The worldwide costs of dementia in 2019

Impact of diet and exercise on mitochondrial quality and mitophagy in Alzheimer's disease

Alzheimer's disease (AD) is a devastating neurodegenerative disorder that affects millions of people worldwide. It is characterized by the accumulation of beta-amyloid and phosphorylated tau, synaptic damage, and mitochondrial abnormalities in the brain, leading to the progressive loss of cognitive function and memory. In AD, emerging research suggests that lifestyle factors such as a healthy diet and regular exercise may play a significant role in delaying the onset and progression of the disease. Mitochondria are often referred to as the powerhouse of the cell, as they are responsible for producing the energy to cells, including neurons to maintain cognitive function. Our article elaborates on how mitochondrial quality and function decline with age and AD, leading to an increase in oxidative stress and a decrease in ATP production. Decline in mitochondrial quality can impair cellular functions contributing to the development and progression of disease with the loss of neuronal functions in AD. This article also covered mitophagy, the process by which damaged or dysfunctional mitochondria are selectively removed from the cell to maintain cellular homeostasis. Impaired mitophagy has been implicated in the progression and pathogenesis of AD. We also discussed the impact of impaired mitophagy implicated in AD, as the accumulation of damaged mitochondria can lead to increased oxidative stress. We expounded how dietary interventions and exercise can help to improve mitochondrial quality, and mitochondrial function and enhance mitophagy in AD. A diet rich in antioxidants, polyphenols, and mitochondria-targeted small molecules has been shown to enhance mitochondrial function and protect against oxidative stress, particularly in neurons with aged and mild cognitively impaired subjects and AD patients. Promoting a healthy lifestyle, mainly balanced diet and regular exercise that support mitochondrial health, in an individual can potentially delay the onset and progression of AD. In conclusion, a healthy diet and regular exercise play a crucial role in maintaining mitochondrial quality and mitochondrial function, in turn, enhancing mitophagy and synaptic activities that delay AD in the elderly populations.

Agile Implementation of a Digital Cognitive Assessment for Dementia in Primary Care

PURPOSE

This study aimed to assess how agile implementation-driven iterative processes and tailored workflows can facilitate the implementation of a digital cognitive assessment (DCA) tool for patients aged 65 years or older into primary care practices.

METHODS

We used agile implementation principles to integrate a DCA tool into routine workflows across 7 primary care clinics. The intervention involved a structured selection process for identifying an appropriate DCA tool, stakeholder engagement through iterative sprints (structured, time-bound cycles), and development of tailored workflows to meet clinic-specific needs. A brain health navigator role was established to support patients with positive or borderline screenings, and assist primary care clinicians with follow-up assessment. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate the intervention's performance over a 12-month period.

RESULTS

The intervention engaged 69 (63.8%) of 108 clinicians across the 7 clinics. DCA screening was completed in 1,808 (10.8%) of 16,708 eligible visits. We selected the Linus Health Core Cognitive Evaluation tool as our DCA tool based on stakeholder evaluations. Screening workflows were tailored to each clinic. The brain health navigator received 447 referrals for further assessment of a positive or borderline screening result. Four clinics fully adopted the intervention, achieving a DCA completion rate of at least 20%, and 5 clinics were still routinely using the DCA tool at 12 months.

CONCLUSIONS

Agile implementation effectively helped integrate the DCA tool into primary care workflows. Customized workflows, stakeholder engagement, and iterative improvements were crucial for adoption and sustainability. These insights can guide future efforts for early detection and management of cognitive impairment in primary care, ultimately improving patient outcomes and easing the burden on health care professionals.

Speech-based digital cognitive assessments for detection of mild cognitive impairment: Validation against paper-based neurocognitive assessment scores

BackgroundCognitive decline in Alzheimer's disease (AD) often includes speech impairments, where subtle changes may precede clinical dementia onset. As clinical trials focus on early identification of patients for disease-modifying treatments, digital speech-based assessments for scalable screening have become crucial.ObjectiveThis study aimed to validate a remote, speech-based digital cognitive assessment for mild cognitive impairment (MCI) detection through the comparison with gold-standard paper-based neurocognitive assessments.MethodsWithin the PROSPECT-AD project, speech and clinical data were obtained from the German DELCODE and DESCRIBE cohorts, including 21 healthy controls (HC), 110 participants with subjective cognitive decline (SCD), and 59 with MCI. Spearman rank and partial correlations were computed between speech-based scores and clinical measures. Kruskal-Wallis tests assessed group differences. We trained machine learning models to classify diagnostic groups comparing classification accuracies between gold-standard assessment scores and a speech-based digital cognitive assessment composite score (SB-C).ResultsGlobal cognition, as measured by SB-C, significantly differed between diagnostic groups (H(2) = 30.93, p < 0.001). Speech-based scores were significantly correlated with global anchor scores (MMSE, CDR, PACC5). Speech-based composites for memory, executive function and processing speed were also correlated with respective domain-specific paper-based assessments. In logistic regression classification, the model combining SB-C and neuropsychological tests at baseline achieved a high discriminatory power in differentiating HC/SCD from MCI patients (Area Under the Curve = 0.86).ConclusionsOur findings support speech-based cognitive assessments as a promising avenue towards remote MCI screening, with implications for scalable screening in clinical trials and healthcare.

Epidemiological and sociodemographic transitions in the global burden and risk factors for Alzheimer's disease and other dementias: a secondary analysis of GBD 2021

BACKGROUND

The study aimed to analyze the long-term trends in the global burden of Alzheimer's disease and other dementias(ADOD) in different regions, and assess the association between socio-demographic index(SDI) and disease burden.

METHODS

We extracted data on the incidence, mortality, disability-adjusted life-years(DALYs), and age-standardized rates related to ADOD, as disease burden measures from 1990 to 2021. The joinpoint regression, quantile regression and restricted cubic splines were adopted to estimate the temporal trends and relationships with SDI. Risk factors for deaths and DALYs were also analyzed.

RESULTS

Globally, 9.84 million cases of ADOD occurred in 2021, with 1.95 million ADOD-related deaths, causing 36.33 million DALYs. ADOD incidence, mortality and DALYs all increased from 1990 to 2021. Regional and sex variations persisted, with the fastest increase in age-standardized death rate in low-middle SDI quintiles, experienced the highest estimated annual percentage changes (0.41[0.31,0.52]). The incidence of ADOD increased more rapidly as SDI increased in areas that have historically shown lower incidence compared to other areas. In regions with higher mortality or DALYs burden, these indicators decreased relatively faster as SDI increased. High fasting plasma glucose was the main risk factor, particularly in high SDI region, with an increasing trend in attributable burden. The burden attributable to high BMI was increasing, whereas the burden associated with smoking steadily decreased.

CONCLUSION

ADOD poses a significant and escalating challenge to healthcare sustainability, with persistent regional and gender disparities. By learning from successful ADOD management in certain nations, we can proactively reduce health burdens and bridge disparities between countries at various developmental levels.

The role of the components of PM2.5 in the incidence of Alzheimer's disease and related disorders

BACKGROUND

The associations of PM2.5 mass and various adverse health outcomes have been widely investigated. However, fewer studies focused on the potential health impacts of PM2.5 components, especially for dementia and Alzheimer's diseases (AD).

METHODS

We constructed a nationwide population-based open cohort study among Medicare beneficiaries aged 65 or older during 2000-2018. This dataset was linked with the predicted levels of 15 PM2.5 components, including 5 major mass contributors (EC, OC, NH4+, NO3-, SO42-) and 10 trace elements (Br, Ca, Cu, Fe, K, Ni, Pb, Si, V, Zn) across contiguous U.S. territory. Data were aggregated by ZIP code, calendar year and individual level demographics. Two mixture analysis methods, weighted quantile sum regression (WQS) and quantile g-computation (qgcomp), were used with quasi-Poisson models to analyze the health effects of the total mixture of PM2.5 components on dementia and AD, as well as the relative contribution of individual components.

RESULTS

Exposure to PM2.5 components over the previous 5 years was significantly associated with increased risks of both dementia and AD, with stronger associations observed for AD. SO42-, OC, Cu were identified as major contributors to the combined positive association of the mixture from both WQS and qgcomp models.

CONCLUSION

We found positive associations between the 15 PM2.5 components and the incidence of dementia and AD. Our findings suggest that reducing PM2.5 emissions from traffic and fossil fuel combustion could help mitigate the growing burden of dementia and Alzheimer's disease.

Family caregivers' perspectives on dementia prevention: A mixed-methods systematic review

AIMS

To examine the perceptions and behaviors related to dementia prevention among family caregivers of people with dementia.

DESIGN

We searched PubMed, Embase, CINAHL, Web of Science, PsycINFO, Scopus, CNKI, WanFang, and SinoMed. A convergent integrated approach was used. Quantitative data were transformed into qualitative data and analysed thematically. Methods of data synthesis employed the Health Belief Model for data synthesis.

RESULTS

A total of 10 studies were included. Four themes were emerged: (1) perceived susceptibility to dementia stemming from a family history of dementia; (2) perceived severity of dementia based on the patient's condition; (3) cues to action triggered by family members with dementia; and (4) trade-offs between perceived benefits and perceived barriers.

CONCLUSIONS

We found that psychological change, caregiving experience, family responsibilities, economic status, and sociocultural context collectively influenced threat perception and the likelihood of engaging in dementia preventive behaviors among family caregivers of people with dementia.

Challenging symptoms of persons living with dementia in integrated medical and care institutions: A multilevel analysis

This study aimed to explore the potential factors associated with challenging symptoms. A questionnaire survey was conducted on 823 persons living with dementia in 13 integrated medical and care institutions in Hunan Province, China. The challenging symptoms score was 5.0 (2.0, 8.0). Higher symptom scores were associated with longer dementia duration (b=0.17, P=0.030), moderate dementia (b=1.19, P<0.001), significantly impaired activities of daily living (b=3.20, P=0.012), and risk for abuse (b=3.53, P<0.001). At the caregiver level, anxiety (b=0.12, P=0.044) and the greater the number of persons living with dementia in their care (b=0.24, P<0.001) also increased challenging symptoms. In addition, we reported for the first time the unintended effects of the older adult's cerebrovascular disease (b=-0.83, P=0.007) and psychotropic medications use (b=1.17, P<0.001). The older adult's multiple adverse health-related conditions and the caregiver's negative emotions have an impact on challenging symptoms. The role of psychotropic medications warrants further study.

Association Between Healthy Lifestyle and Cognitive Function in Middle-Aged and Older Adults

Background/Objectives: The adherence to a healthy lifestyle is important for supporting healthy cognitive function as aging progresses. This study aimed to assess the association between a healthy lifestyle, specifically diet quality, physical activity, and smoking, and cognitive function in middle-aged and older adults. Methods: A cross-sectional study was conducted among participants aged 45 and older with normal cognition. Participants' cognitive performance was assessed by the Montreal Cognitive Assessment (MoCA). Dietary intake was assessed using a 24 h dietary recall, and diet quality was assessed using the Diet Quality Index-International (DQI-I). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Participants were categorized as unhealthy (score ≤ 1), average (score 2), and healthy (score 3). Results: In this study, a total of 176 participants were recruited, 46% of them were classified as unhealthy, 40% was average, and 14% as healthy. Participants in the unhealthy group had lower performance in the naming cognitive domain compared to the other groups (p = 0.01). Participants in the average group scored significantly lower than the other groups in the orientation domain (p = 0.02). Performing moderate and high physical activity levels were significantly associated with higher scores of MoCA (p = 0.04) and in the naming domain (p = 0.02). Conclusions: Adopting a healthy lifestyle is associated with maintaining cognitive health among middle-aged and older adults, supporting the relevance of multidomain lifestyle interventions. Further longitudinal research is warranted to evaluate the long-term feasibility and effectiveness of lifestyle interventions in this population.

Joint effects of environmental and neighborhood socioeconomic factors on cognitive function in the Heinz Nixdorf Recall Study

BACKGROUND

Modifiable physical and social environments are believed to influence cognitive health in older age.

OBJECTIVES

To employ cutting-edge methods to analyze the impact of correlated environmental and socioeconomic neighborhood factors on cognitive function in German older participants.

METHODS

In the German Heinz Nixdorf Recall cohort study, participants underwent neuropsychological testing at the first follow-up examination (2006-2008) to derive a global cognitive score (GCS). Long-term exposure to air pollution was estimated by the land-use regression and chemistry transport models. Road traffic noise was assessed as outdoor weighted 24h and nighttime means. Seven neighborhood-level socioeconomic position (nSEP) characteristics were linked from administrative data. The joint effects of exposure combinations on GCS were estimated using two dimensionality reduction techniques: principal component (PC) analysis (PCA) and self-organizing maps (SOM).

RESULTS

Overall, 3748 individuals were included (median age 65 years; 50.7 % female). In single-exposure linear regression analysis, higher particle matter with aerodynamic diameter ≤2.5 μm (PM2.5) and nitrogen oxides exposure, higher proportion of welfare recipients, and lower living area per resident were negatively associated with GCS. In the PCA, the first principal component (PC), the direction of maximum variance, was positively correlated with all disadvantageous nSEP factors and higher concentrations of all environmental exposures except ozone. This PC was associated with lower GCS. SOM revealed associations with lower GCS for 3 of 6 exposure clusters. These clusters were characterized by low nSEP (Cluster 1), high environmental exposure (Cluster 4) and high concentration of accumulation mode particle number concentration (Cluster 5).

DISCUSSION

We identified associations between distinct combinations of intercorrelated air pollution, road traffic noise, and nSEP disadvantages with poorer cognitive function, using two different dimensionality reduction methods. Our findings highlight the importance of considering combined environmental and social exposures to systematically assess the potential benefits of multimodal urban interventions aimed at mitigating these risk factors.

Frequency of care mediates the effect of older adults' cognitive performance on the perceived strain of their informal caregivers in a middle-income country

Background and Objectives: As low and middle-income countries face a rapid increase in their older adult populations, the demand for informal caregiving is expected to rise. Understanding caregiving dynamics in these settings is crucial for developing effective support systems.Aims: To investigate whether the frequency and duration of care provided to older adults mediate the relationship between cognitive performance and caregiver strain.Methods: A cross-sectional study that evaluated informal caregivers of cognitively unimpaired (n = 78) older adults and people living with Alzheimer's dementia (n = 39). We controlled for variables including age, current medications, functional status, cognitive decline, and cognitive functioning. We analyzed whether caregiving frequency and duration mediated the effect of older adults' cognitive performance on caregiver strain.Results: Frequency of care, rather than its duration, significantly mediates the association between older adults' cognitive performance and caregiver strain. Specifically, more days of care are associated with increased caregiver strain, compared to the total number of caregiving hours.Conclusion: Addressing the frequency of caregiving days rather than just the duration in hours offers a more effective approach to reducing caregiver strain. Policies should aim to reduce the number of caregiving days, potentially through expanded respite care programs and full days off for caregivers.

A Comparison of Clinical Diagnostic Classification Criteria Used in Longitudinal Cohort Studies of the Alzheimer's Disease Continuum: A Systematic Review

Alzheimer's is a progressive disease, with a long preclinical phase of many decades. Accurate classification within longitudinal cohort studies is crucial for understanding disease progression and for the comparability and collaboration across studies. The main objective of this systematic review was to identify and compare the diagnostic criteria used in prospective population study cohorts centering on the Alzheimer's disease clinical continuum in older adults. A review was performed of cohort studies started in the year 2000 or later, with a follow-up duration of at least 3 years among people aged between 50 and 85 years old living in the community. Original studies were searched in MEDLINE, Embase, Cochrane, PsycINFO, and Web of Science. Two independent reviewers agreed on the final selection of 28 studies covering 25 cohorts. One study was identified by three independent judges as having methodological limitations due to inadequate reporting as per the modified NIH quality assessment tool. Data was extracted from each included study using a standardized extraction form. In general, the studies followed fewer than 1500 participants. The results showed convergence in the choice of diagnostic classification criteria among the 25 cohorts studied especially for the later stages of AD, while criteria for the earliest stages showed greater variability. Only five cohorts studied were concerned with the follow-up of the full spectrum of the disease. Our study may help to put in place a unified set of clinical diagnostic criteria across the continuum of Alzheimer's disease, rather than criteria developed specifically for a given study.

The impact of unpaid caring on cognitive function: a rapid review

OBJECTIVES

Our review aimed to examine the role of unpaid care in influencing cognitive function independently or via risk factors for dementia.

METHOD

This rapid review, registered in PROSPERO and following PRISMA guidelines, searched EMBASE, MEDLINE, and APA PsycINFO databases for longitudinal studies comparing dementia, cognitive function and associated risk factors for dementia between carers and non-carers. Studies were assessed for quality. Data were synthesised narratively.

RESULTS

Five studies looked at cognitive function directly; others examined risk factors: depression, social isolation, physical activity, body-mass index, type 2 diabetes, high blood pressure, educational attainment, and alcohol consumption. Unpaid carers have increased risk of depression and social isolation, and younger carers have lower educational attainment. Studies evaluating the link between unpaid caring and cognitive decline suggest that caring at low and moderate intensities may act as a protective factor against cognitive decline, but not at higher intensities. Female gender and high-intensity caring significantly influence the strength of association between unpaid care and dementia risk factors.

CONCLUSION

The impact of unpaid caring on cognitive health is complex, influenced by factors like intensity of care and social and cultural context. Across all studies, high-intensity caring negatively impacts carers physical and mental health, which in turn affect their cognitive health.

Behavioural analysis of factors influencing prescribing for neurodegenerative diseases: A rapid review

BACKGROUND

The incidence and prevalence of neurodegenerative diseases (NDs) are growing worldwide. In an environment where healthcare resources are already stretched, it is important to optimise treatment choice to help alleviate healthcare burden. This rapid review aims to consolidate evidence on factors that influence healthcare professionals (HCPs) to prescribe medication for NDs and map them to theoretical models of behaviour change to identify the behavioural determinants that may support in optimising prescribing.

METHODS AND FINDINGS

Embase and Ovid MEDLINE were used to identify relevant empirical research studies. Screening, data extraction and quality assessment were carried out by three independent reviewers to ensure consistency. Factors influencing prescribing were mapped to the Theoretical Domains Framework (TDF) and key behavioural determinants were described using the Capability, Opportunity, Motivation - Behaviour (COM-B) model. An initial 3,099 articles were identified, of which 53 were included for data extraction. Fifty-six factors influencing prescribing were identified and categorised into patient, HCP or healthcare system groups, then mapped to TDF and COM-B domains. Prescribing was influenced by capability of HCPs, namely factors mapped to decision making (e.g., patient age or symptom burden) and knowledge (e.g., clinical understanding) behavioural domains. However, most factors were influenced by HCP opportunity, underpinned by factors mapped to social (e.g., prescribing support or culture) and contextual (e.g., lack of resources or medication availability) domains. Less evidence was available on factors influencing the motivation of HCPs, where evident; factors primarily related to HCP belief about consequences (e.g., side effects) and professional identify (e.g., level of specialism) were often described.

CONCLUSIONS

This systematic analysis of the literature provides an in-depth understanding of the behavioural determinants that may support in optimising prescribing practices (e.g., drug costs or pressure from patients' family members). Understanding these approaches provides an opportunity to identify relevant intervention functions and behaviour change techniques to target the factors that directly influence HCP prescribing behaviour.

Top-funded digital health companies offering lifestyle interventions for dementia prevention: Company overview and evidence analysis

BACKGROUND AND OBJECTIVE

Dementia prevention has been recognized as a top priority by public health authorities due to the lack of a reversible cure. In this regard, digital dementia-preventive lifestyle services (DDLS) emerge as potentially pivotal services, aiming to address modifiable risk factors on a large scale. This study aims to identify the top-funded companies offering DDLS and evaluate their clinical evidence to gain insights into the international service landscape.

METHODS

A systematic screening of two financial databases (Pitchbook and Crunchbase) was conducted. Corresponding published clinical evidence was collected through a systematic literature review and analyzed regarding study purpose, results, quality of results, and level of clinical evidence.

FINDINGS

The ten top-funded companies offering DDLS received a total funding of EUR 128.52 million, of which three companies collected more than 75%. Clinical evidence was limited due to only nine eligible publications, small clinical subject groups, the absence of longitudinal study designs, and no direct evidence of dementia prevention.

CONCLUSION

Our study shows that the level of funding received by companies does not reflect the clinical effectiveness of DDLS. The study serves as an initial step toward understanding how DDLS are currently evaluated in today's market and highlights the need for a more rigorous evaluation of DDLS effectiveness.

A balancing act: exploring ethical and legal concerns associated with release of personal information in alert systems for missing persons with dementia

BACKGROUND

Technology, such as alert systems, can foster community engagement in locating missing persons with dementia and minimize potential harm. However, concerns arise about implications of public disclosure of missing individual's personal information (such as age, photographs, physical descriptions, and medical conditions) within alert systems. Until now, there has been no review of these concerns, particularly in the Canadian context. Our study aimed to explore community members' perspectives on the ethical and legal concerns associated with the release of personal information in alert systems for missing persons with dementia.

METHODS

Using a qualitative descriptive approach, we conducted semi-structured interviews with 18 participants: people living with dementia, care partners, service providers, first responders, and experts in ethics, policy, and the law from Canada and the United Kingdom. We conducted a thematic analysis of the interview data to inductively explore ethical and legal concerns.

RESULTS

Our findings identified the following concerns: Balancing safety and privacy, stigmatization, risk of victimization and abuse, and informed consent. There is a challenge of balancing safety with privacy due to the urgency of locating missing persons when sharing personal information publicly. Disclosure of personal information, such as cognitive impairment, can increase the risk of stigmatization, victimization, and abuse for both the missing individuals and their care partners. Unfortunately, conversations about alert systems and consent do not typically occur before someone goes missing, even though people living with dementia have the right to participate in these conversations.

CONCLUSIONS

Alert systems can promote community involvement in locating missing persons with dementia but must balance safety and privacy concerns. Implementation of education and policies would mitigate stigmatization, victimization, and abuse. Early conversations with people living with dementia and their care partners to understand their preferences, along with an advance consent process, can help address consent concerns. Our framework, which emphasizes ethical and legal considerations, can guide policy, practice, and decision-making to support the autonomy of people living with dementia.

CLINICAL TRIAL NUMBER

Not applicable.

Psychosis associated with dementia: evaluation and management

Dementia is one of the most common neurodegenerative disorders in the world, and 34-63 % of individuals with dementia have psychotic symptoms. Neurobiological correlates of dementia with psychosis include significantly increased densities of senile plaques and neurofibrillary tangles and higher D3 receptor density. Limitations of proposed diagnostic criteria include a lack of specificity for psychotic symptoms in individuals with dementia, a lack of consistent differentiation between symptoms, late recognition, and not accounting for comorbid depression or agitation that may be the primary symptom, which makes diagnosis challenging. This review aims to provide clinicians, researchers, and policymakers with a comprehensive evaluation of psychosis in dementia, covering its epidemiology, neurobiology, diagnosis, and treatment strategies. We review both psychosocial and pharmacological interventions for dementia-related psychosis. Psychosocial treatments such as meaningful communication between persons with dementia and their caregivers, simplifying the living environment, and optimizing tasks can help reduce the adverse impact of psychosis. Evidence from meta-analyses indicates modest efficacy for cholinesterase inhibitors, antidepressants, and antipsychotics for psychosis in dementia. The use of antipsychotic medications is limited by increased risks for serious adverse effects including cerebrovascular events and death. Emerging therapies such as xanomeline-trospium present promising avenues for treatment. By synthesizing current evidence and clinical guidelines, this review provides a framework for improving diagnosis and treatment of psychosis in dementia, helping clinicians and researchers refine patient care strategies while informing future research directions.

Sepsis on dementia risk: A population-based cohort study with dose-dependent analysis

PURPOSE

Emerging evidence links sepsis-related inflammation to dementia risk, but the dose-dependent effects of recurrent sepsis episodes remain unclear. This study assessed whether sepsis increases dementia risk and explored a potential dose-response relationship between sepsis frequency and dementia.

METHODS

We conducted a retrospective cohort study using Taiwan's National Health Insurance Research Database (2005-2022), enrolling patients aged ≥18 years hospitalized with sepsis. An index period (2008-2013) was used to identify patients without prior dementia. A fixed 12-month landmark period (calendar year 2014) was applied to assess the number of sepsis episodes. Patients who died during the landmark period were excluded. Propensity score matching was performed to generate well-balanced sepsis and non-sepsis groups. Follow-up for dementia and mortality began after the landmark period and continued for up to 64 months. Cox and Fine-Gray models were used to account for competing risks of death.

RESULTS

Sepsis was associated with a significantly increased risk of all-cause dementia (HR 1.59; 95 % CI, 1.47-1.72; P < 0.0001). A dose-response relationship was observed: patients with multiple sepsis episodes had the highest dementia risk (sHR 1.63; 95 % CI, 1.39-1.91). Vascular dementia showed the strongest association, with a higher incidence in the sepsis group (1.2 % vs. 0.6 %, P = 0.0003).

CONCLUSIONS

Our findings provide robust evidence of a dose-dependent association between sepsis and increased dementia risk, particularly vascular dementia, even after adjusting for competing mortality risks.

SUMMARY

This study addresses the limitations of previous research by not only employing propensity score matching (PSM) to balance confounding factors between the sepsis and non-sepsis groups but also using an index period and landmark period design to better explore potential causal relationships. These periods ensure that dementia onset occurred after sepsis and allow for the examination of dose-response relationship between sepsis episode frequency and dementia. Furthermore, this is the largest study to date involving sepsis patients, providing more robust evidence than prior studies, which were often smaller and lacked adjustments for competing risks of death.

Longitudinal trends in dementia prevalence among individuals with type 2 diabetes in Taiwan (2009-2022)

OBJECTIVE

This study examined the population-based epidemiological prevalence of early- and late-onset dementia in individuals with type 2 diabetes mellitus (T2DM) compared with the general population in Taiwan from 2009 to 2022.

METHODS

A 14-year nationwide population-based epidemiology study from 2009 to 2022 in Taiwan using the Taiwan National Health Insurance Research Database was conducted to examine the crude and age-standardized dementia prevalence in individuals aged <65 and ≥65. Multivariable logistic regression was used to assess factors associated with dementia prevalence in the T2DM population.

RESULTS

Among individuals aged ≥65 with T2DM, age-standardized dementia prevalence increased from 5.83 per 100 in 2009 to 7.11 per 100 in 2022, while the crude prevalence ratio compared to the general population ranged from 1.19 to 1.08. In the 40-64 age group, standardized dementia prevalence ranged from 0.58 to 0.43 per 100, with crude ratios ranging from 1.76 to 1.41. Our study found a higher risk of dementia prevalence among individuals aged 65 years and older, particularly among those with T2DM. Although the overall prevalence of dementia in the 40-64 age group was lower compared to older adults, individuals in this younger group with T2DM exhibited a significantly higher risk of developing dementia. Given these findings, public policy should prioritize early preventive strategies for individuals with T2DM to monitor and mitigate dementia progression in patients with T2DM.

The costs of dementia care by US state: Medical spending and the cost of unpaid caregiving

BackgroundThere are 5.5 million people living with dementia in the United States (US), with the cost of unpaid care making up a significant portion of the care costs.ObjectiveSummarize variation in the cost of dementia care across the US and examine the association between medical spending and costs of unpaid care at the state level.MethodsWe estimated total cost for dementia by combining recent medical spending estimates from the Disease Expenditure project and unpaid care cost estimates from Lastuka and colleagues. Hours of unpaid care were valued as the hourly wage of a home health aide. We used linear regression to measure the association between the cost of unpaid care and medical spending. The spending that would have occurred if unpaid care had been provided by professional home health care workers was used to measure the cost of unpaid care.ResultsThe annual cost of care attributable to dementia in 2019 was $53,502 (95% uncertainty interval [UI] 46,135-60,594) per case. The contribution of unpaid care to total costs varied by state, ranging from 70.2% (95% UI 64.3-75.4) in the District of Columbia to 89.9% (95% UI 87.8-91.5) in Arizona. We found that higher costs of unpaid care were associated with lower medical spending on nursing facility care.ConclusionsThe large variation in total costs of dementia shows that the economic burden of dementia care is distributed unevenly throughout the US.

Longitudinal, Bidirectional Association between Gait Speed and Cognitive Function in Community-Dwelling Older Adults without Dementia

OBJECTIVES

The causal relationship between slow gait speed and poor cognition is uncertain due to potential reverse causality. This study aimed to examine the reciprocal relationship between gait speed and global as well as domain-specific cognitive functions in older adults.

DESIGN

Prospective cohort study (2013-2022) including 4 repeated measures.

SETTINGS AND PARTICIPANTS

Community-dwelling and adults without dementia aged ≥65 recruited at baseline.

METHODS

Biennial evaluations included assessments of 4-m usual walking speed, global cognition using the Taiwanese version of the Montreal Cognitive Assessment (MoCA), and cognitive domains (memory, executive function, verbal fluency, and attention) using a battery of neuropsychological tests. Cross-lagged models and linear mixed models were used to examine the bidirectional association between gait speed and cognitive functions with adjustment for potential confounders.

RESULTS

At baseline, 511 participants were enrolled, and 459 individuals with a mean age of 74.5 years were ultimately analyzed. A 1-SD decrease in gait speed was associated with a 0.07-0.09 SD decrease in subsequent global cognition [βˆWave 1→2: 0.07, standard error (SE): 0.03; βˆWave 2→3: 0.09, SE: 0.04; βˆWave 3→4: 0.09, SE: 0.04; all P < .05]. Similarly, a 1-SD decrease in global cognition was associated with a 0.18 to 0.19 SD decrease in subsequent gait speed (βˆWave 1→2: 0.18, SE: 0.05; βˆWave 2→3: 0.18, SE: 0.06; βˆWave 3→4: 0.19, SE: 0.07; all P < .001). In addition, slower gait speed was associated with poor memory, verbal fluency, and executive function, and vice versa. The results of linear mixed models were consistent with the findings obtained from cross-lagged models.

CONCLUSIONS AND IMPLICATIONS

This study found a reciprocal association between gait speed and global or domain-specific cognition. Regularly screening gait speed and cognitive function enables the early detection of declines in physical function and cognition.

Comparing the impact of various exercise modalities on old adults with Alzheimer's disease: A Bayesian network meta-analysis

BACKGROUND AND PURPOSE

The global prevalence of Alzheimer's disease (AD) in the elderly is rising, and exercise is increasingly used as a non-pharmacological intervention. However, the most effective exercise modality for improving quality of life, alleviating depression, and reducing neuropsychiatric symptoms in AD patients remains unclear. This study aims to identify the optimal exercise modality for addressing these symptoms through a network meta-analysis.

METHODS

As of November 2024, we conducted a comprehensive search across six databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. This study included only randomized controlled trials (RCTs), with study durations ranging from 2 to 24 weeks, primarily set in clinical or community environments. Following the PRISMA-NMA guidelines, we conducted statistical analysis using the "gemtc" package in R and assessed evidence quality via the CINeMA online platform.

RESULTS

A network meta-analysis of 29 RCTs with 1507 participants showed that for global cognition, Aerobic exercise (AE) [MD = 2.83, 95 % CI (0.66, 4.85)] ranked first with 79.5 % probability; for quality of daily life, Resistance Training (RT) [SMD = 0.96, 95 % CI (-0.14, 2.07)] ranked first with 83.7 %; for depression, Physical Activity Program (PAP) [SMD = -3.76, 95 % CI (-7.06, -0.47)] ranked first with 96.0 %; and for neuropsychiatric inventory outcomes, AE [SMD = -2.35, 95 % CI (-5.95, 1.06)] ranked first with 71.1 %.

CONCLUSIONS

Based on the findings from retrospective studies, aerobic exercise may be an effective intervention for improving overall cognition and quality of life in individuals aged 60 and above with Alzheimer's disease.

Use of sodium-glucose cotransporter-2 inhibitors and risk of dementia: A population-based cohort study

BACKGROUND AND AIMS

The effects of sodium-glucose co-transporter 2 inhibitors (SGLT-2i) on dementia risk have not been assessed in the Chinese population. We aimed to assess the association between the use of SGLT-2i and dementia incidence in a mainland Chinese population.

MATERIALS AND METHODS

A target trial of SGLT-2i vs. dipeptidyl peptidase 4 inhibitors (DPP-4i) was emulated, with cohorts of type 2 diabetes mellitus patients who were new users of SGLT-2i or DPP-4i being assembled using the Yinzhou Regional Health Care Database. Inverse probability of treatment weighting (IPTW) was applied to control potential confounding, and a Cox model was used to estimate the hazard ratio (HR) of the association between the use of SGLT-2i and incident dementia.

RESULTS

The final cohort included 47 335 new users of DPP-4i or SGLT-2i. In the primary analysis, the incidence of dementia was 500.2 and 347.5 per 100 000 person-years in users of DPP-4i and SGLT-2i, respectively. SGLT-2i use was associated with a reduced risk of incident dementia after adjusting for potential confounding using IPTW, with an HR of 0.74 (95% CI, 0.60-0.93). The results were generally consistent in various subgroup analyses and sensitivity analyses.

CONCLUSIONS

The use of SGLT-2i is associated with a decreased risk of dementia incidence in the study population in mainland China.

Cultural adaptations of the WHO iSupport for dementia: A scoping review

IntroductionThe World Health Organisation (WHO) has developed iSupport for Dementia, a self-paced online training programme for caregivers of people with dementia which is adaptable to different cultural contexts. This scoping review aims to understand the iSupport adaptation process in different countries and provide recommendations for future adaptations.MethodsA systematic search was done in electronic databases such as Pubmed, MEDLINE, APA PsycINFO, and EMBASE to obtain relevant publications up to 18 February 2024. Only full-text publications describing iSupport cultural adaptation process were included. The publications obtained were reviewed using the Cultural Adaptation Process framework.ResultsThirteen publications from ten studies were eligible for inclusion. Based on the Cultural Adaptation Process framework, the steps undertaken in the studies were grouped into: (i) setting the stage, (ii) initial adaptation, and (iii) adaptation iterations. The three significant players in this process are the intervention developer (researchers), the cultural adaptation specialist (researchers, caregivers, and dementia care professionals), and the target community (caregivers). In the publications reviewed, cultural adaptation was mostly undertaken using a co-design process between researchers, caregivers, and dementia care professionals deciding on necessary modifications.ConclusioniSupport for Dementia is a versatile programme to support caregivers and is readily available for adaptation to different cultural settings. It is essential to engage caregivers early in co-designing its cultural adaptations to ensure their needs can be met by this online tool.

The Impact of Behavioral and Psychological Symptoms of Dementia on Individual's Autonomy: a Scoping Review

The purpose of this study was to identify, map, summarize, and clarify the existing literature on the effects of behavioral and psychological symptoms of dementia (BPSD) an individual's autonomy across all types of dementia diagnoses. The study aimed to determine whether there is a correlation between BPSD and a decrease in a person's autonomy, as this relationship is important for improving dementia care through effective interventions. To achieve this goal, a scoping review was conducted using the Joanna Briggs Institute's methodology for scoping reviews and the PRISMA extension for scoping reviews checklist. The inclusion criteria were: (i) population: participants with a clinical diagnosis of any type of dementia; (ii) concept: examining the relationship between one or more neuropsychiatric symptoms or BPSD and the individual's autonomy; (iii) context: the progress of any type and any stage of dementia. The database search yielded 74 records, of which 41 fully met the pre-established eligibility criteria. Most studies in this review focused on participants with Alzheimer's disease and analysed their functional abilities. Most studies in this review showed significant outcomes regarding the impact of BPSD on a person's autonomy. The main BPSD investigated in the studies were depression, apathy, irritability, agitation, aggression, disinhibition, and lability. Apathy had a recurrent association with reduced autonomy in persons with dementia, while depression and psychosis were also found to have an impact on individuals' autonomy.

Improving cognitive function in older adults through mind-body Qigong exercise at senior daycare centers: The role of sleep as a moderator and mediator

OBJECTIVES

Mind-body Qigong Baduanjin exercises benefit cognition in community-dwelling older adults, yet mechanisms are poorly understood. We aimed to examine the moderation and mediation roles of sleep on intervention effects in cognition.

METHODS

This 10-week trial included 78 (intervention: n = 47, control: n = 31) older Chinese adults at a daycare center. We measured the sleep quality, both subjective and objective cognition pre- and post-intervention. The intervention served as the independent variable and the post-pre changes in cognition were used as outcomes. Baseline sleep quality was examined as a moderator, while post-pre changes in sleep quality were considered as a mediator. We tested the interaction between intervention and the moderator using a linear regression model, with relevant covariates adjusted. Subgroup analyses were conducted for any potential interaction (p < 0.20). Mediation effects were analyzed through first modeling the effect of the independent variable on the mediator, and then modeling the effect of independent variable and the mediator on the outcome.

RESULTS

Compared to control, Qigong intervention significantly predicted improvements in subjective and objective cognition among older adults, particularly for poor sleepers but not good sleepers. Sleep improvements significantly mediated intervention effects on subjective cognition in participants with less daily exercise (indirect effect: β= -0.412, 95 % CI: [-0.910, -0.066]).

CONCLUSIONS

Qigong improved cognition in older Chinese, particularly those with sleep problems prior to the intervention. Sleep quality changes played a mediating role, especially in individuals with less exercise. Results shed light on future interventions in identifying targeted mediating/moderating factors of Qigong.

Harmonized prevalence estimates of dementia in Europe vary strongly with childhood education

Up-to-date, strictly cross-nationally comparable and nationally representative data on cognitive health are essential for our understanding of the dementia-related challenges in healthcare, to detect shortcomings in healthcare systems and to design effective prevention strategies. Such data have been missing in Europe. We use the most recent 2022 wave of the strictly harmonized Survey of Health, Ageing and Retirement in Europe (SHARE, 47,773 individuals age 65 and older) to obtain prevalence estimates of mild cognitive impairment and dementia for 27 European countries and Israel in 2022. The novelty of the paper is to validate these estimates using the Harmonized Cognitive Assessment Protocol (HCAP) as a validation tool. These new data exhibit much higher prevalence rates of dementia in the Mediterranean and Southeastern European countries and a much larger variation of cognitive impairment across Europe and Israel than previously known. Dementia prevalence ranges from 4.5% in Switzerland to 22.7% in Spain, MCI prevalence from 17.2% in Sweden to 31.1% in Portugal. Most of this variation can be explained by differences in education when respondents were young. Prevalence rates vary plausibly with other risk factors such as age and comorbidities associated with dementia.

Relationship between immediate memory, depressive symptomatology and loneliness in older adults: a longitudinal study

OBJECTIVES

We aimed to study the longitudinal relationship between immediate memory, depressive symptomatology and loneliness controlling for age and number of chronic diseases over time.

METHOD

The study sample consisted of 64,887 participants from three consecutive waves of the Survey of Health, Ageing and Retirement in Europe project, aged 50 or older at the first time (M = 66.68, SD = 10.034). We used cross-lagged panel model.

RESULTS

Within each temporal moment, associations between immediate memory and depressive symptomatology, and associations between immediate memory and loneliness were negative. Associations between depressive symptomatology and loneliness were positive. These three variables feedback on each other over time through small and medium effects. Immediate memory is more affected by depressive symptomatology than by loneliness. However, loneliness may exert a greater negative effect, in relative terms, on immediate memory when it coexists with depressive symptomatology. Depressive symptomatology is more affected by loneliness than by immediate memory deficits. However, deficits in immediate memory may affect depressive symptomatology more in relative terms because such deficits are exacerbated by elevated scores of depressive symptomatology.

CONCLUSION

Despite the effect sizes being small to medium, depressive symptomatology and loneliness are risk factors for cognitive functioning. In addition, cognitive impairment aggravates depressive symptoms and loneliness feelings.

Towards a new Value-based scenario for the management of dementia in Italy: a SINdem delphi consensus study

This national expert-based Delphi-consensus aims at formulating recommendations on the management of dementia care in Italy. This effort seems important and timely given in light of a new scenario arising from a new biological definition of Alzheimer's disease (AD) and the availability of disease-modifying treatments (DMTs).

METHODS

the Steering Committee of the Italian Neurological Society for dementia (SINdem) created appropriate statements. Invited SINdem experts were requested to vote on the statements according to a modified three-round Delphi method. Only those statements reaching Grade A (full agreement ≥ 75%) or B (overall agreement ≥ 80% and full disagreement < 5%) were included in the final document. Round answers' consistency was graded using the Cohen's k and within-class correlation coefficient.

RESULTS

Forty-six experts voted on 20 statements, which focused on the following aspects: i) organization of care services from early diagnosis to the management of advanced clinical stages; ii) access to biomarkers for a biological diagnosis of AD; iii) requirements necessary for the administration of DMTs; iv) main actors and pathways for the management of patients suffering from cognitive disorders. At the end of the process, 4 statements (20%) received a Grade A consensus, while 16 (80%) reached a Grade B consensus. Although the responses reflect heterogeneity among Italian regions, there was a fair degree of consistency for all statements.

CONCLUSION

The high strength of this expert-based Delphi-consensus may offer guidance for improving the patient's journey of individuals with cognitive decline from a biological diagnosis to DMTs administration and may possibly offer hints to the Health Systems on dementia.

Latent cognitive profiles and their associations with instrumental activities of daily living among older adults without dementia: A United States national cross-sectional study

BACKGROUND

Conventional dichotomous classifications of cognitive status in older adults (normal vs impaired) may obscure distinct domain-specific deficits. Identifying nuanced cognitive profiles could enable personalized interventions, particularly when tailored to instrumental activities of daily living (IADLs).

OBJECTIVES

To identify distinct cognitive profiles in older adults without dementia and assess their associations with overall and domain-specific IADL performance.

DESIGN/SETTING/PARTICIPANTS

Cross-sectional data from 2219 adults aged ≥65 years without dementia in the nationally representative National Health and Aging Trends Study.

MEASUREMENTS

Latent profile analysis classified participants across six cognitive domains: episodic memory, executive function, orientation, psychomotor function, visual attention, and working memory. Logistic and linear regression models with Holm-Bonferroni corrections evaluated relationships between cognitive profiles and IADL performance.

RESULTS

Five profiles emerged: Profile 1: Overall intact (50.5 % of participants); Profile 2: Isolated moderate orientation impairment (15.6 %); Profile 3: Mild global impairment with preserved orientation (22.0 %); Profile 4: Mild global impairment with significant orientation impairment (5.5 %); Profile 5: Moderate global impairment (6.2 %). Compared with Profile 1, all other profiles exhibited significantly higher overall IADL difficulty and were more likely to experience challenges with shopping, medication management, meal preparation, and banking (all adjusted p < 0.05). Profile 4 had the highest odds for difficulties with shopping (OR, 2.19; 95 % CI, 1.41-3.38; adjusted p = 0.005) and banking (OR, 3.98; 95 % CI, 2.62-6.04; adjusted p < 0.001), whereas Profile 5 showed the greatest risk for medication management (OR, 2.55; 95 % CI, 1.66-3.90; adjusted p < 0.001) and meal preparation (OR, 2.22; 95 % CI, 1.49-3.31; adjusted p = 0.001).

CONCLUSION

Nearly half of older adults without dementia exhibit distinct cognitive profiles warranting tailored interventions. Profile 5 requires comprehensive strategies, whereas Profiles 2, 3, and 4 may benefit from orientation-targeted and intensity-varied training in other cognition domain. Incorporating specific IADL tasks (e.g., meal preparation, medication management for Profile 5 and shopping, banking for Profile 4) into cognitive interventions may concurrently enhance cognitive health and functional independence.

The Excess Direct Social Costs of Dementia-Related Neuropsychiatric Symptoms: A Regionwide Cohort Study Beyond Silos

OBJECTIVES

To estimate the excess formal social costs or direct non-healthcare costs of dementia-related neuropsychiatric symptoms (NPS).

METHODS

The presence of dementia, NPS, antipsychotic and antidepressant use, somatic and psychiatric comorbidities, and formal social benefits were studied in a regionwide cohort of all 60-year-old and older individuals. A random forest-based algorithm identified NPS, and 2-part regression models and entropy balance were used.

RESULTS

Of the 215 859 individuals, 7553 (3.50%) had dementia, 74 845 (34.7%) had some NPS, and 20 787 (9.63%) received long-term care benefits. Notably, nearly two-thirds (63.9%) of people with dementia received benefits. The probability of having social costs varied markedly with age (odds ratio [OR] 12.28 [10.17-14.82] for >90-year-olds category), and the presence of dementia (OR 7.36 [6.13-8.84]) or NPS (OR 3.23 [2.69-3.88]). NPS (relative change [RC] 1.39 [1.31-1.49]) and dementia (RC 1.32 [1.24-1.41]) were associated with higher average benefit costs. Low socioeconomic status was significantly associated with both a higher probability of receiving benefits (OR 1.52 [1.38-1.68]) and higher costs of their provision (RC 1.18 [1.15-1.21]).

CONCLUSIONS

The burden of caring for NPS is greater than that indicated by the literature as these symptoms multiply the social costs of dementia by more than 3, owing to the greater use of residential care and formal coverage reaching more patients than that indicated by the literature. The greater presence of dementia and NPS in the population of lower socioeconomic status indicates an inequality in health attenuated by greater use of social benefits.

Survey on diagnosis and treatment of cognitive impairment in Sichuan area in China

INTRODUCTION

Dementia imposes significant economic and emotional burdens, with cognitive impairment in China expected to rise. However, diagnosis and treatment remain inadequately standardized. This study surveyed cognitive impairment diagnosis and treatment in Sichuan, China.

METHODS

A retrospective multicenter study analyzed inpatient records from 13 medical institutions over the past 5 years.

RESULTS

Patients exhibited delayed medical care-seeking, primarily visiting tertiary hospitals, where diagnostic and treatment capabilities were superior. Alzheimer's disease (AD) was the most common diagnosis, with memory impairment as the predominant initial symptom. Both pharmacological and non-pharmacological treatments were insufficient.

DISCUSSION

Findings underscore the need to enhance health education, allocate more diagnostic and intervention resources, and strengthen primary healthcare to improve care quality for patients with cognitive impairment in Sichuan.

HIGHLIGHTS

The prevalence of cognitive impairment in China is expected to surge significantly. Despite this trend, the diagnosis and treatment of cognitive disease in China remain unstandardized. A multicenter retrospective study of inpatient records with cognitive impairment or dementia as the first diagnosis treated at 13 medical facilities across Sichuan Province over the past 5 years was performed. The analysis revealed a pattern of delayed medical care-seeking among patients who predominantly accessed tertiary hospitals. Alzheimer's disease (AD) emerged as the most common diagnosis. Memory impairment was identified as the most frequent initial symptom. Tertiary hospitals demonstrated superior diagnostic and treatment capabilities compared to non-tertiary institutions. In addition, the results revealed that the patients received fewer pharmacological and non-pharmacological treatments. The findings highlight the urgent need for the Sichuan region to strengthen health education on cognitive impairment, allocate more diagnostic and intervention resources, and enhance primary healthcare capabilities to improve the quality of care and life for patients with cognitive impairment.

Environmental risk factors for all-cause dementia, Alzheimer's disease dementia, vascular dementia, and mild cognitive impairment: An umbrella review and meta-analysis

BACKGROUND

Mitigation of environmental risk factors for neurocognitive disorders could reduce the number of incident cases. We sought to synthesize the literature on environmental risk factors for dementia and mild cognitive impairment.

METHODS

We conducted an umbrella review and meta-analysis. Multiple databases were systematically searched to identify systematic reviews and meta-analyses of longitudinal studies examining environmental risk factors for dementia or mild cognitive impairment. We used random effects multi-level, meta-analytic models to synthesize risk ratios for each risk factor while accounting for overlap in the studies within reviews. As a secondary objective, we examined risk factors for two common phenotypes of dementia: Alzheimer's disease dementia and vascular dementia.

RESULTS

A total of 19 reviews containing 37 meta-analyses were included umbrella review. We found 9 factors where exposure was associated with higher risks of all-cause dementia: fine particulate matter, particulate matter, nitrogen dioxide, nitrogen oxides, carbon monoxide, shift work, night shift work, chronic noise, and extremely-low frequency magnetic fields. Neighbourhood greenness was associated with a lower risk of all-cause dementia. In a narrative review, we found that exposure to sulfur dioxide, proximity to roadways, ionizing radiation, aluminum, solvents, pesticides, and environmental tobacco smoke were also associated with dementia. We also found that fine particulate matter, extremely-low frequency magnetic fields, sulfur dioxide, chronic noise, and pesticides were related to Alzheimer's disease dementia. Fine particulate matter, particulate matter, and chronic noise were related to vascular dementia. No systematic review reported on mild cognitive impairment.

CONCLUSION

Achieving stronger air quality targets has the potential to reduce population-level dementia risk. Neighbourhood (i.e., greenness and chronic noise) and occupational (i.e., shift work) characteristics are associated with dementia and are viable public health intervention points. Additional research should examine the relationship between other environmental risk factors and mild cognitive impairment and specific types of dementia.

Measuring time saved in Alzheimer's disease: What is a meaningful slowing of progression?

INTRODUCTION

Minimal clinically important differences (MCIDs) for Alzheimer's disease (AD) have previously been estimated using clinician-based anchors. However, MCIDs have been criticized for not reflecting the preferences of people living with AD (PLWAD). Furthermore, interpretations of clinical trial results have been criticized for conflating within-person meaningfulness thresholds and between-group differences. Here, we simulate scenarios of disease slowing and compare those to published MCIDs.

METHODS

Scenarios of 5%-95% disease slowing were simulated using Alzheimer's Disease Neuroimaging Initiative (ADNI) data. Time saved and point differences on the Clinical Dementia Rating scale-Sum of Boxes (CDR-SB) were estimated for these scenarios and compared to published MCIDs.

RESULTS

Scenario analyses resulted in estimates of time saved at ∼3 weeks-17 months and mean changes at 0.08-1.5 CDR-SB points over 18 months. The often referenced MCID for mild cognitive impairment (0.98) thereby corresponded to 11 months slowing, whereas the MCID for mild dementia (1.63) corresponded to >17 months slowing.

DISCUSSION

Translating trial endpoints to estimates of time saved supports that often-referenced MCIDs may not be aligned with realistic and meaningful slowing of clinical progression.

Highlights

AD slowing of clinical progression by 5%-95% resulted in 0.74-17 months saved and 0.08-1.5 CDR-SB points change at 18 months.Slowing of at least 60% or 11 months of time saved over 18 months met an often-cited MCID threshold of 0.98 points for mild cognitive impairment.For mild AD dementia, an MCID of 1.63 meant that even an 18-month delay over 18 months would be considered only borderline meaningful-a face invalid and unrealistic proposition.

Exploring the effectiveness and experiences of people living with dementia interacting with digital interventions: A mixed methods systematic review

Background: As dementia care evolves, digital interventions are being developed to improve the quality of life of people living with dementia. It is also increasingly recognised that some people living with dementia can use and benefit from using digital interventions themselves. Therefore, exploring the effectiveness and experiences of using such interventions is essential to optimise digital intervention development and delivery.Method: 5 databases were searched (MEDLINE (Ovid), PsycINFO, EMBASE, CINAHL and Web of Science) for papers reporting effectiveness outcomes or experiences, involving people living with dementia or mild cognitive impairment engaging with digital interventions for improving their quality of life. 73 relevant papers published between 2018-2023 were identified, 59 included effectiveness data and 18 included data on experiences.Results: The integration of evidence identified that people living with dementia can benefit from engaging in digital interventions, if they are motivated, and provided with tailored training, support, appropriate devices and content. Benefits were seen within the domains of cognition, health and well-being and social relationships. Benefits were more frequent when digital interventions were provided in the home environment with specified daily/weekly usage requirements.Conclusion: This review provides an overview of the current state of research exploring engagement of digital interventions by people with dementia for improving their quality of life. The findings provide guidance on how to optimise the method of delivery. Future research should explore how digital interventions can improve social relationships and self-concept of people living with dementia, the long-term sustainability of digital interventions, and how individuals with dementia form attitudes towards technology.

Chronic Postsurgical Pain Raises Risk of Dementia

PURPOSE

This study aimed to investigate the association between chronic postsurgical pain (CPSP) and the risk of dementia, addressing a significant gap in the existing literature and highlighting potential implications for clinical practice and public health.

PATIENTS AND METHODS

Utilising data from Taiwan's National Health Insurance Research Database, a propensity score-matched cohort study was conducted involving 142,682 patients who underwent major surgery between 2004 and 2018. CPSP was defined as prolonged analgesic use post-surgery, and dementia diagnosis was tracked until December 31, 2022. Multivariable Cox regression models were employed to calculate adjusted hazard ratios (aHRs) for dementia risk in CPSP versus non-CPSP groups.

RESULTS

Before propensity score matching, the CPSP cohort (n = 37,438) exhibited a higher risk of dementia, with aHRs of 1.35 (95% CI: 1.30-1.40). After matching, the aHR remained elevated at 1.31 (95% CI: 1.26-1.37), indicating a significant association between CPSP and dementia risk. Subgroup analysis confirmed this association across various demographic and clinical factors, with sensitivity analysis reinforcing the robustness of the findings.

CONCLUSION

This study establishes CPSP as an independent predictor of dementia risk, highlighting the importance of postoperative pain management in mitigating long-term cognitive outcomes. Approximately 30% of dementia risk post-CPSP presents an opportunity for risk reduction through effective CPSP management strategies, emphasising the need for targeted interventions to address this critical healthcare issue.

SIGNIFICANCE

This study provides compelling evidence that chronic postsurgical pain (CPSP) significantly increases the risk of dementia, highlighting a critical and previously underexplored connection between postoperative pain and long-term cognitive decline. By establishing CPSP as an independent predictor of dementia, our findings underscore the importance of effective pain management strategies in surgical patients, particularly to mitigate the heightened risk of dementia and improve long-term outcomes.

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.

The formal care costs of dementia: a longitudinal study using Swedish register data

BACKGROUND

This study investigates the excess costs of dementia from healthcare, social care services, and prescription drugs 3 years before to 6 years after diagnosis. Further, sociodemographic cost differences are explored.

METHODS

Using Swedish register data from 2013 to 2016 to compare individuals diagnosed with dementia (n = 15,339) with population controls, the excess formal care costs for people with a dementia diagnosis are obtained with longitudinal regression analysis.

RESULTS

People with dementia incur higher formal care costs for all years studied compared to people without dementia. The excess costs vary from €3400 3 years before diagnosis to €49,700 6 years after diagnosis. The costs are mainly driven by institutional care, and solitary living is a strong predictor of high excess costs.

CONCLUSION

The results show that the formal care costs of individuals with dementia are substantial, and that the economic burden of dementia in Sweden is larger than previously estimated.

GSK-3β dysregulation in aging: Implications for tau pathology and Alzheimer's disease progression

The role of glycogen synthase kinase-3β (GSK-3β) in the pathogenesis of Alzheimer's disease (AD) is critical for linking amyloid-beta (Aβ) and Tau pathology. The activity of GSK-3β is dysregulated in the regulation of Tau hyperphosphorylation, formation of neurofibrillary tangles (NFTs), and production of Aβ by modulating amyloid precursor protein (APP) processing. This review discusses the mechanisms controlling GSK-3β dysregulation in aging and its influence on AD progression, focusing on the role of neuroinflammation, oxidative stress, and defective signaling pathways, including PI3K/Akt and Wnt. Critical analysis is presented for therapeutic strategies targeting GSK-3β using natural compounds (e.g., curcumin, geniposide) and emerging approaches such as TREM2 modulation and miRNA therapies. In preclinical models, these interventions promise to reduce Tau hyperphosphorylation and Aβ burden, along with associated neurodegeneration. Nevertheless, achieving selective GSK-3β inhibition and optimizing drug delivery are still critical barriers to clinical translation. This review underscores the central role of GSK-3β in AD pathogenesis to highlight its potential as a multifaceted therapeutic target of an innovative strategy for treating this complex neurodegenerative disease.

Efficacy of Add-On Agomelatine on Agitation, Aggression, and Neuroprotection in Alzheimer's Disease: A Randomized, Blinded, Controlled Trial

BACKGROUND

Agitation and aggression are challenging behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD), which is diagnosed based on NINCDS-ADRDA criteria. Limited efficacy and safety of existing pharmacotherapies complicate treatment. Agomelatine, a melatonergic agonist and serotonergic antagonist, may provide a safer and more effective alternative.

OBJECTIVES

The primary outcome is to evaluate the efficacy of agomelatine as an add-on therapy to nonpharmacological treatment in reducing agitation and aggression in patients with AD, with secondary outcomes assessing its safety and potential neuroprotective effects.

METHODS

In a randomized, triple-blind, placebo-controlled trial, 56 patients with AD (aged ≥65) experiencing agitation and aggression received 12.5 mg agomelatine (n = 28) or placebo (n = 28) daily for 6 weeks. The primary outcome was the Cohen-Mansfield Agitation Inventory (CMAI) score change. Secondary outcomes included serum brain-derived neurotrophic factor (BDNF) levels and safety.

RESULTS

At 6 weeks, the agomelatine group showed a greater reduction in CMAI scores than placebo (mean difference: -12.39, 95% CI: -19.37 to -5.42; p = 0.001). No significant BDNF changes were detected (p = 0.848). Total adverse events (AEs) were more common in the agomelatine group (50.0% vs. 21.4%, p = 0.050), but no serious AEs or liver enzyme abnormalities were reported.

CONCLUSION

A daily dose of 12.5 mg agomelatine may effectively and safely reduce agitation and aggression in patients with AD when used as an add-on therapy. However, further studies with larger samples and extended durations are needed to definitively confirm agomelatine's role in managing BPSD in AD.

Microglia-derived sEV: Friend or foe in the pathogenesis of cognitive impairment

As immune cells, microglia serve a dual role in cognition. Microglia-derived sEV actively contribute to the development of cognitive impairment by selectively targeting specific cells through various substances such as proteins, RNA, DNA, lipids, and metabolic waste. In recent years, there has been an increasing focus on understanding the pathogenesis and therapeutic potential of sEV. This comprehensive review summarizes the detrimental effects of M1 microglial sEV on pathogenic protein transport, neuroinflammation, disruption of the blood-brain barrier (BBB), neuronal death and synaptic dysfunction in relation to cognitive damage. Additionally, it highlights the beneficial effects of M2 microglia on alleviating cognitive impairment based on evidence from cellular experiments and animal studies. Furthermore, since microglial-secreted sEV can be found in cerebrospinal fluid or cross the BBB into plasma circulation, they play a crucial role in diagnosing cognitive impairment. However, using sEV as biomarkers is still at an experimental stage and requires further clinical validation. Future research should aim to explore the mechanisms underlying microglial involvement in various nervous system disorders to identify novel targets for clinical interventions.

Extracted step parameters during the timed up and go test discriminate between groups with different levels of cognitive ability-a cross-sectional study

BACKGROUND

Identifying cognitive impairment at an early stage is important to enable preventive treatment and lifestyle changes. As gait deviations precede cognitive impairment, the aim of this study was to investigate if step parameters during different Timed Up and Go (TUG) conditions could discriminate between people with different cognitive ability.

METHODS

Participants (N = 304) were divided into the following groups: (1) controls, n = 50, mean age:73, 44% women; (2) Subjective cognitive Impairment (SCI), n = 71, mean age:67, 45% women; (3) Mild Cognitive Impairment (MCI), n = 126, mean age: 73, 42% women; and (4) dementia disorders, n = 57, mean age: 78, 51% women. Participants conducted TUG and two motor-cognitive TUG-conditions: TUG while naming animals (TUGdt-NA) and reciting months in reverse order (TUGdt-MB). Tests were video recorded for data extraction of valid spatiotemporal parameters: step length, step width, step duration, single step duration and double step duration. Step length was investigated with the step length/body height ratio (step length divided by body height). Logistic regression models (adjusted for age, sex and education) investigated associations between step parameters and dichotomous variables of groups adjacent in cognitive ability: dementia disorders vs. MCI, MCI vs. SCI, and SCI vs. controls. Results were presented as standardized odds ratios (sORs), with 95% confidence intervals (CI95) and p-values (significance level: p < 0.05). The areas under the Receiver Operating Characteristic curves were presented for the step parameters/conditions with the highest sORs and, where relevant, optimal cutoff values were calculated.

RESULTS

Step length showed greatest overall ability to significantly discriminate between adjacent groups (sOR ≤ . 67, CI95: .45-.99, p = ≤ . 047) during all group comparisons/conditions except three. The highest sOR for step-length was obtained when discriminating between SCI vs controls during TUGdt-MB (sOR = .51, CI95:.29- .87, p = .014), whereby the area under the curve was calculated (c-statistics = .700). The optimal cut-off indicated a step length of less than 32.9% (CI95 = 22.1-43.0) of body height to identify SCI compared with controls.

CONCLUSIONS

The results indicate that step length may be important to assess during TUG, for discrimination between groups with different cognitive ability; and that the presented cut-off has potential to aid early detection of cognitive impairment.

TRIAL REGISTRATION NUMBER

NCT05893524 (retrospectively registered 08/06/23).

Sildenafil and risk of Alzheimer disease: a systematic review and meta-analysis

BACKGROUND

Alzheimer Disease (AD) affects more than 50 million people worldwide, with 10 million new diagnosis each year. The link between Sildenafil, a Phosphodiesterase-5 (PDE5) inhibitor, and risk of AD has been debated. We conducted the first meta-analysis on the association between Sildenafil use and risk of AD.

METHODS

We searched MEDLINE and Embase from inception to March 11, 2024 to identify cohort, case-control studies comparing the frequency of AD in patients taking Sildenafil with those without. We computed risk ratios (RR) and hazard ratios (HR) with accompanying 95% Confidence Intervals (CIs) for each study, and pooled the results using a random-effects meta-analysis.

RESULTS

Out of 415 studies that were screened initially, 5 studies comprising 885,380 patients were included for analysis. Sildenafil use was associated with a reduced risk of developing AD by two-fold compared to non-use (HR: 0.47, 95% CI: 0.27-0.82, p<0.001). There was a similar association in risk reduction of AD in patients on PDE5 inhibitors compared to non-use (RR: 0.55, 95% CI: 0.38-0.80, p=0.002).

CONCLUSIONS

Our meta-analysis showed that the use of Sildenafil is associated with a reduced risk of developing AD by two-fold. Further randomized control trials to ascertain the effect of Sildenafil on AD pathology would be useful.

The global, regional, and national burdens of dementia in 204 countries and territories from 1990 to 2021: A trend analysis based on the Global Burden of Disease Study 2021

The global population is aging, and as a consequence, the prevalence of dementia is increasing rapidly. This study aims to analyze trends in the Global Burden of Disease (GBD) and health inequalities for dementia over the period 1990 to 2021. The incidence, prevalence, and disability-adjusted life year rates of dementia in the GBD 2021 database were analyzed at the global, national, and regional levels for the period 1990 to 2021 using Joinpoint 4.9.1.0 software. The trends over the period were assessed using a combination of age-standardized rates, average annual percentage changes (AAPCs), and a sociodemographic index. The analysis revealed that, from 1990 to 2021, the global AAPC in dementia incidence, prevalence, and disability-adjusted life years amounted to 0.06 (95% confidence interval [CI]: 0.05-0.09), 0.09 (95% CI: 0.08-0.10), and 0.03 (95% CI: 0.01-0.05), respectively. Conversely, the mean AAPC in age-standardized mortality rate remained stable at 0 (95% CI: -0.02 to 0.03). The age-standardized incidence rate and age-standardized prevalence rate of dementia exhibited a positive association with sociodemographic index during the study period. The 3 regions with the highest mean AAPC in age-standardized mortality rate among the 21 GBD regions were South Africa, Central Sub-Saharan Africa, and Eastern Sub-Saharan Africa. The findings of the study indicate that the burden of dementia increases with age and is projected to remain on an upward trend until 2040. The GBD has increased significantly from 1990 to 2021, and the prevention and control of dementia represents a long-term and formidable challenge.

Exploration of health care utilization, social care utilization and costs for individuals discharged from inpatient geriatric care in Sweden - a registry data study

BACKGROUND

Individuals receiving geriatric care are often frail and afflicted with multiple chronic conditions demanding care from several medical disciplines, and from several different care providing units across the health systems.

OBJECTIVE

To explore the six-month service utilization and direct costs attributed to individuals receiving geriatric inpatient care.

METHODS

Health care utilization- in terms of inpatient care, outpatient visits with different health care professions- and social care utilization- in terms of social services, and stay at residential care facility (RCF)- were quantified based on registry data, for a cohort admitted to geriatric inpatient care in Stockholm, Sweden during 2016.

RESULTS

On average, individuals admitted to geriatric inpatient care in Stockholm had 12.8 inpatient care days, 32.1 visits in outpatient care, 432 h of home care and 28.8 days of staying at RCF, during the first six months after discharge. This amounted to an average cost of 722 thousand Swedish kronor (SEK), € 64 900, in 2023 monetary value. Costs were on average 37% attributable to inpatient care including the initial inpatient stay, 12% to outpatient visits, 38% to social services at home, and 13% to stay at residential care facility (whereof 11% short-term, 89% long-term). Total costs differed significantly between groups based on function, age and main diagnosis.

CONCLUSION

Costs of care for individuals treated at geriatric department are substantial. The variation of cost is also significant; higher age and lower function were associated with higher health care and social care costs. Major cost buckets were inpatient health care (region-financed) and social care at home (municipality-financed).

Annual societal cost of Alzheimer's disease in Malaysia: a micro-costing approach

BACKGROUND

Alzheimer's disease (AD) is expected to have a significant impact on resource use and economic consequences along with population aging. This study aims to investigate the annual economic burden of Alzheimer's disease along with underlying cost drivers.

METHODOLOGY

Patients with AD aged 65 and above accompanied with primary caregivers were recruited in 6 tertiary care hospitals. A structured interview was conducted to collect sociodemographic, clinical and resource use information using an adapted questionnaire. Direct medical cost, direct non-medical cost and indirect cost were annualised and categorised by severity level. Generalised linear models were applied to investigate predictors of costs.

RESULTS

Among 135 patient-caregiver dyads, the annual economic burden of AD from a societal perspective was USD 8618.83 ± USD 6740.79 per capita. The societal cost of severe AD patients (USD11943.19 ± USD6954.17) almost doubled those in mild AD (USD6281.10 ± USD6879.83). IDC was the primary cost driver (77.7%) which represented the impact of productivity loss due to informal care. Besides disease severity, time spent in informal care, caregivers' employment and use of special accommodation were predictors of AD cost. This neurodegenerative disorder is estimated to impose a burden of USD1.9 billion in 2022, which represents 0.47% of Malaysia's GDP.

CONCLUSION

This study provided real-world empirical cost estimates of AD burden in Malaysia. Informal care is a significant contributor to the societal cost of AD. Optimal healthcare resource allocation is essential in the decision making of healthcare stakeholders to address rising demands.

Comparing Different Implementation Strategies for Collaborative Dementia Care Management in Terms of Patients' Characteristics, Unmet Needs, and the Impact on Quality of Life and Costs in Germany

OBJECTIVE

To compare the implementation of collaborative dementia care management (cDCM) across two settings regarding patients' characteristics, unmet needs, and the impact on health-related quality of life (HRQoL) and costs.

METHODS

This analysis was based on data from the DCM:IMPact study, implementing cDCM in a physician network (n = 22 practices) and two day care centers (DCC) for community-dwelling persons with dementia over 6 months in Germany. Participants completed comprehensive assessments at baseline and 6 months after, soliciting sociodemographic and clinical characteristics, unmet needs, HRQoL and healthcare resource utilization. Patient characteristics and unmet needs were analyzed descriptively, and the impact of cDCM on costs and HRQoL was assessed using multivariable regression models.

RESULTS

At baseline, patients from the physician network (n = 46) exhibited more pronounced neuropsychiatric symptoms (NPI mean score 14 versus 10, p = 0.075), were more frequently diagnosed with dementia (76% versus 56%, p = 0.040), were less likely assigned a care level by the long-term care insurance (63% versus 91%, p ≤ 0.001) to access formal care services and had more unmet needs (12.8 versus 11.0, p ≤ 0.001), especially for social care services than DCC patients (n = 57). After 6 months, the adjusted means indicated that cDCM implemented in the physician network was more effective [EQ-5D-5L utility score; 0.061; 95% confidence interval (CI) - 0.032 to 0.153] and less costly (- 5950€; 95% CI - 8415€ to - 3485€) than cDCM implemented in DCC.

CONCLUSIONS

Patients and the healthcare system may benefit more when cDCM is implemented in physician networks. However, patient characteristics indicated two samples with specific conditions and various unmet needs using different ways of accessing healthcare, demonstrating the need for cDCM in both settings, which must be considered when implementing cDCM to integrate the respective sectors efficiently.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00025074. Registered 16 April 2021-retrospectively registered.

Peak expiratory flow predicts motoric cognitive risk syndrome: A cohort study

BACKGROUND

Poor respiratory function, including low peak expiratory flow (PEF), is a risk factor for dementia. Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait and subjective cognitive complaints. However, the association between PEF and MCR remains unclear. This study examined the cross-sectional and longitudinal association between PEF and MCR.

METHODS

The National Health and Aging Trends Study (NHATS), which is a nationally representative cohort of adults ≥65 years of age in the United States, was analyzed from 2011 to 2017. Logistic regression and discrete-time proportional hazards models tested the association of PEF standardized residuals (SR) at baseline with prevalent and incident MCR, respectively. The models adjusted for multiple sociodemographic and health-related covariates.

RESULTS

Among 5328 participants (57% women) included at baseline, lower PEF SR was associated with higher prevalence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30-50 percentile groups had significantly higher odds of prevalent MCR (OR 3.04 [95% CI 1.85, 5.01]; OR 2.06 [95% CI 1.19, 3.54], respectively). Over six years of follow-up, lower PEF SR was also associated with higher incidence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30-50 percentile groups had significantly higher risk of incident MCR (HR 1.81 [95% CI 1.24, 2.66]; HR 1.55 [95% CI 1.02, 2.34], respectively).

CONCLUSIONS

Lower PEF was associated with higher prevalence and incidence of MCR. Poor respiratory function should be further investigated as a potentially modifiable risk factor for MCR and cognitive decline.

Unraveling the clinical-pathological correlations of subjects with isolated and mixed neurodegenerative processes in the National Alzheimer's Coordinating Center dataset

Although Alzheimer disease neuropathologic change (ADNC) is the most common pathology underlying clinical dementia, the presence of multiple comorbid neuropathologies is increasingly being recognized as a major contributor to the worldwide dementia burden. We analyzed 1051 subjects with specific combinations of isolated and mixed pathologies and conducted multivariate logistic regression analysis on a cohort of 4624 cases with mixed pathologies to systematically explore the independent cognitive contributions of each pathology. Alzheimer disease neuropathologic change and limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) were both associated with a primary clinical diagnosis of Alzheimer disease (AD) and were characterized by an amnestic dementia phenotype, while only ADNC associated with logopenic variant primary progressive aphasia (PPA). In subjects with ADNC and comorbid LATE-NC, Lewy body disease, and/or cerebrovascular disease, the clinical phenotype was usually diagnosed during life as "Probable AD." Conversely, the combination of ADNC with frontotemporal lobar degeneration with TDP-43, progressive supranuclear palsy (PSP), or corticobasal degeneration (CBD) resulted in a mixed clinical picture, with variable features of amnestic dementia, PPA subtypes, behavioral variant FTD, PSP syndrome, and CBD syndrome. These findings elucidate the cumulative effects of mixed pathologies and provide insights into interactions between neurodegenerative pathologies contributing to a variety of clinical dementia presentations.

Use of Digital Health Technologies for Dementia Care: Bibliometric Analysis and Report

BACKGROUND

Dementia is a syndrome that compromises neurocognitive functions of the individual and that is affecting 55 million individuals globally, as well as global health care systems, national economic systems, and family members.

OBJECTIVE

This study aimed to determine the status quo of scientific production on use of digital health technologies (DHTs) to support (older) people living with dementia, their families, and care partners. In addition, our study aimed to map the current landscape of global research initiatives on DHTs on the prevention, diagnosis, treatment, and support of people living with dementia and their caregivers.

METHODS

A bibliometric analysis was performed as part of a systematic review protocol using MEDLINE, Embase, Scopus, Epistemonikos, the Cochrane Database of Systematic Reviews, and Google Scholar for systematic and scoping reviews on DHTs and dementia up to February 21, 2024. Search terms included various forms of dementia and DHTs. Two independent reviewers conducted a 2-stage screening process with disagreements resolved by a third reviewer. Eligible reviews were then subjected to a bibliometric analysis using VOSviewer to evaluate document types, authorship, countries, institutions, journal sources, references, and keywords, creating social network maps to visualize emergent research trends.

RESULTS

A total of 704 records met the inclusion criteria for bibliometric analysis. Most reviews were systematic, with a substantial number covering mobile health, telehealth, and computer-based cognitive interventions. Bibliometric analysis revealed that the Journal of Medical Internet Research had the highest number of reviews and citations. Researchers from 66 countries contributed, with the United Kingdom and the United States as the most prolific. Overall, the number of publications covering the intersection of DHTs and dementia has increased steadily over time. However, the diversity of reviews conducted on a single topic has resulted in duplicated scientific efforts. Our assessment of contributions from countries, institutions, and key stakeholders reveals significant trends and knowledge gaps, particularly highlighting the dominance of high-income countries in this research domain. Furthermore, our findings emphasize the critical importance of interdisciplinary, collaborative teams and offer clear directions for future research, especially in underrepresented regions.

CONCLUSIONS

Our study shows a steady increase in dementia- and DHT-related publications, particularly in areas such as mobile health, virtual reality, artificial intelligence, and sensor-based technologies interventions. This increase underscores the importance of systematic approaches and interdisciplinary collaborations, while identifying knowledge gaps, especially in lower-income regions. It is crucial that researchers worldwide adhere to evidence-based medicine principles to avoid duplication of efforts. This analysis offers a valuable foundation for policy makers and academics, emphasizing the need for an international collaborative task force to address knowledge gaps and advance dementia care globally.

TRIAL REGISTRATION

PROSPERO CRD42024511241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=511241.

Postoperative sepsis and its sequential impact on dementia

BACKGROUND

Postoperative sepsis is a severe complication associated with increased mortality and potential long-term cognitive decline, including dementia. However, the relationship between postoperative sepsis and dementia remains poorly understood.

METHODS

This retrospective cohort study used data from the National Database in Taiwan, covering the period from January 1, 2005, to December 31, 2022. The index period for surgeries was set between January 1, 2008, and December 31, 2013, allowing the identification of patients without prior dementia. A landmark period of 12 months following surgery was defined to capture the number of postoperative sepsis events, which were then analyzed for their impact on dementia risk. After 1:4 propensity score matching (PSM), dementia and mortality were evaluated using Cox proportional hazards and Fine-Gray competing risk models.

RESULTS

Following PSM, 778 patients were in the postoperative sepsis group and 3,112 in the non-postoperative sepsis group. Dementia incidence was higher in the postoperative sepsis group (26%) compared to the non- postoperative sepsis group (13.6%), with a hazard ratio (HR) of 1.25 (95% CI, 1.03-1.52). A dose-response relationship was observed, with dementia rates of 24.5% for one postoperative sepsis event and 34.9% for two or more events, the latter showing an HR of 1.77 (95% CI, 1.17-2.66). Mortality was also elevated in the postoperative sepsis group (40.5% vs. 31.6%; HR 1.45, 95% CI, 1.28-1.65).

CONCLUSIONS

Postoperative sepsis is significantly associated with increased dementia risk in a dose-dependent manner. These findings highlight the importance of enhancing perioperative infection control to reduce both immediate and long-term cognitive complications.