2024 Alzheimer's disease facts and figures

Real-world healthcare resource utilization of Alzheimer's disease in the early and advanced stages: a retrospective cohort study

AIMS

To compare all-cause and Alzheimer's disease (AD)-related healthcare resource utilization (HCRU) by cognitive stage.

METHODS AND MATERIALS

This retrospective study analyzed insurance claims data linked to electronic health records (01/01/2015-12/31/2021). Patients with ≥1 cognitive assessment (Mini-Mental State Examination or Montreal Cognitive Assessment) and ≥1 medical or pharmacy claim for an AD diagnosis or AD medications were included. Inverse probability of treatment weighting (IPTW) was used to address potential confounding. All-cause and AD-related HCRU were summarized per patient per year (PPPY) and compared between early AD and advanced AD cohorts (defined according to cognitive scores) using generalized linear regression models; adjusted incidence rate ratios (IRRs), and 95% confidence intervals (CI) were reported.

RESULTS

A total of 193 patients were included (median age: 82 years; 63.2% female), 108 with early AD and 85 with advanced AD, with similar mean follow up. All-cause HCRU, on average, was similar between early AD and advanced AD cohorts (37.4 PPPY and 38.9 encounters PPPY, respectively). For AD-related HCRU, patients with early AD had fewer encounters PPPY, on average, than patients with advanced AD (1.26 and 3.88 encounters, respectively). Following IPTW adjustment, the advanced AD cohort had significantly higher overall AD-related HCRU (IRR: 3.64 [95% CI: 1.96-6.75], p < 0.001) and outpatient visits (IRR: 2.76 [95% CI: 1.68-4.54], p < 0.001) compared to the early AD cohort.

LIMITATIONS

The relatively small sample size of patients with linked claims and cognitive score data limited the ability to assess contribution of all encounter types to HCRU trends, as well as generalizability to the broader AD population.

CONCLUSIONS

Although all-cause HCRU was similar, patients with advanced AD incurred higher AD-related HCRU compared to patients living with early AD. Further research is needed to determine whether interventions earlier in disease progression can mitigate the AD-related healthcare burden for patients with advanced AD.

Novel 6xHis/HaloTag mammalian expressed autoantigens for the detection of humoral response with multiplexed electrochemical biosensors: A breakthrough in colorectal cancer and Alzheimer's disease personalized diagnostics

The integration of autoantibody detection with electrochemical biosensors allows the development of a novel strategy for managing colorectal cancer (CRC) and Alzheimer's disease (AD). This work reports the use, for the first time, of sustainable receptors, autoantigens expressed in mammalian cells, fused to 6xHis at the N-terminus and HaloTag at the C-terminus, immobilized on chloroalkane-modified magnetic beads (MBs) to selectively capture plasma autoantibodies. Detection was based on amperometric measurements using disposable multiplexed screen-printed carbon electrodes (x8 sensing surfaces), horseradish peroxidase (HRP)-conjugated secondary antibodies, and the HQ/H2O2 system. HaloTag immobilization gave rise to a great sensitivity allowing discrimination between patients and healthy individuals in comparison with HisTag or -COOH immobilization. The CRC biosensor integrated seven CRC-specific full-length autoantigens, while the AD bioplatform combined three AD-specific full-length proteins and four AD-specific peptides, which allowed a robust diagnostic performance validated by ROC analyses. These multiplexed biosensors provide minimally invasive, cost-effective, and sustainable alternatives to traditional diagnostic methods, and show ideal for discovery of new targets and for mass screening and early disease detection, supporting personalized medicine approaches.

Cerium-doped carbon dots as dual-target agents against Alzheimer's β-amyloid fibrillogenesis and reactive oxygen species

Both fibrillogenesis of amyloid β-protein (Aβ) and elevated levels of reactive oxygen species (ROS) contribute to the pathogenesis of Alzheimer's disease (AD). Beyond Aβ aggregation inhibition, the complexity necessitates the development of comprehensive therapeutic interventions for halting AD progression. Herein, a dual-target agent capable of Aβ aggregation inhibition and ROS scavenging was synthesized by doping cerium into carbon dots (Ce CDs). Ce CDs with a high Ce (III)/Ce (IV) ratio of 0.67 can scavenge various ROS, including superoxide anion radicals, hydroxyl radicals, hydrogen peroxide, and Aβ40-induced ROS, thus mitigating cellular oxidative damage and rescuing cell viability. Additionally, Ce CDs present potent inhibition on Aβ40 on-pathway fibrillization, disrupting the formation of highly ordered β-sheet structures and increasing cell viability from 50.2 % to 91.9 %. It is validated that the electrostatic interactions between Ce CDs and Aβ40 are primarily responsible for preventing the conformational transition of Aβ40 monomers. In vivo experiments with the transgenic Caenorhabditis elegans strain further validate the bifunctionality of Ce CDs in suppression of Aβ fibrillogenesis and attenuation of oxidative stress, thereby demonstrating the potential of combination therapy for AD. This finding highlights the important role of electrostatic interactions between Aβ and inhibitors in regulating Aβ aggregation, and provides new insights into the development of multifunctional agents for AD treatment.

Liquid chromatography-tandem mass spectrometry assay for simultaneous quantification of catecholamines and metabolites in human plasma and cerebrospinal fluid

Catecholamines (CAs) and their metabolites in human cerebrospinal fluid (CSF) and plasma are potential biomarkers of Alzheimer's disease (AD) and facilitate early diagnosis. Liquid chromatography-tandem mass spectrometry is the gold standard method for analyzing CAs. The objective of this study was to develop and validate a liquid chromatography-tandem mass spectrometry assay capable of simultaneously quantifying dopamine (DA), epinephrine (E), norepinephrine (NE), metanephrine (MN), normetanephrine (NMN), and 3-methoxytyramine (3-MT) in both human CSF and plasma. Samples were processed by solid-phase extraction with a weak cation exchange adsorbent and then separated using an ultra-performance reversed-phase chromatography column. Analyte detection was performed using a triple quadrupole mass spectrometer operated in positive-ion multiple reaction monitoring mode. The developed assay was validated according to standard guidelines. The linearity, specificity, precision, accuracy, carryover and stability were assessed to ensure compliance with specified criteria. The lower limits of quantification for DA, E, NE, MN, NMN, and 3-MT were 4.5, 2.5, 4.5, 2.5, 2, and 0.3 pg mL-1, respectively. The total runtime for a single sample was 6.5 min. These results demonstrated that the method was sensitive, rapid, and reliable for the simultaneous quantification of DA, E, NE, MN, NMN, and 3-MT in clinical practice. We successfully detected CAs and their metabolites in plasma and CSF samples from patients with normal cognition and AD. This study demonstrates an efficient laboratory workflow for high-throughput analysis of CAs and their metabolites and lays a foundation for further studies on AD biomarkers.

Vaccines for Alzheimer's disease: a brief scoping review

BACKGROUND

Alzheimer's disease (AD) is a neurodegenerative disorder and the most common cause of dementia among older adults. Existing treatments-such as cholinesterase inhibitors, N-methyl-D-aspartate receptor antagonists, and monoclonal antibodies targeting amyloid beta-can improve functional and neuropsychiatric outcomes but fail to prevent disease onset, halt progression, or adequately reduce amyloid-beta burden. Consequently, research efforts have shifted to primary prevention through immunization, although the efficacy of these strategies remains uncertain. This review explores the efficacy, safety, and adverse events of current immunotherapies for AD and discusses future research and clinical implications.

METHODS

A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-SR) checklist. A systematic search was carried out using PubMed, Scopus, and Web of Science.

RESULTS

A total of 145 studies were included. Preclinical research often employed transgenic mouse models to investigate AD pathology and vaccine benefits, while Phase I and II clinical trials centered on safety and preliminary efficacy in humans. Most studies were conducted in the USA, China, and Japan, highlighting these countries' strong clinical trial infrastructure. Vaccination frequently reduced amyloid-beta or tau pathology in preclinical settings, although cognitive outcomes were inconsistent. Clinical trials primarily focused on safety and immune response, with newer vaccines such as ABvac40 demonstrating encouraging results and minimal adverse events.

CONCLUSION

Although AD vaccines show promise in preclinical settings, longer and more comprehensive clinical trials are necessary to determine their long-term efficacy and safety. Standardized protocols and efforts to reduce regional disparities in research would facilitate better comparability and generalizability of findings, thereby guiding the future development of effective immunotherapies for Alzheimer's disease.

Dietary inflammatory index and Alzheimer's disease mortality in a prospective cohort

OBJECTIVE

This study examined the relationship between the Dietary Inflammatory Index (DII) and Alzheimer's disease (AD) mortality in US adults.

METHODS

Data from 45,093 participants in the 1988-2014 National Health and Nutrition Examination Survey (NHANES) were analyzed, with mortality follow-up through December 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for AD mortality. Restricted cubic spline analysis explored the non-linear association of DII with AD mortality, and stratified analyses identified higher-risk subgroups.

RESULTS

Over a median follow-up of 14.3 years, 455 AD-related deaths occurred. Participants in the highest DII quartile (>2.41) had a 1.50-fold increased risk of AD mortality (95 % CI: 1.12-2.01) compared to the lowest quartile (≤-0.44). Pro-inflammatory diets (DII > 0) were associated with a 44 % higher risk of AD mortality (HR: 1.44, 95 % CI: 1.14-1.81). A dose-response relationship was observed, with increased risks across quartiles, and findings were consistent across demographic and clinical subgroups.

CONCLUSIONS

Higher DII levels were significantly associated with elevated AD mortality risk, highlighting the potential role of pro-inflammatory diets in AD-related outcomes.

Equating conversion norms for the Mini-Mental State Examination and Montreal Cognitive Assessment in healthy subjects and patients with neurodegenerative disorders

INTRODUCTION

The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are globally recognized as validated cognitive screening tests widely used.

OBJECTIVE/AIM

The present study attempted to provide conversion tables from the MMSE to the MoCA and vice versa, deriving them from a large population of healthy older adults and a representative clinical sample of subjects with different types of cognitive decline within the spectrum of Alzheimer's (AD) and Parkinson's (PD) diseases.

METHODS

A total of 1423 Italian participants, including healthy adults (n = 1203), individuals with AD (n = 93), and with PD (n = 127) were assessed using the MMSE and MoCA. Conversion tables were developed using log-linear smoothing equipercentile equating (LSEE). The reliability of the conversion was assessed through the Root Mean Square Error (RMSE) in a train-test approach confirmed in the whole sample.

RESULTS

The findings demonstrated that the LSEE method enables the development of conversion tables allowing users to identify the corresponding MoCA score for each MMSE score within the studied groups, and vice versa. The estimation error RMSE was 1.8, 2.9, and 3.2 for the conversion of MoCA from MMSE and 1.2, 2.3, and 2.2 for the conversion of MMSE from MoCA in healthy subjects, AD, and PD, respectively. The reliability of the conversion is higher in healthy subjects and for higher values of MoCA and MMSE.

CONCLUSION

Results report easy-to-use conversion norms for transforming raw MMSE score to MoCA and vice versa, highlighting areas were the conversion has a strong or low reliability depending on the score range.

Differences in transcriptome characteristics and drug repositioning of Alzheimer's disease according to sex

BACKGROUND

Previous studies have shown significant sex differences in AD with regarding its epidemiology, pathophysiology, clinical presentation, and treatment response. However, the transcriptome variances associated with sex in AD remain unclear.

METHODS

RNA sequencing (RNA-seq) and transcriptomic analyses were performed on peripheral blood samples from total of 54 patients, including male AD patients (n = 15), female AD patients (n = 10), male MCI patients (n = 7), female MCI patients (n = 11), male healthy controls (n = 6), female healthy controls (n = 5). The snRNA-seq dataset (GSE167494, GSE157827) of prefrontal cortex tissues was obtained from the Gene Expression Omnibus (GEO). We conducted an investigation into differentially expressed genes and pathways in the peripheral blood cells as well as prefrontal cortex tissues of both male and female AD patients with consideration to sex-related factors. Additionally, we analyzed the distribution and characteristics of cells in the cerebral cortex as well as the interaction and communication between cells of male and female AD patients. Connectivity Map (CMap) was utilized for predicting and screening potential sex-specific drugs for AD.

RESULTS

The transcriptome profile and associated biological processes in the peripheral blood of male and female AD and MCI patients exhibit discernible differences, including upregulation of BASP1 in AD male patients and arousing TNS1 in AD female patients. The distribution of various cell types in the prefrontal cortex tissues differs between male and female AD patients, like neuron and oligodendrocyte decreased and endothelial cell and astrocyte increased in female compared with male, while a multitude of genes exhibit significant differential expression. The results of cell communication analysis, such as collagen signaling pathway, suggest that sex disparities impact intercellular interactions within prefrontal cortex tissues among individuals with AD. By drug repositioning, several drugs, including torin-2 and YM-298198, might have the potential to therapeutic value of MCI or AD, while drugs like homoharringtonine and teniposide have potential opposite effects in different sexes.

CONCLUSION

The characteristics of the transcriptome in peripheral blood and single-cell transcriptome in the prefrontal cortex exhibit significant differences between male and female patients with AD, which providing a basis for future sex stratified treatment of AD.

Human skeletal muscle mitochondrial pathways are impacted by a neuropathologic diagnosis of Alzheimer's disease

Alzheimer's disease (AD) is associated with reduced lean mass and impaired skeletal muscle mitochondrial and motor function. Although primary mitochondrial defects in AD may underlie these findings, molecular alterations in AD have not been thoroughly examined in human skeletal muscle. Here, we used two human skeletal muscle types, quadriceps (n = 81) and temporalis (n = 66), to compare the proteome of individuals with a neuropathologic AD diagnosis based on AD Neuropathologic Change (ADNPC+: n = 54 temporalis, 44 quadriceps) to controls (ADNPC-: n = 27 temporalis, 22 quadriceps). We determined the effects of ADNPC status within each muscle and within apolipoprotein E4 (APOE4) carriers and APOE4 non-carriers. Pathways that support mitochondrial metabolism, including oxidative phosphorylation, were downregulated in skeletal muscle of ADNPC+ versus ADNPC- individuals. Similar mitochondrial effects were observed across muscle types and APOE4 carrier groups, but nearly four times as many proteins were altered in temporalis versus quadriceps tissue and mitochondrial effects were most pronounced in APOE4 carriers compared to APOE4 non-carriers. Of all detected oxidative phosphorylation proteins, the expression of ∼29-61 % (dependent on muscle/APOE4 carrier group) significantly correlated with AD progression, ranked by Clinical Dementia Rating and ADNPC scores. Of these, 23 proteins decreased in expression with greater AD progression in all skeletal muscle type and APOE4 carrier groups. This is the first study to assess differences in the human skeletal muscle proteome in the context of AD. Our work shows that systemic mitochondrial alterations in AD extend to skeletal muscle and these effects are amplified by APOE4 and correlate with AD progression.

Neuropsychiatric Symptoms and Alzheimer's Disease Severity. A Focus on Sex-Differences

OBJECTIVES

The aim of the present study was to investigate possible sex predictors in the severity of NPS in a large cohort of patients with AD and to assess the role of severity in sex-related differences in NPS.

METHODS

Four hundred and twenty-four participants (295 women, mean age 78.4 ± 8.3 years, mean disease duration 7.4 ± 8.5 years) were included with a diagnosis of AD according to NINCDS/ADRDA criteria. Clinical data and presence of NPS were collected from family interview, medical records, and patient interview and examination. Dementia severity was assessed using the Clinical Dementia Rating Scale (CDRS) extended version.

RESULTS

CDRS score was available for 407 participants (mean score 2.6 ± 1.1); 407 (22.1%) patients had CRDS = 1, 104 (25.5%) had CRDS = 2, 127 (31.2%) had CRDS = 3, 64 (15.7%) had CDRS = 4 and 22 (15.4%) had CDRS = 5. Apathy (85.7%), agitation or restlessness (75.1%) and paranoia (59.4%) were the most common NPS. Higher CDRS scores were associated with several neuropsychiatric features, including apathy, wandering and physical aggression. In the sex-stratified analysis, NPS were associated with more severe AD only in men.

CONCLUSIONS

Our findings suggest relevant sex differences in NPS with increasing severity.

CLINICAL IMPLICATIONS

A timely and targeted behavioral management could improve treatment outcome.

Sex-Specific Genetic Drivers of Memory, Executive Functioning, and Language Performance in Older Adults

We previously identified sex-specific genetic loci associated with memory performance, a strong Alzheimer's disease (AD) endophenotype. Here, we expand on this work by conducting sex-specific, cross-ancestral, genome-wide meta-analyses of three cognitive domains (memory, executive functioning, and language) in 33,918 older adults (57% female; 41% cognitively impaired; mean age=73 years) from 10 aging and AD cohorts. All three domains were comparably heritable across sexes. Genome-wide meta-analyses identified three novel loci: a female-specific language decline-associated locus, VRK2 (rs13387871), which is a published candidate for neuropsychiatric traits involving language ability; a male-specific memory decline-associated locus among cognitive impaired, DCHS2 (rs12501200), which is a published candidate gene for AD age-at-onset; and a sex-interaction with baseline executive functioning, AGA (rs1380012), among cognitive impaired. We additionally provide evidence for shared genetic architecture between lifetime estrogen exposure and AD-related cognitive decline. Overall, we identified sex-specific variants, genes, and pathways relating to three cognitive domains among older adults.

Social determinants of health and their impact on depression in family caregivers of those with dementia: The importance of intermediary determinants

INTRODUCTION

Dementia family caregivers face a significant burden due to the progressive nature of the disease, which places them at high risk for depression. Because a lack of information is available on the social determinants of health that impact depression, this study investigated this relationship.

METHODS

This study was a secondary data analysis using the 2017 National Health and Aging Trends Study (NHATS) Round 11 and the National Study of Caregiving (NSOC) Round 4, which included a nationally representative sample of American older adults and their family caregivers. Weighted multivariate logistic regression models were used for data analysis.

RESULTS

Among 528 family caregivers of persons living with dementia, ≈15.9% had depression. The final logistic regression model showed that intermediary determinants, such as living with a spouse/partner or utilizing a caregiver training program, lowered the likelihood of depression.

DISCUSSION

Health care professionals should pay greater attention to these individuals, and caregiver training programs should be made widely accessible and available.

HIGHLIGHTS

Approximately 15.9% of dementia family caregivers had depression. Family caregivers who were married or living with a partner were less likely to have depression. Family caregivers involved in caregiving training programs were less likely to have depression.

Visual Impairment and Cognitive Function in Aging Adults: Sex and Age Differences in Mediating Effect of Social Isolation and Depression

PURPOSE

Visual impairment (VI) is prevalent in older adults and associated with cognitive decline. However, the mechanisms through which visual impairment affects cognitive functioning during the aging process are poorly understood. Our study aims to estimate the direct effect of visual acuity on cognitive function and its indirect effect through social isolation and depressive symptoms by sex and age.

DESIGN

Cross-sectional study.

PARTICIPANTS

117,231 individuals aged 40-70 participated in the UK Biobank baseline and ocular assessment. Of these, 81% were white, 54% were female, and 45.6% were aged 60-70. The mean age was 56.8 (SD 8.1) years.

METHODS

Path analyses with multiple equations were conducted to examine the direct and indirect effects of visual acuity (VA). Stratified analyses by gender and age were performed.

MAIN OUTCOME MEASURES

LogMAR VA was the exposure, with social isolation and depressive symptoms as mediators. Cognitive functions, including visual memory, verbal-numerical reasoning, processing speed, and prospective memory, were the outcomes.

RESULTS

VA had a direct effect on cognitive function (β = -0.979 for reasoning and OR = 0.67 for prospective memory). VA also influenced cognition indirectly through social isolation and depressive symptoms. The direct effect of VA on cognitive function was similar in men vs. women and middle-aged vs. older. However, there is a marked difference in the mediating effect via social isolation and depressive symptoms by age and sex. The mediating effect of VI on cognition via social isolation was stronger in older adults than middle-aged and in men than women; while the mediating effect via depressive symptoms was stronger in women and middle-aged individuals. VI had the largest mediating effect via social isolation in older males.

CONCLUSION AND RELEVANCE

Vision, social isolation, and depressive symptoms are modifiable factors and can be treated to preserve cognition. Encouraging social engagement among male and older adults with VI and promoting mental health awareness in women and middle-aged individuals with VI will reduce the negative impact of VI on cognition, lower dementia risk, and improve the well-being of aging adults.

Anticipated Responses to Genetic Testing for Alzheimer's Disease Susceptibility among Latinos in Northern Manhattan

Alzheimer's disease (AD) is a debilitating neurodegenerative illness that has become a growing concern for older adults. As such, apolipoprotein E (APOE) genetic testing has become more commonly used to identify individuals' susceptibility to AD. An underrepresented population in AD research, Latinos will be disproportionately affected by AD in the coming decades. To better aid efforts in education and genetic risk counseling for Latino populations, we must first understand the anticipated psychological and behavioral consequences of APOE genetic risk counseling. We conducted semi-structured interviews with 216 Latinos between the ages of 40 and 64 (average age = 53 years) in northern Manhattan to ascertain their hypothetical reactions to learning that they had a higher risk of developing AD compared to other Latinos within their community. Responses were categorized as emotional, practical, and mixed responses. Among our sample, women were more likely to anticipate an emotional response to hearing that they had a higher risk of AD, and participants above the age of 60 were more likely to anticipate disclosing their risk information to immediate family members. Findings support the tailoring of genetic risk counseling sessions across different ethnic groups, genders and age groups. Future work may include the development of psychological and practical support tools for Latinos seeking APOE genetic testing and counseling.

Prediction Model and Nomogram for Amyloid Positivity Using Clinical and MRI Features in Individuals With Subjective Cognitive Decline

There is an urgent need for the precise prediction of cerebral amyloidosis using noninvasive and accessible indicators to facilitate the early diagnosis of individuals with the preclinical stage of Alzheimer's disease (AD). Two hundred and four individuals with subjective cognitive decline (SCD) were enrolled in this study. All subjects completed neuropsychological assessments and underwent 18F-florbetapir PET, structural MRI, and functional MRI. A total of 315 features were extracted from the MRI, demographics, and neuropsychological scales and selected using the least absolute shrinkage and selection operator (LASSO). The logistic regression (LR) model, based on machine learning, was trained to classify SCD as either β-amyloid (Aβ) positive or negative. A nomogram was established using a multivariate LR model to predict the risk of Aβ+. The performance of the prediction model and nomogram was assessed with area under the curve (AUC) and calibration. The final model was based on the right rostral anterior cingulate thickness, the grey matter volume of the right inferior temporal, the ReHo of the left posterior cingulate gyrus and right superior temporal gyrus, as well as MoCA-B and AVLT-R. In the training set, the model achieved a good AUC of 0.78 for predicting Aβ+, with an accuracy of 0.72. The validation of the model also yielded a favorable discriminatory ability with an AUC of 0.88 and an accuracy of 0.83. We have established and validated a model based on cognitive, sMRI, and fMRI data that exhibits adequate discrimination. This model has the potential to predict amyloid status in the SCD group and provide a noninvasive, cost-effective way that might facilitate early screening, clinical diagnosis, and drug clinical trials.

Fluid-based biomarkers for neurodegenerative diseases

Neurodegenerative diseases, such as Alzheimer's Disease (AD), Multiple Sclerosis (MS), Parkinson's Disease (PD), and Amyotrophic Lateral Sclerosis (ALS) are increasingly prevalent as global populations age. Fluid biomarkers, derived from cerebrospinal fluid (CSF), blood, saliva, urine, and exosomes, offer a promising solution for early diagnosis, prognosis, and disease monitoring. These biomarkers can reflect critical pathological processes like amyloid-beta (Aβ) deposition, tau protein hyperphosphorylation, α-syn misfolding, TDP-43 mislocalization and aggregation, and neuronal damage, enabling detection long before clinical symptoms emerge. Recent advances in blood-based biomarkers, particularly plasma Aβ, phosphorylated tau, and TDP-43, have shown diagnostic accuracy equivalent to CSF biomarkers, offering more accessible testing options. This review discusses the current challenges in fluid biomarker research, including variability, standardization, and sensitivity issues, and explores how combining multiple biomarkers with clinical symptoms improves diagnostic reliability. Ethical considerations, future directions involving extracellular vehicles (EVs), and the integration of artificial intelligence (AI) are also highlighted. Continued research efforts will be key to overcoming these obstacles, enabling fluid biomarkers to become crucial tools in personalized medicine for neurodegenerative diseases.

Top-Rated Health Care and Ease of Access to Medications Linked to Lower Medicare and ADRD Costs

IMPORTANCE

Little is known about the extent to which patient self-perception of care experience is associated with costs, especially for people with Alzheimer disease and related dementias (ADRD).

OBJECTIVE

This study explores the relationship between self-reported quality measures and Medicare costs and examines whether the ease of obtaining prescribed medications is associated with reduced overall Medicare costs, focusing on Medicare beneficiaries with ADRD.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, Medicare Beneficiary Summary File data from 2018, 2019, and 2021 were linked to the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey using beneficiary IDs. The study sample included community-dwelling Medicare fee-for-service beneficiaries.

EXPOSURES

Five quality measures were used as key exposure variables: (1) beneficiary's rating on health care; (2) ease of getting care/tests/treatment through the health plan; (3) whether the doctor always explained, listened, respected; and spent enough time with the patient; (4) ease of obtaining prescribed medications; and (5) whether doctor always talked about all the prescription medicines the beneficiary was taking.

MAIN OUTCOME AND MEASURE

Annual total Medicare payments per person.

RESULTS

The study included 230,617 Medicare fee-for-service beneficiaries aged 65 and older, including 16,452 beneficiaries with ADRD. Among the total beneficiaries, 53% were females (vs. 56% of ADRD beneficiaries), with a mean (SD) age of 75.8 (SD 7.27) years [vs. 82.5 (SD 7.97) years for ADRD beneficiaries]. Fully adjusted analyses showed significant negative associations between quality measures and total per-capita payments, with more pronounced cost reductions among patients with ADRD. Specifically, patients with ADRD who reported it was always easy to get care had reductions of $1,922.0 (95% CI, -$3304.8 to -$539.2), while those who reported it was always easy to get prescribed medications had reductions of $2964.5 (95% CI, -$4518.8 to -$1410.1). In addition, beneficiaries who reported that doctors always discussed the medicines experienced cost reductions of $2299.7 (95% CI, -$3800.5 to -$799.0) in medicare costs.

CONCLUSION AND RELEVANCE

Our findings suggest that high-quality care is not necessarily associated with high costs. Meanwhile, focusing on the ease of access to needed care, obtaining prescription drugs, and effective communication about medication is critical in improving care quality while reducing costs.

Why is it Difficult to Recruit/Retain Asian American Family Caregivers in a Virtual Intervention?

BACKGROUND

Virtual interventions using computers and mobile devices have increasingly been developed and tested among racial and ethnic minorities in recent years. Yet, few virtual interventions have been developed for Asian American midlife women who are family caregivers of persons living with Alzheimer's disease (AD). Furthermore, little is known about the feasibility of recruiting this specific group of racial/ethnic minority midlife women to a virtual intervention study.

OBJECTIVE

The purpose of this paper is to discuss practical issues in recruiting and retaining this specific group of racial/ethnic minority midlife women for a virtual intervention study.

METHODS

The ongoing parent study is to develop and test a preliminary version of a virtual intervention for this specific population. During the research process, the research team had regular meetings to have discussions on recruitment and retention issues and each team member wrote research diaries. A content analysis was conducted with the written records including the research team's research diaries and meeting minutes.

RESULTS

The issues were: (1) an extremely small pool of Asian American midlife women who were family caregivers of persons living with AD; (2) competitions with other studies, (3) practicality of inclusion/exclusion criteria, (4) lack of time and interests in research participation, and (5) negative perception of small monetary incentives.

CONCLUSION

Future researchers need to consider the unique cultural and social dynamics of this specific population, foster trusted connections with the communities before initiating the study, and obtain feedback from potential gatekeepers and the communities in advance.

Arsenic exposure activates microglia, inducing neuroinflammation and promoting the occurrence and development of Alzheimer's disease-like neurodegeneration in mice

Health damage caused by environmental arsenic pollution has attracted widespread attention, with Alzheimer's disease (AD) thought to be one of the adverse effects of long-term arsenic exposure. In this study, we sought to investigate the relationship between arsenic exposure and AD-like neurodegeneration and to determine the role of microglia in the process of AD-like neurodegeneration induced by arsenic exposure. The relationship between arsenic exposure and AD-like neurodegeneration was investigated using cognitive assessments and biological experiments. Arsenic exposure induced memory impairment in C57BL/6 mice and resulted in a significant increase in the number of Aβ+ and pTau+ cells in the entorhinal cortex and hippocampus with neuronal granular vacuolar degeneration and necroptosis, accompanied by upregulated expression of related proteins, which showed dose- and time-response relationships. Arsenic exposure intensified memory decline in FAD4T mice with accelerated AD-like neurodegeneration. Correlation analysis showed a negative correlation between memory impairment and neurodegeneration in the entorhinal cortex and hippocampus in mice. Arsenic exposure also activated microglia in the entorhinal cortex and hippocampus, with enlargement of the cytosol, shortened and thickened cell protrusions, hypertrophic changes, and abnormal proliferation, as well as upregulated expression of the pro-inflammatory cytokines TNF-α and IL-1β. Arsenic exposure induced overactivation of microglia in the entorhinal cortex and hippocampus of FAD4T mice, resulting in de-branching or bulbous protrusions and fragmented cytoplasm. Our findings suggest that arsenic exposure promotes the occurrence and development of AD-like neurodegeneration via the activation of microglia, which induces neuroinflammation in mice.

Characterizing the Journey of Early Alzheimer's Disease in Patients Initiating Lecanemab Treatment in the United States: A Real-World Evidence Study

INTRODUCTION

With the advent of disease-modifying therapies for early Alzheimer's disease (AD), a comprehensive characterization of patients initiating lecanemab in the USA is needed to understand its use in real-world settings.

METHODS

This retrospective observational study used administrative claims from the Komodo Research Database (1/1/2023-6/30/2024). Eligible patients had ≥ 1 lecanemab administration (first claim defined the index date) and ≥ 12 months of clinical activity/insurance eligibility before the index date. Patient characteristics, diagnostic process, and AD-related medications were evaluated within 12 months before the index date (baseline), whereas lecanemab treatment patterns and concomitant medications were evaluated on or after the index date (follow-up). Outcomes were reported using descriptive statistics and persistence to lecanemab was evaluated using Kaplan-Meier analysis.

RESULTS

Of 3155 patients included in the study, mean age was 75.0 years, 55.8% were female, 44.2% were male, and most (93.3%) received their index lecanemab administration in an urban setting. Diagnoses of AD (83.8%) and mild cognitive impairment (60.8%) were common at baseline, and 67.6% of patients used AD symptomatic medications. Average time from earliest diagnosis to first lecanemab administration was 4.9 months among patients with a diagnosis in January 2023 (accelerated approval date) or onwards. Over a mean follow-up of 138.8 days, the monthly mean number of administrations of lecanemab was 1.9, with an average of 16.5 days between consecutive administrations and 47.4 days to the first follow-up head magnetic resonance imaging. Persistence to lecanemab was 87.6% at 4 months after treatment initiation.

CONCLUSION

Lecanemab was utilized in appropriate patient populations according to the prescribing information approved by the US Food and Drug Administration. Findings from our study provide first insights into the real-world use of lecanemab in the USA and shed light on the need for increased and timely lecanemab initiation for the long-term management of early AD.

Insulin resistance: fueling oxidative stress and neurodegeneration

The growing prevalence of age-related neurodegenerative diseases is a consequence of population aging and demands urgent treatment strategies. This literature review aims to provide a comprehensive overview of the contribution of oxidative stress and insulin resistance in neurodegenerative diseases, specifically Alzheimer's disease (AD). In addition, current therapeutic approaches to treat oxidative stress and insulin resistance in this age-related neurodegenerative disease will be discussed. AD is the most prevalent form of neurodegenerative disease and is marked at early stages by oxidative stress and insulin resistance. Results indicate that insulin resistance may be central in generating oxidative stress and exacerbating AD hallmarks. In turn, insulin resistance can be influenced by other factors, including amyloid beta (Aβ), impaired biliverdin-reductase A (BVR-A) activity, and the gut microbiota. Defective insulin signaling in the brain comes with consequences ranging from declined cognitive functions, impaired autophagy, mitochondrial dysfunction, hyperphosphorylation of Tau, and increased Aβ production. Multiple therapeutic approaches that target oxidative stress or brain insulin resistance, such as antioxidant supplementation and anti-diabetic drugs, have mostly been inconclusive, except for intranasal insulin. Positive results have been obtained in clinical trials using nasal delivery devices to administer insulin; however, results are inconsistent across studies likely due to inconsistencies in the delivery method. Future investigations should focus on investigating the molecular link between oxidative stress, insulin resistance, and AD to address current knowledge gaps. Moreover, more focus should be given to optimizing the reliability and efficacy of nasal delivery devices before considering such an approach viable to treat neurodegenerative diseases.

Postmortem neuropathologies are associated with retrospective tensor-based morphometry findings in Alzheimer's dementia continuum

BACKGROUND

Understanding the relationship between postmortem neuropathological findings and in vivo imaging biomarkers is crucial for advancing the early diagnosis and treatment of Alzheimer's disease (AD). This study investigates the association between postmortem neuropathologies and retrospective Tensor-Based Morphometry (TBM) findings across the Alzheimer's dementia continuum.

METHODS

This study utilized tensor-based morphometry (TBM) to investigate structural brain changes associated with AD neuropathology. Data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were analyzed, including MRI scans and neuropathological findings from 98 participants. Logistic regression was used to explore the relationship between TBM indices and neuropathological outcomes. The diagnostic performance of TBM was evaluated using accuracy analysis.

RESULTS

Significant differences in TBM indices (StatROI and TempROI) were observed between the dementia and non-dementia groups. Logistic regression indicated that higher StatROI and TempROI indices were associated with lower odds of AD pathology, such as amyloid plaques (OR = 0.939 and 0.927), neurofibrillary tangles (OR = 0.961 and 0.931), and neuritic plaques (OR = 0.943 and 0.916). Accuracy analysis demonstrated good discriminatory power of TBM indices in differentiating pathologically confirmed AD from non-AD dementia (sensitivity up to 61.29, specificity up to 93.33%) and cognitively normal individual (sensitivity up to 82.26, specificity up to 75%).

CONCLUSION

TBM is a promising tool for predicting the underlying neuropathology of AD and distinguishing between different causes of dementia. Integrating TBM into clinical assessments can enhance the accuracy of AD diagnosis and improve patient management.

Self-Efficacy is Key: Examining the Role of Motivation to Engage in Healthy Lifestyle Behaviors for Dementia Prevention in Midlife

Modifiable risk factors account for nearly half of dementia cases, with the greatest impact on dementia prevention in midlife. Little is known about what motivates middle-aged adults to engage in healthy behaviors for dementia risk reduction. This study examined associations between motivation to make lifestyle changes for dementia risk reduction and engagement in health behaviors associated with dementia risk in 347 middle-aged adults. Multivariate linear regressions examined associations between motivation and engagement in health behaviors. Greater self-efficacy and higher education significantly predicted greater physical and cognitive activity and better sleep quality. Greater perceived barriers and general health motivation, lower self-efficacy, and younger age significantly predicted greater perceived loneliness. Self-efficacy consistently predicted engagement in health behaviors associated with dementia risk reduction in midlife. Thus, incorporating empirically supported strategies to increase self-efficacy in lifestyle interventions for dementia prevention may increase long-term adherence and overall success of dementia prevention efforts.

Hypertension and diabetes on cognitive impairment: a case-control study in China

BACKGROUND

Cognitive impairment, hypertension and diabetes are prevalent chronic conditions in populations of older ages. Previous studies have shown that hypertension and diabetes are risk factors for the development of cognitive impairment. However, the impact of hypertension combined with diabetes (HD) and their cumulative effects on cognitive impairment remain unclear. We aimed to investigate whether HD influences development of cognitive impairment and whether the effect is cumulative.

METHODS

A case-control study was conducted. From 40,103 subjects aged 60 years or older, enrolled from 28 representative communities of 9 provinces of China between January 2015 and December 2021 into the Prevention and Intervention on Neurodegenerative Disease for Elderly in China program using multi-stage stratified random sampling, individuals not meeting our propensity score matching criteria were excluded, and 13,252 individuals were finally selected for the study. Exposure factors included hypertension, diabetes and their comorbidity. Odds ratios (ORs) of exposure factors on cognitive impairment were measured using multiple logistic regression.

RESULTS

We found significant impacts of hypertension, diabetes and their comorbidity on cognitive impairment occurrence. The OR values for dementia were 1.18 for individuals with hypertension only, 1.26 for those with diabetes only, and 1.53 for those with HD. Compared to participants without hypertension and diabetes, the OR values for mild cognitive impairment (MCI) were 1.11 for individuals with hypertension only, 1.32 for those with diabetes only, and 1.27 for those with HD. For subjects with HD longer than 5 years, the comorbidity significantly impacted on MCI and dementia, and the degree of impact increased with the duration of comorbidity. For hypertension, the influence of hypertension on dementia were most influential in middle-aged (45-64 years old) people. By contrast, the influence of diabetes on people younger than 45-year-old was most significant, with the middle-age group being the second most impacted subjects.

CONCLUSIONS

The elderly with HD have a heightened risk of developing cognitive impairment, particularly dementia, compared to those with either hypertension or diabetes alone. The study revealed a significant cumulative impact of HD on cognitive impairment.

Recent Advances in Mass Spectrometry-Based Studies of Post-translational Modifications in Alzheimer's Disease

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline. There are over 10 million new cases of AD each year worldwide, implying one new case every 3.2 seconds. Post-translational modifications (PTMs) such as phosphorylation, glycosylation, and citrullination have emerged as key modulators of protein function in AD, influencing protein aggregation, clearance, and toxicity. Mass spectrometry (MS) has become an indispensable tool for detecting and quantifying these PTMs, offering valuable insights into their role in AD pathogenesis. This review explores recent advancements in MS-based studies of PTMs in AD, with emphasis on MS techniques like data-dependent acquisition (DDA) and data-independent acquisition (DIA), as well as enrichment methods used to characterize PTMs. The applications of these MS-based approaches to the study of various PTMs are highlighted, which have significantly accelerated the biomarker discovery process, providing new avenues for early diagnosis and therapeutic targeting. Advances in biological understanding and analytical techniques, while addressing the challenges and future directions, will be discussed.

Implementation of a virtual dementia system of care in a VA health setting

OBJECTIVE

Dementia care remains supportive and geriatric resources are scarce. We describe a dementia system of care consisting of virtual and e-consults working through the primary care provider, as well as providing virtual group caregiver support. These models were developed based on patient and caregiver preferences and necessitated by the Covid public health emergency.

METHODS

A geriatrician supported dementia consult clinic transitioned to a virtual model of care. A centrally located caregiver support group providing a 4-week curriculum and delivered in conjunction with a social worker similarly transitioned to virtual support. Primary care providers generated consults and were provided educational consultations regarding dementia diagnoses and management in the primary care setting.

RESULTS

Between 2018 and 2024, 1176 consultations were provided during this period as the clinic transitioned from in-person to virtual consultation. Recommendation categories included: (1) diagnostic testing, (2) medication recommendations and deprescribing, (3) referral for formal neuropsychological testing, (4) psychiatric referral for behavioral concerns, (5) primary care management and goals of care, (6) safety considerations, (7) home and community-based services, and (8) caregiver support. Providers continue to send new consultations and request follow-up advice on previous consults. A total of 72 family caregivers participated in a virtual 4-class support curriculum.

CONCLUSIONS/IMPACT

Virtual and e-consult dementia care working through the primary care provider, as well as virtual group caregiver support, are feasible, acceptable and sustainable models of dementia care to efficiently utilize scarce geriatrics resources serving a wide geographic area. A virtual dementia system of care may facilitate PCP delivery of supportive care for persons living with dementia, dementia care navigation, and caregiver support.

Lecanemab in clinical practice: real-world outcomes in early Alzheimer's disease

BACKGROUND

Lecanemab, a monoclonal antibody targeting amyloid beta, has recently been approved for treatment of early-stage Alzheimer's disease (AD), demonstrating amyloid plaque reduction and slowing of cognitive decline in clinical trials. However, real-world data on its efficacy and safety remain limited. The Cognitive Neurology Unit at Tel Aviv Medical Center (TLVMC) established an infrastructure to facilitate advanced treatments for AD, utilising a multidisciplinary approach to patient screening, diagnosis, treatment initiation and follow up.

METHODS

Lecanemab administration at the TLVMC commenced in November 2023. Patients with biomarker-confirmed early-stage AD were screened via a structured referral system, including neurological evaluations, MRI, lumbar puncture or Amyloid-PET, genetic testing, and multidisciplinary team (MDT) consensus discussions. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline, six months, and twelve months. Safety monitoring included routine MRI scans for amyloid-related imaging abnormalities (ARIA).

RESULTS

Between July 2023 and January 2025, 169 patients were screened and 86 initiated lecanemab treatment. By January 2025, 53 patients had reached the 6-month follow-up date. In the intention-to-treat (ITT) population, MMSE scores declined significantly over 6 months (F(1, 45.13) = 7.41, p =.009). Subgroup analysis revealed a significant decline in younger patients (n = 31; F(1, 24.67) = 8.06, p =.009), but not in older patients (n = 22; F(1, 19.25) = 0.67, p =.424). At 12 months, 31 patients had reached follow-up, with no significant change in MMSE scores observed (F(1, 17.18) = 2.49, p =.133). Age subgroup analysis was not performed at 12 months due to limited sample size. No significant correlations were found between baseline biomarkers and cognitive change. ARIA occurred in 18.6% of patients, mostly asymptomatic. One patient experienced symptomatic ARIA, required hospitalization with intravenous treatment, and discontinued therapy. A mixed-effects model showed no significant effect of ARIA on MMSE change (p =.264) and no interaction with time (p =.433). Infusion-related reactions occurred in 22.1%, all mild and transient. Treatment was discontinued in 19.8% of patients due to ARIA, financial barriers, comorbidities, or personal preference.

CONCLUSIONS

This real-world analysis demonstrates the feasibility and safety of Lecanemab administration for early-stage AD within a tertiary hospital setting. Establishing dedicated infrastructure enabled streamlined patient evaluations and treatment. The findings suggest a differential response across age groups, consistent with clinical trial data. Continued longitudinal follow-up is needed to assess long-term efficacy and safety.

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.

Association among cardiorespiratory fitness, plasma biomarkers of pathology and astrocyte reactivity, and cognition in autosomal-dominant Alzheimer's disease

BackgroundHigh cardiorespiratory fitness has been associated with greater neuroplasticity, and slower neurodegeneration and cognitive decline in healthy adults. Yet, less is known about whether low-to-intermediate cardiorespiratory fitness is associated with lower markers of disease progression in the preclinical stage of Alzheimer's disease (AD).ObjectiveWe investigated whether cardiorespiratory fitness was associated with plasma biomarkers for AD-related pathology, neural injury and astrocyte reactivity, and episodic memory in Presenilin-1 E280A carriers without dementia from the world's largest kindred with autosomal-dominant AD.MethodsTwenty-seven mutation carriers (25 cognitively unimpaired, 2 with mild cognitive impairment; ages: μ=30.22 years, SD = 5.24; 74% female) participated in the study. Participants underwent a graded aerobic fitness test to assess cardiorespiratory fitness, measured in maximum metabolic equivalent of task (MET). Plasma biomarkers included amyloid 42/40, phosphorylated tau-181, neurofilament light chain, and glial fibrillary acidic protein. Participants completed the Consortium to Establish a Registry for AD word list learning and delayed recall. We conducted multiple linear regressions controlling for age, sex, and years of education.ResultsFourteen participants' MET values were indicative of low cardiorespiratory fitness (<9 MET), and 13 participants' MET values of intermediate cardiorespiratory fitness (9-14 MET). METs were not associated with age, biomarkers, or episodic memory.ConclusionsOur findings suggest that low-to-intermediate cardiorespiratory fitness may not be associated with biomarkers for AD-related pathology, neural injury and astrocyte reactivity, or memory in people at genetic risk for dementia. Longitudinal studies and randomized-controlled trials are needed to better understand the relationships among cardiorespiratory fitness and AD progression.

Spontaneous brain activity in patients with type 2 diabetes: linking serum neuroproteins to cognitive ability

BACKGROUND

Cognitive impairment is a complication of type 2 diabetes with high prevalence and serious harm. This study aims to identify serum and imaging biomarkers of type 2 diabetes with mild cognitive impairment (MCI) and to study whether spontaneous brain activities evaluated by functional MRI mediate the relationships between these serum neuroprotein biomarkers and cognitive ability.

METHODS

According to Montreal Cognitive Assessment (MoCA) scores, 38 patients with MCI and 32 patients with normal cognition in type 2 diabetes were recruited. Serum neuroproteins were determined with Olink Proteomics. Brain activities were evaluated by functional MRI. Logistic regression were performed to determine the biomarkers of type 2 diabetes with MCI. Mediation analysis were performed to examine the potential causal chain between the neuroproteins and cognitive ability.

RESULTS

The levels of Epiregulin (EREG), Abhydrolase domain containing 14B (ABHD14B) and Inositol monophosphatase 1 (IMPA1) decreased, while the level of Cysteine-rich intestinal protein 2 (CRIP2) increased in type 2 diabetic patients with MCI (FDR p < 0.05). Combination of EREG and CRIP2, a ROC curve was generated with an AUC of 0.85 and an accuracy of 70.0%, and a sensitivity of 86.7% for diagnosing type 2 diabetes with MCI. Brain activities in bilateral superior parietal gyrus, bilateral postcentral gyrus, left inferior frontal gyrus, right cerebellum 6, left cerebellum crus1 decreased, while increased in right hippocampus and left middle frontal gyrus in type 2 diabetic patients with MCI (FDR p < 0.05). The mALFF values in the left cerebellum crus-1 mediated 29.1% of the association between the EREG and MoCA scores (p < 0.001). The mALFF values in the right cerebellum-6, left cerebellum crus-1, right hippocampus, right superior parietal gyrus and right postcentral gyrus all significantly and partially mediated the association between ABHD14B levels and MoCA scores, with mediating effects of 21.7%, 27.1%, 25.8%, 20.7% and 19.2%, respectively (all p values < 0.001).

CONCLUSIONS

Type 2 diabetic patients with MCI exhibit specific serum neuroprotein and functional MRI characteristics. The relationships between these neuroproteins and cognitive ability were mediated by spontaneous brain activities.

Feasibility and Acceptability of Implementing a Digital Cognitive Assessment for Alzheimer Disease and Related Dementias in Primary Care

PURPOSE

We assessed the feasibility and acceptability of implementing a digital cognitive assessment (DCA) for Alzheimer disease and related dementias (ADRD) screening into primary care. We also assessed the prevalence of positive screens and measured diagnostic and care outcomes after a positive DCA result.

METHODS

We conducted a single-arm pragmatic clinical demonstration project in 7 diverse primary care clinics to test implementation of the Linus Health Core Cognitive Evaluation and Digital Clock and Recall DCAs (Linus Health, Inc). Eligible patients were aged ≥65 years. Patients were ineligible if unable to see or hear, not English or Spanish speaking, or if they had a DCA in the past 12 months with an unimpaired or impaired result.

RESULTS

There were 16,708 eligible encounters during the 12-month study period (June 2022-May 2023). A total of 1,808 DCAs (10.8%) were completed by 1,722 unique patients; 3,727 (22.3%) declined, and at 9,232 encounters (55.3%) the physicians declined to have the patient complete the DCA or the encounter was deemed out of scope. Among those who completed DCAs, results for 762 (44.3%) were categorized as unimpaired, 628 (36.5%) borderline, 236 (13.7%) impaired, and 96 (5.6%) inconclusive. Among the 236 patients who were categorized as impaired, 2.1% received a new diagnosis of ADRD, and 5.1% received a new diagnosis of mild cognitive impairment within 90 days after the DCA.

CONCLUSIONS

One-half of all patients scored impaired or borderline for cognitive impairment. Digital cognitive assessments can be implemented in primary care, have utility for early detection, and could represent the first step in identification of patients who could benefit from ADRD disease-modifying therapeutics, care management, or other interventions to improve patient and family caregiver outcomes.

Individual electric field in cortical white matter is correlated with cognitive improvement in patients with mild cognitive impairment due to Alzheimer's disease after repetitive transcranial magnetic stimulation treatment

BackgroundRepetitive transcranial magnetic stimulation (rTMS) may be effective for Alzheimer's disease (AD) and mild cognitive impairment (MCI); however, the therapeutic efficacy varies significantly, highlighting the need for reliable biomarkers to predict treatment response. While rTMS may activates cortical white matter, the relationship between induced electric field (E-field) in this region and clinical outcomes remains unclear.ObjectiveThis study characterized the E-field in cortical gray matter (EFgm), cortical white matter (EFwm), and region-of-interest (EFROI) in the left dorsolateral prefrontal cortex (DLPFC), and explored their correlations with treatment efficacy in patients with MCI due to AD.MethodsThirty patients with MCI due to AD received 2-week rTMS treatment, with efficacy measured by Auditory Verbal Learning Test (AVLT) and a comprehensive neuropsychological battery. Responders were defined as those with >25% improvement in AVLT-immediate memory. Correlations between regional brain volumes and E-field magnitudes, and the correlations between E-field magnitudes and cognitive improvement, were analyzed. Predictive performance of E-fields for responder classification was evaluated.ResultsPronounced inter-individual variability in magnitudes of EFgm, EFwm and EFROI was observed, partially explained by differences in regional brain volumes of DLPFC targeted area. Treatment responders exhibited significantly higher EFwm magnitude. EFwm positively correlated with AVLT-immediate memory improvement (R2 = 0.37) and predicted responder groups, achieving an area under the curve (AUC) of 0.76.ConclusionsE-field within cortical white matter in the DLPFC correlates with rTMS efficacy and predicts therapeutic response in MCI due to AD. Personalized stimulation protocols incorporating EFwm modeling may optimize treatment parameters.Trial registrationThis study is registered in the Chinese Clinical Trial Registry, number ChiCTR2200062564, date of registration: 2022-08-11.

Sex differences in risk factors for Alzheimer dementia encephalopathy patients

Background

The objective is to identify risk factors that contribute to sex differences in Alzheimer dementia (AD) patients with encephalopathy (ADEN) and determine whether these factors are different between male and female ADEN patients. This is the first large-scale study comparing sex-specific ADEN risk profiles.

Methods

Our retrospective cohort study analyzed data collected from February 2016 to August 2020. It included a total of 128,769 AD patients, among whom 41,266 AD patients also presented with encephalopathy, compared to 87,503 AD patients that did not. The univariate analysis was used to determine differences in risk factors for male and female AD patients. Multivariate analysis predicted specific risk factors associated with male and female ADEN patients.

Result

In the adjusted analysis, males presented with hypertension (OR = 1.144, 95% CI, 1.094-1.197, p < 0.001), peripheral vascular disease (OR = 1.606, 95% CI, 1.485-1.737, p < 0.001), atrial fibrillation (OR = 1.555, 95% CI, 1.443-1.676, p < 0.001), hallucinations (OR = 1.406, 95% CI, 1.119-1.766, p = 0.003), and traumatic head injury (OR = 3.211, 95% CI, 2.346-4.395, p < 0.001). Females presented with osteoporosis (OR = 0.307, 95% CI, 0.278-0.340, p < 0.001), unspecified cancer (OR = 0.615, 95% CI, 0.512-0.740, p < 0.001), anxiety (OR = 0.609, 95% CI, 0.565-0.655, p < 0.001), urinary tract infections (UTI) (OR = 0.451, 95% CI, 0.423-0.481, p < 0.001), upper respiratory infections (URI) (OR = 0.531, 95% CI, 0.432-0.653, p < 0.001) and gastrointestinal ulceration (OR = 0.338, 95% CI, 0.269-0.424, p < 0.001).

Conclusion

Our analysis identified risk factors that contribute to sex differences in ADEN. This difference was fully mediated by peripheral vascular disease, atrial fibrillation, hallucinations, and traumatic head injury for males and unspecified cancer, anxiety, urinary tract infections, upper respiratory infections, and gastrointestinal ulceration for females. These findings provide valuable insights into the risk factors that can be managed to improve the care of male and female ADEN patients.

Implementing early detection of cognitive impairment in primary care to improve care for older adults

Primary care is the ideal setting for early detection of mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD), as it serves as the primary point of care for most older adults. With the growing aging population, reliance on specialists for detection and diagnosis is unsustainable, highlighting the need for primary care-led assessment. Recent research findings on successful brain health prevention strategies, AD diagnostic tools, and anti-amyloid treatments empower primary care to play a central role in early detection and intervention. Primary care-focused resources are being developed, including tools for cognitive assessments and materials designed to educate patients about brain health and initiate discussions on lifestyle modifications, thereby making early detection more feasible and efficient. Identifying risk factors early enables providers to implement interventions that can slow cognitive decline and improve outcomes for patients and caregivers. If left undetected and unmanaged, MCI and ADRD can lead to worse outcomes, including increased falls, hospitalizations, financial vulnerability, and caregiver stress. Early detection enables the identification of reversible causes of cognitive impairment, supports the management of comorbidities worsened by cognitive decline, mitigates safety risks, and can preserve quality of life. Importantly, primary care is essential for addressing ADRD-related health disparities that disproportionately affect racial minorities, rural populations, and those of lower socioeconomic status. With a focus on the United States healthcare system, this perspective addresses how implementing early detection practices into primary care can improve outcomes for patients and caregivers, reduce societal burdens, and promote health equity in ADRD care.

Synapse vulnerability and resilience across the clinical spectrum of dementias

Preservation of synapses is crucial for healthy cognitive ageing, and synapse loss is one of the closest anatomical correlates of cognitive decline in Alzheimer disease, dementia with Lewy bodies and frontotemporal dementia. In these conditions, some synapses seem particularly vulnerable to degeneration whereas others are resilient and remain preserved. Evidence has highlighted that vulnerability and resilience are intrinsically distinct phenomena linked to specific brain structural and/or functional signatures, yet the key features of vulnerable and resilient synapses in the dementias remain incompletely understood. Defining the characteristics of vulnerable and resilient synapses in each form of dementia could offer novel insight into the mechanisms of synapse preservation and of synapse loss that underlies cognitive decline, thereby facilitating the discovery of targeted biomarkers and disease-modifying therapies. In this Review, we consider the concepts of synapse vulnerability and resilience, and provide an overview of our current understanding of the associations between synaptic protein changes, neuropathology and cognitive decline. We also consider how understanding of the underlying mechanisms could identify novel strategies to mitigate the cognitive dysfunction associated with dementias.

MRI-based diagnostic model for Alzheimer's disease using 3D-ResNet

Alzheimer's disease (AD), a progressive neurodegenerative disorder, is the leading cause of dementia worldwide and remains incurable once it begins. Therefore, early and accurate diagnosis is essential for effective intervention. Leveraging recent advances in deep learning, this study proposes a novel diagnostic model based on the 3D-ResNet architecture to classify three cognitive states: AD, mild cognitive impairment (MCI), and cognitively normal (CN) individuals, using MRI data. The model integrates the strengths of ResNet and 3D convolutional neural networks (3D-CNN), and incorporates a special attention mechanism(SAM) within the residual structure to enhance feature representation. The study utilized the ADNI dataset, comprising 800 brain MRI scans. The dataset was split in a 7:3 ratio for training and testing, and the network was trained using data augmentation and cross-validation strategies. The proposed model achieved 92.33% accuracy in the three-class classification task, and 97.61%, 95.83%, and 93.42% accuracy in binary classifications of AD versus CN, AD versus MCI, and CN versus MCI, respectively, outperforming existing state-of-the-art methods. Furthermore, Grad-CAM heatmaps and 3D MRI reconstructions revealed that the cerebral cortex and hippocampus are critical regions for AD classification. These findings demonstrate a robust and interpretable AI-based diagnostic framework for AD, providing valuable technical support for its timely detection and clinical intervention.

In-Home Assistive Technology May Help Protect Dementia Caregivers from Declining Sleep Efficiency: A Randomized Control Trial

OBJECTIVES

Caregivers for people with dementia (PWDs) often experience sleep problems due to stressors associated with their role (e.g. concern about PWDs' nighttime wandering). We investigated whether a technology system, People Power Caregiver (PPCg), that helps monitor the caregiver's home would benefit caregivers' sleep.

METHODS

Primary caregivers of PWDs (Study 1: N = 70, Age M = 64.54, SD = 11.82, range = 35-84; Study 2: N = 92, Age M = 62.73, SD = 11.10, range = 32-89) were assigned to a fully activated PPCg condition or control condition (Study 1: partially active PPCg; Study 2: waitlist control). Caregivers completed the Pittsburgh Sleep Quality Index at baseline, three-months, and six-months.

RESULTS

Caregivers in the control conditions reported significantly worsening sleep efficiency whereas in comparison, those in the active conditions reported improving sleep efficiency.

CONCLUSIONS

Given how critical sleep is both for caregivers' health and the care they provide, these findings underscore potential benefits of in-home technologies for protecting caregivers' sleep.

CLINICAL IMPLICATIONS

Technology-based interventions that help monitor the home may support caregivers' sleep. Protecting caregivers' sleep may also preserve their ability to provide high-quality care as their loved one's disease and associated functional decline progresses.

Associations between dementia symptoms and caregiver and relationship health: A prominent role for speech and language

BackgroundDementia is a significant public health issue globally. People with dementia (PWD) exhibit symptoms in multiple domains (e.g., cognition, emotion, motor, speech/language) that can vary in their impact on the caregiver and the PWD-caregiver relationship.ObjectiveWe assessed the relative impact of various dementia symptoms on caregiver health and well-being and on the PWD-caregiver relationship using a broad sampling of PWD symptoms and caregiver/relationship outcome measures.MethodsData were analyzed from 54 primary caregivers of PWDs who completed seven questionnaires assessing caregiver health and well-being and PWD-caregiver relationship quality. An exploratory factor analysis of these questionnaires revealed two primary factors: (a) General Distress (anxiety, burden, depression, general health, loneliness), and (b) Relationship Quality (interpersonal closeness, relationship satisfaction). Caregivers also rated nine categories of PWD symptoms (memory, executive functions, speech/language, visual/spatial, motor, changes in behavior, sleep, medical/sensory, activities of daily living).ResultsGreater caregiver General Distress was associated with greater PWD speech/language and sleep symptoms. Lower caregiver Relationship Quality was associated (at trend, p < 0.10, levels) with greater PWD speech/language and activities of daily living symptoms. Correlations with the seven individual caregiver outcome measures revealed that speech/language symptoms were the most robust predictors (correlated with five measures), followed by sleep and activities of daily living symptoms (correlated with two measures), and memory, visual/spatial, and motor symptoms (correlated with one measure).ConclusionsFindings highlight the profound adverse effects that PWD speech and language deficits may have on caregivers and underscore the importance of addressing these deficits in dementia care.

Performance of a smell identification test versus the Mini-Mental Status Exam for the detection of dementia and cognitive impairment among persons with cognitive concerns in primary care

BackgroundOdor identification deficits predict Alzheimer's disease (AD) in epidemiological studies.ObjectiveTo compare the accuracy of a short odor identification test with a short cognitive screening test for the detection of dementia and cognitive impairment in elderly persons with cognitive concerns.MethodsThis was a cross-sectional study of 600 participants 65 years and older, without known mild cognitive impairment (MCI) or dementia, with cognitive concerns, attending primary care practices in New York City. The odor identification test was the Brief Smell Identification Test (BSIT). The comparator test was the Mini Mental Status Exam II (MMSE). Cognitive diagnoses were made using the National Alzheimer's Coordinating Center Uniform Data set (NACC-UDS) version 3 forms with slight modifications. Test performance was compared using Receiver Operating Characteristic analyses.ResultsThe mean age was 72.65 ± 6.31 years, 73.3% were female, 63.3% were Hispanic, 13.5% non-Hispanic Black, and 20.8% non-Hispanic White; 23.5% were classified as normal cognition, 27.7% as cognitive impairment-not mild cognitive impairment (MCI), 31.2% as amnestic MCI, 5.7% as non-amnestic MCI, and 12% as dementia. The MMSE was superior to the BSIT in detecting dementia and any cognitive impairment. Combining abnormal scores in the BSIT (≤8) to MMSE (≤24) improved the MMSE's specificity and positive predictive value (PPV) in detecting cognitive impairment.ConclusionsThe MMSE was superior to the BSIT in detecting dementia and cognitive impairment in primary care but using both tests improved specificity and PPV for identifying persons with subjective complaints needing further cognitive and biomarker evaluation.

Disease-modifying effect of donepezil on APP/PS1 mice at different stages of Alzheimer's disease

Despite Alzheimer's disease (AD) representing a significant global health concern, disease-modifying therapeutic options remain elusive. The use of animal models of the disease to develop drugs intended for the treatment of AD does not always predict their efficacy in clinical trials. Our research demonstrates the benefits of a drug-withdrawal approach to screening AD-modifying compounds, focussing on β-amyloid (Aβ)-related pathological changes in APP/PS1 transgenic mice at different stages of the disease. To assess the efficacy of this approach, we examined the AD-modifying effect of donepezil as a reference drug. A significant cognitive decline exhibited by APP/PS1 transgenic mice from 8.4 months of age was accompanied by progressive accumulation of Aβ plaques, decreased synaptophysin and vesicular acetylcholine transporter immunoexpression. Donepezil had a disease-modifying effect, slowing the deterioration of all the pathological markers studied when treatment was started in a pre-symptomatic stage of AD. However, in the group of mice with advanced stage of AD, such disease-modifying effects were not evident.

BDNF/proBDNF Interplay in the Mediation of Neuronal Apoptotic Mechanisms in Neurodegenerative Diseases

The neurotrophic system includes neurotrophins, such as brain-derived neurotrophic factor (BDNF) and its precursor proBDNF, which play conflicting roles in neuronal survival and apoptosis, with their balance having a significant impact on neurodegenerative outcomes. While BDNF is widely acknowledged as a potent neurotrophin that promotes neuronal survival and differentiation, its precursor, proBDNF, has the opposite effect, promoting apoptosis and neuronal death. This review highlights the new and unique aspects of BDNF/proBDNF interaction in the modulation of neuronal apoptotic pathways in neurodegenerative disorders. It systematically discusses the cross-talk in apoptotic signaling at the molecular level, whereby BDNF activates survival pathways such as PI3K/Akt and MAPK/ERK, whereas proBDNF activates p75NTR and sortilin to induce neuronal apoptosis via JNK, RhoA, NFkB, and Rac-GTPase pathways such as caspase activation and mitochondrial injury. Moreover, this review emphasizes the factors that affect the balance between proBDNF and BDNF levels within the context of neurodegeneration, including proteolytic processing, the expression of TrkB and p75NTR receptors, and extrinsic gene transcription regulators. Cellular injury, stress, or signaling pathway alterations can disrupt the balance of BDNF/proBDNF, which may be involved in apoptotic-related neurodegenerative diseases like Alzheimer's, Parkinson's, and Huntington's diseases. This review provides a comprehensive framework for targeting neurotrophin signaling in the development of innovative therapies for neuronal survival and managing apoptotic-related neurodegenerative disorders, addressing the mechanistic complexity and clinical feasibility of BDNF/proBDNF interaction.

Large-scale plasma proteomic profiling unveils diagnostic biomarkers and pathways for Alzheimer's disease

Proteomic studies have been instrumental in identifying brain, cerebrospinal fluid and plasma proteins associated with Alzheimer's disease (AD). Here, we comprehensively examined 6,905 aptamers corresponding to 6,106 unique proteins in plasma in more than 3,300 well-characterized individuals to identify new proteins, pathways and predictive models for AD. We identified 416 proteins (294 new) associated with clinical AD status and validated the findings in two external datasets representing more than 7,000 samples. AD-related proteins reflected blood-brain barrier disruption and other processes implicated in AD, such as lipid dysregulation or immune responses. A machine learning model was used to identify a set of seven proteins that were highly predictive of both clinical AD (area under the curve (AUC) of >0.72) and biomarker-defined AD status (AUC of >0.88), which were replicated in multiple external cohorts and orthogonal platforms. These findings underscore the potential of using plasma proteins as biomarkers for the early detection and monitoring of AD and for guiding treatment decisions.

Self-assembled cysteine-copper chiral nanoparticles for inhibiting aggregation of amyloid β peptides

Inhibiting the aggregation of amyloid β (Aβ) peptides is a promising strategy for the treatment of Alzheimer's disease (AD). However, there have been very limited reports of highly effective inhibitors of Aβ aggregation in the past few decades. Herein, two types of nanoparticles (NPs) with opposite chirality were prepared through one-step assembly of L-cysteine (L-Cys) or D-cysteine (D-Cys) and Cu2+ at room temperature. L-Cys-Cu NPs and D-Cys-Cu NPs were able to inhibit the aggregation of Aβ42. Compared to their enantiomer L-Cys-Cu NPs, D-Cys-Cu NPs showed a larger binding affinity to Aβ42, leading to stronger inhibition of Aβ42 fibrillation. Moreover, D-Cys-Cu NPs were found to cause the disaggregation of Aβ42 fibrils. Due to their simple preparation, good biocompatibility and significant effects, these chiral Cys-Cu NPs have great potential in inhibiting protein aggregation.

Dietary patterns and transition from normal cognition to mild cognitive impairment and its reversion: A longitudinal study of older adults

BACKGROUND

The reversion from mild cognitive impairment (MCI) to normal cognition (NC) has received less attention than the progression to dementia. We aimed to estimate the MCI-to-NC reversion rate and examine dietary patterns associated with the cognitive transition among older adults.

METHODS

Longitudinal data from 11,211 adults aged 65 years and older were analyzed. Four dietary patterns including plant-based diet index (PDI), simplified healthy eating index (SHEI), dietary diversity score (DDS), and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) were assessed with the food frequency questionnaire. Cognitive function was quantified with the Mini-Mental State Examination. The multi-state Markov models were applied to estimate associations between each dietary pattern and transition of cognitive status with four states: NC, MCI, dementia, and death.

RESULTS

Participants (mean [SD] age, 85.80 [11.13] years; 6211 women [55.40 %] and 5000 men [44.60 %]) were followed over a mean time of 4.76 (SD = 3.14) years. The rate of reversion from MCI to NC was 9.4 %. Hazard ratios (HRs, 95 % confidence interval [CI]) for the progression from NC to MCI were 0.87 (0.77-0.97), 0.81 (0.73-0.91), 0.95 (0.92-0.99), and 0.95 (0.92-0.99) for dietary patterns of healthful PDI (hPDI), SHEI, DDS, and MIND, respectively. Besides, a better adherence to hPDI (HR = 1.21, 95 % CI = 1.03 to 1.43) and SHEI (HR = 1.20, 95 % CI = 1.02 to 1.41) was associated with increased likelihoods to revert from MCI to NC.

CONCLUSIONS

Dietary patterns of hPDI, SHEI, DDS, and MIND were linked to decreased risks of NC-to-MCI progression, and hPDI and SHEI were associated with higher likelihoods of MCI-to-NC reversion in older adults. Interventional studies with dietary patterns were warranted to confirm our findings.

Detection of donepezil concentration in serum by solid-phase extraction liquid chromatography-mass spectrometry based on magnetic molecularly imprinted polymer

Donepezil is a drug used to treat Alzheimer's disease, and its efficacy is closely related to the concentration of the drug in the serum. Therefore, monitoring the concentration of donepezil in the serum is crucial for evaluating the treatment effect and avoiding adverse reactions. In this study, a new method for determining the concentration of donepezil in serum was established by combining magnetic molecularly imprinted polymers (MMIPs) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology. The prepared magnetic molecularly imprinted polymers were characterized by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FT-IR), and transmission electron microscopy (TEM) to confirm that the polymer had effective imprinting and good magnetic responsivity. The adsorption experiment showed that the MMIPs had a saturated adsorption capacity of 15.4 mg g-1 for donepezil and the adsorption behavior followed the quasi-second-order kinetic model. The adsorption of donepezil by MMIPs was a chemical adsorption process. Finally, by combining LC-MS/MS technology, the method successfully achieved rapid, high selectivity, and high specificity separation and enrichment detection of donepezil in serum. The linear range of the method for donepezil in serum was 25-200 ng mL-1, the lowest detection limit was 0.33 ng mL-1, the recovery was 98.7-102.6%, and the relative standard deviation (RSD) was 1.2-4.5% (n = 3). The experiment confirmed that the method is simple and effective for detecting donepezil in serum.

Associations of the body roundness index with cognitive function in US older adults and the mediating role of depression: a cross-sectional study from the NHANES 2011-2014

The body roundness index (BRI) accurately assesses body composition and visceral fat distribution, but its independent associations with cognitive function and cognitive impairment remain unclear. This study, which is based on data from the 2011-2014 U.S. National Health and Nutrition Examination Survey (NHANES), explores the associations between the BRI and cognitive function as well as cognitive impairment in older adults. Weighted linear regression and weighted logistic regression models were used for data analysis. Restricted cubic spline (RCS) models, subgroup analysis, and mediation analysis were conducted to explore effect modification, nonlinear associations, and the mediating role of depression. The BRI score was negatively correlated with the cognitive function score (DSST score β = -0.63, P = 0.037; Sum Score β = -0.83, P = 0.042) and was not significantly associated with cognitive impairment. As the BRI score increases, both the DSST score (trend P = 0.013) and the Sum Score (trend P = 0.023) show a linear decrease. The mediation effect analysis revealed that depression mediated 39.4% of the association between the BRI score and cognitive function, suggesting that the effect may be indirectly mediated through mental health pathways. Subgroup analysis and RCS models did not reveal significant interaction effects or nonlinear associations.

Dementia care management in primary care practices: a descriptive study among nurse practitioners

BACKGROUND

More than 55 million people worldwide have dementia, and every year, 10 million new cases are diagnosed. In the United States (U.S.) alone, 6.9 million Americans ages 65 and older have dementia. Health systems are searching for innovative solutions to expand the primary care system's capacity to care for these patients. Advanced practice nurses such as nurse practitioners (NPs) are vital to increasing primary care capacity to meet the need, yet primary care NPs often face structural, organizational, and workforce challenges. More specifically, little is known about NPs who care for dementia patients in primary care settings. This study explored the practice structural capabilities, organizational context, and job outcomes (i.e., burnout, job dissatisfaction, and intent to leave the practice) among NPs providing care for patients with dementia in U.S. primary care practices.

METHODS

We conducted a national cross-sectional survey of NPs using modified Dillman methods. Between 2021 and 2023, NPs working in primary care practices who cared for patients with dementia received a mail and online survey. Additional survey mailings, emails, postcard reminders, and phone calls encouraged non-respondents to participate. In total, 968 NPs responded across 847 practices. We estimated a response rate of 16.4-36.4%.

RESULTS

NPs reported that the quality of dementia care in their practices is poorer than the overall care provided. About 45% of NPs indicated that dementia care in their practices is less than "very good," while only 17% reported that the overall care delivered falls below that standard. Additionally, NPs reported significant deficits in practice structural capabilities for dementia care and challenges with administration within their organization. The findings show that over a third of NPs report burnout.

CONCLUSIONS

Given the projected growth in the number of patients with dementia and the growing workforce of NPs worldwide, policy and practice efforts should be directed toward strengthening primary care practices to provide quality care for dementia patients. Bolstering NP workforce capacity and supporting NP roles in dementia care could improve organizational capacity to provide dementia care. However, widespread burnout among NPs found in our study could undermine their contribution to the dementia care workforce.

Dysautonomia in Alzheimer's Disease: A Systematic Review

Background: Alzheimer's disease (AD) is the most common cause of dementia. In addition to cognitive decline, non-cognitive symptoms, including dysautonomia, have been reported, although these symptoms are rarely acknowledged by patients. Dysautonomia in AD is thought to arise from either cholinergic deficits or hypothalamic involvement. A wide range of tests has been used to investigate the role of the autonomic nervous system; however, the results have been inconsistent. Aim: To systematically review all published research investigating autonomic nervous system (ANS) involvement in patients with AD. A comprehensive literature search was conducted in December 2024 across the following databases: PubMed, Cochrane Library, ScienceDirect, and Scopus. Results: A total of 1422 records were identified, of which 30 studies fulfilled the inclusion criteria and were included in the review. Several autonomic tests were employed, with Heart Rate Variability (HRV) being the most frequently used. Other tests included assessments of orthostatic hypotension (OH), postprandial hypotension (PPH), sympathetic skin response (SSR), the tilt test, 123I-MIBG cardiac scintigraphy, norepinephrine (NE) measurements in serum and cerebrospinal fluid, and baroreflex sensitivity. In most studies, AD patients were compared to either healthy controls or patients with other types of dementia. Discussion: The primary finding of this review is that, although patients with AD rarely report dysautonomic symptoms, they frequently exhibit abnormal results on various autonomic tests. In some cases, these findings were sufficient to differentiate AD patients from healthy controls as well as from patients with Diffuse Lewy Body disease (DLB). The inconsistency in reporting symptoms, along with the variability in test results, suggests that autonomic dysfunction in AD may be under-recognized and warrants further investigation. Conclusions: The heterogeneity of the included studies limits the generalizability of the results. However, given the potential impact of dysautonomia on both quality of life and mortality, it is recommended that AD patients be systematically assessed for autonomic dysfunction. Even in the absence of overt symptoms, appropriate treatment should be considered where indicated to mitigate potential risks.

Research status of visuospatial dysfunction and spatial navigation

Visuospatial function is a critical aspect of cognitive abilities, encompassing visual perception, attention, memory, and adaptive responses to spatial changes. This paper reviews studies on human visuospatial function, spatial navigation, and factors contributing to visuospatial impairments. After introducing fundamental concepts of visuospatial function and spatial navigation, classical methods for assessing visuospatial performance are summarized. By examining recent advances in spatial navigation studies, this paper discusses factors influencing spatial navigation capabilities and explores how spatial navigation paradigms can be used to investigate visuospatial cognitive impairments. Finally, current limitations in spatial navigation research are highlighted. Overall, the current research has not yet reached definitive conclusions regarding visuospatial aspects. However, this paper aims to enhance the understanding of visuospatial dysfunction and spatial navigation, providing valuable references for future research.

Self-reported motoric cognitive risk syndrome predicts long-term mortality in older adults

OBJECTIVES

Motoric cognitive risk syndrome (MCR) is a pre-dementia syndrome characterized by slow gait and subjective cognitive decline, increasing the risk of adverse clinical events such as dementia and falls in older adults. However, whether self-reported MCR (sMCR) predicts long-term mortality in Chinese older adults remains unknown. This study aimed to explore the role of sMCR in 8-year mortality in community-dwelling older adults.

DESIGN

Longitudinal cohort study.

SETTING

Data were sourced from the Beijing Longitudinal Study of Aging.

PARTICIPANTS

A total of 1,683 community-dwelling individuals aged 65 years and older who were free from disability and dementia at baseline were included.

MEASUREMENTS

sMCR was defined based on the presence of subjective cognitive decline and self-reported slow gait. Mortality data were tracked over the 8-year follow-up period. Cox regression models were used to analyze the association between sMCR and 8-year mortality.

RESULTS

A total of 113 (6.71%) community-dwelling individuals had sMCR. sMCR was associated with female sex, older age, no spouse, living in rural areas, low education level, low monthly income, no work, no tea intake, poor sleep quality, inactivity, poor physical performance, chronic diseases, and frailty. Participants with sMCR had a higher 8-year mortality compared to those without (70.80% vs. 34.52%). Cox regression analysis showed that sMCR predicted 8-year mortality (hazard ratio [HR] = 2.859, 95% confidence interval [CI] 2.260-3.619). This association remained significant even after adjusting for sex, age, area, education level, marital status, chronic diseases, and lifestyle factors (HR = 1.540, 95% CI 1.169-2.028).

CONCLUSIONS

sMCR is a predictor of 8-year mortality in Chinese community-dwelling older adults, which highlights the importance of early identification and intervention for sMCR to reduce adverse clinical outcomes in the aging population.