Higher Rates Of Dementia Research Articles

Exploring Chronic Pain Patterns and Associations With All-Cause Dementia: Results From UK Biobank

The count of locations with chronic pain is widely used in research and clinical practice. However, this approach might be too simplistic to fully capture the complexity of chronic pain experiences. This study identified prevalent patterns of chronic pain locations and evaluated their associations with incident dementia among middle-aged and older adults in the UK. Data were from 445,530 participants who were free of dementia at baseline (2006–2010) in the UK Biobank. We calculated the incidence rates of all-cause dementia by the 20 most prevalent combinations of pain locations assessed at baseline. Cox models were utilized to examine the hazard ratio of incident dementia among each of these 20 combinations compared to 3 groups: 1) participants without chronic pain, 2) participants with only a single chronic pain location not included in the combination, and 3) participants with only a single chronic pain location included in the combination. The 3 most prevalent combinations were neck and back (5.7%), back and knee (5.4%), and neck and knee (4.5%). Chronic back, neck, and knee pain was commonly present either individually or simultaneously in combinations associated with higher dementia rates than persons without chronic pain. The combinations involving back, neck, and knee were associated with higher dementia rates than groups with 1 pain location not included in the combination. Chronic pain is not randomly present in body locations. Understanding how different patterns of chronic pain locations relate to dementia provides new insights into dementia prevention through pain relief. PerspectiveThis article unveils chronic pain patterns and dementia risks in the UK Biobank. Chronic pain in back, neck, and knee presents frequently, either individually or in combinations associated with increased dementia rates. Chronic pain combos correlate with diverse dementia rates, guiding targeted prevention strategies through pain management.

Characteristics associated with progression to probable dementia with Lewy bodies in a cohort with very late-onset psychosis.

Very late-onset psychosis (VLOP) is associated with higher rates of dementia but the proportion who develop dementia with Lewy bodies (DLB) is unknown. We aimed to identify individuals with VLOP who develop dementia and DLB and characterize the risk factors for progression. Anonymized data were retrieved from electronic records for individuals with VLOP. Patients developing dementia after psychosis were identified, in addition to those with >2 core features of DLB at the time of dementia or DLB identified by a natural language processing application (NLP-DLB). Demographic factors, Health of the National Outcome Scale (HoNOS) and symptoms at index psychosis were explored as predictors of progression to dementia. In 1425 patients with VLOP over 4.29 years (mean) follow up, 197 (13.8%) received a subsequent diagnosis of dementia. Of these, 24.4% (n = 48) had >2 core features of DLB and 6% (n = 12) had NLP-DLB. In cox proportional hazard models, older age and cognitive impairment at the time of psychosis were associated with increased risk of incident dementia. Visual hallucinations and 2+ core features of DLB at index psychosis were associated with increased risk of dementia with 2+ symptoms of DLB but not all-cause dementia. Two or more core features of DLB at index psychosis were associated with 81% specificity and 67% sensitivity for incident NLP-DLB. In patients with VLOP who develop dementia, core features of DLB are common. Visual hallucinations or two core features of DLB in VLOP should prompt clinicians to consider DLB and support further investigation.

Young Onset Dementia in New South Wales, Australia in 1891: What has Changed Since Then?

This study aimed to determine the prevalence and types of young onset dementia (YOD) in New South Wales (NSW), Australia, in 1891 with comparisons to 21st century estimates. Changes might inform future service planning for persons with YOD. Medical case books of two Hospitals for the Insane were examined at the State Archives and clinical and sociodemographic information extracted of persons who were under the age of 65 in April 1891, when a NSW Census occurred, and were given a dementia diagnosis or had symptoms consistent with dementia. Consensus 21st century 'probable' and 'possible' all cause dementia and major neurocognitive disorder diagnoses were determined by two psychiatrists. Prevalence estimates of moderate-severe dementia were determined and compared with 21st century estimates and dementia types. Of 161 potential dementia cases, 123 were given a consensus 'probable' dementia diagnosis, 28 a 'possible' dementia diagnosis, and ten were given a non-dementia diagnosis, with 'all cause dementia' and 'major neurocognitive disorder' diagnoses identical. Most dementia cases were male (n=119, 78.8%). 'Unspecified dementia' was the most frequent diagnosis (n=47, 31.1%), followed by dementia secondary to syphilis (n=35, 23.2%), epileptic dementia (n=30, 19.9%), alcohol-related dementia (n=17, 11.3%), and mixed dementia (n=16, 10.6%). Epileptic dementia had the youngest average age of admission (34.9years). Other than epileptic dementia, all other dementia types were more frequent in males. Prominent clinical symptoms included neurological signs (n=79, 52.3%), psychosis (n=77, 51.0%), agitation (n=75, 49.7%), and aggression (n=45, 29.8%). Most dementia cases either died in hospital (n=79, 52.3%) or were transferred to a long stay hospital (n=57, 37.7%). The estimated point prevalence of YOD in persons aged 30-59 in 1891 (86 per 100,000) was higher than current Australian and global estimates in this age group due to the high rates in males (126per 100,000), but in those aged 60-64, the prevalence in 1891 (159per 100,000) was much lower than current estimates. This first examination of YOD in the nineteenth century found high rates of dementia in those under the age of 60 compared with current estimates, particularly in men aged between 30 and 59years old, and largely due to syphilis, alcohol and epilepsy, conditions that are now treatable and thus demonstrating the potential of effective treatments for YOD.

Substantia Nigra Pathology, Contact Sports Play, and Parkinsonism in Chronic Traumatic Encephalopathy

Parkinsonism is associated with traumatic brain injury and chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with repetitive head impact (RHI) exposure, but the neuropathologic substrates that underlie parkinsonism in individuals with CTE are yet to be defined. To evaluate the frequency of parkinsonism in individuals with CTE and the association of RHI and neuropathologic substrates with parkinsonism in these individuals. This cross-sectional study included brain donors with neuropathologically diagnosed CTE without other significant neurodegenerative disease and with information on parkinsonism from the Understanding Neurologic Injury and Traumatic Encephalopathy brain bank between July 2015 and May 2022. Years of contact sports participation as a proxy for RHI. The main outcomes were frequency of parkinsonism in individuals with CTE and associations between (1) RHI with substantia nigra (SN) Lewy bodies (LBs) and neurofibrillary tangles (NFTs); (2) LBs, NFTs, and arteriolosclerosis with SN neuronal loss; and (3) SN neuronal loss, LBs, NFTs, and arteriolosclerosis with parkinsonism, tested by age-adjusted logistic regressions. Of 481 male brain donors with neuropathologically diagnosed CTE, parkinsonism occurred frequently in individuals with CTE (119 [24.7%]; 362 [75.3%] did not have parkinsonism). Participants with parkinsonism had a higher mean (SD) age at death (71.5 [13.0] years) than participants without parkinsonism (54.1 [19.3] years) (P < .001) and higher rates of dementia (104 [87.4%] vs 105 [29.0%]), visual hallucinations (45 [37.8%] vs 51 [14.1%]), and probable rapid eye movement sleep behavior disorder (52 [43.7%] vs 58 [16.0%]) (P < .001 for all). Participants with parkinsonism had a more severe CTE stage (eg, stage IV: 35 [29.4%] vs 39 [10.8%]) and nigral pathology than those without parkinsonism (NFTs: 50 of 117 [42.7%] vs 103 of 344 [29.9%]; P = .01; neuronal loss: 61 of 117 [52.1%] vs 59 of 344 [17.1%]; P < .001; and LBs: 28 of 116 [24.1%] vs 20 of 342 [5.8%]; P < .001). Years of contact sports participation were associated with SN NFTs (adjusted odds ratio [AOR], 1.04; 95% CI, 1.00-1.07; P = .03) and neuronal loss (AOR, 1.05; 95% CI, 1.01-1.08; P = .02). Nigral neuronal loss (AOR, 2.61; 95% CI, 1.52-4.47; P < .001) and LBs (AOR, 2.29; 95% CI, 1.15-4.57; P = .02) were associated with parkinsonism. However, SN neuronal loss was associated with SN LBs (AOR, 4.48; 95% CI, 2.25-8.92; P < .001), SN NFTs (AOR, 2.51; 95% CI, 1.52-4.15; P < .001), and arteriolosclerosis (AOR, 2.27; 95% CI, 1.33-3.85; P = .002). In American football players, regression analysis demonstrated that SN NFTs and neuronal loss mediated the association between years of play and parkinsonism in the context of CTE (β, 0.012; 95% CI, 0.001-0.038). In this cross-sectional study of contact sports athletes with CTE, years of contact sports participation were associated with SN tau pathology and neuronal loss, and these pathologies were associated with parkinsonism. Repetitive head impacts may incite neuropathologic processes that lead to symptoms of parkinsonism in individuals with CTE.

Colonial drivers and cultural protectors of brain health among Indigenous peoples internationally.

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health.

The Care Needs of Patients With Cognitive Impairment in Late-Stage Parkinson's Disease.

Cognitive impairment is common in Parkinson's disease (PD), but care needs and resource use for those with significant cognitive impairment are not well established. 675 participants with PD from the international Care of Late-Stage Parkinsonism (CLaSP) study were grouped into those without (n = 333, 49%) and with cognitive impairment (MMSE < 24/30 or diagnosis of dementia or Mild Cognitive Impairment; n = 342, 51%) and their clinical features, care needs and healthcare utilisation compared. The relationship between cognition and healthcare consultations was investigated through logistic regression. Cognitive impairment was associated with more motor and non-motor symptoms, less antiparkinsonian but higher rates of dementia and antipsychotic medication, worse subjective health status and greater caregiver burden. A considerable proportion did not have a pre-established cognitive diagnosis. Care needs were high across the whole sample but higher in the cognitive impairment group. Home care and care home use was higher in the cognitive impairment group. However, use of healthcare consultations was similar between the groups and significantly fewer participants with cognitive impairment had had recent PD Nurse consultations. Worse cognitive impairment was associated with lower frequency of recent PD nurse and multidisciplinary therapy consultation (physiotherapy, massage, occupational therapy, speech training and general nursing). Those with cognitive impairment have more severe PD, higher care needs and greater social care utilisation than those with normal cognition, yet use of health care services is similar or less. Cognitive impairment appears to be a barrier to PD nurse and multidisciplinary therapy consultations. This challenges current models of care: alternative models of care may be required to serve this population. Parkinson's disease is a long-term progressive health condition. Over time, many people with Parkinson's develop problems with thinking and memory, called cognitive impairment. This can negatively impact the daily lives of the person with Parkinson's and their caregiver. It is also thought to be a barrier to accessing healthcare. How people with Parkinson's who have cognitive impairment use healthcare and detail of their care needs is not well known.We analysed data from a large sample of people with advanced Parkinson's from six European countries to investigate their symptoms, care needs and healthcare use. We compared those with cognitive impairment to (342 people) to those without cognitive impairment (333 people).We found that those with cognitive impairment had more severe Parkinson's across a range of symptoms compared to those without cognitive impairment. They also had more care needs, reported their health status to be worse, and their caregivers experienced greater strain from caring. Whilst use of other healthcare services was similar between the two groups, those with cognitive impairment were less likely to have recently seen a Parkinson's nurse than those without cognitive impairment. Further analysis showed an association between cognitive impairment and not having seen a Parkinson's nurse or therapist recently, taking psychiatric symptoms, functional disability and care home residence into account. Therapists included were physiotherapy, massage, occupational therapy, speech training and general nursing. These findings highlight unmet need. We suggest that healthcare should be more targeted to help this group of people, given their higher care needs.

Limitations and recommendations regarding the Mini-Mental State Examination (MMSE) in illiterate and low educated older adults

Increasing life expectancy has been associated with higher rates of dementia. As illiterate/uneducated individuals are typically over-represented among older cohorts, it is imperative that we identify and/or develop appropriate, non-biased scales and psychometric tests for early detection of, and screening for, cognitive impairment in this group. Given that many traditional neuropsychological tests may underestimate cognitive abilities in illiterate/uneducated and low educated individuals, their use in these groups needs to be reappraised or their format adapted. One of the most commonly used screening tests worldwide is the Mini-Mental State Examination (MMSE). Level of education has been shown to be a significant predictor of performance on the MMSE, hence, there is dispute among researchers related to its applicability in populations with low or no schooling. A wide range of recommendations have been made by scholars for overcoming the education effect on the MMSE, as well as other sources of bias, but some methodological limitations remain, and new ones have emerged concerning its administration to illiterate/uneducated and low educated older individuals. In the present study, we present a theoretical discussion of the challenges inherent in the administration and interpretation of MMSE performance in illiterate/uneducated and low educated individuals, consider previous recommendations and address their limitations, and highlight the optimal methods for clinical assessment of these groups when the MMSE is used.

RACIAL/ETHNIC DIFFERENCES IN NEUROCOGNITIVE PROFILES OF OLDER ADULTS WITH 6-YEAR INCIDENT DEMENTIA

Abstract Hispanic and non-Hispanic Black (NHB) older adults have higher dementia rates than non-Hispanic Whites (NHWs). Estimates of dementia prevalence and incidence in community-based cohorts are mostly based on threshold value performance on cognitive assessment batteries. We used longitudinal data from the HRS Harmonized Cognitive Assessment Protocol (HCAP) to (1) generate and compare, across race/ethnicity, neurocognitive profiles for older adults (&amp;gt;65 years) not meeting research criteria for dementia in 2010 and developing dementia by 2016 (using Langa-Weir’s dementia classification), (2) assess racial/ethnic differences in these profiles, and (3) test socio-demographic effects on dementia-specific differences in neurocognitive performance. Performance on all HCAP measures was highly sensitive to 6-year incident dementia classification. However, we found notable domain-specific differences in test sensitivity, whereby performance on general screeners (e.g., MMSE) and memory-based tests (e.g., CERAD word list recognition) were significantly lower (≤2 SDs from normed population means). Hispanics and NHBs generally performed lower than NHWs, with more pronounced group differences in general screeners and executive function tests. Sociodemographic characteristics significantly attenuated Hispanic differences, but less so for NHBs, relative to NHWs. Despite these group differences, NHWs with incident dementia had worse neurocognitive profiles than their NHB and Hispanic counterparts. Dementia classification algorithms (e.g., Langa-Weir) sensitively detect cognitive impairment. However, these algorithms more accurately identify higher severity cognitive impairment in NHWs compared to NHBs and Hispanics. Such methods can yield dementia estimates biased by sociocultural factors. Further research is needed to identify culturally appropriate neurocognitive tests that enhance precise dementia diagnosis, using population-level epidemiological data.

PHYSICAL ACTIVITY ASSOCIATED TO LOWER PREVALENCE OFDEMENTIA IN BRAZILIAN OLDER ADULTS

AbstractBackgroundEvidences indicate that physically active older individuals maintain healthy functioning longer than do sedentary peers. Some lifestyle could impact the risk of dementia including Alzheimer’s. In spite of this, the effect of physical activity on the relationship between age and the risk of dementia is unknown. This is a two‐phase study that aims to investigate the association of physical exercise and age with the prevalence of dementia in community older adults, from Ribeirao Preto city, state of Sao Paulo, Brazil.MethodCross‐sectional study of a randomized community‐based sample of 928 elderly subjects aged 60 years or older was performed. Standardized instruments for screening dementia and a socio‐economic questionnaire were applied to the subjects at home in phase I. The dementia diagnose was made at hospital in phase II, according to DSM‐V criteria.ResultOveral Dementia was 6.0%. Alzheimer’s disease was the most frequent dementia (2.8%), followed by Vascular dementia (1.3%), and Mixed dementia (1.1%). Initial multivariate analysis showed sociodemographic factors associated to dementia. After adjusting for all the variables, multivariate analysis showed an association with age group ≥80 (OR = 6.7; p&lt;0.001); household chores (OR = 2.7; p = 0.004); no employment (OR = 4.3; p&lt;0.001); and stroke (OR = 4.5; p = 0.001). There was no association with gender, socioeconomic class, educational level, and alcohol use. Secondary analysis showed an inverse relationship between physical activity and age (OR = 0.4; p&lt;0.001). After deliberately exclude age, the final model showed a significant association between higher rates of dementia and lack of physical activity (OR = 2.0; p = 0.024).ConclusionAccording to previous studies, in our sample, lack of exercise was associated with two fold higher risk of dementia, only after exclude age of the analysis. This result could be due to decreasing level of physical activity found in the oldest subjects. We suggest that relatively simple lifestyle changes such as increasing the practice of exercise could enhance cognitive performance in elderly people. Future investigations are needed to clarify the real impact of physical activity on the relationship between dementia and age.

CI-452765-4 SEX-BASED DIFFERENCES IN TRANSVENOUS LEAD EXTRACTION MANAGEMENT AND OUTCOMES AMONG PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES-ASSOCIATED INFECTIVE ENDOCARDITIS

Cardiac implantable electronic device (CIED)-associated infections are responsible for substantial morbidity, mortality, and healthcare costs. Although current guidelines recommend complete CIED system removal for patients with infective endocarditis, transvenous lead extraction/removal (TLE) is often underutilized in clinical practice. Numerous studies have reported sex-based disparities in access to various cardiac procedures which may be associated with higher rates of adverse outcomes. To compare TLE utilization and clinical outcomes for females and males with CIEDs hospitalized with infective endocarditis (IE). Using the Nationwide Readmissions Database (NRD), we evaluated 25,303 admissions between 2016-2019 for patients (mean age 71.2, 39.5% female) with prior CIED hospitalized with IE. ICD-10-CM codes were used to identify TLE occurring during index admission. Outcomes of procedural complications, index mortality, early mortality (defined as death during either index admission or readmission), and readmission were analyzed. Overall, TLE was performed in 11.5% of all study patients. Compared to males, females were significantly less likely to undergo TLE (9.3% vs 12.9%; P<0.001). Overall, female patients in the study cohort had a lower proportion of comorbidities such as diabetes mellitus (36.1% vs 39.8%; p<0.001) and kidney disease (38.5% vs 45.8%; p<0.001), but higher rates of dementia (11.4% vs 9.2%; p<0.001) and drug abuse (7.6% vs 5.6%; p<0.001). On multivariable analysis, female sex was associated with a lower odds of TLE (adjusted odds ratio 0.83, 95% CI 0.73-0.95; p=0.005). Females and males had similar rates of TLE-associated procedural complications (3.1% vs 2.5%; respectively; p=0.474). Overall, there were no significant differences in index mortality, early mortality, or 30-day readmissions between females and males with CIEDs-associated IE. Notably, while male patients had a significant reduction in mortality associate with TLE management (5.1% vs. 9.7%; p<0.001), there was no difference in mortality among female patients who underwent TLE when compared to those who did not (7.9% vs. 9.1%; p= 0.383). Female sex is independently associated with lower utilization of TLE for the management of CIED-associated infective endocarditis. Reasons for sex-based disparities in lead extraction for this high-risk patient population need to be further explored.

The Relationship Between Coronary Artery Calcification and Carotid Intima Media Thickness and Hippocampal Volume: An Analysis From the Dallas Heart Study.

Higher rates of dementia are reported in people with a history of coronary artery disease. Smaller hippocampal volume (HV) is a risk factor for the development of dementia. This study assessed whether coronary artery calcification (CAC) and carotid intima media thickness (CIMT) are associated with HV in participants from the Dallas Heart Study, a community-based study of Dallas County, Texas, residents. Data from a total of n=1821 participants in the Dallas Heart Study with brain magnetic resonance imaging, CAC, and CIMT information were included in the present study, after excluding those with a history of myocardial infarction or stroke. To evaluate the effect of CAC and CIMT on total HV, 4 linear regression analyses were conducted in which the primary predictor was (1) CAC as a continuous metric; (2) CAC as a binary metric (CAC=0 vs. CAC ≥ 1); (3) CAC as a continuous metric but only for those with CAC >0; and (4) CIMT as a continuous metric. Demographic and cardiovascular disease risk factors, as well as intracranial volume, were entered into the model as covariates. Participants were largely women (58.2%) with a mean age of 49.7±10.3 years. Forty-six percent of the sample reported being Black, and approximately 14% reported being Hispanic. All 3 variations of the CAC effect were nonsignificant predictors of total HV (β=-0.013, P=0.602; β=-0.011, P=0.650; β=0.036, P=0.354, respectively), as was the effect of CIMT (β=0.009, P=0.686). Current findings suggest nonsignificant relationships between both CAC and CIMT and between CAC and total HV, while controlling for other related factors in a large, diverse, community-based sample of people without a history of myocardial infarction or stroke. In the context of existing evidence that both coronary artery disease and smaller HV are associated with the development of dementia, the present findings suggest that neither marker of the cardiovascular disease examined here is associated with a reduction in HV in the population studied. Longitudinal studies are needed to assess relationships between CAC and CIMT and between CAC and HV over time.

Total Hip Arthroplasty or Hemiarthroplasty for Displaced Femoral Neck Fractures?: Commentary on an article by Mina Tohidi, MD, FRCS(C), PhD, et al.: "Comparative Effectiveness of Total Hip Arthroplasty and Hemiarthroplasty for Femoral Neck Fracture. A Propensity-Score-Matched Cohort Study".

Commentary This Canadian study involves a subject of continued controversy1,2. It describes the outcomes of a large matched group of patients ≥60 years old with a displaced femoral neck fracture treated with total hip arthroplasty (THA) or hemiarthroplasty (HA). The 2 groups had similar revision and readmission rates, but those treated with THA had higher dislocation rates. Patients treated with HA had higher mortality rates, but they tended to be older and had higher rates of dementia and institutionalization. These findings are not new or unexpected, so what are surgeons to take away from this study? The major strength of this study is the use of a well-matched cohort with a large sample size (9,224). Most previous studies involved far fewer patients or performed meta-analyses of such studies3. Its major weakness is that surgeon and technical factors could not be taken into account. Who performs the surgery and how it is done are very important but were not captured in the data. In clinical practice, a femoral neck fracture is a devastating but common injury. Treatment should be based on shared decision-making involving the surgeon and the patient, family, or individual who has the power of attorney. These other individuals will ultimately rely heavily on the surgeon’s recommendations. The surgeon should clearly explain why a particular treatment is being recommended, along with the specific risks and benefits involved with each treatment. There are also many confounding factors that can influence the surgeon’s recommendation. These can include surgeon experience and comfort with the procedure, as well as institutional support for performing it at less than convenient hours (holidays, weekends). Age, comorbidities, anticipated life expectancy, approach, femoral component head size, use of a dual-mobility construct, bone quality, and use of cement all need to be taken into account. An institutionalized patient with Parkinson disease will be treated very differently from an active 70-year-old who lives at home. Some studies have not found significant differences between these 2 treatments, or have questioned the clinical importance of better quality-of-life scores after THA than after HA4. However, the pendulum is clearly swinging toward the use of THA for this injury5,6. This study provides further evidence that THA is a reasonable treatment for many displaced femoral neck fractures, but reinforces the need to consider factors that will reduce dislocation rates.

Dementia Caregiving Experiences and Health Across Geographic Contexts by Race and Ethnicity.

Few studies have examined how the intersectionality of geographic context and race/ethnicity influences dementia caregiving. Our objectives were to determine whether caregiver experiences and health (a) differed across metro and nonmetro areas and (b) differed by caregiver race/ethnicity and geography. We used data from the 2017 National Health and Aging Trends Study and National Study of Caregiving. The sample included caregivers (n = 808) of care recipients ages 65 and older with "probable" dementia (n = 482). The geographic context was defined as the care recipient's residence in metro or nonmetro counties. Outcomes included caregiving experiences (care situation, burden, and gains) and health (self-rated anxiety, depression symptoms, and chronic health conditions). Bivariate analyses indicated that nonmetro dementia caregivers were less racially/ethnically diverse (82.7% White, non-Hispanic) and more were spouses/partners (20.2%) than their metro counterparts (66.6% White, non-Hispanic; 13.3% spouses/partners). Among racial/ethnic minority dementia caregivers, nonmetro context was associated with more chronic conditions (p < .01), providing less care (p < .01), and not coresiding with care recipients (p < .001). Multivariate analyses demonstrated that nonmetro minority dementia caregivers had 3.11 times higher odds (95% confidence interval [CI] = 1.11-9.00) of reporting anxiety in comparison to metro minority dementia caregivers. Geographic context shapes dementia caregiving experiences and caregiver health differently across racial/ethnic groups. Findings are consistent with previous studies that have shown that feelings of uncertainty, helplessness, guilt, and distress are more prevalent among people providing caregiving from a distance. Despite higher rates of dementia and dementia-related mortality in nonmetro areas, findings suggest both positive and negative aspects of caregiving among White and racial/ethnic minority caregivers.

RESOURCES AND EXPERIENCES AMONG DIVERSE DEMENTIA CAREGIVERS BY GEOGRAPHIC CONTEXT

Abstract Rural caregivers are often underserved by caregiving services, yet little is known about how the intersectionality of geographic context and race/ethnicity relates to caregiving resources among dementia caregivers. We examined whether 1) caregiving resources and experiences differ across metro and non-metro areas; and 2) the use of caregiving resources is associated with geographic context by race/ethnicity, controlling for age, gender, and education. We analyzed a sample of caregivers of care recipients aged 65 years or older with ‘probable’ dementia (n= 808) in the 2017 National Health and Aging Trends Study (NHATS) and the associated National Study of Caregiving (NSOC). We defined geographic context by the recipient’s residence in metro (urban) or non-metro (rural) counties and grouped formal (respite care, support groups, caregiving training) and informal (family or friend help) resources. Among minority caregivers, 47% of those living in metro and 36% in non-metro areas used a formal service, and 83% and 72%, respectively, used informal resources. Among White caregivers, estimates were 44%, 48%, 76%, and 66%, respectively. Multivariate regression analyses revealed that non-metro White dementia caregivers had 2.04 times higher odds (95% CI=1.10-3.78) of using formal resources than metro White dementia caregivers. This pattern was not observed among minority dementia caregivers. The use of informal resources did not differ across geographic contexts by race/ethnicity. Findings suggest the influence of geographic context on the use of formal caregiving resources varies by race/ethnicity. With higher rates of dementia in non-metro areas, formal caregiving resources among non-metro minority dementia caregivers need more attention.

Biofluid biomarkers in an ethnoracially diverse population and their association with AD

AbstractBackgroundPlasma‐based biomarkers of Alzheimer’s disease are cost‐effective, minimally invasive and highly scalable tools to aid in clinical practice and trials. There remain significant gaps in our understanding of the factors that influence their levels. The majority of fluid biomarker research has been conducted in clinical settings using CSF biomarkers with non‐Hispanic Whites. Although Hispanic and African American communities have higher rates of dementia, there is limited research on blood‐based biomarkers of AD in these communities. The current study of a sample of Mexican Americans, African Americans and Non‐Hispanic Whites investigated the performance of plasma biomarker across the three largest ethnic/racial groups in the US to assess the impact of ethnicity/race on the level of the plasma biomarkers of Aβ40, Aβ42, total tau, ptau 181 and NfL.MethodParticipants were 2200 community dwelling older adults (850 Mexican Americans (MA); 850 Non‐Hispanic Whites (NHW) and 500 African Americans (AA) drawn from The Health &amp; Aging Brain Study – Health Disparities (HABS‐HD) study. Cognitive diagnoses were assigned using an algorithm verified by consensus review. Samples were assayed using Simoa technology. Levels of each biomarker were compared for the three ethnoracial groups across cognitive diagnoses.ResultsSignificant differences were found across the groups at each level of cognitive impairment. For those with normal cognition AA had significantly lower levels of each of the biomarkers and NHW had higher levels of Aβ40, Aβ42 and NFL. MA had the highest level of t tau and p tau 181. MCI group NHW had the highest levels on all the biomarkers and AA had the lowest. NHW and MA has higher levels of Aβ40, Aβ42, total tau, ptau 181 compared to AA. NHW levels of NfL were the highest and MA and AA did not differ. For dementia there was no difference between the groups for Aβ42. NHW had significantly higher levels of Aβ40, t tau, ptau 181 and NfL than AA.ConclusionFindings support the importance of considering ethnoracial background in the clinical use of blood‐based biomarkers and the difficulty of establishing universal cutting points for these biomarkers in the diagnostic process.

Dementia ECHO: Evaluation of a telementoring programme to increase dementia knowledge and skills in First Nations-led health services

Introduction High rates of dementia among Australian First Nations’ peoples have resulted in an increased demand for dementia knowledge and skills among the primary health care professionals in these communities. The Dementia Extension for Community Healthcare Outcomes (ECHO) program aims to be a culturally safe way of increasing local health workforce capacity by facilitating dementia knowledge, skills and confidence among primary care professionals in First Nations community settings. Dementia ECHO is based on the international evidence-based telementoring programme, Project Extension for Community Healthcare Outcomes. Every Dementia ECHO session is delivered by videoconference and comprises a specialist-led presentation and a case discussion from a primary care health service participant. The aims of this study were to assess the uptake and reach of Dementia ECHO; examine the perceived importance of dementia care and dementia education among Aboriginal and Torres Strait Islander Community Controlled Health Service staff; and evaluate the potential impact of Dementia ECHO on health service staff pertaining to dementia knowledge, confidence to provide dementia care and professional isolation. Method Dementia ECHO service activity data maintained by the programme providers was reviewed to determine uptake and reach. A pre-implementation survey examined Aboriginal and Torres Strait Islander Community Controlled Health Service staff perspectives on the importance of dementia education and the priority of a range of health issues. After each Dementia ECHO session, a brief online survey gathered quantitative and qualitative data regarding the potential impact of the session. Results Of 30 completed pre-implementation surveys, all staff rated dementia education as either very important or important. Salient themes highlighting why it is important are presented. When asked to rank six different health priorities, dementia (n = 10) and chronic disease (n = 10) were placed as the top priority. The brief post-session feedback provided 44 complete survey responses demonstrating: perceived improvement in dementia knowledge and skills (88.4%); increased confidence to provide dementia care (83%); and a reduction in professional isolation (88%). Conclusion Dementia ECHO addresses a gap in dementia education that is much needed in health professionals with increasing numbers of First Nations people living with dementia. This current study shows that attending an evidence-based telementoring programme, such as Dementia ECHO, can increase dementia knowledge and confidence to care for someone living with dementia and their families.

Long-term recovery after critical illness in older adults.

The population is aging, and recent epidemiologic work reveals that an increasing number of older adults are presenting to the ICU with preexisting geriatric syndromes. In this update, we discuss recent literature pertaining to the long-term recovery of older ICU patients and highlight gaps in current knowledge. A recent longitudinal study demonstrated that the incidence of frailty, disability, and multimorbidity among older ICU patients is rising; these geriatric syndromes have all previously been shown to impact long-term recovery. Recent studies have demonstrated the impact of social factors in long-term outcomes after critical illness; for example, social isolation was recently shown to be associated with disability and mortality among older adults in the year after critical illness. Socioeconomic disadvantage is associated with higher rates of dementia and disability following critical illness impacting recovery, and further studies are necessary to better understand factors influencing this disparity. The COVID-19 pandemic disproportionately impacted older adults, resulting in worse outcomes and increased rates of functional decline and social isolation. In considering how to best facilitate recovery for older ICU survivors, transitional care programs may address the unique needs of older adults and help them adapt to new disability if recovery has not been achieved. Recent work demonstrates increasing trends of geriatric syndromes in the ICU, all of which are known to confer increased vulnerability among critically ill older adults and decrease the likelihood of post-ICU recovery. Risk factors are now known to extend beyond geriatric syndromes and include social risk factors and structural inequity. Strategies to improve post-ICU recovery must be viewed with a lens across the continuum of care, with post-ICU recovery programs targeted to the unique needs of older adults.

Nonalcoholic Fatty Liver Disease and Risk of Dementia: A Population-Based Cohort Study.

Background and ObjectivesNonalcoholic fatty liver disease (NAFLD) and dementia share common risk factors including metabolic disorders. However, whether NAFLD is associated with dementia risk is unclear. We investigated the association between NAFLD and dementia risk as well as the role of cardiovascular complications including heart disease and stroke.MethodsIn this population-based matched cohort study, we identified all Swedish patients aged 65 years or older with NAFLD identified from the National Patient Register (NPR) between 1987 and 2016. These were matched with up to 10 reference individuals from the general population on age, sex, and municipality at the year of diagnosis. Incident dementia diagnosis was derived from the NPR or the Cause of Death Register until 2016. Adjusted hazard ratios (aHRs) and 95% CIs were estimated with Cox regression models.ResultsA total of 2,898 patients with NAFLD and 28,357 matched controls were identified (median age at entry, interquartile range [IQR], 70 [8]; 55.1% female). During a median follow-up of 5.5 years (IQR: 8.5 years), 145 (5.0%) patients with NAFLD and 1,291 (4.6%) reference individuals were diagnosed with dementia. Compared with the reference individuals, patients with NAFLD had higher rates of dementia (aHR 1.38, 95% CI 1.10–1.72) and vascular dementia (aHR 1.44, 95% CI 0.96–2.23, p = 0.07). Comorbid NAFLD and either heart disease (aHR 1.50 95% 1.08–2.05) or stroke (aHR 2.60 95% CI 1.95–3.47) conferred a greater risk of dementia.DiscussionNAFLD had a modest association with increased rates of dementia. This was stronger among patients with NAFLD diagnosed with cardiovascular comorbidities.Classification of EvidenceThis study provides Class II evidence that nonalcoholic fatty liver disease is associated with the development of vascular and nonvascular dementia.

Predictivity of the comorbidity indices for geriatric syndromes

BackgroundThe aging population and increasing chronic diseases make a tremendous burden on the health care system. The study evaluated the relationship between comorbidity indices and common geriatric syndromes.MethodsA total of 366 patients who were hospitalized in a university geriatric inpatient service were included in the study. Sociodemographic characteristics, laboratory findings, and comprehensive geriatric assessment(CGA) parameters were recorded. Malnutrition, urinary incontinence, frailty, polypharmacy, falls, orthostatic hypotension, depression, and cognitive performance were evaluated. Comorbidities were ranked using the Charlson Comorbidity Index(CCI), Elixhauser Comorbidity Index(ECM), Geriatric Index of Comorbidity(GIC), and Medicine Comorbidity Index(MCI). Because, the CCI is a valid and reliable tool used in different clinical settings and diseases, patients with CCI score higher than four was accepted as multimorbid. Additionally, the relationship between geriatric syndromes and comorbidity indices was assessed with regression analysis.ResultsPatients’ mean age was 76.2 ± 7.25 years(67.8% female). The age and sex of multimorbid patients according to the CCI were not different compared to others. The multimorbid group had a higher rate of dementia and polypharmacy among geriatric syndromes. All four indices were associated with frailty and polypharmacy(p < 0.05). CCI and ECM scores were related to dementia, polypharmacy, and frailty. Moreover, CCI was also associated with separately slow walking speed and low muscle strength. On the other hand, unlike CCI, ECM was associated with malnutrition.ConclusionsIn the study comparing the four comorbidity indices, it is revealed that none of the indices is sufficient to use alone in geriatric practice. New indices should be developed considering the complexity of the geriatric cases and the limitations of the existing indices.

Pre-COVID-19 psychotropic medication use linked to higher rate of dementia

Pre-COVID-19 psychotropic medication use linked to higher rate of dementia