Diagnosis and Management of Dementia: Review

Elucidating the mechanisms of Shenwu Capsule in improving the cognitive decline in aging based on the UPLC-Q-TOF-MS, network pharmacology, and experimental validation

Given the growing incidence of dementia-related disorders in the aging population, identifying effective treatments for age-related cognitive decline (ARCD) is crucial. Shenwu Capsule (SWC), shown to have therapeutic efficacy in phase III clinical trials for senile dementia, has unclear mechanisms and active ingredients. Aged mice were administered SWC orally for three months, and behavioral tests, including the Morris water maze, Y maze, and novel object recognition, assessed learning and memory. Neuronal damage was evaluated using histopathology, and the levels of Aβ and phosphorylated tau proteins were measured. UPLC-Q-TOF-MS identified 11 components of SWC capable of crossing the blood-brain barrier (BBB), and network pharmacology was employed to explore their potential mechanisms. Through various detection methods, including transmission electron microscopy, Western blotting, qRT-PCR, ELISA, and immunofluorescence, six key targets (AKT1, TNF, TP53, SRC, EGFR, BCL2) were elucidated. GO and KEGG pathway analyses revealed that the PI3K/Akt signaling pathway plays a crucial role in the pharmacological effects of SWC. SWC was found to suppress neuronal apoptosis by activating the PI3K/Akt/Bcl-2 signaling pathway, as demonstrated by changes in mRNA and protein levels. Histological analysis further showed that SWC treatment restored mitochondrial morphology in the hippocampus of aged mice. Molecular docking simulations confirmed strong binding affinities between the active components and key targets. Psoralidin, a component with strong molecular docking potential, was shown in vitro to activate the PI3K/Akt/Bcl-2 pathway, reduce ROS, decrease apoptosis, improve mitochondrial morphology, and stabilize mitochondrial membrane potential. These protective effects were blocked by the PI3K inhibitor LY294002. Overall, SWC ameliorates ARCD through modulation of the PI3K/Akt/Bcl-2 signaling pathway, with psoralidin identified as a potential active ingredient.

Underdiagnosis of dementia in residents of residential aged care services: A scoping review

OBJECTIVE

Dementia is a leading cause of disability, dependence and death worldwide. Timely diagnosis and management of dementia are essential in the community and residential aged care services (RACS) or nursing homes. Underdiagnosis of dementia in RACS may negatively impact the quality of care, resulting in adverse health outcomes. Hence the objective is to review estimates of the prevalence of dementia underdiagnosis, potential associated factors, consequences and evidence of interventions targeting to reduce this underdiagnosis.

METHODS

Guided by Arksey and O'Malley's scoping review framework, this scoping review was conducted as per the PRISMA extension for Scoping Reviews (PRISMA-ScR). Databases were searched to 31 January 2024 for studies published in English since 2010 in Ovid®, including Scopus, MEDLINE, Embase, Emcare and PubMed Central, as well as CINHAL Ultimate, PsycINFO and ProQuest. After removing duplicates, 545 studies proceeded to title, abstract and full-text screening, resulting in four eligible studies. Two additional studies were identified through reference searching.

RESULTS

A total of six studies were included. Most studies were conducted in the last 5 years. The prevalence of dementia underdiagnosis in RACS was 14%-70%. Different scales were applied to identify dementia. Findings from two studies suggested dementia underdiagnosis is more common among those with less severe disease. No studies investigated health outcomes or explored interventions to reduce dementia underdiagnosis.

CONCLUSIONS

Estimates of underdiagnosis in RACS are high and variable. More research is required to clarify factors associated with dementia underdiagnosis in RACS, its consequences and potential interventions to reduce its risk.

Differential involvement of neurotransmitter pathways in AD, bvFTD and MCI: Whole-brain MRI analysis

BACKGROUND AND OBJECTIVES

Neurodegenerative diseases, including Alzheimer's disease (AD), mild cognitive impairment (MCI), and frontotemporal dementia (FTD), are a growing public health challenge, with dementia incidence projected to triple in the coming decades. AD is associated with memory impairment, bvFTD with behavioral dysfunction, and MCI as a transitional stage between normal cognition and dementia. While structural brain changes have been widely studied, the role of neurotransmitter pathways remains underexplored. This study aims to correlate gray matter atrophy in AD, bvFTD, and MCI with neurotransmitter pathways to identify distinctive neurochemical impairments.

METHODS

We included 214 participants (89 CE, 74 bvFTD, 51 MCI) from a single-center cohort. MRI from 3 T scanners was segmented via FreeSurfer. Neurotransmitter maps were sourced from JuSpace. We performed volumetric and whole-brain correlation analyses to evaluate relationships between brain regional volumes (BRVs) and neurotransmitter pathways. Group differences were assessed with Kruskal-Wallis tests followed by post-hoc analyses.

RESULTS

Volumetric analysis showed expected atrophy patterns in each group. Correlation analysis indicated distinct neurotransmitter involvement: AD showed significant atrophy correlations with dopamine D2 and GABA A receptor distribution; bvFTD had significant negative correlations with the mu-opioid receptor; MCI exhibited early serotonergic dysregulation.

CONCLUSIONS

We identified distinct atrophy patterns linked to specific neurotransmitter systems, each showing unique neurochemical profiles. In AD, precuneus and inferior parietal lobules atrophy aligns with dopaminergic and GABAergic receptors, potentially impacting memory and executive functions. In bvFTD, medial orbitofrontal and temporal atrophy, is linked to mu-opioid receptor impairment, possibly contributing to behavioral symptoms. In MCI, early serotonergic dysregulation involving SERT occurs before detectable atrophy.

Evidence from a Mendelian randomization study: Delirium's noncausal role in dementia onset

BACKGROUND

Previous observational studies have suggested a possible association between dementia and delirium. However, these findings might be influenced by confounding variables. Thus, our study aimed to investigate the causal relationship between dementia and delirium using a bidirectional Mendelian randomization (MR) analysis.

METHODS

In our investigation, bidirectional MR analysis was conducted by summary statistics from genome-wide association studies (GWAS). This enabled us to evaluate the causal impact of delirium and different types of dementia, such as Alzheimer's dementia (AD), vascular dementia (VaD) and Lewy body dementia (LD).

RESULTS

According to MR analysis, there was a significant positive correlation between delirium risk and AD (odds ratio [OR] = 1.363; 95 % confidence interval [CI], 1.223-1.519; p = 2.140E-08) and LD (OR = 1.403; 95 % CI, 1.151-1.711; p = 8.226E-04). However, the analysis also revealed that there was no causal relationship between VaD (OR = 1.044; 95 % CI = 1.136-1.027; p = 0.316) and the risk of delirium. Additionally, our study does not provide evidence to support a causal correlation between delirium and the risk of developing any form of dementia.

CONCLUSION

The results of the MR analysis suggest a potential causal link between dementia and an increased risk of delirium. Nevertheless, it should be emphasized that the existing evidence does not provide support for a causal connection in the reverse direction, implying that delirium may not play a causative role in the onset of dementia.

Effects of Dyadic Psychosocial Education on People Living with Cognitive Impairment and Their Informal Caregivers: A Systematic Review and Meta-Analysis

OBJECTIVES

Cognitive impairment places a substantial burden on both patients and caregivers. Dyadic psychosocial education may be a potential solution, but its effects have not been systematically evaluated. This study aimed to evaluate the effects of dyadic psychosocial education on outcomes and dyadic relationships among cognitively impaired adults and their informal caregivers.

DESIGN

Systematic review and meta-analysis.

SETTINGS AND PARTICIPANTS

People living with cognitive impairment and their informal caregivers.

METHODS

Six electronic databases were systematically searched from January 1, 2004, to October 13, 2024. Two researchers independently screened the literature by title, abstract, and full text. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias for included studies. A meta-analysis was performed using a random effects model, followed by subgroup and sensitivity analyses.

RESULTS

Sixteen studies representing 2446 dyads were identified. No effects were found on overall neuropsychiatric symptoms, agitation, apathy, or depression, nor caregiver quality of life and depression. Pooled results showed dyadic psychosocial education significantly reduced dyadic conflict (SMD = -0.42, 95% CI: -0.66 to -0.18, I2 = 0). No significant effects of dyadic psychosocial education were found on overall cognitive function (SMD = 0.12, 95% CI: -0.13 to 0.38, I2 = 69%) or caregiver burden (SMD = -0.20, 95% CI: -0.43 to 0.03, I2 = 56%). However, subgroup analyses indicated that interventions ≤6 months improved overall cognitive function (SMD = 0.30, 95% CI: 0.06-0.54, I2 = 19%) and reduced caregiver burden (SMD = -0.26, 95% CI: -0.51 to -0.01, I2 = 32%).

CONCLUSIONS AND IMPLICATIONS

These findings demonstrate that dyadic psychosocial education can reduce dyadic conflict. The intervention also benefited cognitive function and caregiver burden, but the intervention duration influenced the effectiveness. Given the instability of the results, the findings of this study need to be interpreted with caution.

Vascular and glymphatic dysfunction as drivers of cognitive impairment in Alzheimer's disease: Insights from computational approaches

Alzheimer's disease (AD) is driven by complex interactions between vascular dysfunction, glymphatic system impairment, and neuroinflammation. Vascular aging, characterized by arterial stiffness and reduced cerebral blood flow (CBF), disrupts the pulsatile forces necessary for glymphatic clearance, exacerbating amyloid-beta (Aβ) accumulation and cognitive decline. This review synthesizes insights into the mechanistic crosstalk between these systems and explores their contributions to AD pathogenesis. Emerging machine learning (ML) tools, such as DeepLabCut and Motion sequencing (MoSeq), offer innovative solutions for analyzing multimodal data and enhancing diagnostic precision. Integrating ML with imaging and behavioral analyses bridges gaps in understanding vascular-glymphatic dysfunction. Future research must prioritize these interactions to develop early diagnostics and targeted interventions, advancing our understanding of neurovascular health in AD.

Music-based interventions for anxiety and depression in older adults with dementia: A systematic review of randomized controlled trials

OBJECTIVE

The objective of this systematic review was to synthesize evidence from randomized controlled trials (RCTs) regarding the efficacy of music-based interventions (MBIs) in improving anxiety and depression in older adults with dementia.

METHODS

Relevant RCTs were identified through searches in electronic databases, including PubMed, Embase, EBSCOhost, Scopus, Web of Science, APA PsycINFO, and Google. The Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to evaluate the risk of bias in the included trials. A narrative synthesis of the included trials was conducted.

RESULTS

Nine RCTs involving 496 patients met the inclusion criteria; five trials evaluated the efficacy of MBIs for anxiety, and six trials evaluated their efficacy for depression in older adults with dementia. Of the nine trials, two reported significant improvements in anxiety in older adults with dementia following MBIs (Cohen's d = -1.71 to -2.48), while one trial reported significant improvements in depression (Cohen's d = -0.66).

CONCLUSIONS

Only a few trials support the efficacy of MBIs in alleviating negative emotions in older adults with dementia, as evidenced by three out of the nine trials. However, due to the small sample sizes and heterogeneity in dementia types, stages, and interventions, quantitative results were not pooled, making it challenging to draw reliable conclusions. Further validation and examination of the findings presented in this study are warranted to strengthen the evidence base for integrating MBIs into dementia care and treatment protocols.

Value of blood neural cell-derived small extracellular vesicles in the diagnosis and prediction of Alzheimer's disease: A systematic revie

Blood neural cell-derived small extracellular vesicles (sEVs) can directly reflect changes in brain tissue and are easier to obtain than cerebrospinal fluid. This article systematically reviews the alterations of proteins and miRNAs from neural cell-derived sEVs in patients with Alzheimer's disease (AD), and summarizes the biomarkers with clinical diagnostic and predictive value. PubMed, Web of Science, Embase, and Cochrane Library were searched for studies in blood neural cell-derived sEVs in AD patients up to May 2024. According to the inclusion and exclusion criteria, the literature was screened, the information was extracted and the quality was evaluated. Proteins and miRNAs from neural cell-derived sEVs were classified and summarized, focusing on target molecules with high diagnostic and predictive values for AD. A final 34 articles reporting 5601 participants were included. In cross-sectional studies, Aβ- and Tau-related proteins (Aβ42, Aβ42/40, p-S396-Tau, p-Tau181), p-S312-IRS-1, and cathepsin D were increased, conversely, synaptic proteins (neurogranin, synaptotagmin, synaptophysin, synaptopodin, NMDAR2A) and REST were decreased in blood neuron-derived sEVs (NDsEVs) of patients with AD. While miR-29c-3p was increased in blood NDsEVs and glial cell-derived sEVs. Each of these proteins and miRNAs demonstrated high AD diagnostic value. Additionally, blood astrocyte-derived sEVs (ADsEVs) showed increased complement effector proteins and decreased complement regulatory proteins with a moderate diagnostic value. In longitudinal cohort studies, three composite models displayed high predictive efficacy for early AD prediction, and could predict the occurrence of AD within 1-10 years. Therefore, Aβ- and Tau-related proteins, synaptic proteins, and miRNA in blood neural cell-derived sEVs demonstrate high AD diagnostic and predictive values serving as important biomarkers. Especially, synaptic proteins showed significant changes in the early clinical stage, which has early predictive value.

Comparative effectiveness of different dual task mode interventions on cognitive function in older adults with mild cognitive impairment or dementia: a systematic review and network meta-analysis

OBJECTIVES

To evaluate and compare the effects of different dual task interventions on cognitive function in older adults with cognitive impairment or dementia.

METHODS

We searched eight databases, including PubMed, Cochrane Library, and EMBASE, to obtain studies exclusively comprising randomized controlled trials on dual task interventions in individuals aged 60 and older with mild cognitive impairment or dementia, up to July 28, 2024. Study quality was evaluated using the Cochrane Risk of Bias Tool. Analyses included pairwise meta-analyses via Review Manager 5.4 and network meta-analyses via Stata 14.0.

RESULTS

A total of 32 RCTs involving 2370 participants were included. Dual cognitive task training had the most significant impact on global cognition (SUCRA = 79.2%, mean rank = 1.6) and motor-cognitive dual task training was the only dual task intervention with a notable improvement in executive function (SMD = 1.53, 95% CI 0.06-3.01). For physical function, dual motor task training was most effective, improving gait performance (SMD = 0.34), muscle strength (SMD = 0.28), and balance (SMD = 0.90). Motor-cognitive dual task training demonstrated the greatest effectiveness in enhancing activities of daily living (SMD = 1.50) and quality of life (SMD = 1.20), while reducing depressive symptoms (SMD = - 0.96).

CONCLUSIONS

Dual cognitive task training is the most effective dual task intervention for enhancing global cognition. Motor-cognitive dual task training is the only dual task mode that significantly improves executive cognition.

Development of a 12-Word Version of a Verbal Learning Test for Persian-Speaking Older Adults: Reliability, Construct Validity, and Normative Standards

OBJECTIVE

As people enter old age, they develop diseases, challenges, and cognitive and behavioral deficits that are associated with decreased abilities. Memory abilities and deficiencies and impaired models can be assessed using neuropsychological instruments, and a rehabilitation program can be developed based on the individuals' memory deficits. The present cross-sectional research aims to develop a new test (henceforth known as the Persian Verbal Learning Test, or PVLT) that is appropriate for Persian-speaking older adults.

METHODS

For normative data, we administered PVLT to a group of 374 Persian-speaking healthy older adults consisting of both genders (190 women and 184 men) who were aged 60-89 years old. To determine reliability and validity, we evaluated neurologically healthy older adults and analyzed the results using intraclass correlation coefficient (ICC) and Pearson's correlation coefficient.

RESULTS

The present findings showed that age, education, and gender significantly affect subtests of the PVLT. In the evaluation of reliability, significant positive correlations were observed between the variables of the PVLT in the standard/standard form. Furthermore, moderate correlations were observed between PVLT variables (immediate recall, short-delay recall, long-delay recall, and recognition), and the Immediate and Delayed Logical Memory subtests of Wechsler Memory Scale-Revised (WMS-R). However, subtests of the PVLT also showed significantly positive correlations with MoCA and non-verbal variables of WMS-R.

CONCLUSION

According to the results of this study and given the good psychometric properties obtained, PVLT can potentially be used as a more appropriate tool than the SVLT for Persian-speaking older adults.

Scoping review exploring the impact of hip fracture in older adults with cognitive impairment or dementia

OBJECTIVES

This review summarises the impact of hip fractures on health outcomes including subsequent falls, hospitalisation, length of hospital stay (LOS), functional status, quality of life and mortality in older adults with cognitive impairment or dementia. It also explores the risk of institutionalisation following a hip fracture in this population.

DESIGN

A scoping review following the Arksey and O'Malley framework guided by the Joanna Briggs Institute methodology and adheres to Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines.

DATA SOURCES

A comprehensive search strategy was developed to search MEDLINE, EMBASE, CINAHL and grey literature, with additional references identified through citation searching and Web of Science.

ELIGIBILITY CRITERIA

Studies were included if they examined older adults with cognitive impairment or dementia who experienced a hip fracture and reported outcomes related to hospitalisation, functional status, quality of life, mortality or institutionalisation.

DATA EXTRACTION AND SYNTHESIS

Study selection and data extraction were conducted independently by two reviewers using Covidence software. A narrative synthesis approach was employed to summarise findings and identify key themes, patterns and gaps in the literature.

RESULTS

We identified 30 studies reporting health outcomes following hip fracture. Overall, the studies indicated that individuals with cognitive impairment or dementia have higher hospitalisation rates, poorer walking ability and functional outcomes, as well as reduced quality of life posthip fracture. The LOS for individuals with dementia following hip fracture was inconsistent across studies, with some reporting shorter LOS and others indicating longer LOS. Individuals with dementia consistently exhibit higher mortality rates at 30 days, 90 days and 1-year postfracture compared with those without dementia. We found 21 studies that evaluated the risk of institutionalisation following a hip fracture. Older adults with dementia were significantly more likely to be institutionalised posthip fracture, with nearly five times the risk of failing to return home compared with those without dementia. This increased risk persists up to 1-year postfracture and is particularly pronounced in those with severe cognitive impairment, with higher rates of nursing home placement observed among individuals with hip fractures.

CONCLUSION

Older adults with cognitive impairment or dementia experience significantly worse outcomes following hip fractures, including higher mortality, poorer functional outcomes, reduced quality of life and a higher risk of institutionalisation postfracture. Future research should focus on developing effective strategies for fracture prevention, including optimising osteoporosis treatment in this high-risk population, and developing targeted interventions to improve the impact of fractures on functional outcomes and reduce institutionalisation rates in this vulnerable population.

The protective effects of insulin on the developing of dementia in chronic kidney disease patients with hypertension and diabetes: a population-based nationwide study

BACKGROUND

Chronic kidney disease (CKD), hypertension, and diabetes are associated with dementia, and insulin resistance promotes vascular dysfunction resulting in dementia. However, the study of insulin use in preventing dementia in CKD patients with diabetes and hypertension is limited. We aim to assess the effects of insulin use on the incidence of dementia in patients with CKD with hypertension and diabetes.

DESIGN, SETTING AND PARTICIPANTS

A retrospective cohort study using the nationwide database from Taiwan's National Health Insurance Research Database. We selected 11,758 CKD patients with diabetes and hypertension in 2006, including 5,864 insulin users and 5,894 non-insulin users. Moreover, their medication possession ratios (MPR) were calculated.

MAIN OUTCOMES

We used the competing risk model to estimate the hazard ratio (HR) for the incidence of dementia for insulin use in the target population.

RESULTS

In a follow-up period of 11 years, 1285 events of dementia were recorded, and the multivariate-adjusted HR for dementia by insulin usage (yes vs. no) and insulin usage per MPR is 0.652 (95% confidence interval [CI]: 0.552 to 0.771) and 0.995 (95% CI: 0.993 to 0.998) respectively. Such a significant negative association was consistent in almost all subgroups. Moreover, a dose-dependent effect of insulin was noted, where patients with higher insulin MPRs were less likely to have dementia.

CONCLUSION

The CKD patients with hypertension and diabetes who received insulin therapy had a 35% decreased risk of dementia.

Association between social networking and dementia: A systematic review of observational studies

Poor social networking (SN) is associated with the development of cognitive impairment and dementia. Our objective was to perform a systematic review of the evidence on the associations between SN and the incidence of dementia, disease pathology, level of cognition, and brain structure. Bibliographic databases (PubMed, Embase, Cochrane Library, CINAHL) and additional sources (Open Gray, Google Scholar, manual searches) were screened through November 30, 2024. Observational studies assessing the SN-dementia link were selected, with data extraction and bias evaluation performed independently by two authors via the PRISMA checklist and Newcastle-Ottawa Scale. We included 17 observational studies (355 initially screened), involving 20,678 participants aged 40-90 years, published between 2000 and 2024. Studies have utilized various SN assessment tools and cognitive measures, including the MMSE and MoCA. Poor SN was consistently associated with increased risks of dementia, cognitive decline, and severe disease pathology, particularly Alzheimer's disease (AD). Larger and more integrated SNs were linked to better cognitive resilience and lower conversion rates from mild cognitive impairment (MCI) to dementia. One study on frontotemporal dementia (FTD) indicated that the SN might mitigate cortical atrophy. SN size and density are also correlated with favorable structural brain changes, such as greater gray matter volume. This review highlights SN as a modifiable factor in dementia risk. However, its role in non-AD dementia, particularly FTD, requires further investigation. Future research should include more culturally diverse and methodologically robust studies. Randomized controlled trials will be important to determine whether intervention to expand social networks decreases incidence of progression of dementia.

Global trends in prevalence, disability adjusted life years, and risk factors for early onset dementia from 1990 to 2021

This study aims to analyze temporal trends in the prevalence and disability-adjusted life year (DALY) burden of early-onset dementia (EOD) globally from 1990 to 2021 and assess the attributable burdens of modifiable risk factors. Data from the Global Burden of Disease Study (GBD) 2021 were used. EOD was defined as dementia in individuals aged 40-64. The analysis included case numbers, age-standardized prevalence rates (ASPRs), and DALY rates (ASDRs) with 95% confidence intervals (CIs), stratified by global, regional, and national levels, sociodemographic index (SDI), and sex. Joinpoint regression analysis evaluated the average annual percent change (AAPC). Population attributable fractions (PAFs) estimated the proportion of DALYs attributable to risk factors. The global number of EOD cases and DALYs nearly doubled from 1990 to 2021, reaching 7.758 million cases (95% CI 5.827-10.081) and 3.774 million DALYs (95% CI 1.696-8.881) in 2021. ASPR and ASDR increased slightly to 355.9 (95% CI 267.2-462.8) and 173.3 (95% CI 77.9-407.7) per 100,000 in 2021. In 2021, the highest ASPR was in high-middle SDI countries at 387.6 per 100,000 (95% CI 291.1-506.8), while the highest ASDR was in middle SDI at 182.9 per 100,000 (95% CI 82.2-431). The fastest ASDR increase was in low and low-middle SDI countries from 2010 to 2021, with AAPCs of 0.42% (95% CI 0.34-0.50) and 0.36% (95% CI 0.33-0.39), respectively. A significant negative correlation was found between SDI and ASDR. During the COVID-19 pandemic (2019-2021), ASPR and ASDR in high-SDI countries declined, while other SDI regions saw an accelerated increase. In 2021, high fasting plasma glucose (FPG) was the most significant attributable risk factor for EOD-related DALYs globally, with PAFs for high body mass index and high FPG increasing in nearly all regions since 1990, while the PAF for smoking decreased. In 2021, EOD burden was highest in high-middle and middle SDI countries, particularly rising during the COVID-19 pandemic. The growing influence of metabolic risk factors underscores the need for targeted public health policies and resource allocation to mitigate the EOD burden.

Effectiveness of structured cognitive intervention among patients diagnosed with late-onset Alzheimer's disease: Report from a pilot study

BackgroundThe type and effectiveness of non-pharmacological interventions varies, and there is a great need to develop structured interventions that can be replicated.ObjectiveThis pilot study aimed to evaluate the effectiveness of a structured cognitive intervention.MethodsSix participants with a diagnosis of late-onset Alzheimer's disease were recruited, cognitively screened and underwent twelve weeks of paper-pencil based cognitive or computer-based training.ResultsParticipant's cognitive functioning improved immediately after the intervention and remained better even after another three months without targeted intervention.ConclusionsPreliminary observations indicating a positive effect are encouraging, but require confirmation on a larger number of subjects.

Are mind-body therapies beneficial for older people with dementia? A Systematic Review and meta-analysis of randomized controlled trials

Objective

This systematic review and meta-analysis aimed to evaluate the potential multidomain benefits of mind-body therapies (MBTs) for behavioral and psychological symptoms of dementia (BPSD) in older people with dementia (OPWD).

Methods

Relevant randomized controlled trials (RCTs) were identified using electronic databases and manual searches. Two independent researchers evaluated the risk of bias in the included trials using the Revised Cochrane Risk-of-Bias tool for randomized trials. A standardized mean difference (SMD) with a 95% confidence interval (CI) was used to combine effect sizes.

Results

This review included 35 RCTs comprising 4,043 patients, of whom 24 were included in the meta-analyses. MBTs effectively improved BPSD (SMD = -0.33; 95% CI -0.49 to -0.16; p < 0.01), anxiety (SMD = -0.82; 95% CI -1.53 to -0.10; p = 0.02), and depression (SMD = -0.57; 95% CI -1.06 to -0.08; p = 0.02), with no significant improvements observed in agitation (SMD = -0.09; 95% CI -0.25 to 0.07; p = 0.27) among patients with dementia. The certainty of evidence across the outcomes ranged from low to very low, based on the Grading of Recommendations, Assessment, Development, and Evaluations ratings.

Conclusion

Effective nursing for patients with dementia is vital, as they are undergoing a major transition in their physical and mental health. In clinical practice, healthcare and social care therapists should develop personalized intervention programs based on patient individual differences and the actual dose-response relationship, which will help maximize the clinical benefits of non-pharmacological treatments in the context of limited medical resources. More high-quality RCTs could be conducted to compare the differential efficacy of non-pharmacological treatments on various aspects of BPSD in OPWD to provide a better evidence base to guide individual care and policy guidance.

Systematic review registration

PROSPERO, identifier CRD42024559809.

Development of a dementia literacy scale among community-dwelling older adults

With global ageing society, the prevalence of dementia continues to increase. Increased dementia literacy may promote the early diagnosis of dementia. This study aimed to develop a dementia literacy measurement scale for community-dwelling older adults and assess its psychometric properties. Three experts generated items on dementia literacy and dementia knowledge based on a literature review. Altogether, data from 102 older adults who completed the questionnaire were analyzed. The instruments were assessed through an exploratory factor analysis. The results showed that 20 items were loaded, indicating three factors for the questionnaire, which explained 45 % of the variance observed. The factors were coded as follows: respect for people with dementia, understanding of people with dementia, and information and help seeking. A higher dementia knowledge score correlated with enhanced dementia literacy. The developed dementia literacy scale is a validated and reliable tool for assessing the understanding of people with dementia among older adults.

Transformative advances in modeling brain aging and longevity: Success, challenges and future directions

Research on brain aging is crucial for understanding age-related neurodegenerative disorders and developing several therapeutic interventions. Numerous models ranging from two-dimensional (2D) cell-based, invertebrate, vertebrate, and sophisticated three-dimensional (3D) models have been used to understand the process of brain aging. Invertebrate models are ideal for researching conserved aging processes because of their simplicity, short lifespans, and genetic tractability. Moreover, vertebrate models, including zebrafish and rodents, exhibit more complex nervous systems and behaviors, enabling the exploration of age-related neurodegeneration and cognitive decline. 2D cell culture models derived from primary cells or immortalized cell lines are widely used for mechanistic studies at the cellular level but lack the physiological complexity of brain tissue. Recent advancements have shifted focus to 3D models, which better recapitulate the brain's microenvironment. Organoids derived from induced pluripotent stem cells mimic human brain architecture and enable the study of cell-cell interactions and aging in a human-specific context. Brain-on-a-chip systems integrate microfluidics and 3D cultures to model blood-brain barrier dynamics and neuronal networks. Additionally, scaffold-based 3D cultures and spheroids provide intermediate complexity, allowing researchers to study extracellular matrix interactions and age-related changes in neuronal function. These 3D models bridge the gap between traditional 2D cultures and animal-based in vivo studies, offering unprecedented insights into brain aging mechanisms. By combining these diverse models, researchers can unravel the multifaceted processes of brain aging and accelerate the development of targeted therapies for age-related neurodegenerative disorders.

Individuals with Cognitive Impairment Entering Long-Term Care: Characteristics and Cumulative Incidence of Dementia after Care Entry

OBJECTIVES

To characterize individuals entering long-term care facilities (LTCFs) with evidence of cognitive impairment and without a diagnosis of dementia, and to ascertain the cumulative incidence of dementia after care entry.

DESIGN

Retrospective cohort study using the Registry of Senior Australians (ROSA) National Historical Cohort.

SETTING AND PARTICIPANTS

Individuals aged 65 to 105 years who entered LTCFs between 2009 and 2018, received a cognitive evaluation, and had no recorded dementia diagnosis at the time of care entry.

METHODS

Cognitive function was determined via the Psychogeriatric Assessment Scales-Cognitive Impairment Scales (PAS-CIS) and defined as none or minimal (PAS-CIS score 0 to <4), mild (4 to <10), or moderate to severe (10 to 21). The cumulative incidence of dementia, determined by aged care assessments, hospitalization, medication, or cause of death, was ascertained for the total cohort and by cognitive impairment status at care entry.

RESULTS

In total, 90,122 individuals [median age 85 years; interquartile range (IQR) 81-89; 64.6% female] were studied, of whom 76.6% (n = 69,075) had cognitive impairment, including 51.4% (n = 46,350) with mild and 25.2% (n = 22,725) with moderate to severe impairment. Over a median follow-up of 1.5 years (IQR 0.6-2.9), the cumulative incidence of dementia was 26.8% [95% confidence interval (CI), 26.5-27.1]. Stratification by cognitive impairment status showed the cumulative incidence of dementia was 17.4% (95% CI, 16.8-17.9) for none or minimal, 27.3% (95% CI, 26.9-27.8) for mild, and 35.3% (95% CI, 34.7-36.0) for moderate to severe.

CONCLUSIONS AND IMPLICATIONS

The cohort of people entering LTCFs with cognitive impairment had a high incidence of dementia diagnosis within 1.5 years after entry. Routine cognitive impairment assessments can inform dementia screening strategies by identifying individuals at higher risk of dementia.

Alzheimer's disease and insomnia: a bibliometric study and visualization analysis

Background

Alzheimer's disease (AD) is the fastest-growing neurodegenerative disorder globally, with patient numbers expected to rise to 130 million by 2050. Insomnia, a prevalent comorbidity, exhibits a bidirectional relationship with AD: insomnia accelerates AD pathology, while AD worsens sleep disorders. This relationship has emerged as a key area of research. Current mechanisms involve oxidative stress, inflammatory responses, and glymphatic system dysfunction, yet a comprehensive review of these processes remains absent.

Objective

To conduct a visual analysis of the relationship between Alzheimer's disease and insomnia using CiteSpace.

Methods

Literature on "insomnia" and "Alzheimer's disease" published between January 1, 2000, and October 31, 2024, was retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer software were used to analyze institutions, authors, and keywords.

Results

A total of 1,907 articles were analyzed, revealing a consistent upward trend in publication volume. The United States and the Mayo Clinic were identified as leading contributors, producing 704 and 57 publications, respectively. Boeve Bradley F the most prolific author contributed 30 publications. Collaboration was actively observed among countries, institutions, and authors. High-frequency keywords identified were "Parkinson's disease," "cognitive impairment," and "sleep behavior disorder." Emerging research areas are likely to focus on "sleep quality" and the "glymphatic system."

Conclusion

This study is the first to apply bibliometric analysis to identify three key trends in AD and insomnia research: the dominance of the United States and Mayo Clinic, strong international collaboration, and a focus on critical areas such as cognitive impairment, the glymphatic system, and sleep interventions. Insomnia may accelerate AD progression via multiple pathways, indicating that enhancing sleep quality could provide new strategies for early intervention. Future research should prioritize advancing the clinical translation of sleep interventions and investigating the mechanisms of the glymphatic system.

Dementia classification using two-channel electroencephalography features

This study aimed to develop a novel classification model using wearable two-channel electroencephalography (EEG) data to differentiate between patients with dementia and normal controls (NCs). We employed an extreme gradient boosting (Xgboost) model combined with recursive feature elimination with cross-validation (RFECV) to classify patients and NCs. The study included 54 NCs and 29 patients with dementia. Resting-state EEG was recorded, and Mini-Mental Status Exam (MMSE) and Clinical Dementia Rating (CDR) assessments were conducted. Significant differences were observed in peak frequency (PF), alpha (A), theta (T), the ratio of alpha to theta (A/T), the ratio of alpha to low-beta (A/BL), and coherence (CH) between patients and NCs. Patients with dementia exhibited decreases in PF, CH_A/T, CH_A/BL, A/T, and A/BL, while an increase in T was noted. The primary finding was that the Xgboost model, a tree ensemble classification, achieved a balanced accuracy of 97.05% with the RFECV-selected feature, which was PF. This study suggests that the novel Xgboost with RFECV classification model using two-channel EEG data could be a valuable tool for diagnosing dementia.

Plasma proteomics-based brain aging signature and incident dementia risk

Investigating brain-enriched proteins with machine learning methods may enable a brain-specific understanding of brain aging and provide insights into the molecular mechanisms and pathological pathways of dementia. The study aims to analyze associations of brain-specific plasma proteomic aging signature with risks of incident dementia. In 45,429 dementia-free UK Biobank participants at baseline, we generated a brain-specific biological age using 63 brain-enriched plasma proteins with machine learning methods. The brain age gap was estimated, and Cox proportional hazards models were used to study the association with incident all-cause dementia, Alzheimer's disease (AD), and vascular dementia. Per-unit increment in the brain age gap z-score was associated with significantly higher risks of all-cause dementia (hazard ratio [95% confidence interval], 1.67 [1.56-1.79], P < 0.001), AD (1.85 [1.66-2.08], P < 0.001), and vascular dementia (1.86 [1.55-2.24], P < 0.001), respectively. Notably, 2.1% of the study population exhibited extreme old brain aging defined as brain age gap z-score > 2, correlating with over threefold increased risks of all-cause dementia and vascular dementia (3.42 [2.25-5.20], P < 0.001, and 3.41 [1.05-11.13], P = 0.042, respectively), and fourfold increased risk of AD (4.45 [2.32-8.54], P < 0.001). The associations were stronger among participants with healthier lifestyle factors (all P-interaction < 0.05). These findings were corroborated by magnetic resonance imaging assessments showing that a higher brain age gap aligns global pathophysiology of dementia, including global and regional atrophy in gray matter, and white matter lesions (P < 0.001). The brain-specific proteomic age gap is a powerful biomarker of brain aging, indicative of dementia risk and neurodegeneration.

Healthcare providers perspectives and perceptions of dementia diagnosis and management at the Aga Khan University Hospital, Nairobi, Kenya

BackgroundThe rising number of older people, including those living with Alzheimer's disease and related dementias (AD/ADRD) in sub-Saharan Africa (SSA) highlights the need for an improved clinical diagnosis and management of the diseases.ObjectiveTo understand and describe healthcare providers' perceptions and practices regarding AD/ADRD diagnosis and care in Kenya, not previously reported.MethodsThis was an ethnographic study involving observations and semi-structured interviews with healthcare providers working at the Aga Khan University Hospital, Nairobi (AKUHN) Kenya. Twenty-one healthcare providers were purposively recruited and interviewed in English, with the data transcribed verbatim and thematically analysed using Nvivo version 14.ResultsOur findings reveal that AKUHN's dementia diagnostic pathway aligns with universal best practice models and involves multidisciplinary care. Yet, healthcare providers noted that this level of care is not representative of most public hospitals in Kenya, where a lack of diagnostic equipment and trained staff severely limits patient access to timely dementia care. In addition, new medications that can slow AD/ADRD progression, are not readily available in Africa, including Kenya. We also identified barriers to timely diagnosis and care such as: lack of dementia policy and guidelines, limited expertise of healthcare providers, high cost of care, and sociocultural factors, including stigma.ConclusionsWe emphasize the need for the Kenyan government and relevant stakeholders to develop social and healthcare policies and allocate resources to raise awareness about dementia and combat stigma; train healthcare providers; improve early detection and service delivery through access to diagnostic tools, and establish clear guidelines/protocols for AD/ADRD care.

Obsessive-compulsive symptoms in dementia: Systematic review with meta-analysis

Dementia is a highly prevalent syndrome with various causes, characterized by cognitive deficit in one or more domains, with important impairment of functioning, which frequently presents with neuropsychiatric symptoms that may include obsessive-compulsive symptoms.

OBJECTIVES

The main goal of this meta-analysis was to describe and determine the prevalence of obsessive-compulsive symptoms in dementia.

MATERIALS AND METHODS

To accomplish that, MEDLINE, CENTRAL and Psycnet databases were searched from inception to March 2023. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was applied. The principal summary measures were the mean of prevalence of obsessive-compulsive symptoms in patients with dementia and the number of each type of obsession or compulsion.

RESULTS

Of the 643 articles screened, 92 were accepted for full-text assessment. Of these, 30 with information on prevalence of obsessive-compulsive symptoms in dementia or any description of those were included, yielding a total of 37 cohorts (5 studies with two cohorts and 1 study with three cohorts). According to our results, obsessive-compulsive symptoms have considerable prevalence in dementia (35.3%, 23.1-47.6%), namely in frontotemporal dementia (48.4%, 29.8-67.0%); obsessive-compulsive symptoms were less frequent in other dementia diagnosis (17.6%, 9.1-26.2%). The more frequent obsessive contents are symmetry (28.6%) and somatic (20.0%); and the more frequent compulsions are checking (27.4%); hoarding is also a relevant symptom (27.8%).

DISCUSSION

There was considerable heterogeneity in the prevalence of obsessive-compulsive symptoms in frontotemporal dementia, that is, in part related with diagnostic criteria for dementia, as well as obsessive-compulsive symptom assessment. A careful distinction between compulsions and compulsive-like symptoms is fundamental. Hypervigilance for somatic symptoms and concerns about disease and mortality, as well as deficits in cognitive domains like attention and memory may explain why somatic obsessions and checking compulsions are more prevalent.

CONCLUSIONS

The present results indicate that obsessive-compulsive symptoms may be prevalent in the clinical course of many patients with dementia, especially frontotemporal dementia. Better instruments are needed to describe obsessive-compulsive phenomena in a reliable and comparable way, particularly in a population such as dementia patients, whose subjectivity is difficult to access.

Unveiling Cognitive Impairment in Older Adults with Cancer on Systemic Anticancer Therapy: A Comprehensive Review

Cancer-related cognitive impairment significantly affects cancer management and decision-making. While the exact mechanisms underlying cancer-related cognitive dysfunction remain complex and multifaceted, different factors have been identified that may help predict which patients are at increased risk for cognitive decline. In this article, we provide a comprehensive overview of systemic cancer therapy-induced cognitive impairment in older adults, including signs and symptoms, diagnosis, and management. In addition, we discuss the evidence available on the impact of endocrine therapy, cytotoxic chemotherapy, immunotherapy and targeted agents on cognition in this population.

Particulate matter, socioeconomic status, and cognitive function among older adults in China

BACKGROUND

Both air pollution and low socioeconomic status (SES) are associated with worse cognitive function. The extent to which low SES may compound the adverse effect of air pollution on cognitive function remains unclear.

METHODS

7,087 older adults aged 65 and above were included from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and followed up in 4 waves during 2008-2018. Cognitive function was measured repeatedly at each wave using the modified Chinese Mini-Mental State Examination (MMSE). Concentrations of particulate matter (PM1, PM2.5, and PM10) were evaluated using satellite-based spatiotemporal models. SES was measured based on five components and categorized into three levels (low, middle, and high). Generalized estimating equation models were used to estimate the association of PM and SES with cognitive function. Stratified analyses and effect modification by SES levels were further conducted.

RESULTS

Each 10 µg/m3 increase in PM1, PM2.5, and PM10 was associated with a 0.43 (95 % CI: -0.58, -0.27), 0.29 (95% CI: -0.37, -0.20), and 0.17 (95 % CI: -0.22, -0.13) unit decrease in MMSE scores, respectively. Lower SES was associated with worse cognitive function. Significant effect modifications were observed by SES, with the corresponding association of PM exposure being more pronounced among participants with a lower SES (p-interaction = 0.006, 0.001, and 0.006 for PM1, PM2.5, and PM10, respectively).

CONCLUSIONS

SES is an important effect modifier, and lower SES may compound the detrimental effect of PM on cognitive health. This finding may have implications for identifying vulnerable populations and targeted interventions against air pollution.

Effects of digital technology-based serious games interventions for older adults with mild cognitive impairment: a meta-analysis of randomised controlled trials

OBJECTIVE

To evaluate the effectiveness of digital technology-based serious games (DTBSGs) interventions in older adults with mild cognitive impairment (MCI).

METHODS

A librarian-designed search of eight databases was conducted to identify randomised controlled trials published in English or Chinese up to 10 August 2024. The primary and secondary outcomes were compared between the intervention and control groups. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS

A meta-analysis of 28 trials, including 1698 participants, showed greater improvements in favour of interventions using DTBSGs compared to the control group in global cognitive function, executive function, attention function, depression, and activities of daily living (ADL). However, there was no significant improvement in memory function, anxiety, apathy or quality of life (QOL) compared to the control group. Subgroup analysis showed that computer games, exergames and iPad tablet games were superior to immersive virtual reality (VR) games in terms of global cognitive and executive function. VR games were superior to computer games in terms of attention and ADL. The GRADE evidence quality assessment results showed that global cognitive function and ADL were of moderate quality; executive function, attention, depression and anxiety were of low quality; and memory, apathy and QOL were of very low quality.

CONCLUSION

Patients with MCI benefited from DTBSGs. With the rapid development of information and communication technology, DTBSGs have great potential and may be used as adjuncts or substitutes in MCI rehabilitation.

Construction and evaluation of a diagnostic model for Alzheimer's disease based on mitophagy-related genes

Alzheimer's disease (AD) is the most common cause of dementia. Mitophagy fulfills crucial functions in neurodegenerative disorders and neuronal survival but the relationship between mitophagy and AD is unclear. Mitophagy correlation scores between AD samples and control samples were calculated using single-sample GSEA (ssGSEA) based on two datasets from gene expression omnibus (GEO) database. Mitophagy-related genes (MRGs) and differentially expressed genes (DEGs) in AD screened by WGCNA and "limma" package were intersected to take common genes. These overlapping genes were further compressed and used for diagnostic modeling by adopting the recursive feature elimination (RFE) and LASSO analysis. The reliability of the diagnostic model was verified based on the receiver operating characteristic (ROC) curve. Then, a transcription factor (TF)-mRNA regulatory network of these key genes was established. Lastly, ssGSEA was employed to examine the relationship between the identified genes and cellular pathways and immune cell infiltration. AD samples had notably lower mitophagy correlation scores than control samples. A total of 12 MRGs in the module with the greatest mitophagy connection with AD patients were identified. Functional enrichment analysis revealed that the DEGs were significantly enriched in synaptic function-related pathways. Based on GSE122063, a diagnostic prediction model was created and validated using two mitophagy-related genes (YWHAZ and NDE1), showing an area under ROC curve (AUC) greater than 0.7. This confirmed that the diagnostic model had a high predictive value. The TF-mRNA network showed that four TFs, namely, FOXC1, FOXL1, HOXA5 and GATA2, were regulated by both YWHAZ and NDE1 genes. Immune infiltration analysis revealed that NDE1 promoted the infiltration of most immune cells, while YWHAZ mainly inhibited the infiltration of most immune cells. The current findings improved our understanding of mitophagy in AD, contributing to future research and treatment development in AD.

Exercise Delays Brain Ageing Through Muscle-Brain Crosstalk

Ageing is often accompanied by cognitive decline and an increased risk of dementia. Exercise is a powerful tool for slowing brain ageing and enhancing cognitive function, as well as alleviating depression, improving sleep, and promoting overall well-being. The connection between exercise and healthy brain ageing is particularly intriguing, with exercise-induced pathways playing key roles. This review explores the link between exercise and brain health, focusing on how skeletal muscle influences the brain through muscle-brain crosstalk. We examine the interaction between the brain with well-known myokines, including brain-derived neurotrophic factor, macrophage colony-stimulating factor, vascular endothelial growth factor and cathepsin B. Neuroinflammation accumulates in the ageing brain and leads to cognitive decline, impaired motor skills and increased susceptibility to neurodegenerative diseases. Finally, we examine the evidence on the effects of exercise on neuronal myelination in the central nervous system, a crucial factor in maintaining brain health throughout the lifespan.

Pilot study of the Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability in individuals with subjective cognitive decline: paving the way towards brain health clinics in Greece

The pilot phase of the Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability (GINGER) aims to assess the feasibility of a multi-level dementia risk reduction intervention in individuals with subjective cognitive decline (SCD) over a six-month period. The study design incorporates a comprehensive set of trans-disciplinary assessments and interventions in multiple centers across Greece. Individuals 55 years or older with subjective cognitive complaints who do not fulfill criteria for either mild cognitive impairment or dementia are screened for dementia risk factors in the following domains: nutrition, physical activities, vision and hearing, vascular and metabolic parameters, anxiety and depressive symptoms, and insomnia. All GINGER participants receive a cognitive empowerment intervention. Using a precision medicine approach, they receive up to three additional domain-specific interventions based on their individual risk factor profiles. Changes in cognition, dementia risk factors, quality of life and other measures compared to baseline are assessed at three- and six months after the initiation of the intervention. The GINGER protocol was designed and is run by a multi-disciplinary team of dieticians, neurologists, psychiatrists, psychologists, and physiotherapists, while computer scientists oversee data management. The objectives of this pilot phase are (i) evaluation of the protocol's feasibility, (ii) assessment of intervention effects on the individual risk domains targeted by the interventions, (iii) estimation of the overall effects of the intervention on cognitive function, dementia risk and quality of life. The GINGER findings will provide a solid foundation for paving the way towards a network of evidence-based brain health clinics in Greece.

Exploring the association between physical activity and cognitive function among people living with dementia

BackgroundPhysical activity preserves cognitive function in people without dementia, but the relationship between physical activity and cognitive domains among people living with dementia is unclear.ObjectiveThe objective of this study was to explore the association between physical activity and cognition domains among people living with dementia.MethodsParticipants living with dementia in residential care facilities (complete case analysis: n = 24/42) completed a battery of cognitive tests (global cognition: Montreal Cognitive Assessment; executive function: Trail-Making Test, Digit Span Forward Test; perception and orientation: Benton Judgement of Line Orientation Test; language: Boston Naming Test; learning and memory: Rey Auditory Verbal Learning Test; complex attention: Digit Symbol Substitution Test). Participants wore an actigraphy monitor on their non-dominant wrist over seven days. We conducted a linear regression for total physical activity (independent variable) with race (white/black), fall risk (Morse Fall Scale), and the number of comorbidities (Functional Comorbidities Index) as covariates, and cognitive tests as variables of interest.ResultsParticipants were primarily male (75%), white (87.5%), and 50%had unspecified dementia (Alzheimer's disease: 33%). Greater physical activity was associated with poorer global cognition, better executive function, and better learning and memory (ps <  0.05). Physical activity was not related to visuospatial perception, language, or complex attention.ConclusionsPhysical activity may preserve executive function and learning and memory among people living with dementia. Wandering is more common in later stages of dementia, which may explain greater physical activity observed with lower global cognition. Regularly assessing physical activity may be useful in screening and monitoring cognitive changes.

Perimenopause promotes neuroinflammation in select hippocampal regions in a mouse model of Alzheimer's disease

Alzheimer's disease (AD) is the most common neurodegenerative disorder characterized by age-dependent amyloid beta (Aβ) aggregation and accumulation, neuroinflammation, and cognitive deficits. Significantly, there are prominent sex differences in the risk, onset, progression, and severity of AD, as well as response to therapies, with disease burden disproportionally affecting women. Although menopause onset (i.e., perimenopause) may be a critical transition stage for AD susceptibility in women, the role of early ovarian decline in initial disease pathology, particularly key neuroinflammatory processes, is not well understood. To study this, we developed a unique mouse model of perimenopausal AD by combining an accelerated ovarian failure (AOF) model of menopause induced by 4-vinylcyclohexene diepoxide (VCD) with the 5xFAD transgenic AD mouse model. To target early stages of disease progression, 5xFAD females were studied at a young age (∼4 months) and at the beginning stage of ovarian failure analogous to human perimenopause (termed "peri-AOF"), and compared to age-matched males. Assessment of neuropathology was performed by immunohistochemical labeling of Aβ as well as markers of astrocyte and microglia activity in the hippocampus, a brain region involved in learning and memory that is deleteriously impacted during AD. Our results show that genotype, AOF, and sex contributed to AD-like pathology. Aggregation of Aβ was heightened in female 5xFAD mice and further increased at peri-AOF, with hippocampal subregion specificity. Further, select increases in glial activation also paralleled Aβ pathology in distinct hippocampal subregions. However, cognitive function was not affected by peri-AOF. These findings align with the hypothesis that perimenopause constitutes a period of susceptibility for AD pathogenesis in women.

Differential cognitive functioning in the digital clock drawing test in AD-MCI and PD-MCI populations

Background

Mild cognitive impairment (MCI) is common in Alzheimer's disease (AD) and Parkinson's disease (PD), but there are differences in pathogenesis and cognitive performance between Mild cognitive impairment due to Alzheimer's disease (AD-MCI) and Parkinson's disease with Mild cognitive impairment (PD-MCI) populations. Studies have shown that assessments based on the digital clock drawing test (dCDT) can effectively reflect cognitive deficits. Based on this, we proposed the following research hypothesis: there is a difference in cognitive functioning between AD-MCI and PD-MCI populations in the CDT, and the two populations can be effectively distinguished based on this feature.

Methods

To test this hypothesis, we designed the dCDT to extract digital biomarkers that can characterize and quantify cognitive function differences between AD-MCI and PD-MCI populations. We enrolled a total of 40 AD-MCI patients, 40 PD-MCI patients, 41 PD with normal cognition (PD-NC) patients and 40 normal cognition (NC) controls.

Results

Through a cross-sectional study, we revealed a difference in cognitive function between AD-MCI and PD-MCI populations in the dCDT, which distinguished AD-MCI from PD-MCI patients, the area under the roc curve (AUC) = 0.923, 95% confidence interval (CI) = 0.866-0.983. The AUC for effective differentiation between AD-MCI and PD-MCI patients with high education (≥12 years of education) was 0.968, CI = 0.927-1.000. By correlation analysis, we found that the overall plotting of task performance score (VFDB 1) correlated with the [visuospatial/executive] subtest score on the Montreal Cognitive Assessment (MoCA) scale (Spearman rank correlation coefficient [R] = 0.472, p < 0.001).

Conclusion

The dCDT is a tool that can rapidly and accurately characterize and quantify differences in cognitive functioning in AD-MCI and PD-MCI populations.

Association Between Cognitive Impairment and Poor Oral Function in Community-Dwelling Older People: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

The population of Japan has a high life expectancy, but there is room for improvement in terms of the country's healthy life expectancy. The long period of care dependency among Japan's elderly is also a major economic health challenge. Dementia is a major factor in the need for care, and its prevention is a crucial and urgent challenge. There are recent reports of a possible association between changes in oral function and cognitive impairment, but the details of this association remain unclear. To clarify the relationship between poor oral function and cognitive impairment, we conducted an exploratory investigation using a cognitive function assessment (Mini-Cog) administered in a large-scale study and its relevance to oral function.

METHODS

The study population was 678 community-dwelling individuals aged ≥65 years living in Tarumizu city, Japan, in 2019. Cognitive function was assessed using the Mini-Cog test, and the oral survey was a modification of the content of the Oral Hypofunction Examination as defined by the Japanese Society of Gerodontology.

RESULTS

The participants' median age was 73 years. The oral function results revealed median scores below the oral hypofunction criterion for occlusal force, tongue pressure, oral diadochokinesis, and swallowing function. The results of a binomial logistic regression analysis indicated that tongue-lip motor function was independently associated with oral function in relation to cognitive impairment.

CONCLUSIONS

The oral function associated with cognitive impairment in this study was tongue-lip motor function. Aiming to improve this function may prevent the exacerbation of cognitive impairment.

Differential Transcriptional Programs Reveal Modular Network Rearrangements Associated with Late-Onset Alzheimer's Disease

Alzheimer's disease (AD) is a complex, genetically heterogeneous disorder. The diverse phenotypes associated with AD result from interactions between genetic and environmental factors, influencing multiple biological pathways throughout disease progression. Network-based approaches offer a way to assess phenotype-specific states. In this study, we calculated key network metrics to characterize the network transcriptional structure and organization in LOAD, focusing on genes and pathways implicated in AD pathology within the dorsolateral prefrontal cortex (DLPFC). Our findings revealed disease-specific coexpression markers associated with diverse metabolic functions. Additionally, significant differences were observed at both the mesoscopic and local levels between AD and control networks, along with a restructuring of gene coexpression and biological functions into distinct transcriptional modules. These results show the molecular reorganization of the transcriptional program occurring in LOAD, highlighting specific adaptations that may contribute to or result from cellular responses to pathological stressors. Our findings may support the development of a unified model for the causal mechanisms of AD, suggesting that its diverse manifestations arise from multiple pathways working together to produce the disease's complex clinical patho-phenotype.

Diagnosis and Management of Dementia for the Nephrology Clinician: A Review

Dementia describes when a person has cognitive limitations that impede function. Persons with kidney disease are unduly impacted by dementia: up to 87% of the dialysis population has cognitive impairment. In this review, we discuss the diagnosis and management of dementia, including the role of cerebrovascular disease and other risk factors. We review the available screening tools for the diagnosis of dementia. We discuss how the diagnosis of dementia differs from the diagnosis of mild cognitive impairment and also detail how delirium and depression can mimic dementia. In terms of treatments for dementia, we highlight 4 components. First, we describe pharmacologic treatments for the management of dementia, including the cholinesterase inhibitors N-methyl-d-aspartate antagonists as well as the newer antiamyloid antibody drugs for Alzheimer dementia. Second, we discuss the importance of nonpharmacologic interventions for the management of dementia, especially exercise. Third, we review approaches for the behavioral and neuropsychiatric symptoms associated with dementia, including potential medication management. Fourth, we highlight the essential and valuable role of caregivers in both the diagnosis and management of dementia. We conclude with key considerations about the impact of dementia for persons receiving dialysis and the role of dementia in kidney transplant evaluation.

Longitudinal Engagement in Modifiable Lifestyle Behaviors and Racial-Ethnic Differences in Dementia Risk

ObjectivesThe objective was to examine racial-ethnic differences in longitudinal engagement for lifestyle behaviors and moderating role of race-ethnicity between lifestyle behaviors and dementia risk.MethodsWe analyzed 2011-2021 National Health and Aging Trends Study data, a nationally representative U.S. sample of 6155 White, Black, Hispanic, and Asian older adults aged 65+. Cox models regressed dementia on the interaction between lifestyle behaviors (physical activity, smoking, and social contacts) and race-ethnicity.ResultsOnly smoking was associated with about a 45% higher dementia risk (aHR = 1.45, 95% CI = 1.11-1.89). On average, Black and Hispanic respondents exhibited less frequent physical activity and social contacts, along with more frequent smoking. There was one significant interaction; more social contacts were associated with lower dementia risk among Asian respondents (aHR = 0.16, 95% CI = 0.05-0.55).DiscussionRacial-ethnic differences in lifestyle behaviors should be considered when addressing dementia disparities. Future research needs to explore the relationship between social contacts and lower dementia risk among Asian older adults.

The role of ferritinophagy and ferroptosis in Alzheimer's disease

Iron is a crucial mineral element within human cells, serving as a pivotal cofactor for diverse biological enzymes. Ferritin plays a crucial role in maintaining iron homeostasis within the body through its ability to sequester and release iron. Ferritinophagy is a selective autophagic process in cells that specifically facilitates the degradation of ferritin and subsequent release of free iron, thereby regulating intracellular iron homeostasis. The nuclear receptor coactivator 4 (NCOA4) serves as a pivotal regulator in the entire process of ferritinophagy, facilitating its binding to ferritin and subsequent delivering to lysosomes for degradation, thereby enabling the release of free iron. The free iron ions within the cell undergo catalysis through the Fenton reaction, resulting in a substantial generation of reactive oxygen species (ROS). This process induces lipid peroxidation, thereby stimulating a cascade leading to cellular tissue damage and subsequent initiation of ferroptosis. Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progressive deterioration of emotional memory and cognitive function, accompanied by mental and behavioral aberrations. The pathology of the disease is characterized by aberrant deposition of amyloid β-protein (Aβ) and hyperphosphorylated tau protein. It has been observed that evident iron metabolism disorders and accumulation of lipid peroxides occur in AD, indicating a significant impact of ferritinophagy and ferroptosis on the pathogenesis and progression of AD. This article elucidates the process and mechanism of ferritinophagy and ferroptosis, investigating their implications in AD to identify novel targets for therapeutic intervention.

Alzheimer's Disease Diagnosis and Management in the Age of Amyloid Monoclonal Antibodies

Alzheimer's disease (AD) is the most common neurodegenerative disorder, and for providers the term AD is often avoided, favoring generic terms like memory loss or dementia. This is partly not only by limitations in using diagnostics and busy clinics but also by a sense that an AD diagnosis will not lead to a meaningful change in management. However, a turning point has occurred with advancements in diagnostics and disease-modifying therapies. Additionally, AD prevention therapies are not too far into the future. This review will cover AD clinical presentation and symptomatic management with focus on AD diagnostics and disease-modifying therapies.

Yoga-A complementary and traditional medicine for human health

Yoga is a therapeutic practice renowned for its multifaceted benefits across the body's systems. Its positive impact spans the physical, mental and emotional realms, fostering harmony and well-being. Through a combination of postures, breathing techniques and meditation, yoga offers profound effects, enhancing flexibility, strength and balance while simultaneously promoting relaxation and reducing stress. This integrative approach not only cultivates physical resilience but also supports mental clarity, emotional balance and overall vitality, showcasing yoga as a comprehensive and impactful system for holistic health. The review delved into the multifaceted ways in which yoga exerts a positive influence on the body's various systems. It highlights how yoga serves as a beneficial tool in addressing and counteracting the underlying factors associated with different diseases. By examining yoga's effects on these systems and its potential in combating illness, the paper sheds light on the comprehensive therapeutic benefits that yoga offers. Please cite this article as: Pandey S, Pandey AC, Kotecha VR. Yoga-A complementary and traditional medicine for human health. J Integr Med. 2025; 23(2): 93-105.

Comparative effectiveness of SGLT2 inhibitors and GLP-1 receptor agonists in preventing Alzheimer's disease, vascular dementia, and other dementia types among patients with type 2 diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) is associated with an elevated risk of dementia, including Alzheimer's disease (AD) and vascular dementia (VaD). While sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists have shown neuroprotective potential, comparative data on their efficacy in dementia prevention remain scarce.

METHODS

- We conducted a retrospective cohort study using the TriNetX database, including 307,103 SGLT2 inhibitor users and 348,686 GLP-1 receptor agonist users with T2DM. Propensity score matching yielded 221,883 pairs with balanced baseline characteristics. The primary outcome was overall dementia incidence, with secondary outcomes including AD, VaD, and all-cause mortality. Hazard ratios (HRs) were calculated using Cox proportional hazards models.

RESULTS

SGLT2 inhibitors were associated with a significantly lower incidence of overall dementia compared to GLP-1 receptor agonists (2.7 % vs. 3.6 %; HR, 0.92; 95 % CI, 0.89-0.95). The risk of VaD (HR, 0.89; 95 % CI, 0.84-0.95) and AD (HR, 0.90; 95 % CI, 0.86-0.94) was also reduced with SGLT2 inhibitors. All-cause mortality was lower in the SGLT2 group (3.6 % vs. 4.6 %; HR, 0.95; 95 % CI, 0.92-0.98). No significant difference was observed in other dementia subtypes (HR, 0.96; 95 % CI, 0.91-1.01).

CONCLUSIONS

In this large, real-world cohort, SGLT2 inhibitors demonstrated superior efficacy over GLP-1 receptor agonists in reducing the risks of overall dementia, VaD, and AD among patients with T2DM. These findings support the preferential use of SGLT2 inhibitors in mitigating dementia risk in this population, though randomized controlled trials are warranted for confirmation.

Neurologic Complications of Influenza and Potential Protective Vaccine Effects

Influenza is a common respiratory infection affecting persons of all ages and results in significant morbidity and mortality. Respiratory complications are well known, but important nonpulmonary complications are less well recognized. Neurologic complications following influenza infection may accompany the acute illness or may be chronic in nature. The acute complications such as seizures, encephalitis, myelitis and Guillain Barre Syndrome are well documented but fortunately are uncommon. However, stroke and dementia are leading causes of death and disability worldwide, and there is increasing evidence linking these devasting illnesses with influenza. In addition, influenza vaccine has been associated with protective effects against stroke and dementia risk.

Modifiable risk factors for early- and late-onset dementia using the Korean national health insurance service database

BACKGROUND

Early-onset dementia (EOD) and late-onset dementia (LOD) may have distinct modifiable risk-factor profiles.

OBJECTIVE

To identify and compare factors associated with EOD and LOD using a nationwide cohort database.

DESIGN

Nationwide two nested case-control studies.

SETTING

We used the National Health Insurance Service-National Sample Cohort database (2004-2019).

PARTICIPANTS

The initial sample size was 514,866; 5157 EOD and 39,326 LOD cases were matched 1:1 with controls based on age, sex, and the Charlson Comorbidity Index.

MEASUREMENTS

Socioeconomic status, residential area, body mass index, alcohol consumption, smoking status, physical activity, blood pressure, and laboratory findings were analyzed. Multivariable logistic regression models were used to identify the risk factors.

RESULTS

Higher socioeconomic status and increased frequency of physical activity were associated with a lower risk of both EOD and LOD. Rural residence, heavy alcohol consumption, and higher fasting blood sugar levels were associated with an increased risk of LOD, although there was no significant association with EOD. Overall, these factors impacted LOD more strongly than EOD. Demographic and lifestyle factors had a greater effect on LOD than blood pressure and relevant laboratory findings.

CONCLUSION

Modifiable risk factors were associated with LOD and EOD. The influence of some modifiable risk factors was more pronounced in the LOD group than in the EOD group. Identifying modifiable risk factors associated with dementia can aid in the development of preventive strategies, underscoring the clinical importance of our findings.

A review of AI-based radiogenomics in neurodegenerative disease

Neurodegenerative diseases are chronic, progressive conditions that cause irreversible damage to the nervous system, particularly in aging populations. Early diagnosis is a critical challenge, as these diseases often develop slowly and without clear symptoms until significant damage has occurred. Recent advances in radiomics and genomics have provided valuable insights into the mechanisms of these diseases by identifying specific imaging features and genomic patterns. Radiogenomics enhances diagnostic capabilities by linking genomics with imaging phenotypes, offering a more comprehensive understanding of disease progression. The growing field of artificial intelligence (AI), including machine learning and deep learning, opens new opportunities for improving the accuracy and timeliness of these diagnoses. This review examines the application of AI-based radiogenomics in neurodegenerative diseases, summarizing key model designs, performance metrics, publicly available data resources, significant findings, and future research directions. It provides a starting point and guidance for those seeking to explore this emerging area of study.

Predicting the Beneficial Effects of Cognitive Stimulation and Transcranial Direct Current Stimulation in Amnestic Mild Cognitive Impairment with Clinical, Inflammation, and Human Microglia Exposed to Serum as Potential Markers: A Double-Blind Placebo-Controlled Randomized Clinical Trial

In amnestic mild cognitive impairment (aMCI), neuroinflammation evolves during disease progression, affecting microglial function and potentially accelerating the pathological process. Currently, no effective treatment exists, leading to explorations of various symptomatic approaches, though few target the underlying physiological mechanisms. Modulating inflammatory processes may be critical in slowing disease progression. Cognitive stimulation (CS) and transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex (l-DLPFC) show promise, but the results are heterogeneous. Thus, a randomized, double-blind, placebo-controlled clinical trial is currently underway. The first-stage results were examined after three weeks of intervention in two groups: active tDCS combined with CS and sham tDCS combined with CS. Twenty-two participants underwent two assessments: T0 (baseline) and T1 (after 15 sessions of tDCS, active or sham, and 9 sessions of CS). The results demonstrated that CS improved cognition, increased brain-derived neurotrophic factor (BDNF) levels, and reduced peripheral proinflammatory cytokine levels (interleukin IL-6 and chemokine CX3CL1) in serum. This decrease in IL-6 may promote microglial proliferation and survival as a modulatory effect response, while the increase in BDNF might suggest a regulatory mechanism in microglia-neuron interaction responses. However, tDCS did not enhance the cognitive or modulatory effects of CS, suggesting that longer interventions might be required to achieve substantial benefits.

Cataract and Risk of Fracture: A Systematic Review, Meta-Analysis, and Bayesian Network Meta-Analysis

TOPIC

To evaluate the odds ratio (OR) and hazard ratio (HR) of bone fracture in phakic subjects with cataract compared with phakic subjects without cataract and pseudophakic individuals.

CLINICAL RELEVANCE

Despite the growing recognition of the link between cataract and fracture, the available evidence remains inconclusive.

METHODS

The results of this meta-analysis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study protocol was registered on the International Prospective Register of Systematic Reviews (ID: CRD42024587477). Four electronic databases were searched from their inception to May 2024: PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two reviewers performed title and abstract screening, full-text assessment, and study quality appraisal. Frequentist inference meta-analysis and Bayesian network meta-analyses (NMAs) were conducted to assess the OR and HR of fracture among the 3 groups of interest.

RESULTS

Sixteen articles met the predefined inclusion and exclusion criteria, with the 11 included in the quantitative synthesis encompassing a population of 4 713 458 subjects and reporting on 284 811 fractures. The certainty of evidence was rated from low to moderate. Compared with subjects without cataract, the OR and the HR for fractures in the cataract group were 1.44 (95% confidence interval [CI]: 0.75-2.75; P > 0.05) and 1.51 (95% CI: 1.14-2.01; P = 0.0152), respectively. Bayesian NMAs indicated that subjects with cataracts have an increased OR and HR of fractures compared with both phakic subjects without cataracts (OR: 3.0 [95% credible interval (CrI): 2.8-3.3]; HR 1.1 [95% CrI: 1.09-1.12]) and pseudophakic individuals (OR: 1.7 [95% CrI: 1.6-1.8]; HR: 1.28 [95% CrI: 1.24-1.31]). Pseudophakic individuals exhibit a 27% reduction in fracture risk compared with phakic individuals with cataracts, with 1 less fracture event for every 8 pseudophakic subjects.

CONCLUSION

Low-certainty evidence suggests a higher fracture risk in individuals with cataract compared with those without. Moderate-certainty evidence indicates that pseudophakic individuals have the lowest fracture risk compared with phakic patients with or without cataract. Further research should explore the causal link between cataract and fracture risk and evaluate the impact of cataract surgery on fracture prevention.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Altered angular gyrus activation during the digit symbol substitution test in people living with HIV: beyond information processing speed deficits

Speed-of-information processing (SIP) is often impaired in people living with HIV (PLWH), typically assessed through tests such as the digit symbol (DS) and symbol search, which also rely on motor and executive functions. This study aims to disentangle SIP deficits from other cognitive impairments in PLWH using an MRI-adapted digit symbol substitution test (mDSST). Fifty-seven PLWH (34.7 ± 11.2 years) and 50 age-matched people living without HIV (PLWoH, 31.8 ± 9.9 years) completed standardized neuropsychological tests and the mDSST. Behavioral performances and brain activations were compared, with correlations drawn between group-differentiating brain activations and clinical ratings of cognitive domains. Results showed that PLWH performed worse in DS and symbol search, made fewer responses, and was slower in mDSST, with performances correlating to SIP and motor ratings. Notably, PLWH showed greater deficits in attention compared to PLWoH, rather than in SIP or motor. PLWH also exhibited greater primary motor cortex activation and reduced right angular gyrus activation. These findings suggest that slower performances on SIP-related tests in PLWH may be partially linked to abnormal visuospatial attention, as reflected by reduced angular gyrus activation, with higher motor cortex activation potentially serving as a compensatory mechanism. Future studies should explore whether prefrontal regions implicated in SIP are impaired in more severely affected PLWH.

Genome-wide pleiotropy analysis of longitudinal blood pressure and harmonized cognitive performance measures

Background

Genome-wide association studies (GWAS) have identified over 1,000 blood pressure (BP) loci and over 80 loci for Alzheimer's disease (AD). Considering BP is an AD risk factor, identifying pleiotropy in BP and cognitive performance measures may indicate mechanistic links between BP and AD.

Methods

Genome-wide scans for pleiotropy in BP variables-systolic (SBP), diastolic (DBP), mean arterial (MAP), and pulse pressure (PP)-and co-calibrated scores for cognitive domains (executive function, language, and memory) were performed using generalized linear mixed models and 116,075 longitudinal measures from 25,726 participants of clinic-based and prospective cohorts. GWAS was conducted using PLACO to estimate each SNP's main effect and interaction with age, and their joint effect on pleiotropy. Effects of genome-wide significant (GWS) pleiotropic SNPs on cognition as direct or mediated through BP were evaluated using Mendelian randomization. Potential contribution of genes in top-ranked pleiotropic loci to cognitive resilience was assessed by comparing their expression in brain tissue from pathologically confirmed AD cases with and without clinical symptoms.

Results

Pleiotropy GWAS identified GWS associations with APOE and 11 novel loci. In the total sample, pleiotropy was identified for SBP and language with JPH2 ( P Joint =6.09×10 -9 ) and GATA3 ( P G×Age =1.42×10 -8 ), MAP and executive function with PAX2 ( P G×Age =4.22×10 -8 ), MAP and language with LOC105371656 ( P G×Age =1.75×10 -8 ), and DBP and language with SUFU ( P G =2.10×10 -8 ). In prospective cohorts, pleiotropy was found for SBP and language with RTN4 ( P G×Age =1.49×10 -8 ), DBP and executive function with ULK2 ( P Joint =2.85×10 -8 ), PP and memory with SORBS2 ( P G =2.33×10 -8 ), and DBP and memory with LOC100128993 ( P G×Age =2.81×10 -8 ). In clinic-based cohorts, pleiotropy was observed for PP and language with ADAMTS3 ( P G =2.37×10 -8 ) and SBP and memory with LINC02946 ( P G×Age =3.47×10 -8 ). Five GWS pleiotropic loci influence cognition directly, and genes at six pleiotropic loci were differentially expressed between pathologically confirmed AD cases with and without clinical symptoms.

Conclusion

Our results provide insight into the underlying mechanisms of high BP and AD. Ongoing efforts to harmonize BP and cognitive measures across several cohorts will improve the power of discovering, replicating, and generalizing novel associations with pleiotropic loci.

A systematic review and meta-analysis of pteridines in mild cognitive impairment and Alzheimer's disease

BACKGROUND

Alterations in specific pteridine metabolites, particularly neopterin, biopterin, and tetrahydrobiopterin have been reported in mild cognitive impairment, Alzheimer's disease, and other types of dementia. However, the available evidence regarding such alterations has not been comprehensively and critically appraised.

METHODS

We systematically reviewed studies reporting the concentrations of biopterin, tetrahydrobiopterin, and neopterin in different biological fluids in patients with mild cognitive impairment, Alzheimer's disease or other types of dementia, and healthy controls. Electronic databases were searched from inception to 29 February 2024.

RESULTS

Overall, there were no significant differences in plasma/serum concentrations of neopterin between patients with mild cognitive impairment, Alzheimer's disease, or other types of dementia, when grouped together, and healthy controls after adjusting for publication bias (11 studies, standard mean difference, SMD = 0.20, 95% CI -0.02 to 0.41, p = 0.076). In meta-regression and subgroup analysis, the effect size was significantly associated with age, number of participants, study continent, presence of mild cognitive impairment, presence of Alzheimer's disease, analytical method, and assessment of serum vs. plasma. One study reported higher urine neopterin in patients with Alzheimer's disease vs. controls whereas another study reported non-significant between-group differences in cerebrospinal neopterin. The cerebrospinal fluid concentrations of biopterin were significantly lower in patients with Alzheimer's disease vs. controls (two studies, SMD = -0.75, 95% CI -1.23 to -0.27, p = 0.002; I2 = 0.0%, p = 0.46). One study showed non-significant between-group differences in plasma biopterin whereas another study showed higher concentrations of urine biopterin in patients with Alzheimer's disease. Our search did not identify studies investigating tetrahydrobiopterin.

CONCLUSION

Our study showed no significant differences in circulating neopterin between patients with mild cognitive impairment, Alzheimer's disease, or other types of dementia, when grouped together, and healthy controls. The significant associations observed between the effect size and mild cognitive impairment and Alzheimer's disease in subgroup analysis warrant further investigation. (PROSPERO registration number: CRD42024523478).

Blood-based biomarkers in mild behavioral impairment: an updated overview

Identifying individuals at-risk for dementia is one of the critical objectives of current research efforts, highlighting the need for simple, cost-effective, and minimally invasive biomarkers. Mild behavioral impairment (MBI), characterized by the emergence of persistent neuropsychiatric manifestations in older adults, has attracted increasing attention as a potential early indicator of cognitive decline and dementia. A growing number of studies have recently begun to explore the relationship between MBI and several blood-based biomarkers associated with Alzheimer's disease (AD) pathology, neurodegeneration, as well as systemic metabolic and inflammatory dysregulation. In this context, MBI has been associated with lower plasma Aβ42/Αβ40 ratio, higher plasma phosphorylated tau at threonine 181 (p-tau181), increased neurofilament light chain (NfL) levels, as well as disturbances in metabolic markers, including homocysteine, insulin and ferritin, suggesting a multifaceted neurobiological basis for this syndrome. These findings offer insights into the underlying pathophysiology of MBI, and connection between neuropsychiatric symptoms and progression of AD. In this narrative review, we aim to summarize and critically discuss the emerging literature evidence linking MBI to blood-based biomarkers, hoping to shed more light on MBI's pathophysiology, its connection to AD-related neurobiology, as well as its potential practical utility for predicting cognitive impairment, guiding early interventions and managing the risk for dementia.