Prevalence Of Dementia Research Articles

Relationship of Hearing Loss to Parkinson's Disease, Dementia, and APOE Genotype in Adults.

Background: Hearing loss has been recognized as a risk factor for dementia and non-motor features of Parkinson's disease (PD). The apolipoprotein E (APOE) protein contributes to maintenance and repair of neuronal cell membranes, causing age-related disorders. This study aimed to analyze the impact of hearing loss on cognitive impairment, PD severity, and APOE gene expression in these patients. Methods: A total of 72 out-patients diagnosed with either PD or hearing loss were enrolled in this study. The hearing assessment included pure-tone audiometry, speech reception thresholds, and speech discrimination ability. Dementia was assessed by filling out the Clinical Dementia Rating and Mini-Mental State Examination questionnaires. The severity of PD was assessed using the Modified Hoehn and Yahr scale. Blood samples were tested for the gene expression of APOE. Results: Out of the 72 cases, there were 44 males and 28 females, with an average age of 64.4 ± 9.1 years. A total of 41 out of 72 cases had dementia and had a worse hearing threshold than those without dementia (47.1 ± 24.4 vs. 31.7 ± 22.1 dB, p = 0.006). A total of 58 patients were diagnosed with PD, with 14 of them classified as having severe symptoms (Modified Hoehn and Yahr scale > 2). Patients with severe PD were found to have a worse hearing threshold (49.6 ± 28.3 vs. 30.3 ± 17.8 dB, p = 0.028) and higher prevalence of dementia (12/14 vs. 18/44, p = 0.006). Among 10 individuals with the APOE ε4 gene, the prevalence of dementia was higher than those without the ε4 allele (9/10 vs. 32/62, p = 0.036). Conclusions: Hearing loss is common in severe PD and in dementia patients. Severe PD has a negative impact on the hearing threshold and cognitive dysfunction. Patients with APOE ε4 have a higher prevalence of dementia.

State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis

With older drivers representing the fastest growing segment of the driver population and dementia prevalence increasing with age, policymakers face the challenge of balancing road safety and mobility of older adults. In states that require reporting a dementia diagnosis to the Department of Motor Vehicles (DMV), individuals with dementia may be reluctant to disclose symptoms of cognitive decline, and clinicians may be reluctant to probe for those symptoms, which may be associated with missed or delayed diagnoses. To assess whether DMV reporting policies for drivers with dementia are associated with primary care clinicians' underdiagnosing dementia. This cross-sectional study used data from the 100% Medicare fee-for-service program and the Medicare Advantage plans from 2017 to 2019 on 223 036 primary care clinicians with at least 25 Medicare patients. Statistical analysis was performed from July to October 2023. State DMV reporting policies for drivers with dementia. The main outcome was a binary variable indicating whether the clinician underdiagnosed dementia or not. Each clinician's expected number of dementia cases was estimated using a predictive model based on patient characteristics. Comparing the estimation with observed dementia diagnoses identified clinicians who underdiagnosed dementia vs those who did not, after accounting for sampling errors. Four states have clinician reporting mandates, 14 have mandates requiring drivers to self-report dementia diagnoses, and 32 states and the District of Columbia do not have explicit requirements. Among primary care clinicians in states with clinician reporting mandates (n = 35 620), 51.4% were female, 91.9% worked in a metropolitan area, and 19.9% of the patient panel were beneficiaries dually eligible for Medicare and Medicaid. Among primary care clinicians in states with patient self-reporting mandates (n = 57 548), 55.7% were female, 83.1% worked in a metropolitan area, and 15.4% of the patient panel were dually eligible for Medicare and Medicaid. Among clinicians in states without mandates, 55.7% were female, 83.0% worked in a metropolitan area, and 14.6% of the patient panel were dually eligible for Medicare and Medicaid. Clinicians in states with clinician reporting mandates had an adjusted 12.4% (95% CI, 10.5%-14.2%) probability of underdiagnosing dementia compared with 7.8% (95% CI, 6.9%-8.7%) in states with self-reporting and 7.7% (95% CI, 6.9%-8.4%) in states with no mandates, an approximately 4-percentage point difference (P < .001). Results of this cross-sectional study of primary care clinicians suggest that mandatory DMV policies for clinicians to report patients with dementia may be associated with a higher risk of missed or delayed dementia diagnoses. Future research is needed to better understand the unintended consequences and the risk-benefit tradeoffs of these policies.

Prevalence of and Annual Conversion Rates to Mild Cognitive Impairment and Dementia: Prospective, Longitudinal Study of an Essential Tremor Cohort.

Despite recent attention to cognitive impairment in essential tremor, few studies examine rates of conversion to diagnoses of mild cognitive impairment and dementia. Development of dementia in essential tremor is associated with loss of functional ability and a doubling of mortality rate. This prospective, longitudinal study comprehensively reports the prevalence and incidence of, and the annual rates of conversion to, mild cognitive impairment and dementia in an essential tremor cohort. Patients underwent detailed cognitive assessments and were assigned diagnoses of normal cognition, mild cognitive impairment, or dementia. There were 222 patients at baseline (mean age = 79.3 ± 9.7 years), and 177 patients participated in follow-up evaluations at 18, 36, 54, and 72 months (mean years of observation = 5.1 ± 1.7). Data were compared to those of historical controls and Parkinson disease patients. The cumulative prevalence of dementia and average annual conversion rate of mild cognitive impairment to dementia were 18.5% and 12.2%, nearly three times higher than rates in the general population, and approximately one half the magnitude of those reported for Parkinson disease patients. The cumulative prevalence of mild cognitive impairment (26.6%) was almost double that of the general population, but less than that in Parkinson disease populations. We present the most complete exposition of the longitudinal trajectory of cognitive impairment in an essential tremor cohort yet presented. The prevalence of and conversion rates to dementia in essential tremor fall between those associated with the natural course of aging and the more pronounced rates observed in Parkinson disease. ANN NEUROL 2024;95:1193-1204.

Signatures and Discriminative Abilities of Multi-Omics between States of Cognitive Decline.

Dementia poses a substantial global health challenge, warranting an exploration of its intricate pathophysiological mechanisms and potential intervention targets. Leveraging multi-omic technology, this study utilizes data from 2251 participants to construct classification models using lipidomic, gut metabolomic, and cerebrospinal fluid (CSF) proteomic markers to distinguish between the states of cognitive decline, namely, the cognitively unimpaired state, mild cognitive impairment, and dementia. The analysis identifies three CSF proteins (apolipoprotein E, neuronal pentraxin-2, and fatty-acid-binding protein), four lipids (DEDE.18.2, DEDE.20.4, LPC.O.20.1, and LPC.P.18.1), and five serum gut metabolites (Hyodeoxycholic acid, Glycohyodeoxycholic acid, Hippuric acid, Glyceric acid, and Glycodeoxycholic acid) capable of predicting dementia prevalence from cognitively unimpaired participants, achieving Area Under the Curve (AUC) values of 0.879 (95% CI: 0.802-0.956), 0.766 (95% CI: 0.700-0.835), and 0.717 (95% CI: 0.657-0.777), respectively. Furthermore, exclusively three CSF proteins exhibit the potential to predict mild cognitive impairment prevalence from cognitively unimpaired subjects, with an AUC of 0.760 (95% CI: 0.691-0.828). In conclusion, we present novel combinations of lipids, gut metabolites, and CSF proteins that showed discriminative abilities between the states of cognitive decline and underscore the potential of these molecules in elucidating the mechanisms of cognitive decline.

STIMULASI KOGNITIF LANSIA MELALUI MOKA GAMES DI WILAYAH SIMOKERTO KOTA SURABAYA

Introduction &amp; Aims: According to WHO, there are 65.6 million elderly people throughout the world who experience impaired cognitive function. The impact of cognitive disorders in the elderly causes a shift in the role of the elderly in social interactions in society and within the family, followed by a decrease in physical and mental activity, impaired social function, and a decrease in quality of life. East Java is in second place with the highest dementia rate with a dementia prevalence of 10.40% and increasing with each passing year. Based on preliminary data in the RW 07 area, Kapasan, Simokerto District, the risk of cognitive impairment in the elderly is in fourth place with a percentage of 20%. So it is important to intervene regarding the risk of cognitive impairment in the elderly. The aim of this activity was to stimulate the cognitive abilities of the elderly through MOKA Games. Method of Activity: Community service activities were carried out in the RW.07 area, Kapasan, Simokerto District, Surabaya City, in February 2024. Implementation of this activity included opening, filling out the pre-test, explaining the material using leaflets, MOKA (Cognitive Monitoring of the Elderly) demonstration. Games, discussions, and post-test completion. MOKA Games is a game innovation based on the MMSE instrument, equipped with a guidebook containing a game monitoring table, each player has a monitoring table containing the score for each question. Result: There was an increase in audience knowledge as shown by an increase in the percentage of knowledge from pre-test to post-test, apart from that respondents were able to carry out a MOKA Games simulation with the direction of elderly cadres. Discussion: Cognitive stimulation activities for the elderly through MOKA Games received a positive response and good enthusiasm from the audience, with MOKA Games we can find out the condition of cognitive abilities and stimulate the elderly.

Kinship and Care: Racial Disparities in Potential Dementia Caregiving in the United States From 2000 to 2060.

Although the family plays a pivotal role in older adults' care, there is limited research on how evolving demographic trends affect older adults' support networks and how the trends vary by race. To fill this gap, we examine the influence of shifting family demographics on future care needs for older adults with dementia, emphasizing the unequal health and potential caregiving burdens by race in the United States. Using demographic models of kinship, we estimate the availability of potential caregivers, and dementia prevalence among one's kin by race, kin type, and the age of a focal person from 2000 to 2060. We introduce an index called the Dementia Dependency Ratio to assess dementia caregiving demands at the population level, taking into account the age and kinship structure of the population. Our findings suggest that Black individuals tend to have more children, grandchildren, and nieces/nephews as they age. However, Black individuals also tend to have more kin with dementia compared to their White counterparts. This elevated prevalence of dementia among Black kinship networks counterbalances the advantage of having more kin as potential caregivers. A further projection analysis suggests that the racial gap in caregiving demand within the kinship network will widen in the next 4 decades if the racial gap in dementia prevalence remains unchanged. These findings emphasize the urgency of reducing racial inequality in dementia prevalence rates and increasing public support for families with extended members affected by dementia. With the shrinkage of nuclear families and population aging in the next few decades, extended family members may undertake more caregiving responsibilities for dementia. We call for a kinship perspective in understanding dementia care in future research.

Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study.

With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale-10 to assess general anxiety levels at each cognitive screening. The SCREEN's scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. The study found that the SCREEN's longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. RR2-10.2196/25520.

The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study.

The increasing prevalence of Alzheimer disease and Alzheimer disease-related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ≥50 years (25/30, 83%), women (23/30, 77%), White (25/30, 83%), and financially stable (20/30, 67%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90% (27/30) rated the app overall positively. Most of the participants (21/30, 70%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population.

Screening for dementia and associated factors in older adults from low socioeconomic communities in iLembe, KwaZulu-Natal.

Dementia is one of the leading non-communicable causes of disability and mortality in older adults, with recent research showing that it is increasing in low-middle-income countries compared to high-income countries. As such, multidisciplinary efforts are needed to effectively reduce the prevalence and risk of dementia through quick screening, diagnosis, and management of those with dementia and those at risk. The study's objectives were to estimate the prevalence of dementia and measure the sociodemographic and clinical risks in older adults in low socioeconomic communities. The study was conducted among older adults aged ≥ 60 years from the iLembe district in South Africa. This cross-sectional, one-phased, household study was conducted to screen for dementia over 8 months between October 2018 and October 2019. Demographic and clinical data were collected using a semi-structured questionnaire. In addition, the Mini-Mental Status Exam, Ascertain Dementia Eight-item questionnaire and Instrumental Activities of Daily Living Scale were administered to a multi-stage cluster sample of 320 participants to ascertain dementia prevalence. Frequencies and multivariate logistic regression were conducted to determine risk factors correlated with dementia. The prevalence of dementia was 13.4%. Participants aged 80 years and above were 2.73 times more likely to develop dementia than participants younger than 80 years. Those with an education level of Grade 1-7 had a 69% less chance of developing dementia than those without formal education. Single participants showed an almost seven-fold increase in dementia. Lastly, depression increased the risk of dementia by two-fold. Dementia was probable in over one-sixth of the sample. Dementia risk factors were both modifiable and non-modifiable. Dementia prevalence in South Africa is increasing and therefore it is crucial to develop a dementia plan that is specific to the South African context which will include strategies for early identification of the disease, reducing modifiable risks and strategic management of dementia associated medical conditions such as depression and vascular diseases.

Longitudinal markers of cerebral amyloid angiopathy and related inflammation in rTg-DI rats

Cerebral amyloid angiopathy (CAA) is a prevalent vascular dementia and common comorbidity of Alzheimer’s disease (AD). While it is known that vascular fibrillar amyloid β (Aβ) deposits leads to vascular deterioration and can drive parenchymal CAA related inflammation (CAA-ri), underlying mechanisms of CAA pathology remain poorly understood. Here, we conducted brain regional proteomic analysis of early and late disease stages in the rTg-DI CAA rat model to gain molecular insight to mechanisms of CAA/CAA-ri progression and identify potential brain protein markers of CAA/CAA-ri. Longitudinal brain regional proteomic analysis revealed increased differentially expressed proteins (DEP) including ANXA3, HTRA1, APOE, CST3, and CLU, shared between the cortex, hippocampus, and thalamus, at both stages of disease in rTg-DI rats. Subsequent pathway analysis indicated pathway enrichment and predicted activation of TGF-β1, which was confirmed by immunolabeling and ELISA. Further, we identified numerous CAA related DEPs associate with astrocytes (HSPB1 and MLC1) and microglia (ANXA3, SPARC, TGF-β1) not previously associated with astrocytes or microglia in other AD models, possibly indicating that they are specific to CAA-ri. Thus, the data presented here identify several potential brain protein biomarkers of CAA/CAA-ri while providing novel molecular and mechanistic insight to mechanisms of CAA and CAA-ri pathological progression and glial cell mediated responses.

Comparison of Different Green Space Measures and Their Impact on Dementia Cases in South Korea: A Spatial Panel Analysis

Dementia has become a profound public health problem due to the number of patients increasing every year. Previous studies have reported that environmental factors, including greenness, may influence the development and progression of dementia. Studies have found that exposure to green space is associated with a lower incidence of dementia. However, many definitions of green space exist, and the effects of its use may differ with the type of green space. Therefore, two types of green space measures were considered in this study to assess the differences in their impact on the prevalence of dementia among females and males. This study used five years of data (2017–2021) from 235 districts in South Korea. The two green space measures used were open space density and normalized difference vegetation index (NDVI), which were derived from satellite images. The analysis utilized a combination of traditional and spatial panel analyses to account for the spatial and temporal effects of independent variables on dementia prevalence. The spatial autocorrelation results revealed that both measures of greenness were spatially correlated with dementia prevalence. The spatial panel regression results revealed a significant positive association between NDVI and dementia prevalence, and open space had a negative association with dementia prevalence in both genders. The difference in the findings can serve as the basis for further research when choosing a greenspace measure, as it affects the analysis results, depending on the objective of the study. This study adds to the knowledge regarding improving dementia studies and the application of spatial panel analysis in epidemiological studies.

Association of Rare NOTCH3 Variants with Prevalent and Incident Stroke and Dementia in the General Population (P8-4.003)

Association of Rare NOTCH3 Variants with Prevalent and Incident Stroke and Dementia in the General Population (P8-4.003)

The effect of combining an e-learning module with s Virtual Dementia Tour® on knowledge and attitudes toward person-centered dementia care in prelicensure nursing education

BackgroundDue to the global prevalence of dementia the U. S. Department of Health and Human Services’ National Plan to Address Alzheimer’s Disease recommended that healthcare professionals prepare to address the complex needs of people with dementia. To address this gap, nursing programs adopted experiential learning methods. While such methodologies are increasingly used, limited evidence exists to inform best teaching practices. PurposeThis study evaluated the combined effect of an e-learning module with a virtual simulation on nursing students’ knowledge and attitudes of dementia. MethodsThe study followed quasi-experimental design with a cross-over and pretest/posttest design. A convenience sample of nursing students was recruited from three public universities in the Southeast United States. ResultsSignificant improvements in attitudes toward people with dementia were found in students with previous dementia care experience or those employed to provide services to people with dementia. Experience was a stronger predictor of attitudes than education. However, the reliability of the Dementia Knowledge Assessment Scale was not sufficient in this study. SignificanceThe findings may inform best practices in nursing education to prepare graduates to provide quality care for people with dementia.

The role of the cholinergic system in the memory-protecting effects of metformin in a model of scopolamine-induced memory impairment in aged rats

PurposeAs the elderly population grows, the prevalence of dementia is also rapidly increasing worldwide. Metformin, an antidiabetic drug, has been shown to have ameliorative effects on impaired cognitive functions in experimental models. However, studies have generally used young animals. Additionally, although it has a major role in Alzheimer's disease (AD) and memory, literature information about the effects of metformin on the cholinergic system is limited. In this study, we investigated the effects of metformin on memory in a model of scopolamine-induced memory impairment in aged rats. We also examined the effects of metformin on the cholinergic system, which is very important in cognitive functions. MethodsMetformin was administered orally to male Wistar rats (20–22 months old) at 100 mg/kg/day for three weeks. Morris water maze (MWM) tests were performed to assess spatial memory. Before the probe test of the MWM test, scopolamine was injected intraperitoneally at a dose of 1 mg/kg. After testing, animals were sacrificed, whole brains were removed, and hippocampus samples were separated for biochemical analysis. ResultsImpaired memory associated with scopolamine administration was reversed by metformin. In addition, metformin administration ameliorated scopolamine-induced changes in acetylcholine (ACh) levels, acetylcholinesterase (AChE), butyrylcholinesterase (BuChE), and choline acetyltransferase (ChAT) activity. ConclusionOur results show that metformin may have protective effects in a scopolamine-induced memory impairment model in aged animals by improving cholinergic function. Metformin shows promise in preventing dementia with its dual cholinesterase inhibition and ChAT activation effect.

Association of diabetes mellitus with dementia- and non-dementia-related mortality amongst women: a secondary competing risks analysis of the California Teachers Study.

The prevalence of dementia is rapidly increasing. Attempts to further understand modifiable risk factors such as diabetes mellitus (DM) are urgently needed to inform public health policies for prevention. Thus, the objective of the current study was to assess the relationship between DM and risk of dementia and non-dementia mortality amongst women in the California Teachers Study prospective cohort. Women (n = 124,509) aged 22-104 years at baseline were included. DM was ascertained from self-reported questionnaires and hospital-linked records. Dementia-related deaths were ascertained from state and national records. Competing risk regression models were used to estimate cause-specific hazard ratios and 95% confidence intervals for the association of DM with dementia- and non-dementia-related mortality. There were 10,511 total DM cases and 3625 deaths due to dementia over a mean of 21.3 years of follow-up. Fully adjusted cause-specific hazard ratios of the association with DM were 2.26 (2.01, 2.55) for dementia-related and 1.97 (1.89, 2.05) for the competing risk of non-dementia-related mortality. This association was strongest amongst participants with incident DM, younger age at baseline and higher alcohol consumption or who were overweight. In the California Teachers Study, women with DM had increased risk of mortality due to both dementia and non-dementia causes; however, the risk of mortality due to dementia was elevated compared to non-dementia causes only amongst participants with incident DM.

Benzodiazepines and risk of dementia – Is there a reason for alarm?

IntroductionThe population ageing is a reality associated with an increase in prevalence of Dementia. The use of benzodiazepines is often postulated as a risk factor in these syndromes.Contrary to recommendations for its short-time use, long-term and chronic use are common, with an estimated 8,7% of elderly people in the US taking benzodiazepines.ObjectivesTo clarify the most recent evidence on the use of benzodiazepines and the risk of developing dementia.MethodsNon-systematic review of literature, using PubMed as database and filtering the results for meta-analysis.ResultsFour articles were included in this review.Zhong G et al. concluded that risk of dementia increased in consumers of benzodiazepines and it was associated with higher doses.In turn, AlDawasari A et al., when trying to clarify the use of different sedative-hypnotic drugs, found and increased risk with the consumption of benzodiazepines. After exclusion of articles with confounders and adjustment for protopathic bias, the risk was not maintained.Lucchetta RC et al. concluded that the risk exists but without inferring differences between doses or duration of action.Finally, Penninkilampi R e Eslick GD investigated this association, after controlling for the protopathic bias, concluding, contrary to AlDawasari et al., that the association benzodiazepines consumption and dementia do not result from this bias.ConclusionsWe cannot draw robust and concrete conclusions between benzodiazepines consumption and the pathogenesis of dementia because not only is the literature limited, but results are also heterogeneous. However, these prescriptions must be carried out cautiously, especially in the elderly, due to the known adverse effects associated with them.Disclosure of InterestNone Declared

Prevalence of Dementia, associated Co-morbidities, and Multidisciplinary Team Involvement in a Psychiatry of Old Age Service

IntroductionDementia is a common diagnosis in service users seen by Psychiatry of Old Age (POA) Services. This clinical audit was conducted prior to the services engagement with a focus group, which aimed to explore the implementation of the “Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia” (National Clinical Guideline No. 21) and identify additional resource requirements to be submitted for consideration by the HSE’s estimate process for 2023.ObjectivesIts aims were to evaluate:•The prevalence of service users with a dementia diagnosis among those seen by the POA Service, from January 2018-June 2022•The prevalence of co-morbid psychiatric diagnoses among those with a dementia diagnosis.•The resources needed to manage currently active cases with a diagnosis of dementia, by evaluating MDT member involvement.MethodsData is routinely collected on service users treated by the POA service for service evaluation, including service users’ diagnoses, and current MDT member involvement. All service users seen by the POA service between Jan 2018 – June 2022 were included. The total number of service users, and service users with dementia and mild Cognitive impairment were counted, in order to evaluate the prevalence of dementia. We then evaluated the proportion of those with dementia who had co-morbid psychiatric diagnoses. We then looked at currently active cases with dementia, and evaluated how many MDT members were involved in their ongoing care.Results392 service users were treated by the service from Jan 2018-June 2022. Of these 104 cases were still active with the service. 152 (39%) of these service users had a diagnosis of dementia. Of those with dementia, 45% (68, n=152) also had another psychiatric co-morbidity. Psychosis was the most common psychiatric co-morbidity, seen in 22% of those with dementia (33, n=152). 12% of active service users with a dementia diagnosis were only seen in outpatients clinics only, 60% were seeing one MDT member, 28% were seeing multiple MDT members (n=25).ConclusionsDementia was the most common diagnosis among service users seen by the POA service. 45% of service users with dementia being seen by the POA service also had another psychiatric co-morbidity. Such patients require significant MDT input.Disclosure of InterestNone Declared

Gender differences in the association of dementia symptoms severity and hospital anxiety

IntroductionSymptoms of anxiety can worsen cognitive decline in people with dementia, and symptoms of dementia and fears of further cognitive decline can cause anxiety. Advanced dementia is not necessarily associated with a loss of emotion, which means that people may still experience anxiety, but their ability to cope in a healthy way is reduced. The problem is exacerbated by the fact that hospital care alone can contribute to the severity of anxiety symptoms due to change in routine of daily activities, unfamiliar surroundings, uncertainty about health status, prognosis and various medical procedures. There are differences between women and men in the prevalence, course and manifestation of both dementia and anxiety disorders.ObjectivesTo examine whether there are differences between women and men in the association of hospital anxiety with eight symptoms of dementia: difficulties with memory, orientation, judgement, problem solving, fulfilling social obligations, daily activities at home and with hobbies, or personal care, in patients with mild to moderate dementia.Methods A cross-sectional study was conducted at Sveti Ivan Psychiatric Clinic in Zagreb in June 2023. The target population were hospitalised patients diagnosed with dementia, both genderes, aged 60-90 years, without psychotic disorder. Anxiety during hospitalisation was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the severity of dementia symptoms was measured using the Dementia Assessment Instrument (CDR). The hypothesis was tested using Wald test of differences between women and men in unstandardised linear regression coefficients of the HADS-A on individual dementia symptoms, after adjustment for age, education, presence of a married or stable non-marital partner and duration of current hospitalisation.ResultsWe enrolled 65 women and 35 men of comparable age. There were significant gender-related differences in the association between hospital anxiety and difficulties with judgement (P = 0.01), fulfilling social obligations (P &lt; 0.001), difficulties with home and hobbies (P = 0.02), and personal care (P = 0.00). In women, more pronounced difficulties with judgement and with home and hobbies were associated with higher anxiety, and in men the presence of these two symptoms of dementia was associated with lower anxiety. Difficulties with fulfilling social obligations are associated with lower anxiety in women and higher anxiety in men. Difficulties with personal care were associated with lower anxiety in both genders, but this effect was stronger in men.ConclusionsThere are differences between women and men in the association between anxiety during hospital treatment and the severity of individual dementia symptoms. These differences are present in difficulties with judgement, fulfilling social obligations, home, hobbies and personal care.Disclosure of InterestNone Declared

Culturally adapted cognitive assessment tool for Indigenous communities in Brazil: Content, construct, and criterion validity.

Initial dementia prevalence estimates have revealed a significant burden of the disease in Indigenous communities in Amazonas, Brazil. However, the need for culturally adapted cognitive tools poses a critical challenge when assessing cognitive performance in these communities. This study addressed this issue by culturally adapting and providing validity indicators for the Brazilian Indigenous Cognitive Assessment (BRICA) tool in Manaus, Brazil's urban multiethnic Indigenous community. Using a three-stage process and a stakeholder-engaged approach, the BRICA tool was culturally adapted in an urban multiethnic Indigenous community from Manaus, Brazil. The content validity index (CVI) examined inter-rater concordance between experts, while criterion and concurrent validity were performed using diagnostic consensus criteria in 141 Indigenous participants aged ≥ 50 years. Findings showed evidence of content validity in terms of equivalence aspects (scale CVI [S-CVI] 0.93) and relevance ratings (S-CVI 0.85) between expert panels. The identified cut-off score of ≤ 33/39 on the BRICA demonstrated a sensitivity of 94.4%, specificity of 99.2%, positive predictive value of 94.4%, and negative predictive value of 99.2% for dementia diagnosis. Using a stakeholder-engaged approach, we culturally adapted the BRICA tool for a Brazilian urban multiethnic Indigenous community. This comprehensive adaptation process resulted in favorable indicators of content, construct, and criteria validity for the BRICA tool. By addressing the existing bias in cognitive assessment within Indigenous communities, the BRICA tool represents a noteworthy breakthrough. Its implementation exhibits potential for improving the early detection and management of dementia among Indigenous groups. Culturally sensitive tools are essential to assess cognition in Indigenous populations.An expert panel and stakeholders' perspectives were incorporated to design the Brazilian Indigenous Cognitive Assessment (BRICA) tool.A cognitive screening tool was adapted and validated using a stakeholder approach.BRICA is the first culturally sensitive cognitive tool for urban Brazilian Indigenous individuals.

Dementia Disorders: A Narrative Review

This narrative review of research includes summaries of 40 papers on dementia disorders that were published during 2023. The publications of this period are primarily randomized controlled trials and systematic reviews/ meta-analyses of randomized controlled trials. A few of these are focused on the prevalence of dementia which approximated one per cent of the world’s population. Only a few studies focused on effects of dementia disorders including memory loss, discrimination, pain, depression and suicidality. Most of the studies addressed predictors of dementia disorders including neurotic personality, frequent tv/computer use and excessive exposure to metals. Loss of short-term memory and other negative experiences including negative life events, loneliness, stress and depression were also significant predictor variables in this recent literature. Physical conditions that were predictive of dementia included pain, hypertension, atrial fibrillation, multi-morbidities, inflammation, encephalitis and neuropathology. Potential underlying mechanisms included dysfunctional neurotransmitter systems (serotonergic, noradrenergic and dopaminergic) and gray matter loss in prefrontal, temporal and other regions associated with memory. Several research groups reported on effective interventions including a Mediterranean diet, plant-based diets, medicinal plants, psychedelics, second generation antidepressants, blood pressure medication, music therapy, aromatherapy and other alternative therapies. Methodological problems relate to the variability in the assessments of dementia disorders, the self-report measures and the cross-sectional data that are not definitive about directionality of predictors and effects of dementia disorders.