 mph]). <h3>Results:</h3> Drivers with MCI drove further below the posted speed limit compared to controls (<i>b</i> = −0.235, <i>p</i> &lt; 0.001). Individual driver speed patterns correlated at baseline and longitudinal (r = 0.63). Commercial (<i>b</i> = −0.541, <i>p</i> &lt; 0.001) and residential (<i>b</i> = −0.647, <i>p</i> &lt; 0.001) roadways showed ability to detect differences in speed limit compliance based on driver MCI class. High-speed driving (interstate roadways) revealed greater differences in speed limit compliance for MCI drivers compared to those without MCI. <h3>Conclusions:</h3> Results demonstrate feasibility to detect early dementia stages, like MCI, from real-world, digital driving sensor data. Findings reveal key environments that show discriminative MCI utility. Data show longitudinal reliability across individuals suggesting utility of data to predict decline progression for AD intervention. Sensor-based digital health biomarkers hold promise to deliver clinicians timely, objective data on patient health and risk. <b>Disclosure:</b> Dr. Chang has nothing to disclose. Mr. Wu has nothing to disclose. The institution of Prof. Zhang has received research support from National Institute of Health. Prof. Zhang has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant with Nationwide Children Hospital. The institution of Dr. Rizzo has received research support from NIH. Dr. Rizzo has a non-compensated relationship as a Chair with ABC that is relevant to AAN interests or activities. Jennifer Merickel has nothing to disclose.

The Behavioural Dysfunction Questionnaire discriminates behavioural variant frontotemporal dementia from Alzheimer’s disease dementia and major depressive disorder

Background and objectivesEarly-stage behavioural variant frontotemporal dementia (bvFTD) is often misdiagnosed, highlighting the need for new diagnostic instruments. Based on the revised diagnostic criteria for bvFTD, we developed the Behavioural Dysfunction Questionnaire (BDQ). In this explorative study, we aimed to determine the best scoring and analytical method for the BDQ to discriminate between bvFTD and non-bvFTD patients.Materials and methods34 patients with early-stage bvFTD, 56 with early-stage Alzheimer's disease dementia (ADD) and 41 with major depressive disorder (MDD) were recruited. We calculated BDQ-items with or without inclusion of a time criterion: (a) without time criterion, (b) with 10 years’ time criterion (symptom presence less than 10 years), and (c) with 3 years’ time criterion (symptom presentation within the first 3 years). Using these three differently calculated items, we generated six variables, i.e. 3*2 [BDQ-Global Score (BDQ-GS; domains average score); BDQ-Global Domain Score (BDQ-GDS; domains categorical score)]. Then, we performed univariate and bivariate (BDQ-GS and BDQ-GDS combined) ROC analyses.ResultsModels including BDQ-GS, BDQ-GDS or both variables combined discriminated similarly between groups. In contrast, models without time criterion or with 10 years’ time criterion discriminated better than models including variables with 3 years’ time criterion. These models discriminated highly (AUC = 85.98–87.78) between bvFTD and MDD and bvFTD and ADD, respectively.ConclusionBDQ-scores without any time criterion discriminated highly between early-stage bvFTD and non-bvFTD groups, which could improve the early diagnosis of bvFTD. With its standardised procedure, the BDQ is also appropriate for repeated assessments.

Racial and Ethnic Differences in Subjective Cognitive Decline - United States, 2015-2020.

Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, might be a symptom of early-stage dementia or future serious cognitive decline such as Alzheimer disease* or a related dementia (ADRD) (1). Established modifiable risk factors for ADRD include high blood pressure, inadequate physical activity, obesity, diabetes, depression, current cigarette smoking, and hearing loss (2). An estimated 6.5 million persons aged ≥65 years in the United States live with Alzheimer disease, the most common dementia (1). This number is projected to double by 2060, with the largest increase among non-Hispanic Black or African American (Black), and Hispanic or Latino (Hispanic) adults (1,3). Using data from the Behavioral Risk Factor Surveillance System (BRFSS), CDC assessed racial and ethnic, select demographic, and geographical differences in SCD prevalence, and prevalence of health care professional conversations among those reporting SCD. The age-adjusted prevalence of SCD during 2015-2020 was 9.6% among adults aged ≥45 years (5.0% of Asian or Pacific Islander [A/PI] adults, 9.3% of non-Hispanic White [White] adults, 10.1% of Black adults, 11.4% of Hispanic adults, and 16.7% of non-Hispanic American Indian or Alaska Native [AI/AN] adults). College education was associated with a lower prevalence of SCD among all racial and ethnic groups. Only 47.3% of adults with SCD reported that they had discussed confusion or memory loss with a health care professional. Discussing changes in cognition with a physician can allow for the identification of potentially treatable conditions, early detection of dementia, promotion of dementia risk reduction behaviors, and establishing a treatment or care plan to help adults remain healthy and independent for as long as possible.

The effectiveness of mental imagery on motor, cognitive and emotional status of older people with early-stage dementia: A study protocol.

Dementia involves the loss of cognitive abilities and represents a decline from the prior level of function which impairs functional abilities in day-to-day life. No previous experimental research has been done to assess mental imagery (MI) effectiveness in the motor, cognitive and emotional status of individuals with early-stage dementia. One hundred and forty older individuals with early-stage dementia from the Day Care Centre of the Alzheimer Association in Athens will take part in this study. The sample will be randomly divided into three groups: MI and physical exercise (intervention group), only physical exercise (1st control group), and neither MI nor physical exercise (2nd control group). Assessment will be obtained one week prior to the program, in the middle of the program (6th week of the intervention program) and after the end of the program (13th week of the intervention program). Participants of the intervention group will perform a 30-minute MI programme after the end of every physiotherapy session. Reliable and valid instruments will be used to assess the primary outcomes, i.e., balance and functional status as well as the secondary outcomes i.e., cognitive ability, emotional state and quality of life. The two-way Mixed ANOVA with factors 'intervention' (between groups) and 'time' (within group) will be used as a statistical analysis. Approvals of clinical trial protocol: a) UNIWA Research Committee study protocol approval: 93292 - 26/10/2021. b) ClinicalTrials.gov: ID NCT05232526.