Early Dementia Research Articles

Substantia nigra hyperechogenicity and brain ventricular size as biomarkers of early dementia with Lewy bodies

BackgroundDiagnosis of dementia with Lewy bodies (DLB) is challenging, especially in the earlier stages of the disease, owing to the clinical overlap with other neurodegenerative diseases such as Alzheimer’s (AD) and Parkinson’s disease (PD). We aimed to identify the transcranial sonography (TCS) parameters that can help us to detect early DLB patients.MethodsIn this cross-sectional study, we prospectively recruited newly diagnosed DLB patients with less than 3 years from the onset of cognitive symptoms. For comparison purposes, we also included AD and PD patients, with a disease duration of less than 3 years, and a control group. TCS was performed to assess the substantia nigra (SN) echogenicity, the width of the third ventricle, and the frontal horns of the lateral ventricles. Subsequently, TCS images were analyzed with the medical image viewer Horos in order to quantify the intensity of the echogenicity of the SN. Univariate analysis and a logistic regression model were used to identify which variables can predict the diagnosis of DLB.ResultsOne hundred and seven participants were included (23 DLB, 26 AD, 27 PD and 31 controls). The median age of DLB patients was 75(72–77) years, with a disease duration of 2 years. DLB and PD patients showed higher SN hyperechogenicity rates (72.73% and 81.82%, respectively) and a greater area of the SN compared to AD patients and controls (p < 0.001). DLB and AD patients had wider ventricular systems than the other study groups. The SN hyperechogenicity predicted a diagnosis of DLB with an odds ratio of 22.67 (95%CI 3.98; 129.12, p < 0.001) when compared to AD patients. Unilateral and bilateral widened frontal horns predicted diagnosis of DLB compared to PD with an odds ratio of 9.5 (95%CI 0.97; 92.83, p = 0.053) and 5.7 (95%CI 0.97; 33.6, p = 0.054), respectively. ConclusionsEchogenicity of the SN and widening of the frontal horns of lateral ventricles can predict the diagnosis of early DLB in this cohort of newly diagnosed patients, when compared to AD and PD patients. Transcranial sonography, a non-invasive tool, could be helpful for the diagnosis of DLB at its earlier stages.

Alzheimer's dementia in people with Down syndrome : Results of guideline-assisted expert interviews on healthcare deficits in the diagnostics and treatment as well as solution approaches

People with Down syndrome have agenetically increased risk of developing early onset Alzheimer's dementia. An interview study with healthcare providers, patient representatives and employees in residential and work facilities was conducted to identify deficits in the healthcare process and approaches to overcoming them. In this study 14 semi-structured interviews were conducted and analyzed using qualitative content analysis. Alack of knowledge and experience on the part of medical service providers in dealing with and providing medical care for people with Down syndrome was identified as akey challenge. In addition, the diagnosis of dementia in people with Down syndrome is difficult for various reasons (including lack of appropriate diagnostic tools in standard care and lack of time or financial resources). Doubts were expressed about the efficacy of antidementia medications and the reasons for the increased use of sedatives were discussed. Attentive observation of behavior and involvement of caregivers, regular review and reduction of polypharmacy and the use of alternative behavior modification techniques were mentioned as possible solutions. The identified deficits in the medical care of the target population and the approaches to solving them will be incorporated into the development of health policy recommendations in order to optimize the care situation of those affected in the long term.

Annual Wellness Visits and Early Dementia Diagnosis Among Medicare Beneficiaries

Early recognition of cognitive impairment is key to optimal dementia care. No previous research has examined the probability of developing mild cognitive impairment (MCI) or Alzheimer disease and related dementias (ADRD) at 5-year follow-up among older adult Medicare beneficiaries by receipt of an annual wellness visit (AWV). To assess the association of incident AWV with the first ADRD or MCI diagnosis among older adults with Medicare fee-for-service benefits. This retrospective population-based cohort study used 100% Texas fee-for-service Medicare data from 2015 to 2022. Participants comprised 549 516 community-dwelling Medicare beneficiaries aged 68 years or older in 2018, with complete Medicare fee-for-service Parts A and B and no Medicare Advantage plan enrollment for 2015 to 2018. Medicare AWVs. The first MCI or ADRD diagnosis (reported as MCI or ADRD diagnosis, MCI diagnosis, and ADRD diagnosis) from the AWV index date in 2018 through December 31, 2022. In this cohort study of 549 516 Medicare beneficiaries with no diagnosis of MCI or ADRD in 2015 to 2017 (mean [SD] age, 76.7 [6.6] years; 289 932 women [52.8%]), 66 433 (12.1%) had an incident AWV in 2018. Annual wellness visit recipients were more likely than those who did not receive an AWV to be female, to be non-Hispanic White (followed by Hispanic, non-Hispanic Black, and other), to have more education, to reside in a metropolitan area, to have more comorbidities, and to have a primary care professional in the 12 months before the AWV index date. After propensity score matching, AWV receipt was associated with a 21% increase in MCI diagnosis (hazard ratio, 1.21 [95% CI, 1.16-1.27]) and a 4% increase in ADRD diagnosis (hazard ratio, 1.04 [95% CI, 1.02-1.06]). The increase in MCI diagnosis associated with AWV was larger when the AWV was censored or treated as a time-dependent covariate in the follow-up period. These findings indicate that AWV recipients had a timelier first MCI diagnosis than those who did not receive an AWV, but first ADRD diagnosis differed little. This study suggests that the Medicare AWV health policy may increase MCI identification, prompting more specialized care.

Maximizing Early Dementia Detection Through Medicare Annual Wellness Visits

Maximizing Early Dementia Detection Through Medicare Annual Wellness Visits

Vulnerability of neurofilament-expressing neurons in frontotemporal dementia

Frontotemporal dementia (FTD) is an umbrella term for several early onset dementias, that are caused by frontotemporal lobar degeneration (FTLD), which involves the atrophy of the frontal and temporal lobes of the brain. Neuron loss in the frontal and temporal lobes is a characteristic feature of FTLD, however the selective vulnerability of different neuronal populations in this group of diseases is not fully understood. Neurofilament-expressing neurons have been shown to be selectively vulnerable in other neurodegenerative diseases, including Alzheimer's disease and amyotrophic lateral sclerosis, therefore we sought to investigate whether this neuronal population is vulnerable in FTLD. We also examined whether neuronal sub-type vulnerability differed between FTLD with TDP-43 inclusions (FTLD-TDP) and FTLD with tau inclusions (FTLD-Tau). Post-mortem human tissue from the superior frontal gyrus (SFG) of FTLD-TDP (n = 15), FTLD-Tau (n = 8) and aged Control cases (n = 6) was immunolabelled using antibodies against non-phosphorylated neurofilaments (SMI32 antibody), calretinin and NeuN, to explore neuronal cell loss. The presence of non-phosphorylated neurofilament immunolabelling in axons of the SFG white matter was also quantified as a measure of axon pathology, as axonal neurofilaments are normally phosphorylated. We demonstrate the selective loss of neurofilament-expressing neurons in both FTLD-TDP and FTLD-Tau cases compared to aged Controls. We also show that non-phosphorylated neurofilament axonal pathology in the SFG white matter was associated with increasing age, but not FTLD. This data suggests neurofilament-expressing neurons are vulnerable in both FTLD-TDP and FTLD-Tau.

Estimating the Prevalence of Cognitive Impairment and Its Associated Factors in Albania: A Nationwide Cross-Sectional Study.

Cognitive impairment is an intermediate state between normal aging and dementia, and its detection in the early stages is essential to prevent dementia, an incurable pathology. The aim of this study is to screen and estimate the prevalence of cognitive impairment, including dementia, and its correlated factors in a community-based sample of the Albanian population over 50 years old. We carried out a door-to-door neuropsychological screening of Albanian residents older than 50 years from November 2023 to June 2024 in 12 Albanian districts. Participants completed the Early Dementia Questionnaire (EDQ) and the Mini Mental State Examination (MMSE). The overall estimating prevalence of cognitive impairment and early dementia among the Albanian population over 50 years old was 14.04% using the MMSE, with 2.31% for MMSE ≤18 (serious cognitive impairment), 5.51% for MMSE 19-22 (mild cognitive impairment (MCI)), and 6.22 for MMSE 23-24 (suspected cognitive impairment or dementia),respectively. The prevalence of early dementia using the EDQ was significantly higher (53.99%).The number of male participants with MMSE scores of 23-24 (suspected cognitive impairment or early dementia) was 2.5 times higher with respect to female participants. Smoking and alcohol consumption decreased the MMSE scores. The number of participants with normal cognitive function (MMSE scores 25-30) was lower among participants with hypertension, diabetes, hyperlipidemia, and cerebral ischemia. A diagnostic evaluation, including a clinical examination, neuroimaging, and laboratory studies, is further required for a diagnosis. Despite limitations, the data provided in this study are the only ones reported for a large community-based sample of the older adult Albanian population, which can help health care providers to diagnose cognitive impairment.

A novel integrated logistic regression model enhanced with recursive feature elimination and explainable artificial intelligence for dementia prediction

Dementia is a major global health issue that significantly impacts millions of individuals, families, and societies worldwide, creating a substantial burden on healthcare systems. This study introduces a novel approach for predicting dementia by employing the Logistic Regression (LR) model, enhanced with Recursive Feature Elimination (RFE), applied to a unique dataset comprising 1000 patients, with 49.60% male and 50.40% female. The LR model, recognized for its simplicity and effectiveness in binary classification tasks, is optimized through RFE, a technique that iteratively eliminates less significant features to improve model performance. The model’s effectiveness was assessed using comprehensive metrics, including accuracy, precision, recall, F1-score, Matthews Correlation Coefficient (MCC), and Kappa score. Furthermore, SHapley Additive exPlanations (SHAP) values were employed to increase the interpretability of the model, providing insights into the most influential features for dementia prediction. To address the issue of overfitting, a standardization technique was implemented, which enhanced the model’s predictive performance. The findings of this study hold potential implications for early dementia detection, informing intervention strategies, and optimizing healthcare resource allocation.

Understanding how community-dwelling persons with early dementia perceive health and community services: Informing the dementia strategy of Newfoundland and Labrador, Canada.

With an increased aging population, the number of individuals with dementia is expected to rise. The onset of dementia marks the start of negotiating access to a wide range of health and social services to find practical and emotional supports to deal with the management of changes and subsequent challenges that individual with dementia face. The toll of dementia goes beyond the health care system, affecting families and caregivers' quality of life. This places more pressure on family caregivers and health care institutions to provide services for affected individuals. It is important to understand the service needs of this population to enable them to live at home longer, contribute to society and maintain a positive quality of life. To increase understanding of how persons living at home with early dementia and their caregivers/significant others currently perceive and interact with health and community-based services and service providers. A qualitative descriptive approach was used to explore the experiences of individuals with early dementia and care providers with health and community-based services using semi-structured interviews and content analysis. Participants included 16 individuals 50years and older with mild/early dementia living at home, 22 informal caregivers of individuals with mild/early dementia, and 5 key community informants (community health nurses and social workers). Four thematic categories of barriers and two thematic categories of facilitators for access to and uptake of supportive services were identified. Five strategies to inform the development of an action plan to enhance access to, and uptake of, supportive services were determined. Early recognition of dementia through education and publicity enhanced public awareness, attention, and social inclusion with dementia-friendly neighborhoods and facilities need to be considered to achieve effective dementia-related services. Inclusion and recognition of the wishes of persons with dementia is key.

A - 132 Perceptions of Functional Competency in Persons with Subjective Memory Complaints, Mild Cognitive Impairment, and Early Dementia of the Alzheimer’s Type

Abstract Objective This study evaluated whether persons with Subject Memory Complaints (SMC) perceive their overall functional abilities differently than persons with known memory impairments. We predicted SMC persons would describe themselves as less functionally competent compared to persons with objective memory impairments while relatives would perceive them as more functionally competent than what they report. Method As a part of an ongoing study evaluating cognitive and motor correlates of SMC, Mild Cognitive Impairment (MCI), and early Alzheimer’s disease (ad), 10 persons with SMC, 14 with MCI, and 11 with early ad completed the Patient Competency Rating Scale (PCRS). A family member or significant other completed the Patient Competency Rating Scale-Relative Form. Subjects were matched on age, education, and sex. Results Self-reported competency varied across groups (p &amp;lt; 0.05), with the SMC group reporting less competency than the MCI group but at a level of competency similar to the ad group. Relatives’ ratings were also significantly different across groups (p &amp;lt; 0.05). SMC persons were considered by relatives as more functionally competent than the MCI and ad groups. Discrepancy scores between the PCRS and PCRS-R differed across groups (p &amp;lt; 0.05). SMC persons underestimated their functional abilities while persons with MCI and ad overestimated their abilities. Conclusion The findings support the predictions and are compatible with reports in the literature. The PCRS and PCRS-R provide clinically relevant information regarding both a person’s functional abilities in everyday life (according to a relative) while also detecting potential disturbances in self-awareness. SMC patients appear to overstate their functional limitations in many domains in addition to memory.

A - 4 The Potential Applications of Software Supporting the Early Detection of Cognitive Disorders and Dementia in Diagnostics and Prevention

Abstract Objective In Hungary, the process of diagnosing dementia is slow and time-consuming. Currently, there are no well-developed systems and strategies at the local level for screening, and there is no artificial intelligence algorithm that could determine early signs of dementia based on the patient’s digital behavioral patterns. Methods Two PILOTs were conducted using the PreDem platform. Over the PILOTs’ duration (2021.09.01.-2024.04.09), 61,902 test data were analyzed. The 259 participants completed SDMT-type tests, Stroop tests, and memory/word games. Results We established a unified system for task evaluation, facilitating cross-test result comparisons. Participants (n = 43,902) were grouped into three categories: 1st - presumed dementia patients (13,932), 2nd - diagnosed MS patients (16,175), and 3rd - presumably normal population (13,795). Comparing the first two groups to the normal population revealed significant differences, vividly illustrated by density functions. A key finding is the substantial improvement in individuals dealing with memory disorders and forgetfulness through regular cognitive game performance. Conclusion Study results reveal the PreDem platform’s potential as a valuable tool for early dementia detection and prevention. Combining cognitive tests and artificial intelligence, the platform can successfully identify early signs of dementia and cognitive impairment (90% accuracy), potentially leading to early diagnosis, treatment, and improved quality of life for patients and families.

A rare case of early onset lewy body dementia with parkinsonism associated with chronic exposure to copper contaminated drinking water.

There is a well-recognized relationship between a person's body burden of essential trace elements such as copper and their neurological function in which both deficiencies and exposures to excessive concentrations are associated with adverse clinical outcomes. Preclinical studies indicate chronic excess copper exposure is associated with altered motor function, dopaminergic neuronal loss, astrocytosis, and microgliosis. Copper also promotes oligomerization and fibrilization of α-synuclein suggesting it may hasten the course of an α-synucleinopathy. Here we report a rare case of early onset Lewy Body Dementia with Parkinsonism in a 53-year-old Caucasian woman exposed to copper contaminated drinking water for more than 10 years. Her hair and that of her daughter had streaks of blue-green discoloration as did the porcelain sinks in their home. Testing confirmed copper contamination of the drinking water. A neurologist diagnosed her with Lewy Body Dementia with Parkinsonism. Skin biopsy for phosphorylated α was consistent with a diagnosis of an α-synucleinopathy. These findings suggest chronic exposure to excessive copper may act as disease modifying factor in Lewy Body Dementia with Parkinsonism. It has previously been recommended that individuals at risk of Alzheimer's disease (AD) avoid excessive intake of copper. Genetic studies indicate that Lewy Body Dementia shares risk factors and pathways with AD. Based on the observations in this patient we recommend that individuals at risk for an α-synucleinopathy based on a positive family history, genetic testing, and/or positive results on a skin biopsy for phosphorylated α-synuclein avoid exposure to excess copper.

Guardians of memory: The urgency of early dementia screening in an aging society.

The global aging population has led to a significant rise in the prevalence of age-related non-communicable diseases such as dementia and other cognitive disorders. In 2019, there were 57.4 million people with dementia worldwide, and this number is projected to triple by 2050. Intervening in and managing 12 potentially modifiable dementia risk factors can prevent or delay the onset and progression of about 40% of dementia cases. Neuroimaging, biomarkers, and advanced neuropsychological testing offer promising pathways for the early detection of dementia. Emphasis should be placed on educating the public about the importance of brain health and the early signs of cognitive impairment, as well as promoting dementia prevention measures. Adopting a healthy lifestyle - including a balanced diet, regular physical exercise, active social engagement, cognitive activities, and avoiding smoking and excessive alcohol consumption - can help reduce the risk of cognitive decline and prevent cognitive disorders. Government policies on dementia prevention and health care, along with early and regular dementia screening programs, can enhance the early identification and management of individuals at risk. In addition, integrating cognitive health assessments into routine medical check-ups is essential for the early screening and management of dementia.

Blood-based multivariate methylation risk score for cognitive impairment and dementia.

The established link between DNA methylation and pathophysiology of dementia, along with its potential role as a molecular mediator of lifestyle and environmental influences, positions blood-derived DNA methylation as a promising tool for early dementia risk detection. In conjunction with an extensive array of machine learning techniques, we employed whole blood genome-wide DNA methylation data as a surrogate for 14 modifiable and non-modifiable factors in the assessment of dementia risk in independent dementia cohorts. We established a multivariate methylation risk score (MMRS) for identifying mild cognitive impairment cross-sectionally, independent of age and sex (P=2.0×10-3). This score significantly predicted the prospective development of cognitive impairments in independent studies of Alzheimer's disease (hazard ratio for Rey's Auditory Verbal Learning Test (RAVLT)-Learning=2.47) and Parkinson's disease (hazard ratio for MCI/dementia=2.59). Our work shows the potential of employing blood-derived DNA methylation data in the assessment of dementia risk. We used whole blood DNA methylation as a surrogate for 14 dementia risk factors. Created a multivariate methylation risk score for predicting cognitive impairment. Emphasized the role of machine learning and omics data in predicting dementia. The score predicts cognitive impairment development at the population level.

Clinical and neuroradiological spectrum of biallelic variants in NOTCH3

NOTCH3 encodes a transmembrane receptor critical for vascular smooth muscle cell function. NOTCH3 variants are the leading cause of hereditary cerebral small vessel disease (SVD). While monoallelic cysteine-involving missense variants in NOTCH3 are well-studied in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), patients with biallelic variants in NOTCH3 are extremely rare and not well characterised. In this study, we present clinical and genetic data from 25 patients with biallelic NOTCH3 variants and conduct a literature review of another 25 cases (50 patients in total). Brain magnetic resonance imaging (MRI) were analysed by expert neuroradiologists to better understand the phenotype associated with biallelic NOTCH3 variants. Our systematic analyses verified distinct genotype-phenotype correlations for the two types of biallelic variants in NOTCH3. Biallelic loss-of-function variants (26 patients) lead to a neurodevelopmental disorder characterised by spasticity, childhood-onset stroke, and periatrial white matter volume loss resembling periventricular leukomalacia. Conversely, patients with biallelic cysteine-involving missense variants (24 patients) fall within CADASIL spectrum phenotype with early adulthood onset stroke, dementia, and deep white matter lesions without significant volume loss. White matter lesion volume is comparable between patients with biallelic cysteine-involving missense variants and individuals with CADASIL. Notably, monoallelic carriers of loss-of-function variants are predominantly asymptomatic, with only a few cases reporting nonspecific headaches. We propose a NOTCH3-SVD classification depending on dosage and variant type. This study not only expands our knowledge of biallelic NOTCH3 variants but also provides valuable insight into the underlying mechanisms of the disease, contributing to a more comprehensive understanding of NOTCH3-related SVD. The Wellcome Trust, the MRC.

A portable and efficient dementia screening tool using eye tracking machine learning and virtual reality

Dementia represents a significant global health challenge, with early screening during the preclinical stage being crucial for effective management. Traditional diagnostic biomarkers for Alzheimer’s Disease, the most common form of dementia, are limited by cost and invasiveness. Mild cognitive impairment (MCI), a precursor to dementia, is currently identified through neuropsychological tests like the Montreal Cognitive Assessment (MoCA), which are not suitable for large-scale screening. Eye-tracking technology, capturing and quantifying eye movements related to cognitive behavior, has emerged as a promising tool for cognitive assessment. Subtle changes in eye movements could serve as early indicators of MCI. However, the interpretation of eye-tracking data is challenging. This study introduced a dementia screening tool, VR Eye-tracking Cognitive Assessment (VECA), using eye-tracking technology, machine learning, and virtual reality (VR) to offer a non-invasive, efficient alternative capable of large-scale deployment. VECA was conducted with 201 participants from Shenzhen Baoan Chronic Hospital, utilizing eye-tracking data captured via VR headsets to predict MoCA scores and classify cognitive impairment across different educational backgrounds. The support vector regression model employed demonstrated a high correlation (0.9) with MoCA scores, significantly outperforming baseline models. Furthermore, it established optimal cut-off scores for identifying cognitive impairment with notable sensitivity (88.5%) and specificity (83%). This study underscores VECA’s potential as a portable, efficient tool for early dementia screening, highlighting the benefits of integrating eye-tracking technology, machine learning, and VR in cognitive health assessments.

Very early onset dementias: Importance of differentiating from schizophrenia spectrum disorders

Very early onset dementias: Importance of differentiating from schizophrenia spectrum disorders

A Cognitive Function Test Utilizing Eye-tracking Technology in Virtual Reality is useful to distinguish between normal cognition, MCI and mild dementia.

AimThis study aimed to verify the usability of our newly developed virtual reality-based cognitive function examination (VR-E) to differentiate mild cognitive impairment (MCI) from normal cognition and mild dementia. MethodThe subjects of analysis were 71 people (26 males and 45 females, aged from 59 to 94), including 31 with normal cognitive function, 26 with MCI, and 14 with mild dementia, according to the Clinical Dementia Rating (CDR). The total score and each cognitive domain score of VR-E were compared among CDR0, CDR0.5 and CDR1. In addition, for CDR0 vs. CDR0.5 and CDR 0.5 vs. 1, the areas under the curve (ROC) were examined using the total score and each cognitive domain of VR-E. AimThis study aimed to verify the usability of our newly developed virtual reality-based cognitive function examination (VR-E) to differentiate mild cognitive impairment (MCI) from normal cognition and mild dementia. MethodThe subjects of analysis were 71 people (26 males and 45 females, aged from 59 to 94), including 31 with normal cognitive function, 26 with MCI, and 14 with mild dementia, according to the Clinical Dementia Rating (CDR). The total score and each cognitive domain (memory, judgement, spatial cognition, calculation, language function) score of VR-E were compared among CDR0, CDR0.5 and CDR1. In addition, for CDR0 vs. CDR0.5 and CDR 0.5 vs. 1, the areas under the curve (ROC) were examined using the total score and each cognitive domain of VR-E. ResultsThere were significant differences between the three CDR groups in the VR-E scores as well as each VR-E cognitive domain score. The ROC analysis with an AUC value for the VR-E scores between CDR 0 and 0.5 was 0.71, and between CDR 0.5 and 1 was 0.92. For each VR-E cognitive domain, the ROC analysis with an AUC value between CDR 0 and 0.5 was 0.63 for memory, 0.79 for judgment, 0.70 for spatial cognition, 0.62 for calculation, and 0.57 for language. Between CDR 0.5 and 1, the AUC values were 0.81 for memory, 0.75 for judgment, 0.82 for spatial cognition, 0.88 for calculation, and 0.86 for language. ConclusionThe results suggest that VR-E is useful for differentiating mild cognitive impairment from normal cognition and early dementia.

Robot voice calls asking older adults daily life difficulties for the prevention of early dementia

Robot voice calls asking older adults daily life difficulties for the prevention of early dementia

Social participation in the promoting activity, independence and stability in early dementia (PrAISED), a home-based therapy intervention for people living with dementia: a realist evaluation

BackgroundInterventions promoting social activity may reduce behavioural psychological symptoms and improve quality of life in people living with dementia. This study aimed to identify social benefits for participants living with dementia in the context of Promoting Activity, Independence and Stability in Early Dementia (PrAISED), an exercise intervention programme promoting physical activity and independence in participants living with dementia in England.MethodsThis was a multi-method realist evaluation undertaking secondary analysis of data collected during the PrAISED process evaluation, including qualitative interviews with participants with dementia, caregivers and therapists, personal notes of researchers, and video recordings of therapy sessions. The study consisted of four phases: (1) Setting operational definition of social outcomes in PrAISED; (2) Developing Context, Mechanisms, Outcome (CMO) configurations; (3) Testing and refining CMOs; and (4) Synthesising definitive CMOs into a middle range theory.ResultsTwo CMOs were identified. (1) When therapists were able to make therapy sessions engaging and had the caregivers’ support, the participants experienced therapy sessions as an opportunity to achieve goals in areas they were interested in. They also found the sessions enjoyable. This all led to the participants being highly engaged in their social interactions with the therapists. (2) When the participants realised that they were gaining benefits and progress through the PrAISED intervention, such as increased balance, this boosted their confidence in physical ability. It might also reduce caregivers’ risk-aversion/gatekeeping attitude, which in turn would lead to participants’ increased participation in social activities.ConclusionThe PrAISED intervention supported social participation in participants living with dementia. Under certain circumstances, home-based therapy interventions can be beneficial for social health (regardless of physical health gains). Given the limitations of currently available outcome measures to assess social participation, qualitative methods should be used to explore social health outcomes.

First Responders to 9/11 WTC Site Had Up to a 14-Fold Risk of Early Dementia

First Responders to 9/11 WTC Site Had Up to a 14-Fold Risk of Early Dementia