Intercepting Dementia: Awareness and Innovation as Key Tools

Factors associated with cognitive function outcomes among older adults in Kuwait: A cross-sectional study

BACKGROUND

The number of people living with dementia and/or cognitive impairment worldwide is rising with a negative effect on quality of life for many older adults. This study aims to examine the factors associated with cognitive function among older adults in Kuwait.

METHODS

This cross-sectional study recruited 253 older adults ≥ 60 years from a Geriatric outpatient unit in Kuwait. Cognitive function (dependent variable) was assessed using the Arabic version of the Mini-Mental State Examination (MMSE) with scores < 24 indicative of cognitive impairment. Biochemical, nutritional, clinical, lifestyle, anthropometric, and sociodemographic independent variables were included.

RESULTS

A normal MMSE score was reported for 51.0% (n = 129) of the sample, with 34.7% and 14.2% of participants having mild and moderate/severe cognitive impairment, respectively. Multivariate ordinal logistic regression analysis indicated that Type 2 diabetes was associated with more than double the odds of cognitive impairment (OR = 2.15, 95% CI: 1.19-3.94; P = 0.01). Each additional level of education was associated with a lower likelihood of cognitive impairment (OR = 0.34, 95% CI: 0.26-0.43; P < 0.001).

CONCLUSION

This study identifies key risk factors associated with cognitive impairment in older Kuwaiti adults. These findings underscore the need for targeted interventions to mitigate cognitive decline in aging populations and provide context-specific data to support policy decisions.

Leaders at Italian Alzheimer's Cafés addressing ethical issues: from advocacy response against human trafficking to Dolcezza approach with persons living with dementia

OBJECTIVES

This article features results of a qualitative research conducted with twenty-nine men and women responsible for Alzheimer's cafés in Italy, on the topic of ethical issues in dementia care. The goal was to identify the sources of moral distress for caregivers, exploring some bottom-up solutions that have been implemented shared with others in informal settings.

METHOD

During the in-depth interviews participants shared about challenges and opportunities related to dementia care and ethics, informed by the symbolic interactionist approach to the theory of social representations.

RESULTS

The analysis of interviews resulted in identification of six main themes, each with some sub-themes: awareness, personhood, social connectedness, isolation, access, and institutional dimension.

CONCLUSION

The results pointed out the importance of culturally appropriate approach and advocacy for tackling ethical issues, especially in the light of morally wrong egregious abuse of persons with dementia (as related by participants), which can be classified as benefits trafficking, a form of human trafficking.

Using Routinely Collected Health Data to Estimate the Prevalence of Alzheimer's Disease and Potentially Modifiable Risk Factors in Colombia

OBJECTIVE

With an increasing prevalence, Alzheimer's Disease (AD) is the most common cause of dementia. However, a percentage of potentially modifiable cases have been reported. This article describes the prevalence of four of these potentially modifiable risk factors: hearing loss, diabetes mellitus (DM), obesity, and hypertension.

METHODS

Descriptive cross-sectional study with data from 2018 to 2022, using the Colombian health system database SISPRO. The population of this study consisted of all people within the age range 50-100 with a main diagnosis of AD according to the ICD-10 codes. Subjects were divided by decades, and the prevalence ratio (PR) for the outcome of AD and each of its potentially modifiable risk factors was then calculated and adjusted by age using the Mantel-Haenszel formula.

RESULTS

167,556 cases of AD were identified, with 66.4% being females. Peak age was in octogenarians, and the five-years period prevalence for people older than 50 was 12.6 cases/1000 people. The PRs showed a positive association for all risk factors, except obesity. Following age correction, obesity's PR value shifted to positive in males and overall population but remained negative for females. The highest post-correction PR in the overall population was hypertension (1.44), followed by DM (1.34), hearing loss (1.31) and obesity (1.12). Notably, PRs had a greater magnitude in younger and male age groups.

CONCLUSION

The results of this study are consistent with the fact that the prevalence of potentially modifiable risk factors is higher within the group of people with AD as their main diagnosis.

Mild cognitive impairment prediction and cognitive score regression in the elderly using EEG topological data analysis and machine learning with awareness assessed in affective reminiscent paradigm

Introduction

The main objective of this study is to evaluate working memory and determine EEG biomarkers that can assist in the field of health neuroscience. Our ultimate goal is to utilize this approach to predict the early signs of mild cognitive impairment (MCI) in healthy elderly individuals, which could potentially lead to dementia. The advancements in health neuroscience research have revealed that affective reminiscence stimulation is an effective method for developing EEG-based neuro-biomarkers that can detect the signs of MCI.

Methods

We use topological data analysis (TDA) on multivariate EEG data to extract features that can be used for unsupervised clustering, subsequent machine learning-based classification, and cognitive score regression. We perform EEG experiments to evaluate conscious awareness in affective reminiscent photography settings.

Results

We use EEG and interior photography to distinguish between healthy cognitive aging and MCI. Our clustering UMAP and random forest application accurately predict MCI stage and MoCA scores.

Discussion

Our team has successfully implemented TDA feature extraction, MCI classification, and an initial regression of MoCA scores. However, our study has certain limitations due to a small sample size of only 23 participants and an unbalanced class distribution. To enhance the accuracy and validity of our results, future research should focus on expanding the sample size, ensuring gender balance, and extending the study to a cross-cultural context.

A Paradigm Shift on Deinstitutionalization and Dementia Care: A Narrative Review

This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.

Breaking the barriers: overcoming dementia-related stigma in minority communities

Dementia is a global health concern that affects individuals irrespective of their cultural or linguistic backgrounds. However, research has long recognized the pronounced stigma associated with dementia, particularly within Culturally and Linguistically Diverse (CALD) communities. This article seeks to summarize the underlying factors contributing to the heightened levels of dementia stigma within CALD communities, through a review of the literature. Our examination shows that cultural beliefs, language barriers, limited awareness, and the impact of migration on perceptions of aging and cognitive decline are contributing factors. Consequently, our analysis highlights the need for tailored, culturally appropriate interventions aimed at mitigating stigma and enhancing dementia care within CALD populations. Our proposed solutions, built on a social-ecological approach, highlights the critical role of collaborative efforts involving policymakers, healthcare providers, community organizations, and CALD community members in fostering a more dementia-inclusive society. This perspective piece aims to shed light on the distinct challenges faced by CALD communities, while advocating for a holistic approach to redefine perceptions and care strategies tailored to these populations.

Association of dementia with clinical and financial outcomes following lobectomy for lung cancer

Objective

The number of adults with dementia is rising worldwide. Although dementia has been linked with inferior outcomes following various operations, this phenomenon has not been fully elucidated among patients undergoing elective lung resection. Using a national cohort, we evaluated the association of dementia with clinical and financial outcomes following lobectomy for cancer.

Methods

Adults undergoing lobectomy for lung cancer were identified within the 2010-2020 Nationwide Readmissions Database. Patients with a comorbid diagnosis of dementia were considered the Dementia cohort (others: Non-Dementia). Multivariable regressions were developed to evaluate the association between dementia and key outcomes.

Results

Of ∼314,436 patients, 2863 (0.9%) comprised the Dementia cohort. Compared with Non-Dementia, the Dementia cohort was older (75 vs 68 years, P < .001), less commonly female (49.4 vs 53.9%, P = .01), and had a greater burden of comorbid conditions. After adjustment, dementia remained associated with similar odds of in-hospital mortality (adjusted odds ratio [aOR], 0.86; 95% confidence interval [CI], 0.54-1.38) but greater likelihood of pneumonia (aOR, 1.31; CI, 1.04-1.65) and infectious complications (aOR, 1.37; CI, 1.01-1.87). Further, dementia was associated with longer length of stay (β +0.96 days; CI, 0.51-1.41), but no difference in hospitalization cost (β $1528; CI, -92 to 3148).

Conclusions

Patients with dementia faced similar odds of mortality, but greater complications and resource use following lobectomy for lung cancer. Novel interventions are needed to improve care coordination and develop standardized recovery pathways for this growing cohort.

Wearable Sensors to Evaluate Autonomic Response to Olfactory Stimulation: The Influence of Short, Intensive Sensory Training

In the last few decades, while the sensory evaluation of edible products has been leveraged to make strategic decisions about many domains, the traditional descriptive analysis performed by a skilled sensory panel has been seen to be too complex and time-consuming for the industry needs, making it largely unsustainable in most cases. In this context, the study of the effectiveness of different methods for sensory training on panel performances represents a new trend in research activity. With this purpose, wearable sensors are applied to study physiological signals (ECG and skin conductance) concerned with the emotions in a cohort of volunteers undergoing a short, two-day (16 h) sensory training period related to wine tasting. The results were compared with a previous study based on a conventional three-month (65 h) period of sensory training. According to what was previously reported for long panel training, it was seen that even short, intensive sensory training modulated the ANS activity toward a less sympathetically mediated response as soon as odorous compounds become familiar. A large-scale application of shorter formative courses in this domain appears possible without reducing the effectiveness of the training, thus leading to money saving for academia and scientific societies, and challenging dropout rates that might affect longer courses.

COVID-19 as a Risk Factor for Alzheimer's Disease

Severe acute respiratory disease coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic. Although a primarily respiratory disease, recent reports indicate that it also affects the central nervous system (CNS). Over 25% of COVID-19 patients report neurological symptoms such as memory loss, anosmia, hyposmia, confusion, and headaches. The neurological outcomes may be a result of viral entry into the CNS and/or resulting neuroinflammation, both of which underlie an elevated risk for Alzheimer's disease (AD). Herein, we ask: Is COVID-19 a risk factor for AD? To answer, we identify the literature and review mechanisms by which COVID-19-mediated neuroinflammation can contribute to the development of AD, evaluate the effects of acute versus chronic phases of infection, and lastly, discuss potential therapeutics to address the rising rates of COVID-19 neurological sequelae.

Potential Predictors for Cognitive Decline in Vascular Dementia: A Machine Learning Analysis

Vascular dementia (VD) is a cognitive impairment typical of advanced age with vascular etiology. It results from several vascular micro-accidents involving brain vessels carrying less oxygen and nutrients than it needs. This being a degenerative disease, the diagnosis often arrives too late, when the brain tissue is already damaged. Thus, prevention is the best solution to avoid irreversible cognitive impairment in patients with specific risk factors. Using the machine learning (ML) approach, our group evaluated Mini-Mental State Examination (MMSE) changes in patients affected by Alzheimer’s disease by considering different clinical parameters. We decided to apply a similar ML scheme to VD due to the consistent data obtained from the first work, including the assessment of various ML models (LASSO, RIDGE, Elastic Net, CART, Random Forest) for the outcome prediction (i.e., the MMSE modification throughout time). MMSE at recruitment, folate, MCV, PTH, creatinine, vitamin B12, TSH, and hemoglobinwere the best predictive parameters individuated by the best ML model: Random Forest. ML results can be useful inidentify predictive biomarkers for cognitive worsening in VD early and also for focusing on necessary examinations at the first visits to draw the most predictive features, saving time and money and reducethe burden on the patients themselves. Such results should be integrated with brain imaging, physiological signal measurements, and sensory patterns, particularly forthose senses already demonstrated to have a significant link with neurodegeneration. Adjusting compound deficit by administering nutraceuticals could support treatment effectiveness and lead to a better quality of life for patients, families, and caregivers, with a consistent impact on the national health systems load.

Effect of Obesity and High-Density Lipoprotein Concentration on the Pathological Characteristics of Alzheimer's Disease in High-Fat Diet-Fed Mice

The typical pathological features of Alzheimer's disease (AD) are the accumulation of amyloid plaques in the brain and reactivity of glial cells such as astrocytes and microglia. Clinically, the development of AD and obesity are known to be correlated. In this study, we analyzed the changes in AD pathological characteristics in 5XFAD mice after obesity induction through a high-fat diet (HFD). Surprisingly, high-density lipoprotein and apolipoprotein AI (APOA-I) serum levels were increased without low-density lipoprotein alteration in both HFD groups. The reactivity of astrocytes and microglia in the dentate gyrus of the hippocampus and fornix of the hypothalamus in 5XFAD mice was decreased in the transgenic (TG)-HFD high group. Finally, the accumulation of amyloid plaques in the dentate gyrus region of the hippocampus was also significantly decreased in the TG-HFD high group. These results suggest that increased high-density lipoprotein level, especially with increased APOA-I serum level, alleviates the pathological features of AD and could be a new potential therapeutic strategy for AD treatment.

Olfactory dysfunction is associated with mild cognitive impairment in community-dwelling older adults

Background

Olfactory impairment is aging related and is associated with cognitive decline in older adults. However, it remains unclear if an olfactory impairment is associated with mild cognitive impairment (MCI) and the degree of impairment in the MCI subtypes.

Materials and methods

In a cohort of community-living older adults aged 60 years and above, 670 participants were recruited from the Community Health and Intergenerational (CHI) Study. Olfactory function was assessed using a locally developed nine-item smell test in association with neurocognitive assessments. Analysis of covariance (ANCOVA) was used to examine the association of smell identification score and clinical cognitive status while considering demographic, clinical, and neuropsychological factors with Bonferroni correction for group comparisons.

Results

Age-related smell detection between normal aging (NA) and MCI participants had no significant difference. The overall mean smell identification score in older adults was negatively correlated with age. The mean smell identification score of MCI participants was also not significantly different as compared with NA, but an amnestic MCI multiple domain (aMCI_MD) subgroup had significantly lower (impaired) mean smell identification scores compared with the NA and MCI single domain (amnestic and non-amnestic) group.

Conclusion

This study demonstrated that olfactory identification impairment is a comorbidity in older adults with amnestic MCI (aMCI) and is a potential marker associated with an early stage of a neurocognitive disorder. The smell test could act as a screening tool to help in the early detection of smell impairment for heterogeneous syndromes of MCI among community-dwelling older adults. Clinicians and researchers could benefit from utilizing the locally developed smell test to screen their patients or research participants before the initiation of an appropriate health intervention or in a clinical trial.