Diagnosis and Management of Dementia: Review

Identifying natural inhibitors against FUS protein in dementia through machine learning, molecular docking, and dynamics simulation

Dementia, a complex and debilitating spectrum of neurodegenerative diseases, presents a profound challenge in the quest for effective treatments. The FUS protein is well at the center of this problem, as it is frequently dysregulated in the various disorders. We chose a route of computational work that involves targeting natural inhibitors of the FUS protein, offering a novel treatment strategy. We first reviewed the FUS protein's framework; early forecasting models using the AlphaFold2 and SwissModel algorithms indicated a loop-rich protein-a structure component correlating with flexibility. However, these models showed limitations, as reflected by inadequate ERRAT and Verify3D scores. Seeking enhanced accuracy, we turned to the I-TASSER suite, which delivered a refined structural model affirmed by robust validation metrics. With a reliable model in hand, our study utilized machine learning techniques, particularly the Random Forest algorithm, to navigate through a vast dataset of phytochemicals. This led to the identification of nimbinin, dehydroxymethylflazine, and several other compounds as potential FUS inhibitors. Notably, dehydroxymethylflazine and cleroindicin C identified during molecular docking analyses-facilitated by AutoDock Vina-for their high binding affinities and stability in interaction with the FUS protein, as corroborated by extensive molecular dynamics simulations. Originating from medicinal plants, these compounds are not only structurally compatible with the target protein but also adhere to pharmacokinetic profiles suitable for drug development, including optimal molecular weight and LogP values conducive to blood-brain barrier penetration. This computational exploration paves the way for subsequent experimental validation and highlights the potential of these natural compounds as innovative agents in the treatment of dementia.

Therapeutic effect of dihydroartemisinin on Alzheimer's disease model mice with senile macular degeneration

OBJECTIVES

This study focuses on the preventive and therapeutic effects of Dihydroartemisinin (DHA) on Alzheimer's disease (AD) model mice and the effects of DHA and donepezil on amyloid β-protein deposition and autophagy in nerve cells.

METHODS

Six autophagy related targets were selected for molecular docking with DHA to predict the affinity between DHA and the target. The AD mouse model was established and treated with donepezil and DHA, respectively. Morris water maze was used to detect the spatial learning and memory ability of AD mice. Hematoxylin eosin (he) staining was used to observe the structural changes of cerebral cortical neurons and retina, and transmission electron microscope was used to observe the structural changes of mitochondria and synapses. Immunohistochemistry (IHC) and immunofluorescence staining were used to detect the deposition of amyloid beta protein. Western blot was used to detect the expression of apoptosis and autophagy related proteins in the brain tissue of mice in each group.

RESULTS

The results of molecular docking showed that the selected active compounds had good binding activity with the target. The binding energy between DHA and Aβ, Bcl-2, ATG5, LC3, Caspase3, LAMP1 is -5.7, -7.0, -5.8, -7.2, -6.9 kcal/mol. The water maze test showed that compared with the wild type (WT) group, the spatial memory ability of AD model group mice (5× FAD) was significantly decreased, and the search time (27.62 ± 6.51 s vs. 282.80 ± 17.15 s) and average path (106.30 ± 29.65 cm vs. 993.20 ± 135.80 cm) were significantly prolonged. The application of donepezil and DHA significantly shortened the exploration time and average path (donepezil: 116.10 ± 10.58 s, 529.40 ± 106.00 cm; DHA: 99.71 ± 14.22 s, 373.30 ± 60.97 cm). The path to find the platform in DHA treatment group was shorter than donepezil treatment group (P < 0.05). HE staining showed that the arrangement of nerve cells in 5× FAD mice was disordered, and IHC showed that amyloid β-protein deposition was obvious. DHA and donepezil could improve the damage of cerebral cortex structure and reduce the deposition of extracellular amyloid β-protein in AD mice. Transmission electron microscopy showed that DHA and donepezil could reduce mitochondrial vacuolation and synaptic edema. The above results showed that DHA treatment effect was better than donepezil. Compared with the conventional feeding group, autophagy and apoptosis related proteins B-cell lymphoma-2 (BCL2) and anti-thymocyte globulin (ATG) were significantly down regulated in the 5× FAD group, and the expressions of BCL2 and ATG were increased after treatment with DHA and donepezil.

CONCLUSIONS

DHA combined with BCL2 and ATG protein, through promoting autophagy protein, can reduce the damage of cerebral cortex structure in AD mice, reduce the deposition of extracellular β-amyloid protein, and then improve the memory ability of AD model mice. DHA treatment is superior to donepezil monotherapy.

Generalizable Prediction of Alzheimer Disease Pathologies with a Scalable Annotation Tool and an High-Accuracy Model

Characterizing the cardinal neuropathologies in Alzheimer disease (AD) can be laborious, time consuming, and susceptible to intra- and inter-observer variability. The lack of high throughput unbiased approaches to reliably assess neuropathology hampers efforts to use pathology as a means to link clinical features of AD to molecular pathogenesis in the ever-growing datasets of persons with AD. To remove this roadblock, we designed an annotation tool in addition to a computational pipeline to analyze digital microscopic images of postmortem tissue from persons with AD in a fully automated and unbiased manner in only a fraction of the time taken with conventional approaches and allows neuropathological analyses and lesion quantification at multiple scales. The pipeline includes a Mask Regional-Convolutional Neural Network (Mask R-CNN) we trained to detect, classify, and segment different types of amyloid. To establish ground truth for training and validation, we utilized an existing open source platform, QuPath, and developed a tool to collect consensus annotations of neuropathology experts. The Mask R-CNN identified amyloid pathology in samples (with accuracy: 94.6%, F1: 87.7%, Dice: 81.8%) unrelated to the training dataset, indicating that it detects generalizable pathology features. Its quantitative measurements of amyloid pathology on 298 samples correlated with the severity of AD neuropathology assessed by experts and neuropathologists (CERAD ratings) and estimates of cognitive compromise (Clinical Dementia Ratings (CDR)). Our computational pipeline should enable rapid, unbiased, inexpensive, quantitative, and comprehensive neuropathological analysis of large tissue collections and integration with orthogonal clinical and multi-omic measurements.

Dietary inflammatory potential and the risk of cognitive impairment: A meta-analysis of prospective cohort studies

OBJECTIVE

Dietary inflammatory potential, measured by the dietary inflammatory index (DII) has been linked to cognitive impairment. However, evidence was mostly driven by cross-sectional studies. This meta-analysis of prospective cohort studies aims to evaluate the relationship between DII and the risk of cognitive impairment, including mild cognitive impairment (MCI) and dementia.

METHODS

We conducted a systematic search of PubMed, Web of Science, and Embase for studies published up to July 25, 2024. Prospective cohort studies with adults aged 18 years or older, without dementia at baseline, and reporting the incidence of cognitive impairment by DII category were included. Data were analyzed using a random-effects model to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS

Nine prospective cohort studies with 266,169 participants were included. A high DII at baseline was associated with an increased risk of cognitive impairment during follow-up (RR: 1.34, 95% CI: 1.15-1.55, p < 0.001) with moderate heterogeneity (I² = 56%). Subgroup analyses revealed consistent associations across types of cognitive impairment (MCI, overall dementia, Alzheimer's disease) and study characteristics (p for subgroup difference all >0.05). Sensitivity analyses confirmed the robustness of the results.

CONCLUSIONS

This meta-analysis suggests that a higher dietary inflammatory potential is independently associated with an increased risk of cognitive impairment. These findings underscore the potential impact of dietary inflammation on cognitive health and highlight the need for dietary strategies to mitigate cognitive decline risk.

Dementia subtypes and suicidality: A systematic review and meta-analysis

AIMS

Recent research has highlighted a link between dementia and increased risk of suicidal ideation, suicide attempts and suicide deaths. Understanding the relative risk of suicide between subtypes of dementia is important for services to offer appropriate intervention.

METHOD

We searched five databases from inception to July 2023 for peer-reviewed publications reporting suicidal ideation, suicide attempt or death by suicide for at least two dementia subtypes. Meta-analyses compared suicidality between subtypes of dementia with Alzheimer's Disease (AD).

RESULTS

From 4983 studies identified, 12 met inclusion criteria. Pooling data, people with Vascular Dementia were significantly more likely to experience suicidal ideation (OR= 2.02 [95 % CI= 1.06;3.8]) and attempt suicide (OR=1.94 [95 % CI= 1.28;2.94]) than people with AD, but not die by suicide (OR= 1.05 [95 % CI= 0.69;1.59]). People with Dementia with Lewy Bodies were significantly more likely to report suicidal ideation (OR= 1.56 [95 % CI= 1.09;2.23]) than AD but not attempt suicide (OR= 1.12 [95 % CI= 0.83;1.50]). People with Frontotemporal Dementia were significantly more likely to attempt suicide (OR= 2.42 [95 % CI= 1.02;5.72]) than people with AD but not report suicidal ideation (OR= 1.67 [95 % CI= 0.34;8.33]). People with Mixed Dementia were significantly more likely to attempt suicide (OR= 2.83 [95 % CI= 1.52;5.27]) than people with AD but not report suicidal ideation (OR = 1.65 [95 % CI= 0.5;5.46]).

CONCLUSIONS

Further research is needed to understand what underlies the increased risks of suicidal ideation and suicide attempts for rarer subtypes.

Potential molecular mechanisms of tobacco smoke exposure in Alzheimer's disease

BACKGROUND

Smoking is detrimental to health, with tobacco use being a critical factor in the development of various neurodegenerative diseases, including Alzheimer's disease (AD), which progressively impairs brain function and poses a significant threat to public health. This study aims to examine the potential genetic alterations induced by smoking that are associated with AD and to investigate the underlying regulatory mechanisms. The research will provide theoretical foundations for targeted prevention and treatment strategies for AD.

METHODS

This study analyzed datasets from the Gene Expression Omnibus (GEO) and the Comparative Toxicogenomics Database (CTD) to identify genes affected by tobacco smoke exposure and those altered in patients with AD relative to normal controls. We conducted Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses using OmicShare tools to screen for key pathways. Key genes were identified by constructing protein-protein interaction networks (PPI) in the STRING database with the aid of CytoHubba. Additionally, the binding activity of the proteins encoded by these key genes to nicotine, the main component of tobacco, was analyzed using molecular docking techniques. Finally, the analytical results were verified using Quantitative Real-Time Polymerase Chain Reaction.

RESULTS

The CTD identified 12,164 CE-related genes affected by tobacco smoke exposure. A comparison of these datasets yielded 94 common genes that were both influenced by tobacco and differentially expressed across all brain regions. The GO and KEGG pathway enrichment analyses showed that these common differentially expressed genes (DEGs) were predominantly enriched in the Wnt/β-catenin and PI3K-AKT signaling pathways. The DEGs' PPI network, constructed using the STRING database, highlighted key genes such as HSP90AB1, SOS2, MAGI1, and YWHAZ. Molecular docking studies demonstrated that nicotine binds effectively to the protein structures of these key genes, primarily through amino acid residues such as Ser and Glu. Experimental validation showed that HSP90AB1 and YWHAZ exhibited notable expression discrepancies under varying concentrations of cigarette smoke extract (CSE) treatments, particularly demonstrating a pronounced down-regulation trend at elevated concentrations.

CONCLUSION

The study indicates that tobacco may impact the function of transmembrane transporter proteins and contribute to the development of AD by affecting key genes such as HSP90AB1 and YWHAZ, as well as signaling pathways like PI3K-AKT.

Long-Term Impact of Delirium on the Risk of Dementia in Hospitalized Older Patients: A Real-World Multicenter Study

BACKGROUND

The association between delirium and dementia has been suggested, but mostly in the postoperative setting. This study aims to explore this relationship in a broader inpatient population, leveraging extensive real-world data to provide a more generalized understanding.

METHODS

In this retrospective cohort study, electronic health records of 11,970,475 hospitalized patients aged over 60 from nine institutions in South Korea were analyzed. Patients with and without delirium were identified, and propensity score matching (PSM) was used to create comparable groups. A 10-year longitudinal analysis was conducted using the Cox proportional hazards model, which calculated the hazard ratio (HR) and 95% confidence interval (CI). Additionally, a meta-analysis was performed, aggregating results from all nine medical institutions. Lastly, we conducted various subgroup and sensitivity analyses to demonstrate the consistency of our study results across diverse conditions.

RESULTS

After 1:1 PSM, a total of 47,306 patients were matched in both the delirium and nondelirium groups. Both groups had a median age group of 75-79 years, with 43.1% being female. The delirium group showed a significantly higher risk of all dementia compared with the nondelirium group (HR: 2.70 [95% CI: 2.27-3.20]). The incidence risk for different types of dementia was also notably higher in the delirium group (all dementia or mild cognitive impairment, HR: 2.46 [95% CI: 2.10-2.88]; Alzheimer's disease, HR: 2.74 [95% CI: 2.40-3.13]; vascular dementia, HR: 2.55 [95% CI: 2.07-3.13]). This pattern was consistent across all subgroup and sensitivity analyses.

CONCLUSIONS

Delirium significantly increases the risk of onset for all types of dementia. These findings highlight the importance of early detection of delirium and prompt intervention. Further research studies are warranted to investigate the mechanisms linking delirium and dementia.

Efficacy of a group-based 8-week multicomponent cognitive training on cognition, mood and activities of daily living among healthy older adults: A two-year follow-up of a randomized controlled trial

BACKGROUND

Cognitive training (CT) has been one of the important non-pharmaceutical interventions that could delay cognitive decline. Currently, no definite CT methods are available. Furthermore, little attention has been paid to the effect of CT on mood and instrumental activities of daily living (IADL).

OBJECTIVES

To assess the effectiveness of a multicomponent CT using a training program of executive functions, attention, memory and visuospatial functions (TEAM-V Program) on cognition, mood and instrumental ADL.

DESIGN

A randomized, single-blinded, treatment-as-usual controlled trial.

SETTING

Geriatric clinic in Bangkok, Thailand.

PARTICIPANTS

80 nondemented community-dwelling older adults (mean age 65.7 ± 4.3 years).

INTERVENTION

The CT (TEAM-V) Program or the treatment-as-usual controlled group. The TEAM-V intervention was conducted over 5 sessions, with a 2-week interval between each session. A total of 80 participants were randomized (n = 40 the TEAM-V Program; n = 40 the control group).

MEASUREMENTS

The Thai version of Montreal Cognitive Assessment (MoCA), The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Thai version of Hospital Anxiety and Depression Scale (HADS) and The Chula ADL were used to assess at baseline, 6 months, 1 year and 2 years.

RESULTS

Compared with the control arm (n = 36), the TEAM-V Program (n = 39) was associated with significantly improved general cognition (MoCA, P = 0.02) at 2 years. Compared with baseline, participants receiving the TEAM-V Program were associated with significantly improved immediate recall (word recall task, P < 0.001), retrieval and retention of memory processes (word recognition task, P = 0.01) and attention (number cancellation part A, P = 0.01) at 2 years. No training effects on anxiety (P = 0.94), depression (P = 0.093) and IADL (P = 0.48) were detected.

CONCLUSIONS

The TEAM-V Program was effective in improving global cognitive function. Even though, the program did not significantly improve anxiety, depression and IADL compared with the control group, memory and attention improved in the intervention group compared with baseline. Further studies incorporating a larger sample size, longitudinal follow-up and higher-intensity CT should be conducted.

The Beneficial Effects of Combined Exercise and Polyphenols in Alzheimer's Disease

Regular exercise enhances life quality, lowers the risk of cognitive damage, and slows the advancement of Alzheimer's disease (AD). Natural compounds rich in polyphenols have garnered attention as a non-pharmacological means of treating and preventing AD. The primary component of wine, grape seeds, and nuts is polyphenols. Research suggests that polyphenols slow down the rate of neurodegeneration in AD and lessen learning impairment. Furthermore, polyphenols lessen brain impairments related to cognition. Additionally, polyphenols can specifically restructure amyloid-β (Aβ) structures and soluble oligomers into non-toxic alternative species. They have also been revealed to increase brain-derived neurotrophic factors expression, suggesting that they have a positive impact on the creation of neurotrophins. The benefits of polyphenol supplementation and exercise, which can both provide neuroprotection, have not been well studied in AD patients. This review aimed to investigate the effects of combined exercise polyphenols on inflammation, neuroprotection, several conformational toxic species of Aβ, and Aβ-induced apoptosis in AD.

Population-Based Norms for the Montreal Cognitive Assessment in Arab Adults

OBJECTIVE

The Montreal Cognitive Assessment (MoCA) is a brief screening instrument for detecting mild cognitive dysfunction, a precursor to many cognitive disorders, such as dementia, which have increased in prevalence globally. Qatar, a small high-income country, has the largest projected increase in dementia of any country in the Middle East. Yet no population-based norms for cognitive function are available to date.

METHODS

As part of the first national cross-sectional study of mental health, a total of 395 Qatari and non-Qatari Arabs, 18-74 years of age, were evaluated face-to-face using the Arabic version of the original MoCA (version 7.1). We computed raw and demographically (gender, age in years, and four education categories) adjusted scores for the overall MoCA test and six domains (visuospatial, executive function, attention, language, delayed memory, and orientation). The percentile ranking of raw and adjusted normative (z) scores was computed. The 5th percentile ranking was used to derive potential cut-offs for the overall test and the six related domains.

RESULTS

Female gender, older age, and lower levels of education were associated with poorer overall test scores. The following MoCA overall test and domains cut-off scores (rounded to the nearest integer) were identified: MoCA (22), visuospatial (2), executive (2.5), attention (4), language (4), and delayed memory (3).

CONCLUSIONS

On the basis of our population-based data, scores below these 5th percentile cut-offs may warrant further testing and clinical follow-up for mild cognitive impairment (MCI) in otherwise healthy Arab adults.

Toward a biological definition of neuronal and glial synucleinopathies

Cerebral accumulation of alpha-synuclein (αSyn) aggregates is the hallmark event in a group of neurodegenerative diseases-collectively called synucleinopathies-which include Parkinson's disease, dementia with Lewy bodies and multiple system atrophy. Currently, these are diagnosed by their clinical symptoms and definitively confirmed postmortem by the presence of αSyn deposits in the brain. Here, we summarize the drawbacks of the current clinical definition of synucleinopathies and outline the rationale for moving toward an earlier, biology-anchored definition of these disorders, with or without the presence of clinical symptoms. We underscore the utility of the αSyn seed amplification assay to detect aggregated αSyn in living patients and to differentiate between neuronal or glial αSyn pathology. We anticipate that a biological definition of synucleinopathies, if well-integrated with the current clinical classifications, will enable further understanding of the disease pathogenesis and contribute to the development of effective, disease-modifying therapies.

Retinal vascular alterations in cognitive impairment: A multicenter study in China

INTRODUCTION

Foundational models suggest Alzheimer's disease (AD) can be diagnosed using retinal images, but the specific structural features remain poorly understood. This study investigates retinal vascular changes in individuals with cognitive impairment in three East Asian regions.

METHODS

A multicenter study was conducted in Shanghai, Hong Kong, and Ningxia, collecting retinal images from 176 patients with mild cognitive impairment (MCI) or AD and 264 controls. The VC-Net deep learning model segmented arterial/venous networks, extracting 36 vascular features.

RESULTS

Significant reductions in vessel length, segment number, and vascular density were observed in cognitively impaired patients, while venous structure and complexity were correlated with the level of cognitive function.

DISCUSSION

Retinal vascular changes may serve as indicators of cognitive impairment, requiring validation in larger cohorts and exploration of the underlying mechanisms.

HIGHLIGHTS

A deep learning segmentation model extracted diverse retinal vascular features. Significant alterations in the structure of retinal arterial/venous networks were identified. Partitioning vessel-rich retinal zones improved detection of vascular changes. Decreases in vessel length, segment number, and vascular density were found in CI individuals.

Progress in the treatment of Alzheimer's disease based on nanosized traditional Chinese medicines

Traditional Chinese medicine (TCM) has been employed for centuries in treating and managing Alzheimer's disease (AD). However, their effective delivery to target sites can be a major challenge. This is due to their poor water solubility, low bioavailability, and potential toxicity. Furthermore, the blood-brain barrier (BBB) is a major obstacle to effective TCM delivery, significantly reducing efficacy. Advancements in nanotechnology and its applications in TCM (nano-TCM) can deliver active ingredients or components of TCM across the BBB to the targeted brain area. This review summarizes the recent advances in nanocarrier-based delivery systems for different types of active constituents of TCM for AD, including terpenoids, polyphenols, alkaloids, flavonoids, and quinones. Besides, the main challenges and opportunities for the future development of these advanced TCM nanocarriers are emphasized. In conclusion, this review provides valuable insights and guidance for utilizing nanocarriers to shape future TCM drug delivery.

Ginsenoside Rg1 attenuates Aβ1-42-induced microglial cell apoptosis and inflammation in Alzheimer's disease via the GATA4/PDE4A/PI3K/AKT axis

Ginsenoside Rg1 (Rg1) has been shown to treat a variety of human diseases, including Alzheimer's disease (AD). However, its mechanism in AD needs further investigation. Microglial cells (BV2) were treated with Aβ1-42 to induce AD cell models. Cell viability and apoptosis were tested by cell counting kit 8 assay and flow cytometry. The protein levels of GATA-binding protein 4 (GATA4), phosphodiesterase 4A (PDE4A), autophagy-related markers, M1/M2 polarization-related markers and PI3K/AKT-related markers were detected by western blot. Inflammation factors were detected by ELISA. Jaspar and dual-luciferase reporter assay were used to evaluate the interaction between GATA4 and PDE4A. Our results showed that Rg1 promoted viability and autophagy, while suppressed apoptosis and inflammation in Aβ1-42-induced BV2 cells. Rg1 reduced GATA4 protein expression, and GATA4 upregulation reversed the regulation of Rg1 on Aβ1-42-induced BV2 cell injury. GATA4 interacted with PDE4A, and GATA4 facilitated Aβ1-42-induced BV2 cell injury by increasing PDE4A expression. Besides, GATA4 knockdown reduced PDE4A protein expression and inactivated PI3K/AKT axis, while these effects were abolished by PDE4A overexpression. In conclusion, our data suggested that Ginsenoside Rg1 inhibited microglial cell apoptosis and inflammation to attenuate AD progression by regulating the GATA4/PDE4A/PI3K/AKT axis.

Non-Invasive Retinal Biomarkers for Early Diagnosis of Alzheimer's Disease

Alzheimer's disease (AD) is a progressive neurodegenerative disorder of the brain associated with ageing and is the most prevalent form of dementia, affecting an estimated 55 million people worldwide, with projections suggesting this number will exceed 150 million by 2050. With its increasing prevalence, AD represents a significant global health challenge with potentially serious social and economic consequences. Diagnosing AD is particularly challenging as it requires timely recognition. Currently, there is no effective therapy for AD; however, certain medications may help slow its progression. Existing diagnostic methods such as magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), and biomarker analysis in cerebrospinal fluid tend to be expensive and invasive, making them impractical for widespread use. Consequently, research into non-invasive biomarkers that enable early detection and screening for AD is a crucial area of contemporary clinical investigation. One promising approach for the early diagnosis of AD may be retinal imaging. As an extension of the central nervous system, the retina offers a distinctive opportunity for non-invasive brain structure and function assessment. Considering their shared embryological origins and the vascular and immunological similarities between the eye and brain, alterations in the retina may indicate pathological changes in the brain, including those specifically related to AD. Studies suggest that structural and vascular changes in the retina, particularly within the neuronal network and blood vessels, may act as markers of cerebral changes caused by AD. These retinal alterations have the potential to act as biomarkers for early diagnosis. Since AD is typically diagnosed only after a significant neuronal loss has occurred, identifying early diagnostic markers could enable timely intervention and help prevent disease progression. Non-invasive retinal imaging techniques, such as optical coherence tomography (OCT) and OCT angiography, provide accessible methods for the early detection of changes linked to AD. This review article focuses on the potential of retinal imaging as a non-invasive biomarker for early diagnosis of AD. Investigating the ageing of the retina and its connections to neurodegenerative processes could significantly enhance the diagnosis, monitoring, and treatment of AD, paving the way for new diagnostic and therapeutic approaches.

Causal relationships between hippocampal volumetric traits and the risk of Alzheimer's disease: a Mendelian randomization study

Alzheimer's disease, a common and progressive neurodegenerative disorder, is associated with alterations in hippocampal volume, as revealed by neuroimaging research. However, the causal links between the volumes of the hippocampus and its subfield structures with Alzheimer's disease remain unknown. A genetic correlation analysis using linkage disequilibrium score regression was conducted to identify hippocampal volumetric traits linked to Alzheimer's disease. Following this, to examine the causal links between Alzheimer's disease and hippocampal volumetric traits, we applied a two-sample Mendelian randomization approach, utilizing a bidirectional framework. Seven hippocampal volumetric traits were found as genetically correlated with Alzheimer's disease in the genetic correlation analysis and were then included in the Mendelian randomization analyses. Inverse variance weighted Mendelian randomization analyses revealed that increased volumes in the left whole hippocampus, left hippocampal body, right presubiculum head and right cornu ammonis 1 head were causally related to higher risks of Alzheimer's disease. Conversely, a higher risk of Alzheimer's disease was causally associated with decreased volumes of the left hippocampal body and left whole hippocampus. These results were validated through other Mendelian randomization approaches and sensitivity analysis. Our findings uncover bidirectional causal relationships between Alzheimer's disease and hippocampal volumetric traits, suggesting not only the potential significance of these traits in predicting Alzheimer's disease but also the reciprocal influence of Alzheimer's disease on hippocampal volumes.

The interplay between gut microbiota composition and dementia

Recently, researchers have been interested in the potential connection between gut microbiota composition and various neuropsychological disorders. Dementia significantly affects the socioeconomics of families. Gut microbiota is considered as a probable factor in its pathogenesis. Multiple bacterial metabolites such as short-chain fatty acids, lipopolysaccharides, and various neurotransmitters that are responsible for the incidence and progression of dementia can be produced by gut microbiota. Various bacterial species such as Bifidobacterium breve, Akkermansia muciniphila, Streptococcus thermophilus, Escherichia coli, Blautia hydrogenotrophica, etc. are implicated in the pathogenesis of dementia. Gut microbiota can be a great target for imitating or inhibiting their metabolites as an adjunctive therapy based on their role in its pathogenesis. Therefore, some diets can prevent or decelerate dementia by altering the gut microbiota composition. Moreover, probiotics can modulate gut microbiota composition by increasing beneficial bacteria and reducing detrimental species. These therapeutic modalities are considered novel methods that are probably safe and effective. They can enhance the efficacy of traditional medications and improve cognitive function.

Neurodegenerative Disorders in Criminal Offending and Cognitive Decline Among Aging Inmates

Dementia, including Alzheimer's disease (AD) and frontotemporal dementia (FTD), presents critical challenges for correctional systems, particularly as global populations age. AD, affecting 60-80% of dementia cases, primarily impairs memory and cognition in individuals over 65. In contrast, FTD, rarer than AD but not uncommon in those under 65, affects the frontal and temporal brain regions, leading to deficits in social behavior, language, and impulse control, often resulting in antisocial actions and legal consequences. Behavioral variant FTD is especially associated with socially inappropriate and impulsive behaviors due to frontal lobe degeneration. The prevalence of cognitive impairment in incarcerated populations is high, exacerbated by prison environments that compound distress and limited access to specialized healthcare. Studies indicate that up to 11% of United States state prison inmates over the age of 55 exhibit cognitive impairments, often undiagnosed, resulting in punitive rather than rehabilitative responses to symptoms like disinhibition and aggression. Ethical concerns around criminal responsibility for individuals with dementia are increasingly prominent, particularly regarding their ability to comprehend and engage in legal proceedings. The growing elderly prison population necessitates reform in correctional healthcare to include early cognitive assessment, targeted intervention, and tailored post-release programs. Addressing these needs is essential to ensure appropriate treatments, alleviate healthcare demands, and support reintegration for cognitively impaired inmates.

The role of the Mediterranean diet in reducing the risk of cognitive impairement, dementia, and Alzheimer's disease: a meta-analysis

Age-related cognitive impairment and dementia pose a significant global health, social, and economic challenge. While Alzheimer's disease (AD) has historically been viewed as the leading cause of dementia, recent evidence reveals the considerable impact of vascular cognitive impairment and dementia (VCID), which now accounts for nearly half of all dementia cases. The Mediterranean diet-characterized by high consumption of fruits, vegetables, whole grains, fish, and olive oil-has been widely recognized for its cardiovascular benefits and may also reduce the risk of cognitive decline and dementia. To investigate the protective effects of the Mediterranean diet on cognitive health, we conducted a systematic literature review using PubMed, Web of Science, and Google Scholar, focusing on studies published between 2000 and 2024. The studies included in the meta-nalysis examined the adherence to the Mediterranean diet and the incidence of dementia and AD. We applied a random-effects model to calculate pooled hazard ratios (HRs) with 95% confidence intervals (CIs) and assessed heterogeneity through I-square statistics. Forest plots, funnel plots, and Z-score plots were used to visualize study outcomes. Of the 324 full-text records reviewed, 23 studies met the inclusion criteria. The combined HR for cognitive impairment among those adhering to the Mediterranean diet was 0.82 (95% CI 0.75-0.89); for dementia, the HR was 0.89 (95% CI 0.83-0.95); and for AD, the HR was 0.70 (95% CI 0.60-0.82), indicating substantial protective effects. Significant heterogeneity was observed across studies, though Z-score plots suggested sufficient sample sizes to support reliable conclusions for each condition. In conclusion, this meta-analysis confirms that adherence to the Mediterranean diet is associated with an 11-30% reduction in the risk of age-related cognitive disorders, including cognitive impairment, dementia, and AD. These findings underscore the Mediterranean diet's potential as a central element in neuroprotective public health strategies to mitigate the global impact of cognitive decline and dementia and to promote healthier cognitive aging.

Minocycline nanoplatform penetrates the BBB and enables the targeted treatment of Parkinson's disease with cognitive impairment

Parkinson's disease (PD)-induced motor dysfunction and cognitive impairment are becoming increasingly common due to global population aging. However, efficient treatment strategies for these conditions are still lacking. Recent studies indicated that neuroinflammation and neuronal apoptosis could greatly worsen the symptoms of PD. Therefore, anti-apoptotic and anti-inflammatory drugs could be useful in the management of PD. In the present study, minocycline (MIN)-loaded Fe3O4 nanoparticles (Fe3O4-MIN NPs) were prepared for the targeted treatment of PD. Owing to their near-infrared (NIR) irradiation-induced photothermal effects, the Fe3O4-MIN NPs could cross the blood-brain barrier (BBB), thus enhancing the delivery of Fe3O4-MIN NPs to the brain parenchyma. Subsequently, the Fe3O4-MIN NPs exerted strong anti-inflammatory effects and alleviated neuroinflammation in the brain. Furthermore, they exerted anti-oxidative effects, scavenging excessive reactive oxygen species in the brain parenchyma and thus protecting both dopaminergic and hippocampal neurons from neuroinflammation and apoptosis. Consequently, Fe3O4-MIN NPs + NIR treatment attenuated the motor dysfunction and cognitive impairment observed in PD mice. Notably, the Fe3O4-MIN NPs also showed high biocompatibility. Hence, these BBB-penetrating MIN-loaded Fe3O4 NPs demonstrate great therapeutic potential for PD accompanied by cognitive impairment.

Longitudinal study of care needs and behavioural changes in people living with dementia using in-home assessment data

BACKGROUND

People living with dementia often experience changes in independence and daily living, affecting their well-being and quality of life. Behavioural changes correlate with cognitive decline, functional impairment, caregiver distress, and care availability.

METHODS

We use data from a 3-year prospective observational study of 141 people with dementia at home, using the Bristol Activities of Daily Living Scale, Neuropsychiatric Inventory and cognitive assessments, alongside self-reported and healthcare-related data.

RESULTS

Here we show, psychiatric behavioural symptoms and difficulties in activities of daily living, fluctuate alongside cognitive decline. 677 activities of daily living and 632 psychiatric behaviour questionnaires are available at intervals of 3 months. Clustering shows three severity-based groups. Mild cognitive decline associates with higher caregiver anxiety, while the most severe group interacts more with community services, but less with hospitals.

CONCLUSIONS

We characterise behavioural symptoms and difficulties in activities of daily living in dementia, offering clinically relevant insights not commonly considered in current practice. We provide a holistic overview of participants' health during their progression of dementia.

Establishing cutoff values for visual amyloid positivity in [18F]flutemetamol PET

BACKGROUND

This study aimed to establish the optimal cutoff values for visual amyloid positivity using standardized uptake value ratios (SUVRs) in [18F]flutemetamol (FMM) positron emission tomography (PET) imaging. Given the variability in amyloid assessment, our goal was to determine cutoff values that enhance diagnostic accuracy and assist clinicians in reliably identifying amyloid positivity.

RESULTS

The identified cutoff values for visual amyloid positivity were > 1.6 for the cerebellar gray matter, > 1.38 for the whole cerebellum, and > 0.63 for the pons, yielding high sensitivity (95.5%, 94.5%, and 95.8%, respectively) and specificity (91.2%, 94.3%, and 95.2%, respectively).

CONCLUSIONS

The SUVR cutoff values demonstrated excellent diagnostic performance, supporting their clinical use in assessing visual amyloid positivity in [18F]FMM PET imaging.

Neuropathology-based approach reveals novel Alzheimer's Disease genes and highlights female-specific pathways and causal links to disrupted lipid metabolism: insights into a vicious cycle

Dementia refers to an umbrella phenotype of many different underlying pathologies with Alzheimer's disease (AD) being the most common type. Neuropathological examination remains the gold standard for accurate AD diagnosis, however, most that we know about AD genetics is based on Genome-Wide Association Studies (GWAS) of clinically defined AD. Such studies have identified multiple AD susceptibility variants with a significant portion of the heritability unexplained and highlighting the phenotypic and genetic heterogeneity of the clinically defined entity. Furthermore, despite women's increased susceptibility to dementia, there is a lack of sex-specific genetic studies and understanding of sex-specific background for the disorder. Here, we aim to tackle the heterogeneity of AD by specifically concentrating on neuropathological features and pursuing sex-specific analysis. We bring together 14 different genomic and neuropathology datasets (6960 individuals) and we integrate our GWAS findings with transcriptomic and phenotypic data aiming to also identify biomarkers for AD progression. We uncover novel genetic associations to AD neuropathology, including BIN1 and OPCML. Our sex-specific analysis points to a role for BIN1 specifically in women as well as novel AD loci including QRFPR and SGCZ. Post-GWAS analyses illuminate the functional and biological mechanisms underlying AD and reveal sex-specific differences. Finally, through PheWAS and Mendelian Randomization analysis, we identify causal links with AD neuropathology pointing to disrupted lipid metabolism, as well as impaired peripheral immune response and liver dysfunction as part of a vicious cycle that fuels neurodegeneration.

Effect of proanthocyanidins on cognitive improvement in thyroxin-induced aging mice

As the population ages, functional dietary supplements are increasingly used to reduce age-related diseases, especially in the field of cognitive impairment. In this study, a thyroxine (Th)-induced aging model was established, and the effect of proanthocyanidins (Pc) on cognitive impairment of aging mice was evaluated based on cognitive ability, neuroinflammation and immune level. The results showed that Pc significantly reduced AchE activity compared to the Model group, improving learning deficits and spatial memory in aged mice (P < 0.01). Further study showed that Pc could maintain the organism's redox balance, markedly increasing T-AOC, GSH, and SOD levels (P < 0.01) while reducing MPO and MDA levels (P < 0.01). Pc also improved systemic inflammation, raising the levels of the anti-inflammatory cytokine PF4 and significantly lowering pro-inflammatory factors in the blood (P < 0.01). In the DG region of the hippocampus, Pc effectively repaired nerve damage, inhibited the over-activation of microglia and astrocytes, down-regulated GFAP and IBA-1 proteins (P < 0.01), and then reduced neuroinflammation. Additionally, Pc supplementation also significantly increased the levels of WBC, Lymph, Mid, and Gran in aged mice (P < 0.01), aiding in the recovery of leukocyte counts. At the same time, the CD3+ level and CD4+/CD8+ ratio were significantly increased (P < 0.01) to maintain the dynamic balance of lymphocyte subsets in aging mice and enhance the immune capacity of aging mice. The study revealed that Pc, as a dietary supplement, can effectively alleviate cognitive impairment in the elderly population. This provides a new dietary nutrition supplement strategy for the health of the aging population.

Resting-state functional magnetic resonance imaging study on cerebrovascular reactivity changes in the precuneus of Alzheimer's disease and mild cognitive impairment patients

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by memory impairment and cognitive decline, ultimately culminating in dementia. This study aims to evaluate cerebrovascular reactivity (CVR) and functional connectivity (FC) in patients with AD and mild cognitive impairment (MCI) using resting-state functional magnetic resonance imaging (rs-fMRI), bypassing the requirement for hypercapnia. The study cohort comprised 53 AD patients, 38 MCI patients, and 39 normal control (NC) subjects. CVR is derived by extracting signals within specific frequency bands of rs-fMRI. This study compares the differences in CVR and FC among the three groups, using the brain regions with CVR differences as region of interest (ROI) for FC analysis. The correlation between CVR and FC and cognitive scale score was discussed. Compared with NC subjects, AD patients exhibited a decrease in CVR in the PCUN.L, whereas MCI patients showed an increase in CVR in the PCUN.R. With PCUN.L as ROI, FC in PCUN.R decreased in AD patients, and FC in SFGmed.R and other brain regions increased in MCI patients compared with NC subjects. The results of the correlation analysis indicate that CVR in all patients, as well as FC with the PCUN.L as the ROI to the PCUN.R and SFGmed.R, show positive correlations with MMSE and MoCA scores. These results suggest that there are significant differences between CVR and FC with CVR differential brain regions as ROI among the AD, MCI, and NC groups, which may help to explain the hemodynamic mechanism. CVR obtained with rs-fMRI may be a potential biomarker for assessing cognitive impairment.

SENP3 knockdown improves motor and cognitive impairments in the intranasal MPTP rodent model of Parkinson's disease

Several mechanisms underlying Parkinson's disease (PD) remain unclear, and effective treatments are still lacking. The conjugation of the small ubiquitin-like modifier (SUMO), known as SUMOylation, to key proteins in PD has shown potential beneficial effects. Considering that this process is reversed by SUMO-specific proteases (SENPs), this study addressed the effects of increased SUMO-2/3 conjugation, mediated by SENP3 knockdown, in the intranasal 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) rodent model of PD. Two weeks after infusion of the shRNA-containing lentiviral vector into the dorsolateral striatum and one week following intranasal MPTP administration, male Wistar rats were evaluated using cognitive and motor behavioural tests. Infection efficiency was confirmed by detecting GFP expression in the dorsolateral striatum. SENP3 knockdown, verified by Western blotting, resulted in increased SUMO-2/3 conjugation. MPTP-administered rats displayed impairments in both recognition and spatial memories, while SENP3 knockdown prevented these deficits. Rats exposed to MPTP also exhibited motor dysfunction, which was ameliorated by SENP3 knockdown. These findings underscore the involvement of SUMO-2/3 conjugation in PD and its potential as a novel therapeutic target to counteract cognitive and motor impairments induced by neurodegeneration.

Dementia health matters: Influence of literacy, fears, and endorsements on dementia risk mitigation and screening among community-dwelling older adults

BACKGROUND

Up to one-third of dementia cases may be preventable, with evidence suggesting that modifying lifestyle and health behaviors can significantly lower the risk of developing dementia. However, motivating older adults to adopt and sustain these changes poses a considerable challenge, particularly when facing the specter of dementia.

AIM

To explore the interaction effect between dementia fear and dementia literacy on the perceived ability of community-dwelling older adults to reduce dementia risk and engage in dementia screening.

METHOD

A cross-sectional study involving 1,067 community-dwelling older adults was conducted from August 2022 to December 2023. Participants completed surveys assessing their dementia literacy, personal dementia fear, motivation to change lifestyle and health behaviors, and willingness to engage in investigational screening for memory in primary care.

FINDINGS

Personal dementia fear exhibited significant positive correlations with motivation to change lifestyle and health behavior (r = 0.621, p < 0.001) and investigational screening for memory in primary care (r = 0.559, p < 0.001), indicating that higher levels of fear are associated with increased motivation. Second, dementia literacy demonstrated positive correlations with motivation to change lifestyle and health behavior (r = 0.349, p < 0.001) and investigational screening (r = 0.269, p < 0.001), suggesting that more excellent knowledge enhances perceived ability. Lastly, both dementia literacy and personal dementia fear were positively correlated with motivation to change health behaviors, with respective effects of β = 0.266 and β = 0.595, highlighting their interactive role in shaping perceptions of risk reduction and screening.

IMPLICATION

The significant contributions of dementia literacy, personal dementia fear, and their interaction highlight the importance of these factors in accepting investigational screening for memory in primary care.

The Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for specialty care

US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or a related dementia (ADRD) are two decades old. This evidence-based guideline was developed to empower all clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. An expert workgroup conducted a review of 7374 publications (133 met inclusion criteria) and developed recommendations as steps in an evaluation process. This summary briefly reviews core recommendations and details specialist recommendations of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing, and disclosing the patient's cognitive functional status, cognitive-behavioral syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed; a companion article summarizes primary care recommendations. If clinicians use the recommendations in this guideline and health-care systems provide adequate resources, outcomes should improve in most patients in most practice settings. HIGHLIGHTS: US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. This summary focuses on recommendations appropriate for specialty practice settings, forming key elements of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing, and disclosing the patient's cognitive functional status, cognitive-behavioral syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed; a companion article summarizes primary care recommendations. If clinicians use this guideline and health-care systems provide adequate resources, outcomes should improve in most patients in most practice settings.

Systematic review and meta-analysis of repetitive transcranial magnetic stimulation (rTMS) for activities of daily living in Alzheimer's disease

OBJECTIVE

This systematic review of randomised controlled trials (RCTs) was conducted to assess the effect of repetitive transcranial magnetic stimulation (rTMS) on activities of daily living (ADLs) in Alzheimer's disease (AD) patients.

DATA SOURCES

Ten databases were retrieved for pertinent Chinese and English literatures published up until January 2024.

REVIEW METHODS

All RCTs of rTMS for ADLs in AD were included in this meta-analysis. Two researchers independently selected the literatures, retrieved the data of included literatures, accessed risk-of-bias of literatures with the Cochrane Collaboration's quality criteria and then cross-checked. Meta-analysis was carried out with Cochrane's Review Manager (RevMan, version 5.4). The PRISMA guidelines were followed in this systematic review.

RESULTS

The 37 literatures involving 2461 patients with AD were included in this study. Compared with the control groups received the interventions such as routine pharmacotherapy, cognitive training, ect., with/without sham-rTMS, the experiment groups received the interventions of the control groups and rTMS. The findings were as follows: ADL scale [mean difference (MD) = -3.92, 95%CI (-4.93, -2.91), P < 0.00001]; Barthel Index (BI) [MD = 9.75, 95% CI (6.66, 12.85), P < 0.00001]; Modified Barthel Index (MBI) [MD = 5.43, 95% CI (3.13, 7.73), P < 0.00001]. The differences were statistically significant for all indicators. In 29 studies, rTMS stimulation sites were located in the dorsolateral prefrontal cortex (DLPFC).

CONCLUSION

The rTMS could improve the ADLs in AD patients, and the DLPFC was a frequently used stimulation site of the rTMS for AD treatment.

Telemedicine in Alzheimer's disease and other dementias: Where we are?

The prevalence and global health burden of dementia including Alzheimer's disease (AD) is rising, while patients living in remote and underserved areas face significant challenges in reaching specialized care. Telemedicine offers a valuable solution in bridging this widening gap, by providing equal and timely access to tertiary-specialized centers. Accumulating evidence highlights that most parts of the remote neuropsychological and neurological evaluation are feasible, with patients, healthcare professionals and caregivers being generally satisfied with this means of care. Herein, we provide an updated overview of the available evidence on the use of telemedicine for patients with cognitive disorders, focusing on the different applications and settings, the remote, video-based neurological and neuropsychological assessment, current recommendations, non-pharmacological interventions, as well as legal and ethical considerations. Based on the literature review and our three-year experience in the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network" in the Aiginition University Hospital of Athens, we propose a brief guide for assessing patients with cognitive impairment via telemedicine and suggest future research directions for the more effective and appropriate use of telemedicine in dementia assessment and care.

Factors influencing advance care planning behaviors among geriatric nurses: knowledge, attitudes, and self-efficacy

OBJECTIVES

To explore the knowledge, attitudes, behaviors, and self-efficacy of geriatric nurses regarding Advance Care Planning (ACP) for older adults.

METHODS

Cross-sectional study of 281 geriatric nurses in a Northern Taiwan teaching hospital using ACP knowledge, attitudes, actions, and self-efficacy scales.

RESULTS

Nurses showed slightly insufficient ACP knowledge and self-efficacy, positive attitudes, and neutral behaviors. ACP attitudes (β = 0.11, p = 0.02) and self-efficacy (β = -0.37, p < 0.001) significantly correlated with behaviors. The nurses of the medical ward demonstrated more positive ACP behaviors than surgical ward nurses (β = 0.12, p = 0.02). The model explained 48.6 % of variance in ACP behaviors.

CONCLUSIONS

Enhance nurses' ACP self-efficacy through professional training and experiential learning programs, particularly for surgical ward nurses and those without hospice care consent experience. This can improve nurses' confidence in discussing care plans with patients and families, ensuring better end-of-life care quality.

Novel techniques for early diagnosis and monitoring of Alzheimer's disease

INTRODUCTION

Alzheimer's disease (AD) is the most common neurodegenerative disorder, which is characterized by a progressive loss of cognitive functions. The high prevalence, chronicity, and multimorbidity are very common in AD, which significantly impair the quality of life and functioning of patients. Early detection and accurate diagnosis of Alzheimer's disease (AD) can stop the illness from progressing thereby postponing its symptoms. Therefore, for the early diagnosis and monitoring of AD, more sensitive, noninvasive, straightforward, and affordable screening tools are needed.

AREAS COVERED

This review summarizes the importance of early detection methods and novel techniques for Alzheimer's disease diagnosis that can be used by healthcare professionals.

EXPERT OPINION

Early diagnosis assists the patient and caregivers to understand the problem establishing reasonable goals and making future plans together. Early diagnosis techniques not only help in monitoring disease progression but also provide crucial information for the development of novel therapeutic targets. Researchers can plan to potentially alleviate symptoms or slow down the progression of Alzheimer's disease by identifying early molecular changes and targeting altered pathways.

Oral Diseases Are Associated with Cognitive Decline and Dementia

Common oral diseases, including periodontitis and dental caries, and their endpoint as tooth loss are controllable yet highly prevalent among adults worldwide. Cognitive decline also poses significant global public health challenges during the aging process, especially the pathological form of cognitive decline such as dementia. Dementia is irreversible and is one of the leading causes of death, disability, and dependency in the aging population. Emerging research suggests a bidirectional association between oral diseases and cognitive decline or dementia. This potential link has implications for designing better oral care plans for patients with dementia and recognizing oral diseases as modifiable risk factors for dementia prevention.This chapter provides an overview of the association between oral diseases and cognitive decline, followed by a discussion of current evidence on such associations in two directions: (1) the impact of cognitive decline or dementia on oral health and (2) the role of oral diseases as modifiable risk factors for dementia. We critically evaluate several hypotheses regarding the underlying mechanisms of this association, including (1) life-course hypothesis, (2) shared inflammation and bacterial infection mechanisms, (3) malnourishment mechanism, (4) pain pathway, and (5) sensory feedback pathway.However, the association between oral diseases and cognitive decline or dementia remains controversial due to limited high-quality evidence, particularly from biomedical research. Much of the existing evidence is from observational studies prone to confounding bias, with inconclusive questions about causation and the direction of causality.This chapter concludes by emphasizing the need for future studies with robust methodological designs, including randomized controlled trials, biomedical studies, and innovative research techniques such as Mendelian randomization. Such studies are crucial for disease prevention and enhancing patient care and quality of life. By providing a comprehensive overview, this chapter contributes to an advanced understanding of this field, addresses current study gaps, and suggests future research directions.

Longitudinal associations between air pollution and incident dementia as mediated by MRI-measured brain volumes in the UK Biobank

BACKGROUND

Although there is increasing evidence that environmental exposures are associated with the risk of neurodegenerative conditions, there is still limited mechanistic evidence evaluating potential mediators in human populations.

METHODS

UK Biobank is a large long-term study of 500,000 adults enrolled from 2006 to 2010 age 40-69 years. ICD-10 classified reports of dementia cases up to 2022 (Alzheimer's disease, vascular dementia, dementia in other classified diseases, and unspecified dementia) were identified from health record linkage. Estimates of residential air pollution, traffic noise, and greenspace exposure have been modelled. Structural brain MRI was conducted from 2014 to 2022, with brain volumes relevant to dementia identified a priori. Associations between environmental exposures, brain volumes, and dementia cases (diagnosed post-MRI) were tested using linear and logistic regression and adjusted for age, sex, household income, ethnicity, education, smoking, and area-level deprivation. Mediation of exposure-outcome associations by plausible brain volumes (those associated with both environmental exposure and dementia outcomes) were modelled using the quasi-Bayesian Monte Carlo method (N = 34,817-39,772).

RESULTS

Small but significant mediating effects (2%-8% of relationships mediated) were observed between PM2.5abs exposure and dementia risk by reduced total brain volume, NOx and Alzheimer's disease risk by reduced peripheral cortical grey matter, PM2.5abs and vascular dementia risk by reduced peripheral cortical grey matter, PM2.5abs and other dementia risk by reduced total grey matter, and PM10 and other dementia risk by reduced total grey matter. Greenspace and noise were not associated with dementia outcomes in the subset of the cohort providing brain imaging data.

CONCLUSIONS

This study adds to existing evidence of associations between environmental exposures and dementia outcomes. Our findings provide novel evidence that differences in brain volume may mediate these relationships. Future research is required to prove this mechanism and establish the other mechanisms through which exposure to air pollution might increase dementia risk.

Pseudobulbar Affect Among Patients With Dementia

OBJECTIVE

Dementia is a neurocognitive disorder characterized by memory loss and deficits in multiple cognitive domains, caused by damage to or loss of neurons in the brain, which impairs one's abilities and capabilities for independent daily living. The etiologies of dementia are diverse, including vascular, infectious, traumatic, and neurodegenerative causes. The most common types of dementia include Alzheimer's dementia, vascular dementia, Lewy body dementia, and frontotemporal dementia. Patients with dementia frequently develop cognitive, psycho-behavioral, emotional, and mood symptoms. One largely unstudied mood symptom seen in dementia patients is pseudobulbar affect (PBA). PBA is a state of emotional incontinence characterized by episodes of uncontrolled crying or laughter that are inconsistent with the social context or the patient's emotional state. Although many neurological disorders may present with PBA, only a small fraction of the literature focuses on PBA in dementia patients. In the present study, we used the TriNetX database to identify a cohort of patients with both PBA and dementia. We describe this cohort to provide a foundation for further research on this patient population.

RESULTS

Seventy-three percent (n=182) of the cohort had postconcussion syndrome, 18% (n=44) had overt dementia, 49% (n=121) had mild cognitive impairment, and 42% (n=105) had some form of amnesia. Many patients had comorbid psychiatric disorders, including anxiety and depressive disorders.

CONCLUSIONS

The multitude of comorbid mood disorders and symptoms can complicate the clinical management of dementia patients, adding to their distress and that of their caregivers. Understanding these symptoms is essential for providing an accurate diagnosis and effective management of PBA in dementia.

Effects of eccentric versus stretching exercise training on cognitive function of older women

Exercises focusing on eccentric contractions may stimulate the brain better, improving cognitive function. We tested the hypothesis that executive function and attention would improve more after eccentric resistance exercise (ECC) than stretching exercise (STRETCH) training. Healthy older women (65-75 years) underwent either ECC (n = 14) or STRETCH (n = 14) intervention for 8 weeks. ECC consisted of seven exercises emphasizing eccentric contractions while STRETCH performed 12 stretching exercises, with supervised sessions undertaken twice weekly accompanied by a home-based program. Executive function and attention were assessed using the Stroop test of color naming (STCN) and conflicting color words, symbol digit modalities test, digit span test (DST), and trail making tests (TMT-A and TMT-B), and six physical function tests were undertaken before and after the 8-week training period. Fasting blood samples were obtained before and after the training. A significant (p < 0.05) group × time interaction effect was evident for STCN, DST, and TMT-A, with only ECC showing improvements (DST:14.7 ± 27% and TMT-A:10.2 ± 12%) from pre- to post-training. No significant changes in other cognitive function tests were found for either group. All physical function tests except one-leg balance test showed greater improvement (p < 0.05) for ECC than STRETCH. No significant changes in blood lipid profile and brain-derived neurotrophic factor were found, but serum glucose concentration and glycosylated hemoglobin decreased (p < 0.05) in ECC. These results suggest that a short-term body-weight eccentric exercise intervention was effective in enhancing components of cognitive and physical function of older women and may prove a useful strategy in combating age-related decline in cognitive and physical function.

Saccharomyces boulardii Ameliorates LPS-Induced Amyloidogenesis in Rats

Gut brain axis can affect the incidence of Alzheimer's disease (AD). Probiotics restore the homeostasis of gut dysbiosis and prevent AD. Here, we evaluated the impact of Saccharomyces boulardii on rats with lipopolysaccharide (LPS)-induced amyloidogenesis. Rats were classified into four groups: (1) Control (saline), (2) LPS 250 µg/kg (saline + LPS), (3) S. boulardii (1010 CFU/mL/rat), and (4) S. boulardii (1010 CFU/mL/rat) + LPS (250 μg/kg). The passive behavioral test, Western blotting, and immunohistochemistry were done using the animal hippocampi. Step-through latency (STL) indicated that the LPS-treated group had decreased memory retrieval compared to the control group. The LPS group had increased hippocampal levels of amyloid-β peptide, amyloid-β precursor protein (APP), and β-secretase (BACE). Administration of the S. boulardii before LPS prolonged STL which has been shortened in the LPS group (P < 0.05). In the LPS + S group, S. boulardii reduced the levels of APP significantly compared to the LPS group (P < 0.01). S. boulardii mitigated Aβ buildup and memory dysfunction caused by LPS through modulating the APP, BACE1, and Aβ pathways. Future studies are required to explain the neuroprotective effects of S. boulardii, since it could be a novel therapy or prevention strategy for AD.

Diagnosis of cognitive impairment and dementia: blood plasma and optical coherence tomography

Accurate and early diagnosis of Alzheimer's disease and vascular dementia is crucial for enabling timely interventions and improving patient outcomes. This study evaluates the diagnostic performance of plasma biomarkers (neurofilament light chain and phosphorylated tau181) and retinal biomarkers (retinal nerve fibre layer and ganglion cell-inner plexiform layer), individually and in combination, in differentiating moderate cognitive impairment and dementia from mild cognitive impairment and no cognitive impairment. A cross-sectional study was conducted involving 509 participants, aged 50 and older, recruited from a memory clinic. The participants were categorized as normal (n = 100), mild cognitive impairment (n = 144), moderate cognitive impairment (n = 90) or dementia (n = 175) based on detailed clinical assessments, neuropsychological testing and MRI scans. The thickness of the ganglion cell-inner plexiform layer (P < 0.001) and retinal nerve fibre layer (P = 0.030) decreased progressively from normal cognition to cognitive impairment and dementia. The thickest layers were observed in individuals with no cognitive impairment (mean ± standard deviation: ganglion cell-inner plexiform layer: 76 ± 11 µm, retinal nerve fibre layer: 92 ± 10 µm), while the thinnest layers were found in individuals with dementia (ganglion cell-inner plexiform layer: 72 ± 14 µm, retinal nerve fibre layer: 89 ± 12 µm). Plasma biomarker levels increased progressively from normal cognition to cognitive impairment and dementia (P < 0.001). Levels were lowest in individuals with no cognitive impairment [median (interquartile range): neurofilament light chain: 15 (9) pg/mL, phosphorylated tau181: 1.85 (1.00) pg/mL] and highest in those with dementia [neurofilament light chain: 34 (27) pg/mL, phosphorylated tau181: 3.24 (2.81) pg/mL]. After adjusting for retinal scan signal strength, neurofilament light chain showed a stronger negative association with retinal nerve fibre layer thickness [standardized beta estimate (β) = -0.184] and ganglion cell-inner plexiform layer thickness (β = -0.139) compared to phosphorylated tau181, which exhibited weaker associations with ganglion cell-inner plexiform layer (β = -0.091) and retinal nerve fibre layer (β = -0.059). While retinal parameters provided modest discriminatory ability (AUC = 0.60), plasma biomarkers demonstrated superior diagnostic performance (AUC = 0.76). Notably, neurofilament light chain had a stronger association with retinal thinning than phosphorylated tau181 and offered superior diagnostic value for identifying moderate cognitive decline. These findings underscore the potential of plasma biomarkers, particularly neurofilament light chain, for the early detection of dementia.

Shared Genetic Architecture Between COVID-19 Severity and Alzheimer's Disease Across European and African Ancestries

The global outbreak of COVID-19, caused by the SARS-CoV-2 virus, has been linked to long-term neurological complications, including an increased risk of Alzheimer's disease (AD) among older adults. However, the precise genetic impact of COVID-19 on long-term AD development remains unclear. This study leveraged genome-wide association study (GWAS) data and genotype data to explore the genetic association between AD and various COVID-19 phenotypes across European ancestry (EA) and African ancestry (AA) cohorts, and the possibility of a causal effect of COVID-19 on AD. We first calculated polygenic risk scores (PRSs) of three COVID-19 phenotypes in AD cases and controls from both EA and AA populations, then determined the genetic associations between COVID-19 PRSs and AD by logistic regression analyses with or without adjusting for age, sex, and APOE genotypes. Significant positive associations were found between AD diagnosis and COVID-19 PRSs in both populations, with the strongest associations identified in the AA population. However, Mendelian randomization (MR) analyses revealed no evidence of a causal effect of COVID-19 phenotypes on AD liability. We explored this finding further through the analysis of shared genomic regions between the COVID-19 phenotypes and AD and found a region of overlap on chromosome 17 that was highly pleiotropic for traits implicating immune function, psychiatric disorders, and lung function phenotypes. These findings suggest that while COVID-19 and AD share overlapping polygenic contributions involving peripheral genes across multiple traits, they lack a direct connection involving core genes that drive the development of their respective pathologies.

Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for primary care

US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or AD and related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. Through a modified-Delphi approach and guideline-development process (7374 publications were reviewed; 133 met inclusion criteria) an expert workgroup developed recommendations as steps in a patient-centered evaluation process. This summary focuses on recommendations, appropriate for any practice setting, forming core elements of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing, and disclosing the patient's cognitive functional status, cognitive-behavioral syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed; a companion article summarizes specialist recommendations. If clinicians use this guideline and health-care systems provide adequate resources, outcomes should improve in most patients in most practice settings. Highlights US clinical practice guidelines for the diagnostic evaluation of cognitive impairment due to Alzheimer's disease (AD) or AD and related dementias (ADRD) are decades old and aimed at specialists. This evidence-based guideline was developed to empower all-including primary care-clinicians to implement a structured approach for evaluating a patient with symptoms that may represent clinical AD/ADRD. This summary focuses on recommendations, appropriate for any practice setting, forming core elements of a high-quality, evidence-supported evaluation process aimed at characterizing, diagnosing, and disclosing the patient's cognitive functional status, cognitive-behavioral syndrome, and likely underlying brain disease so that optimal care plans to maximize patient/care partner dyad quality of life can be developed; a companion article summarizes specialist recommendations. If clinicians use this guideline and health-care systems provide adequate resources, outcomes should improve in most patients in most practice settings.

Development and validation of a self-administered computerized cognitive assessment based on automatic speech recognition

Existing computerized cognitive tests (CCTs) lack speech recognition, which limits their assessment of language function. Therefore, we developed CogMo, a self-administered CCT that uses automatic speech recognition (ASR) to assess multi-domain cognitive functions, including language. This study investigated the validity and reliability of CogMo in discriminating cognitive impairments. CogMo automatically provides CCT results; however, manual scoring using recorded audio was performed to verify its ASR accuracy. The mini-mental state examination (MMSE) was used to assess cognitive functions. Pearson's correlation was used to analyze the relationship between the MMSE and CogMo results, intraclass correlation coefficient (ICC) was used to evaluate the test-retest reliability of CogMo, and receiver operating characteristic (ROC) analysis validated its diagnostic accuracy for cognitive impairments. Data of 100 participants (70 with normal cognition, 30 with cognitive impairment), mean age 74.6±7.4 years, were analyzed. The CogMo scores indicated significant differences in cognitive levels for all test items, including manual and automatic scoring for the speech recognition test, and a very high correlation (r = 0.98) between the manual and automatic CogMo scores. Additionally, the total CogMo and MMSE scores exhibited a strong correlation (r = 0.89). Moreover, CogMo exhibited high test-retest reliability (ICC = 0.94) and ROC analysis yielded an area under the curve of 0.89 (sensitivity = 90.0%, specificity = 82.9%) at a cutoff value of 68.8 points. The CogMo demonstrated adequate validity and reliability for discriminating multi-domain cognitive impairment, including language function, in community-dwelling older adults.

Early Detection of Dementia in Populations With Type 2 Diabetes: Predictive Analytics Using Machine Learning Approach

BACKGROUND

The possible association between diabetes mellitus and dementia has raised concerns, given the observed coincidental occurrences.

OBJECTIVE

This study aimed to develop a personalized predictive model, using artificial intelligence, to assess the 5-year and 10-year dementia risk among patients with type 2 diabetes mellitus (T2DM) who are prescribed antidiabetic medications.

METHODS

This retrospective multicenter study used data from the Taipei Medical University Clinical Research Database, which comprises electronic medical records from 3 hospitals in Taiwan. This study applied 8 machine learning algorithms to develop prediction models, including logistic regression, linear discriminant analysis, gradient boosting machine, light gradient boosting machine, AdaBoost, random forest, extreme gradient boosting, and artificial neural network (ANN). These models incorporated a range of variables, encompassing patient characteristics, comorbidities, medication usage, laboratory results, and examination data.

RESULTS

This study involved a cohort of 43,068 patients diagnosed with type 2 diabetes mellitus, which accounted for a total of 1,937,692 visits. For model development and validation, 1,300,829 visits were used, while an additional 636,863 visits were reserved for external testing. The area under the curve of the prediction models range from 0.67 for the logistic regression to 0.98 for the ANNs. Based on the external test results, the model built using the ANN algorithm had the best area under the curve (0.97 for 5-year follow-up period and 0.98 for 10-year follow-up period). Based on the best model (ANN), age, gender, triglyceride, hemoglobin A1c, antidiabetic agents, stroke history, and other long-term medications were the most important predictors.

CONCLUSIONS

We have successfully developed a novel, computer-aided, dementia risk prediction model that can facilitate the clinical diagnosis and management of patients prescribed with antidiabetic medications. However, further investigation is required to assess the model's feasibility and external validity.

Development of coumarin-inspired bifunctional hybrids as a new class of anti-Alzheimer's agents with potent in vivo efficacy

Considering the multifactorial and complex nature of Alzheimer's disease and the requirement of an optimum multifunctional anti-Alzheimer's agent, a series of triazole tethered coumarin-eugenol hybrid molecules was designed as potential multifunctional anti-Alzheimer's agents using donepezil and a template. The designed hybrid molecules were synthesized via a click chemistry approach and preliminarily screened for cholinesterase and Aβ1-42 aggregation inhibition. Among them, AS15 emerged as a selective inhibitor of AChE (IC50 = 0.047 μM) over butyrylcholinesterase (BuChE: IC50 ≥ 10 μM) with desired Aβ1-42 aggregation inhibition (72.21% at 50 μM) properties. In addition, AS15 showed protective effects against DNA damage caused by hydroxyl radicals originating from H2O2. Molecular docking and simulation studies confirmed the favorable interactions of AChE and the Aβ1-42 monomer desired for their inhibition. AS15 exhibited an LD50 value of 300 mg kg-1 and showed significant improvements in memory and learning behavior in scopolamine-induced cognition impairment mouse-based animal models (Y-maze test and Morris water maze test) for behavioral analysis. Overall outcomes suggest AS15 as a potential preclinical multifunctional candidate for the management of Alzheimer's disease, and it serves as a promising lead for further development of potent and safer multifunctional anti-Alzheimer's agents.

The Needs and Experiences of People With Early-Stage Dementia Using an Application for Cognitive and Physical Activation in Germany: Qualitative Study

Background

The demand for support among people with dementia is increasing, while caregiving capacity is declining. As the trend of aging at home continues, technologies can help maintain the autonomy of people with dementia, enabling them to live independently for as long as possible. Furthermore, digital applications can have numerous positive biopsychosocial effects on the health of people with dementia, enhancing their physical, cognitive, and social functioning.

Objective

This study aims to investigate the needs and experiences of people with dementia regarding a prototype tablet-based application designed to promote cognitive and physical activity.

Methods

We conducted a methodical triangulation by combining semistructured interviews with people with dementia and external overt participant observation while testing a tablet-based application. A qualitative content analysis, as outlined by Kuckartz, was used to analyze the data.

Results

Participants demonstrated varying levels of ability and prior experience with technology. While most were initially hesitant to use the tablet independently, they were more willing to try it after receiving encouragement. Some individuals required more assistance than others, indicating the need for individualized adjustments. Personal relevance to the content appeared to be crucial for cognitive tasks, as it helped to minimize overload for people with dementia. The participants appreciated social interaction with researchers and direct communication. Therefore, it is important to consider the role of personal support when developing and implementing technology.

Conclusions

The successful implementation and use of technology requires acceptance and an effective interaction between people with dementia, technology, and caregivers or caring relatives providing personal support. The acceptance of the application was found to be less influenced by the types and presentation of tasks and more by content relevance and social interaction. Ideally, one-on-one support will be provided during use, though this requires additional time and financial resources, which are often limited in caregiving settings.

New Insights into the Role of SGLT-2 Inhibitors in the Prevention of Dementia

Diabetes mellitus (DM) is a chronic disease associated with numerous complications, including cardiovascular diseases, nephropathy, and neuropathy. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, a class of novel antidiabetic agents, have demonstrated promising therapeutic effects beyond glycemic control, with potential benefits extending to the cardiovascular and renal systems. Recently, research has increasingly focused on exploring the potential role of SGLT-2 inhibitors in preventing dementia. The aim of this review is to summarize the current research suggesting that SGLT-2 inhibitors, such as empagliflozin and dapagliflozin, may have neuroprotective effects that reduce dementia risk and improve cognitive function in type 2 diabetes patients. These benefits are likely due to better glycemic control, reduced oxidative stress, and less advanced glycation end-product (AGE) formation, all linked to neurodegeneration. Despite these promising findings, existing studies are limited by small sample sizes and short follow-up durations, which may not adequately capture long-term outcomes. To establish more robust evidence, larger-scale, long-term randomized controlled trials (RCTs) involving diverse populations are needed. These studies should involve diverse populations and focus on understanding the mechanisms behind the neuroprotective effects. Addressing these limitations will provide clearer guidelines for using SGLT-2 inhibitors in dementia prevention and management. This will help improve therapeutic strategies for cognitive health in diabetic patients.

Redox regulation, protein S-nitrosylation, and synapse loss in Alzheimer's and related dementias

Redox-mediated posttranslational modification, as exemplified by protein S-nitrosylation, modulates protein activity and function in both health and disease. Here, we review recent findings that show how normal aging, infection/inflammation, trauma, environmental toxins, and diseases associated with protein aggregation can each trigger excessive nitrosative stress, resulting in aberrant protein S-nitrosylation and hence dysfunctional protein networks. These redox reactions contribute to the etiology of multiple neurodegenerative disorders as well as systemic diseases. In the CNS, aberrant S-nitrosylation reactions of single proteins or, in many cases, interconnected networks of proteins lead to dysfunctional pathways affecting endoplasmic reticulum (ER) stress, inflammatory signaling, autophagy/mitophagy, the ubiquitin-proteasome system, transcriptional and enzymatic machinery, and mitochondrial metabolism. Aberrant protein S-nitrosylation and transnitrosylation (transfer of nitric oxide [NO]-related species from one protein to another) trigger protein aggregation, neuronal bioenergetic compromise, and microglial phagocytosis, all of which contribute to the synapse loss that underlies cognitive decline in Alzheimer's disease and related dementias.

Geriatric drug delivery - barriers, current technologies and the road ahead

The geriatric population encompasses the largest part of the health care system worldwide. Chronic medical conditions are highly prevalent in the elderly, consequently, due to their complex health needs, there is a significant rate of multi-drug therapy. Despite the high numbers of medications prescribed, geriatric patients face several barriers when it comes to successful drug delivery including alterations in cognitive and physical function. The current review highlights the impact of chronic diseases on the ageing population along with how changes in drug pharmacokinetics could impact drug efficacy and safety. Also discussed are applications of administration routes in the geriatric population and complications that could arise. A focus is placed on the traditional and upcoming drug delivery advancements being employed in seniors with a focus addressing obstacles faced by this patient category. Nanomedicines, three-dimensional printing, long-acting formulations, transdermal systems, orally disintegrating tablets, and shape/taste modification technologies are discussed. Several barriers to drug delivery in the elderly have been identified in literature and directions for future studies should focus on addressing these gaps for geriatric drug formulation development including personalised medicine, insights into novel drug delivery systems like nanomedicines, methods for decreasing pill burden and shape/size modifications.ARTICLE HIGHLIGHTSTypically, senior citizens take more medications than any other patient population, yet most drug delivery technologies are not tailored to address the specific cognitive and physical barriers that these individuals encounter.The safety of drug delivery systems in the elderly patients should be prioritised with considerations on changes in pharmacokinetics with age, use of non-toxic excipients, and selecting drugs with minimal off-target side effects.Several commercialised and upcoming drug delivery technologies have begun to address the current limitations that the ageing population faces.Future research should focus on applying novel strategies like 3D printing, personalised medicine, and long-acting formulations to improve drug delivery to elderly patients.

Prevalence of involuntary treatment among community-living older persons with dementia: A systematic review

OBJECTIVE

This systematic review and meta-analysis aimed to ascertain the prevalence of involuntary treatment among community-living older persons with dementia and explore associated factors.

METHODS

We comprehensively searched seven electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, and Scopus) from their inception to October 17, 2023, with an update conducted on April 1, 2024. Meta-analysis synthesized prevalence estimates of involuntary treatment and its three subcategories, with 95% confidence intervals.

RESULTS

This study included 11 research papers involving 12,136 community-dwelling individuals with cognitive impairment and dementia from 19 countries. The pooled prevalence of involuntary treatment among community-dwelling older persons with dementia was 45.2% (95% CI: 33.7-60.5%). Subcategories included physical restraints (9.8%, 95% CI: 5.1-18.8%), psychotropic medication (19.1%, 95% CI: 13.6-26.9%), and non-consensual care (34.3%, 27.6-42.7%). Factors influencing involuntary treatment were categorized as caregiver-related and care recipient-related.

CONCLUSION

This study underscores the prevalent use of involuntary treatment among community-dwelling older persons with dementia, emphasizing its association with specific caregiver and care recipient factors. Addressing these findings underscores the importance of proactive measures and targeted interventions to improve the quality of care for this vulnerable population.

Association of Open-Angle Glaucoma With Dementia in California Medicare Beneficiaries

PURPOSE

To examine the associations between open-angle glaucoma (OAG) subtypes and dementia in 2019 California Medicare beneficiaries.

DESIGN

Retrospective cross-sectional study.

METHODS

OAG diagnosis was determined by the International Classification of Diseases, Tenth Revision (ICD-10), diagnosis codes in part B claims, including the following OAG subtypes: primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), pseudoexfoliative glaucoma (PXG), and pigmentary glaucoma (PG). Diagnoses of any dementia, Alzheimer dementia (AD), frontotemporal dementia (FTD), Lewy body dementia (LBD), and vascular dementia (VD) were identified by ICD-10 diagnosis codes. Covariates included demographics, systemic diseases, depression, hearing loss, obesity, smoking and alcohol-related disorders, and long-term aspirin, anticoagulant, and antithrombotic or antiplatelet use. Univariate and multivariable logistic regression models were used to assess the associations between OAG and dementia, adjusting for all covariates. Age-stratified analysis was also performed for beneficiaries aged 65-74 years, 75-84 years, and ≥85 years.

RESULTS

Among the 2,431,150 California Medicare beneficiaries included in this study, 104,873 (4.3%) had POAG, 9199 (0.4%) had NTG, 4045 (0.2%) had PXG, and 1267 (0.05%) had PG. The overall prevalence of any dementia was 3.2% (n = 79,009). In adjusted analyses, the odds of any dementia were lower for beneficiaries with all OAG subtypes compared with beneficiaries without glaucoma (odds ratio [OR] = 0.74 for POAG, OR = 0.74 for PXG, OR = 0.60 for NTG, and OR = 0.38 for PG; P < .01). In age-stratified analyses, beneficiaries with PXG had greater odds of VD (OR 2.84, P = .006; aOR 2.18, P = .04) in the youngest age stratum (65-74 years) compared to patients with no glaucoma. The odds for any dementia were lower for beneficiaries with all OAG subtypes compared to beneficiaries without glaucoma in the oldest, but not in the youngest, age stratum.

CONCLUSIONS

In the 2019 California Medicare population, PXG is associated with an increased likelihood of VD in beneficiaries 65-74 years old, whereas other subtypes of POAG are associated with a decreased likelihood of any dementia. These findings may suggest selection bias because older adults who continue to follow up with glaucoma care may be more cognitively intact. Further studies are needed to better understand the complex relationship between glaucoma, dementia, and their subtypes.