High Prevalence Of Dementia Research Articles

Cognitive concerns are a risk factor for mortality in people with human immunodeficiency virus and COVID-19.

Data supporting dementia as a risk factor for COVID-19 mortality relied on ICD-10 codes, yet nearly 40% of individuals with probable dementia lack a formal diagnosis. Dementia coding is not well-established for people with HIV (PWH), and its reliance may affect risk assessment. This retrospective cohort analysis of PWH with SARS-CoV-2 polymerase chain reaction positivity includes comparisons to people without HIV (PWoH), matched by age, sex, race, and zipcode. Primary exposures were dementia diagnosis, by ICD-10 codes, and cognitive concerns, defined as possible cognitive impairment up to 12 months before COVID-19 diagnosis after clinical review of notes from the electronic health record. Logistic regression models assessed the effect of dementia and cognitive concerns on odds of death (OR [95% confidence interval]); models adjusted for VACS Index 2.0. Sixty-four PWH were identified out of 14,129 patients with SARS-CoV-2 infection and matched to 463 PWoH. Compared to PWoH, PWH had a higher prevalence of dementia (15.6% vs. 6%, p = 0.01) and cognitive concerns (21.9% vs. 15.8%, p = 0.04). Death was more frequent in PWH (p < 0.01). Adjusted for VACS Index 2.0, dementia (2.4 [1.0-5.8], p = 0.05) and cognitive concerns (2.4 [1.1-5.3], p = 0.03) were associated with increased odds of death. In PWH, the association between cognitive concern and death trended towards statistical significance (3.92 [0.81-20.19], p = 0.09); there was no association with dementia. Cognitive status assessments are important for care in COVID-19, especially among PWH. Larger studies should validate findings and determine long-term COVID-19 consequences in PWH with pre-existing cognitive deficits.

Cognitive Concerns are a Risk Factor for Mortality in People with Human Immunodeficiency Virus and COVID-19 (S21.003)

<h3>Objective:</h3> To assess the contribution of cognitive symptoms to risk of mortality from COVID-19 in people with HIV (PWH). <h3>Background:</h3> Despite higher prevalence of cognitive disorders in PWH and dementia being a risk factor for COVID-19 mortality, the association between cognitive impairment and adverse outcomes in PWH with COVID-19 has not been well established. <h3>Design/Methods:</h3> Matched case-control study (1:10) of PWH and without (PWoH) with documented SARS-CoV-2 PCR positivity from March 2020-March 2021 evaluated at a Boston-based healthcare system. Data were extracted from the electronic health record. Matching was on age, sex, race, and zip code. Primary exposures were dementia (ICD-10 code) and cognitive concerns (concern for impairment within 12 months pre-COVID-19, ascertained using a semi-automated chart annotation tool). VACS2.0 Index (including general and HIV-specific biomarkers) was calculated. VACS2.0 Index-adjusted logistic regression models assessed effect of dementia and cognitive concerns on odds of death (OR[95% confidence interval]). <h3>Results:</h3> Among 14,129 patients with COVID-19, 64 PWH were identified and matched to 463 PWoH. Among PWH, 89% were on antiretroviral therapy, 87% had an HIV-1 viral load &lt;200 copies/mL, and 19% had CD4 &lt;200 cells/μL. VACS2.0 score predicted level of care and mortality in both PWH and PWoH. PWH had higher prevalence of dementia (16% vs. 6%, p=0.01) and cognitive concerns (22% vs. 16%, p=0.04). Death was more frequent in PWH (17% vs. 6%, p&lt;0.01), at younger ages (58 vs. 66 years, p=0.03). VACS2.0-adjusted regression models found cognitive concerns (2.4[1.1–5.3], p=0.03) and dementia (2.4[1.0–5.8], p=0.05) significantly associated with odds of death in the overall group. Among PWH only, aOR for cognitive concern approached significance (3.9[0.81–20.19], p=0.09), while dementia (1.75[0.29–8.71], p=0.50) did not. <h3>Conclusions:</h3> Dementia and cognitive concerns were associated with mortality among people with COVID-19, and the magnitude of the effect of cognitive impairment may be greater in PWH. Assessment of cognitive status is an important component to care for PWH in the COVID-19 era. <b>Disclosure:</b> Ms. Rudmann has nothing to disclose. Dr. Wilcox has nothing to disclose. Elissa Ye has received personal compensation for serving as an employee of Massachusetts General Hospital. Mr. Noori has nothing to disclose. Colin Magdamo has received research support from National Institutes of Health. Aayushee Jain has nothing to disclose. Dr. Alabsi has received personal compensation for serving as an employee of Biogen. Virginia Triant has nothing to disclose. The institution of Gregory Robbins has received research support from Gilead Sciences. The institution of Gregory Robbins has received research support from Citius Pharm. The institution of Gregory Robbins has received research support from Emergent Biosolutions. The institution of Gregory Robbins has received research support from Pfizer. The institution of Gregory Robbins has received research support from Leonard Meron Biosciences. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities. An immediate family member of Sudeshna Das has received personal compensation for serving as an employee of Alix Partners. An immediate family member of Sudeshna Das has received stock or an ownership interest from Alix Partners. The institution of Sudeshna Das has received research support from NIA. The institution of Sudeshna Das has received research support from Mass Life Sciences Center. The institution of Sudeshna Das has received research support from IOS Press. Dr. Mukerji has stock in Gilead Science. The institution of Dr. Mukerji has received research support from NIH. The institution of Dr. Mukerji has received research support from Massachusetts General Hospital.

Multimedikation in Einrichtungen der stationären Langzeitpflege: Möglichkeiten einer Verbesserung der Arzneimitteltherapiesicherheit (AMTS)

Patients in need of care usually suffer from multiple chronic conditions and therefore receive ahigh number of drugs. Polypharmacy involves multiple risks, for example, drug-drug and drug-disease interactions, adverse effects and potentially inappropriate medication (PIM), more hospital admissions, and increased mortality.Residents in long-term care facilities are particularly sensitive to adverse drug reactions because of age-related changes, frailty, and the high prevalence of dementia. Numerous drugs have side effects that lead to sedation, particularly in old age, and increase the risk of falls. In addition, anticholinergic effects negatively modify cognition. These PIMs are frequently prescribed to nursing home residents.The medication process in long-term care facilities is complex and requires numerous coordinated processes. In addition to the correct administration, the nursing staff have other important tasks such as monitoring the effects and potential adverse drug reactions and communicating their observations to the prescribing physicians and home-supplying pharmacists. The nursing staff therefore play acrucial role in the prescription of psychotropic drugs and contribute to the medication quality for nursing home residents. National and international studies indicate that improvements of polypharmacy and drug therapy safety in nursing homes can only be achieved by interprofessional collaboration.

A Feasibility Evaluation of the Need-Centered Watch–Assess–Need Intervention–Think Education and Training Program for Behavioral and Psychological Symptoms of Dementia

Despite the high prevalence of dementia among residents living in long-term care facilities in Taiwan, most care providers in these facilities have not received adequate training to deal with the behavioral and psychological symptoms of dementia (BPSD). An original care and management model for BPSD has been developed, and model-based recommendations for an education and training program have been made. However, empirical testing has not yet been conducted to determine the efficacy of this program. This study was designed to evaluate the feasibility of using the Watch-Assess-Need intervention-Think (WANT) education and training program for BPSD in long-term care settings. A mixed-method design was used. Twenty care providers and 20 corresponding care receivers (residents with dementia) from a nursing home in southern Taiwan were enrolled. Data were collected using a variety of measurement tools, including the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Attitude towards Dementia Care Scale, and Dementia Behavior Disturbance Self-efficacy Scale. Qualitative data, including care-provider perspectives on the efficacy of the WANT education and training program, were also collected. Repeated measures were conducted on the results of quantitative data analysis, whereas content analysis was performed on the results of qualitative data analysis. Findings indicate that the program relieves agitated behavior (p = .01), alleviates depression in those with dementia (p < .001), and enhances care-provider attitudes toward dementia care (p = .01). However, no significant improvement was found in self-efficacy among the care providers (p = .11). In terms of qualitative outcomes, care providers indicated they perceived improved self-efficacy in managing BPSD, improved ability to view problems from a more need-centered perspective, improved attitudes toward dementia and patients' BPSD, and decreased care burden and stress. The study found the WANT education and training program to be feasible in clinical practice. Because of this program's simple and easy-to-remember characteristics, it is recommended that it be vigorously promoted to care providers in both long-term institutional and home care settings to help them effectively address the BPSD.

Dementia in rural settings: a scoping review exploring the personal experiences of people with dementia and their carers

AbstractRural areas tend to be inhabited by more older people and thus have a higher prevalence of dementia. Combined with lower population densities and more sparse geography, rural areas pose numerous barriers and costs relating to support and resource provision. This may leave people with dementia in rural places at a significant disadvantage, leading to a heavy reliance on informal support networks. The present study explores the personal experiences of people living with dementia and carers living in rural areas, seeking to discover both benefits and challenges, as well as recommendations within the literature for improving the lives of those affected by dementia in rural areas. A scoping review following the framework of Arksey and O'Malley identified 60 studies that describe or discuss the personal experience of dementia (either by the person with dementia or carer), in relation to living in rural or remote geographical areas. Four overarching themes were derived, namely the possible benefits of living in a rural community (supportive rural communities), sources of strength described by people affected by dementia in rural areas (managing and coping), detrimental aspects of living in a rural community (rural community challenges) and difficulties with dementia care services. Three further themes yielded recommendations for improving the experience of dementia in rural areas. This review highlights some potential opportunities related to living in rural areas for people living with dementia. These often come with parallel challenges, reflecting a delicate balance between being well-supported and being in crisis for those living in rural areas. Given the limited access to formal services, supporting people with dementia in rural areas requires input and innovation from the people, organisations and services local to those communities.

Prevalence of Dementia and Cognitive Impairment No Dementia in a Large and Diverse Nationally Representative Sample: The ELSI-BrazilStudy.

Approximately 77% of older adults with dementia in Brazil have not been diagnosed, indicating a major public health issue. Previous epidemiological dementia studies in Brazil were based on data from 1 geopolitical region. We aimed to estimate the general and subgroup-specific (age, education, and sex) prevalence of dementia and cognitive impairment no dementia (CIND) classification using data from 5249 participants aged 60years and older from the ELSI-Brazil, a large nationally representative sample. Participants were classified as having normal cognitive function, CIND, or dementia based on a combination of the individual's cognitive and functional status. We found a general prevalence of 5.8% (95% CI=4.7-7.2) for dementia and 8.1% (95% CI=6.8-9.5) for CIND. Dementia prevalence ranged from 3.2% (60-64years old) to 42.8% (≥90years old) by age, and from 2.1% (college level or higher) to 16.5% (illiterates) by education. Females had a higher dementia prevalence (6.8%) than males (4.6%). CIND prevalence was similar across age, sex, and education. The estimated dementia prevalence is lower than that in previous Brazilian epidemiological studies, but is in line with other Latin American studies. Only 1.2% of the ELSI-Brazil participants reported having a previous diagnosis of dementia, revealing that underdiagnosis is rampant and a common reality. Based on our results and national statistics projections, we estimate that in 2019, there were 1757480 people aged 60years and older living with dementia in Brazil and, at least, another 2271314 having to deal with some form of cognitive impairment.

Cognitive status in institutionalized oldest old

Introduction. Oldest old are the fastest growing age group in most countries of the world, including the Russian Federation. A signifi cant part of oldest old are feel lonely, need care and live in long term care facilities (institutionalized). Disability and institutionalization are associated with an increased risk of cognitive impairment in oldest old. The cognitive status in this group has been studied insuffi ciently in Russia. Determination of diagnostic standards for cognitive functions assessment scales in oldest old is important both for clinical practice and for scientifi c research.Objective: to evaluate cognitive functions and to determine diagnostic value for various psychological tests in persons aged ≥ 90, who live in long term care facilities (LTCF).Material and methods. The persons aged ≥ 90 years that live in LTCF (boarding houses or nursing homes) in Moscow were examined. All patients passed neuropsychological examination, which included Mini-mental State Examination (MMSE), Frontal Assessment Battery (FAB), 5-word test, clock-drawing test and verbal fl uency tests. In addition, original questionnaire was used for cognitive impairment screening.Results. Dementia was found in 69% of oldest old, who live in LTCF; frontal dysfunction in 89.1% and “hippocampal type” of memory disorders in 57.5%. The results of phonemic verbal fl uency test were normal in 6.7% only and of semantic verbal fl uency test in 8.1%. For diagnosis of dementia in institutionalized subjects sensitivity of MMSE ≤ 23 points was 97% and specifi city was 90.9%. For the FAB optimal sensitivity/specifi city ratio (98/83.7%) was at score of ≤ 14. The clock-drawing test sensitivity for dementia was 91.9% and specifi city was 69.7% at total score ≤ 6 .Conclusion. Institutionalized persons aged ≥ 90 years have a high prevalence of dementia. The above mentioned tests can be used for oldest old examination. Further studies of the relationship of cognitive impairment with other geriatric disorders in oldest old are needed.

Reading Holy Qur’an to Improve Verbal Fluency in Elderly

The high prevalence of dementia that impairs verbal fluency has been a global source of concern. As a result, strategies for preserving or improving verbal fluency in the elderly are required. A neuroplasticity-based reading program has been shown to improve verbal fluency. This study aims to ascertain whether reading the Holy Qur'an has an effect on an older adult's ability to communicate fluently. It is an experimental study with a quasi-experimental design with pretest-posttest control groups. This study sampled 22 elderly individuals with the following criteria: age greater than 60 years, ability to speak and read the Holy Qur'an, a Mini-Mental State Examination (MMSE) score greater than 24, absence of psychiatric disorders, absence of head trauma, and absence of neurological disease. The intervention group read the Quran for two weeks, while the control group did not. Both groups were measured for Verbal fluency at the beginning and after the intervention. There were significant differences in post-test phonemic scores between the control group (CG) and the intervention group (IG) (p=0.019). Meanwhile, there was no significant difference in semantic score in all groups (p0.852). Reading the Holy Qur’an activity intervention for two weeks affected verbal fluency in the elderly by increasing phonemic but not semantic scores.

SKRINING DEMENSIA DAN EDUKASI POTENSI SUMBER DAYA LAUT UNTUK MENCEGAH PENYAKIT NEURODEGENERATIF PADA MASYARAKAT PESISIR DI KABUPATEN LOMBOK UTARA (KLU)

Improving the quality of health services has resulted in a high elderly population. The elderly are more susceptible to various degenerative diseases, including dementia. The high prevalence of dementia is a major health issue that has an impact on global socioeconomic problems. Indonesia is one of the world's largest archipelagic countries. As an archipelago-based region, West Nusa Tenggara (NTB) has numerous marine resources that could be utilized as potential dementia therapies. This program aims to conduct health screenings for dementia and educate about the potential of marine resources for dementia treatment. This program consists of two phases. The first phase consists of a health screening to assess the risk of dementia. This phase includes measuring blood pressure, measuring blood sugar, and evaluating cognitive performance. The second phase consists of health education regarding the potential of marine resources. Based on dementia screening revealed that 96% of participants need additional evaluation. About 47.3% of the patients were diagnosed with hypertension, 61.1% required further confirmation for diabetes mellitus, and 5.6% were diagnosed with diabetes mellitus. Health education explains the importance of marine resources in preventing degenerative diseases, the nutritional value of marine resources, and the proper treatment of marine resources as food and medication. The community's enthusiasm for health education is high. The high interest of the people was evidenced by a large number of attendees and queries asked. The community participates actively, and the programs run as intended.

2358. Dementia and Cognitive Concerns are Risk Factors for Mortality in People with Human Immunodeficiency Virus and COVID-19

Abstract Background Despite higher prevalence of cognitive disorders in people with human immunodeficiency virus (PWH) and dementia being a risk factor for COVID-19 mortality, the association between dementia and adverse outcomes in PWH with COVID-19 has not been well established. Methods This was a matched case-control study (1:10) of patients with and without HIV at an academic institution with documented SARS-CoV-2 polymerase chain reaction (PCR) positivity from March 2020-March 2021. Data were extracted from the electronic health record data registry. PWH were matched to people without HIV (PWoH) by age, sex, race, and zip code. The primary exposures were dementia (identified using International Classification of Diseases, Tenth Revision codes) and cognitive concerns, defined as documentation of possible cognitive impairment up to 12 months prior to COVID-19 diagnosis and ascertained using a semi-automated natural language processing annotation tool. VACS 2.0 Index (including age, sex, body mass index, CD4+ T-cell count and HIV-1 RNA) was calculated. Logistic regression models assessed the effect of dementia and cognitive concerns on the odds of death (OR [95% confidence interval]), adjusted for VACS 2.0 Index. Results Sixty-four (0.45%) PWH were identified among 14129 patients with COVID-19 and were matched to 463 PWoH. Among PWH, 59% were virally suppressed, and 14% had CD4&amp;lt; 200 cells/μL. Compared to 463 matched PWoH, PWH had higher prevalence of dementia (16% vs. 6%, p=0.01) and cognitive concerns (22% vs. 16%, p=0.04). Death was more frequent in PWH (17% vs. 6%, p&amp;lt; 0.01) and at younger ages (58 vs. 66 years, p=0.03). Cognitive concerns (2.5 [1.1–5.9], p=0.03) and dementia (3.4 [1.3–8.1], p=0.01) were significantly associated with increased adjusted odds of death in the overall group. Among PWH, cognitive concerns (7.2 [1.1–48], p=0.04) and dementia (6.0 [0.8–43.8], p=0.08) remained associated with mortality. Conclusion Dementia and cognitive concerns were associated with mortality among PWH with COVID-19. The magnitude of the effect of cognitive impairment on COVID-19 outcomes may be greater in HIV, and additional studies with larger cohorts will help to assess this association further. Assessment of cognitive status is an important component to care for aging PWH in the COVID-19 era. Disclosures All Authors: No reported disclosures.

Association between reproductive factors in women and risk of brain ageing and dementia

AbstractBackgroundWomen have a higher prevalence of dementia than men. We determined the association between female reproductive factors and risk of cognitive outcomes, including incident dementia, in a community‐based sample of cognitively healthy individuals.MethodLifetime reproductive factors including age of menarche, age of menopause, reproductive lifespan (age of menopause minus age of menarche), number of live births, post‐menopausal hormone replacement therapy use, and serum estradiol and estrone concentrations were measured in 796 dementia‐free women [mean age 68.4 (SD 5.7) yr] from the Framingham Heart Study Offspring cohort at examination cycle seven (1998‐2001). We related reproductive factors to subsequent risk of incident dementia. Structural MRI brain measures and neurocognitive test performance were included as secondary outcomes.ResultDuring a median 10 [Q1‐Q3, 8.04‐10.0] year follow‐up, 138 participants developed dementia. On Cox proportional‐hazards analysis adjusting for age and education, a longer reproductive lifespan was associated with a reduced risk of incident dementia (HR 0.94, 95% CI 0.91‐0.98, p = 0.004) while earlier age of menopause of ≤49 vs 50‐51 years was associated with an increased dementia risk (HR 2.56, 95% CI 1.12‐5.88, p = 0.027). Earlier menopause (≤49 versus 50‐51 years) was cross‐sectionally associated with lower hippocampal volume (β±SE, ‐0.123±0.057, p = 0.03). Compared to no live births, 1‐2 live births (5.85±2.03, p = 0.004) and ≥3 live births (5.17±2.06, p = 0.01) were associated with greater total cerebral brain volume. Use of post‐menopausal HRT (0.15±0.055, p = 0.007) and elevated serum estradiol (0.058±0.027, p = 0.03) and estrone concentrations (0.078±0.029, p = 0.006) were cross‐sectionally associated with improved abstract reasoning (Similarities test). Compared to no live births, 1‐2 live births (0.20±0.08, p = 0.018) and ≥3 live births (0.25±0.08, p = 0.003) were also associated with superior visuospatial performance.ConclusionGreater exposure to estrogen throughout a woman’s reproductive life was associated with a lower risk of incident dementia and cross‐sectionally associated with larger brain volumes and enhanced cognitive performance. Our results suggest positive cognitive benefits of greater lifetime estrogen exposure and highlight the potential role of estrogen exposure in modifying the risk of dementia.

Hypertension and cognitive dysfunction: a narrative review.

Cognitive dysfunction is relatively less considered a complication of hypertension. However, there is sufficient evidence to show that high blood pressure in middle age increases the risk of cognitive decline and dementia in old age. The greatest impact on cognitive function in those with hypertension is on executive or frontal lobe function, similar to the area most damaged in vascular dementia. Possible cognitive disorders associated with hypertension are vascular dementia, Alzheimer disease, and Lewy body dementia, listed in decreasing strength of association. The pathophysiology of cognitive dysfunction in individuals with hypertension includes brain atrophy, microinfarcts, microbleeds, neuronal loss, white matter lesions, network disruption, neurovascular unit damage, reduced cerebral blood flow, blood-brain barrier damage, enlarged perivascular damage, and proteinopathy. Antihypertensive drugs may reduce the risk of cognitive decline and dementia. Given the high prevalence of dementia and its impact on quality of life, treatment of hypertension to reduce cognitive decline may be a clinically relevant intervention.

Circulating endothelial and angiogenic cells predict hippocampal volume as a function of HIV status.

Circulating endothelial cells (CECs) and myeloid angiogenic cells (MACs) have the capacity to stabilize human blood vessels in vivo. Evidence suggests that these cells are depleted in dementia and in persons living with HIV (PWH), who have a higher prevalence of dementia and other cognitive deficits associated with aging. However, the associations of CECs and MACs with MRI-based measures of aging brain health, such as hippocampal gray matter volume, have not been previously demonstrated. The present study examined differences in these associations in 51 postmenopausal women with and without HIV infection. Gray matter volume was quantified using MRI. CECs and MACs were enumerated using fluorescence-activated cell sorting. Analyses examined the association of these cell counts with left and right hippocampal gray matter volume while controlling for age and hypertension status. The main finding was an interaction suggesting that compared to controls, postmenopausal PWH with greater levels of CECs and MACs had significantly greater hippocampus GMV. Further research is necessary to examine potential underlying pathophysiological mechanisms in HIV infection linking morpho-functional circulatory reparative processes with more diminished hippocampal volume in postmenopausal women.

Association of plasma brain-derived neurotrophic factor levels and frailty in community-dwelling older adults

Brain-derived neurotrophic factor (BDNF), an exercise-induced neurotrophin, is an important factor in memory consolidation and cognitive function. This study evaluates the association between plasma BDNF levels and frailty in community-dwelling older adults. Plasma BDNF levels were analyzed in a total of 302 individuals aged 70–84 years from the Korean Frailty and Aging Cohort Study. There were 30 (9.9%) participants with frailty. They were older and had a higher prevalence of dementia and depression than those without frailty. There were no differences in the proportion of male sex between the frail and non-frail groups. Plasma BDNF levels were significantly lower in participants with frailty than in those without frailty. The presence of frailty was significantly associated with plasma BDNF levels (odds ratio 0.508, 95% confidence interval 0.304–0.849) as well as age, hemoglobin, and the presence of dementia, and depression. After adjustment for confounding factors, the significant association between plasma BDNF and frailty was maintained (0.495, 0.281–0.874). This association remained consistent after exclusion of individuals with dementia, depression, stroke, diabetes, and osteoporosis. Plasma BDNF levels were significantly associated with frailty in community-dwelling older adults. Our study may suggest the possible role of BDNF as a novel biomarker of frailty.

Rehabilitation Outcomes among Frail Older Adults in the United States.

Background: Current rehabilitation care paradigms are not well aligned with the needs of frail older adults, but the resultant impact on rehabilitation outcomes is unclear. Understanding how frailty may impact rehabilitation outcomes, and understanding some of the underlying mechanisms, may help inform payment policy changes. Design: This study was a cross-sectional analysis of data from Round 5 of the National Health and Aging and Trends Study (NHATS). We identified older adults who had completed one or more episodes of rehabilitation care and used a validated 5-item NHATS Fried Frailty scale to categorize patients as frail (3/5 or more) or non-frail (≤2/5). We then evaluated the association between frailty status and three key patient outcomes: (1) achievement of rehabilitation goals, (2) functional improvement during rehabilitation episodes, and (3) discontinuation of therapy after exhausting insurance benefits. Lastly, we used multivariable, survey-weighted logistic regression models to estimate adjusted relationships between frailty and rehabilitation outcomes. Results: An estimated 5.6 million survey-weighted older adults in the United States (95% CI 5.1 to 6.0 million) completed an episode of rehabilitation in the past year, an estimated 1,271,290 (95% CI 921,758 to 1,620,822; weighted: 22.8%) of whom were frail. Frail rehabilitation recipients were generally older, had a greater comorbidity burden, and had a higher prevalence of dementia. In adjusted models, frailty was associated with poorer functional outcomes, a lower probability of meeting rehabilitation goals and a greater likelihood of exhausting rehabilitation insurance benefits. Conclusions: Exercise is a well-supported intervention for the management of frailty, but our results suggest that frail older adults are not getting the volume or intensity of rehabilitation treatment needed to maximally improve outcomes—in part due to limited payer coverage of rehabilitation services in the United States.

Anti-dementia medication use in Aotearoa New Zealand: An exploratory study using health data from the Integrated Data Infrastructure (IDI).

Anti-dementia medications such as acetylcholinesterase inhibitors are an important part of the management pathway for dementia. However, there are limited data in New Zealand that have examined the rates and patterns of use of funded anti-dementia medication and how use differs with ethnicity, age and sex. This was a retrospective population-based descriptive study. Using the Integrated Data Infrastructure, we identified individuals of all ages coded for a diagnosis of dementia and estimated the proportion dispensed funded anti-dementia medication - donepezil tablets and rivastigmine patches - between 1 July 2016 and 30 June 2020. Rates of medication use in five main ethnic groups (Māori, Pacific peoples, Asian, European, and Middle Eastern, Latin American and African) in the <65, 65-79 and 80 and over (80+) age groups were compared and also between males and females in all sub-groups. Log-binomial models were used to calculate relative risks to determine any differences in anti-dementia medication use in the five ethnic groups and the three age groups and between males and females in each of the four study years. Overall, one-third of the dementia population received a funded anti-dementia medication in the total population (all ages) between 2016 and 2020. Donepezil tablets were dispensed in 31.6-34.0% and rivastigmine patches in 1.4-2.1% across the four study years. Compared to people of European ethnicity, Māori, Pacific peoples, and Middle Eastern, Latin American and African groups were less likely to be dispensed an anti-dementia medication (Māori: relative risk = 0.79-0.81, p < 0.0001; Pacific peoples: relative risk = 0.72-0.74, p < 0.0001; Middle Eastern, Latin American and African: relative risk = 0.73-0.78, p < 0.05). Compared to the age 80+ group, the 65-79 age group was more likely (relative risk = 1.50-1.54, p < 0.0001), while the age <65 group was less likely (relative risk = 0.67-0.71, p < 0.0001) to be dispensed an anti-dementia medication. There were no statistically significant differences in anti-dementia medication use between males and females. This study provides important information about funded anti-dementia medication use in New Zealand and how this differs by ethnicity, age and sex. Despite higher dementia prevalence in Māori and Pacific peoples, these groups were less likely to receive funded anti-dementia medication.

A Predictive Model of Regional Dementia Prevalence Using Geographic Weighted Regression Analysis.

Globally, dementia is one of the highest priority public health policy issues. This study was conducted to analyze the spatial distribution pattern of dementia prevalence using geographic weighted regression analysis and to identify preventable risk factors at the regional level of dementia prevalence. For the data to be analyzed, this work used the 2020 regional dementia prevalence index of the Korea Central Dementia Center and the regional health statistics of the Korea Centers for Disease Control and Prevention Agency (KDCA). Spatial autocorrelation analysis, hot spot analysis, and geographic weighted regression analysis were performed to identify regional associations of dementia prevalence, cluster regions with high dementia prevalence, and risk factors for regional dementia prevalence. As a result of the hot spot analysis, the regions corresponding to the hot spots with the high prevalence of dementia were found to be adjacent to each other, such as in Jeonnam, Jeonbuk, and Gyeongbuk, and the regions corresponding to the cold spots with the low prevalence of dementia were adjacent to each other, such as Seoul, Gyeonggi, Incheon, Busan, and Ulsan. The results of geographic weighted regression analysis showed that educational level, walking practice rate, hypertension prevalence, and a low-sodium diet preference were found to be risk factors for the prevalence of dementia. These results suggest that there is a need for a dementia prevalence management strategy to increase the walking practice rate and low-sodium diet preference rate, and decrease the hypertension prevalence, centering on the hot spot area, which is a cluster area with high dementia prevalence. This study is expected to be useful as basic data that can help in prioritizing health policies considering spatial characteristics for community health promotion.

Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations.

Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations. We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non-Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample. Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8%-25.4%), but was substantially higher in AAs (33.6%; P<0.001). APOE ε4 carriers had higher dementia prevalence across all groups. APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.

Concurrent vision and hearing impairment associated with cognitive dysfunction in a population aged 85+ years: the Ural Very Old Study

ObjectiveTo assess the prevalence of vision impairment, hearing impairment and dual sensory impairment (DSI) as combination of vision and hearing impairment, in association with cognitive dysfunction in a population aged...

Association of Multidimensional Poverty With Dementia in Adults Aged 50 Years or Older in South Africa

Limited research exists investigating the association between multidimensional poverty and dementia in low-and middle-income countries (LMICs). To investigate the association between multidimensional poverty and dementia among adults aged 50 years or older living in South Africa. This cross-sectional study was conducted in Soweto, Johannesburg, South Africa, between November 11, 2019, and February 28, 2020. Participants included 227 adults aged 50 years or older. Data analysis was concluded from August 1 to 30, 2021. Multidimensional poverty included 7 dimensions that are central to well-being (education, health, economic activity, living standards, social participation, fair treatment, and psychological well-being) and 11 indicators of deprivation within those dimensions (limited access to education; severe limitation of activity; difficulty functioning; unemployment; deprivation of access to running water, electricity, and a flush toilet; lack of involvement in community groups; discrimination; depression; and decreased self-esteem). The 8-item Interview to Differentiate Aging and Dementia (Assessing Dementia 8 [AD8]) and the Rowland Universal Dementia Assessment Scale (RUDAS) were used to assess dementia. Level and depth of poverty were compared between adults with no dementia and those with a score above the threshold for either the AD8 or the RUDAS, or for both the AD8 and the RUDAS, adjusting for gender, age group, and marital status. Correlation analyses assessed the overlap of dimensions of deprivation. Associations between dementia and multidimensional poverty were investigated using a multivariable logistic regression model. A total of 227 adults (146 women [64.3%]; mean [SD] age, 63.7 [0.5] years) were included in the study; 101 (44.5%) had dementia identified by the AD8, 14 (6.2%) had dementia identified by the RUDAS, and 50 (22.0%) had dementia identified by both the AD8 and the RUDAS. More men than women did not have dementia (26 of 81 [32.1%] vs 36 of 146 [24.7%]), and 33 of 165 adults with dementia (20.0%) compared with 6 of 62 adults (9.7%) without dementia were found to be deprived in 4 dimensions or more. The difference between adults with and adults without dementia in the Multidimensional Poverty Index for deprivation in 4 dimensions was 145.8% for dementia identified by both the AD8 and the RUDAS and 118.2% for dementia identified by either the AD8 or the RUDAS. Education, health, and employment were the main contributors to the adjusted poverty head count ratio. Multidimensional poverty was strongly associated with dementia as measured by the AD8 and the RUDAS (adjusted odds ratio [OR], 2.31; 95% CI, 1.08-4.95), with higher odds for older women (OR, 2.03; 95% CI, 1.00-4.12) or those living in large households (for each additional household member: OR, 1.27; 95% CI, 1.05-1.53). This study suggests that the prevalence and depth of poverty were higher among adults with dementia. A lack of education, poor health, and unemployment were major dimensions of poverty that were associated with a higher prevalence of dementia. Long-term interventions beginning early in life may affect social determinants of health through targeted structural policies (eg, access to quality education and health care) and prevent dementia later in life.