LaPoint MR, Roscoe JN, Whitmer RA
… +9 more, Gutierrez S, Eng CW, Glymour MM, Mayeda ER, DeCarli C, Barnes LL, Gavett B, Maillard P, Gilsanz P
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 41222104
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OBJECTIVES: Education quality varies across the United States, both by state and by race/ethnicity, and it is unclear what impacts, if any, this may have on the brain in later life. In this study, we investigated the ass...OBJECTIVES: Education quality varies across the United States, both by state and by race/ethnicity, and it is unclear what impacts, if any, this may have on the brain in later life. In this study, we investigated the association between ninth-grade county-level education quality and brain health in 2 racially/ethnically diverse cohorts of older adults (n = 450, ages 61 to 102). METHODS: Historical county-level measures of education quality (percentage attendance, teacher-student ratio, and term length) were linked to total gray matter volume, ventricular volume, hippocampal volume, white matter hyperintensities, free water, and fractional anisotropy using linear regression models with robust SEs, adjusting for demographic factors, childhood socioeconomic status, state history of de jure school segregation, and study cohort. RESULTS: Teacher-student ratio and term length were not associated with brain imaging measures in fully adjusted models. Higher percentage attendance was associated with higher free water (β = 0.05, 95% CI: 0.0006, 0.09) and larger ventricular volume (β = 1.50, 95% CI: 0.41, 2.59). CONCLUSIONS: Though these relationships were not in the expected direction, they provide some evidence that education quality may be associated with brain health at older ages.
BACKGROUND: Quality of life (QoL) is a complex concept, potentially influenced by subjective well-being. This study aims to identify clinical characteristics related to QoL evaluation across different levels of awareness...BACKGROUND: Quality of life (QoL) is a complex concept, potentially influenced by subjective well-being. This study aims to identify clinical characteristics related to QoL evaluation across different levels of awareness of disease and determine whether QoL in individuals with Alzheimer disease correlates with emotional or cognitive/functional domains at varying levels of awareness of disease. METHODS: QoL was assessed in 179 individuals with Alzheimer disease, comparing 3 groups: N=32 with preserved awareness, N=88 with mildly impaired awareness, and N=59 with severe deficit/absent awareness. Participants and caregivers completed questionnaires about QoL, awareness of disease, cognition, dementia severity, functionality, neuropsychiatric symptoms, and depression. RESULTS: Individuals with preserved awareness reported lower QoL than those with mildly impaired awareness. The severe deficit/absent awareness group showed greater cognitive impairment ( P =0.010), more neuropsychiatric symptoms ( P <0.001), higher depression severity ( P =0.001), lower daily living activity ( P <0.001), and better QoL ( P <0.001) compared with other groups. QoL was negatively associated with neuropsychiatric symptoms in individuals with preserved awareness ( P =0.029) and mildly impaired awareness ( P =0.004), and with marital status ( P =0.002) in those with severe deficit/absent awareness. CONCLUSIONS: Awareness of disease inversely influences QoL evaluation. Psychosocial and emotional factors prevail in higher awareness deficits, whereas functional aspects are more important in lower deficits.
PURPOSE: Alzheimer disease (AD) is the most common neurodegenerative disorder, affecting millions worldwide. COVID-19 has increased the risk of acute complications and death for patients with AD, but the long-term effect...PURPOSE: Alzheimer disease (AD) is the most common neurodegenerative disorder, affecting millions worldwide. COVID-19 has increased the risk of acute complications and death for patients with AD, but the long-term effects on survivors have been little studied. Thus, given the potential role of SARS-CoV-2 in accelerating cognitive decline, this study aimed to assess the effect of COVID-19 on functional deterioration, AD progression, and mortality in these patients. METHODS: This retrospective cohort study examined medical records of patients with mild to moderate AD treated at a public dementia clinic in southern Brazil between March 2020 and March 2025. Sociodemographic and clinical data were extracted, including COVID-19 status confirmed by molecular testing. AD progression was assessed using the Mini-Mental State Examination (MMSE) and the Katz Index. Multivariate statistical analyses were conducted to identify associations between COVID-19 infection and disease progression. Survival was described by Kaplan-Meier test and analyzed by Cox regression. RESULTS: A total of 105 individuals with DA were included, of whom 28 (26.7%) were COVID-19 survivors during the follow-up period. COVID-19 patients showed rapid AD progression compared with the control group (OR 4.76; 95% CI: 1.04-21.7; P = 0.044). Likewise, SARS-CoV-2 infection decreased patients' functionality, as indicated by the Katz index ( P =0.001). Functional impairment was observed in both mild and hospitalized cases of COVID-19. Hospitalized patients during COVID-19 demonstrated lower survival rates at the 5-year follow-up. CONCLUSION: These findings suggest that SARS-CoV-2 infection may accelerate AD progression and reduce survival, particularly in cases requiring hospitalization. Future multicenter studies with large sample sizes are needed to confirm these findings.
ICAA is an underdiagnosed inflammatory response to β-amyloid (Aβ) deposition in the cortical and leptomeningeal microcirculation, and is clinically heterogeneous. We present a retrospective observational study conducted...ICAA is an underdiagnosed inflammatory response to β-amyloid (Aβ) deposition in the cortical and leptomeningeal microcirculation, and is clinically heterogeneous. We present a retrospective observational study conducted at a tertiary center from 2011 to 2024, including 11 patients who met the 2016 clinicoradiological criteria. Eleven patients were included in the study. Seven patients (64%) were female. The mean age was 70.6 years. The most frequent symptoms were seizures (n=9, 82%) and headaches (n=8, 73%). All patients presented with cortical microbleeds and white matter hyperintensities in MRI. Cortical and leptomeningeal biopsies were performed in 2 cases due to diagnostic uncertainty. Corticosteroid therapy was used in 9 (82%) patients, but clinical relapse occurred in 55%, and 45% were functionally dependent after 1 year. This case series highlights the heterogeneous clinical and radiologic presentation of ICAA and the challenges in its diagnosis and management, highlighting the need for standardized therapeutic approaches and further research to improve its prognosis.
Mueller KD, Soldan A, Langhough R
… +9 more, Bruno D, Jauregi-Zinkunegi A, Basche K, Hale MR, He D, Moghekar A, Hermann B, Albert M, Pettigrew C
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 41208050
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BACKGROUND: Early detection of Alzheimer disease (AD) is crucial; however, standard neuropsychological tests often lack sensitivity. Process scores, such as proper name (PN) recall from Logical Memory, may improve the de...BACKGROUND: Early detection of Alzheimer disease (AD) is crucial; however, standard neuropsychological tests often lack sensitivity. Process scores, such as proper name (PN) recall from Logical Memory, may improve the detection of AD-related biomarker positivity. We examined whether baseline PN recall predicted future cerebrospinal fluid (CSF) amyloid (Aβ42/Aβ40) and tau (pTau 181 ) status, and whether biomarker status predicted PN recall trajectories. METHODS: We analyzed 271 cognitively unimpaired BIOCARD participants (mean age=57.3, 60.3% female, mean follow-up=15.5) using logistic regression and mixed-effects models to examine the associations between PN recall and CSF biomarkers. RESULTS: Higher baseline PN recall predicted lower amyloid positivity [odds ratio (OR)=0.72, P =0.015]. Amyloid and tau positivity have been linked to a faster decline in PN. Biomarker-positive participants in the biomarker-negative group lacked practice effects. CONCLUSIONS: PN recall predicts future AD biomarker positivity and may enhance early detection of AD-related cognitive decline.
BACKGROUND: A genetic variant in the fibronectin FN1 gene reduces the odds of developing AD by up to 70%. This variant, rs140926439, appears to prevent the buildup of excess fibronectin at the blood brain barrier. Increa...BACKGROUND: A genetic variant in the fibronectin FN1 gene reduces the odds of developing AD by up to 70%. This variant, rs140926439, appears to prevent the buildup of excess fibronectin at the blood brain barrier. Increased fibronectin levels are typically observed in people with Alzheimer disease (AD), but the variant appears to counteract its effects. Our study aims to replicate findings from previous research that identified a relationship between the fibronectin FN1 gene variant rs140926439 and a lower risk of Alzheimer disease (AD) in APOEε4 carriers. METHODS: We analyzed the relationship of FN1 SNP rs140926439, APOEε4, and AD in the UK Biobank cohort. RESULTS: When rs140926439 was absent, 0.10% of APOEε2/3 carriers had AD, while 0.43% of APOEε4 carriers or homozygotes had AD. This difference was significant ( P <0.001, 2-tail the Fisher exact test). When rs140926439 was present, 0.10% of APOEε2/3 carriers had AD, while 0.10% of APOEε4 carriers or homozygotes had AD. This difference was insignificant ( P =1). To examine the overall relationship of rs140926439 and APOE isoform to AD, we used the univariate general linear model, AD (present or absent) dependent variable, rs140926439 (present or absent) and APOE isoform (APOEε2/3 or APOEε4 carrier or homozygote) as fixed factors. The effect of rs140926439 was significant ( P =0.025). The effect of the APOE isoform was significant ( P =0.030). There was also a significant interaction between rs140926439 and APOE isoform ( P =0.031). CONCLUSION: Fibronectin is an adhesive molecule that is essential to wound healing, especially to the production of the extracellular matrix and reepithelialization. Some cases of AD may be due to the initiation of the brain wound healing process, often in the absence of any actual wound. NSAIDS may reduce the risk of AD because they potently inhibit wound healing. FN1 appears to be a key player in AD, and its risk-lowering variant could offer insights into potential therapeutic targets. However, further research is needed to fully understand the intricate mechanisms underlying AD and to develop effective treatments.
BACKGROUND: Social health has been increasingly recognized as an important determinant of dementia progression and quality of life. The Social Network Index (SNI), developed by Cohen, is widely used to assess social netw...BACKGROUND: Social health has been increasingly recognized as an important determinant of dementia progression and quality of life. The Social Network Index (SNI), developed by Cohen, is widely used to assess social networks as a proxy for social health. This study aimed to adapt the SNI cross-culturally and validate its psychometric properties for use among Indonesians with dementia. METHODS: A cross-sectional study was conducted at the Memory Clinic of Dr. Sardjito General Hospital, Yogyakarta, Indonesia, involving 56 individuals with mild to moderate dementia. The original 12-item SNI was translated and culturally adapted according to WHO guidelines. Construct validity was examined using Confirmatory Factor Analysis (CFA). Composite Reliability (CR) and Average Variance Extracted (AVE) were used to assess internal consistency. RESULTS: The finalized modified Indonesian version of the SNI (m-SNI-INA), consisting of 10 items (2 excluded due to low factor loadings), demonstrated strong construct validity with factor loadings >0.5 and good model fit (GFI=0.958, AGFI=0.934, CFI=1.000, RMSEA=0.000). Reliability was high (CR=0.91; AVE=0.53). CONCLUSIONS: The m-SNI-INA is a valid, reliable, and culturally adapted tool for assessing social networks in people with dementia in Indonesia. Further studies should examine its predictive validity in larger populations.
Amin S, Liu J, Gilsanz P
… +5 more, Fletcher E, DeCarli C, Barnes LL, Whitmer RA, Hayes-Larson E
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 41178729
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INTRODUCTION: Divorce is a common life stressor that may impact late-life brain health. Literature evaluating the relationship of divorce with neuroimaging measures, including structural MRI and amyloid PET, is limited a...INTRODUCTION: Divorce is a common life stressor that may impact late-life brain health. Literature evaluating the relationship of divorce with neuroimaging measures, including structural MRI and amyloid PET, is limited and mixed. METHODS: Using the Kaiser Healthy Aging and Different Life Experiences (KHANDLE) and Study of Healthy Aging in African Americans (STAR) datasets, we analyzed the association of history of divorce with MRI outcomes (n=664) including volumetric measures and white matter hyperintensities using linear regression models, and with PET outcomes (n=385), including standardized uptake value ratio using linear regression and amyloid positivity using relative risk regression. Models adjusted for demographics, southern birth, and parental separation/divorce. Sensitivity analyses included further adjustment for childhood socioeconomic status and stratification by sex. RESULTS: Those with a history of divorce had slightly smaller total cerebrum and hippocampal volumes, as well as greater white matter hyperintensities, but the estimates were imprecise and crossed the null. No association with amyloid was observed. Results were similar in sensitivity analyses. DISCUSSION: Divorce was not meaningfully associated with late-life brain outcomes. Further research should investigate possible sources of heterogeneity, such as differences in the subjective experience of divorce, to understand the role of this stressor in brain aging.
BACKGROUND: Function Focused Care (FFC) encourages mobility during hospitalization, but participation varies. This study examined whether cognitive function, delirium severity, behavioral symptoms, and pain mediate the r...BACKGROUND: Function Focused Care (FFC) encourages mobility during hospitalization, but participation varies. This study examined whether cognitive function, delirium severity, behavioral symptoms, and pain mediate the relationship between physical function and FFC participation. METHODS: Discharge data from the FFC for the acute care trial (N=428) were analyzed. Physical function was the independent variable, FFC participation the outcome, and cognitive function, delirium severity, behavioral symptoms, and pain were tested as potential mediators. A multiple mediation model assessed indirect effects. RESULTS: Indirect effects through cognitive function (B=0.125, 95% CI [0.064-0.184]) and delirium severity (B=0.110, 95% CI [0.052- 0.168]) were significant, accounting for 24.5% and 21.6% of the total effect, respectively. Indirect effects through behavioral symptoms and pain were not significant. CONCLUSION: Findings highlight cognitive function and delirium severity as key factors influencing FFC participation during hospitalization, underscoring the importance of tailoring strategies to enhance engagement in mobility-focused interventions among persons living with dementia.
Graff RE, Chen DM, Swinnerton KN
… +10 more, Ackley SF, Ospina-Romero M, Zimmerman SC, Wang J, Buto P, Nierenberg JL, Elahi FM, Lu KP, Witte JS, Glymour MM
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 41128446
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BACKGROUND: Accumulating evidence suggests that the incidence of cancer and dementia are inversely associated. Bias does not appear to fully account for the relationship, but causal explanations have not been adequately...BACKGROUND: Accumulating evidence suggests that the incidence of cancer and dementia are inversely associated. Bias does not appear to fully account for the relationship, but causal explanations have not been adequately investigated. We thus considered a possible inverse shared genetic basis. METHODS: We constructed polygenic risk scores for cancer (PRS cancer ) and Alzheimer disease (PRS AD ) in European ancestry UK Biobank (UKB) and Health and Retirement Study (HRS) participants aged 60 years or older. Linear mixed-effects models evaluated associations of PRS cancer with cognition, and logistic regression evaluated associations of PRS AD with cancer. RESULTS: In UKB, PRS cancer was nominally associated with improved fluid intelligence ( β : 0.12, 95% CI: 0.01-0.22). Twelve variants in PRS cancer , including 7 in the human leukocyte antigen (HLA) complex, were positively associated with fluid intelligence, and 7 were inversely associated ( P <5.8×10 -5 ). PRS cancer and its contributing variants were not associated with cognitive outcomes in HRS. PRS AD was not associated with cancer risk in either study cohort. DISCUSSION: Though not conclusive, the direction of the association between PRS cancer and fluid intelligence was consistent with our a priori hypothesis that cancer risk variants would decrease cognitive decline. The association pattern with HLA-related variants suggests potential relevance of immune surveillance for the inverse association between dementia and cancer.
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 41098071
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We tested whether White Americans of Southern European descent (AmEuro-S) have a lower APOE ε4 prevalence than their Northern European descent peers (AmEuro-N), and if APOE ε4-dementia-related outcome associations vary b...We tested whether White Americans of Southern European descent (AmEuro-S) have a lower APOE ε4 prevalence than their Northern European descent peers (AmEuro-N), and if APOE ε4-dementia-related outcome associations vary by European descent. We used secondary cross-sectional data from a US-based large cohort study. Using logistic regression, we compared the prevalence of APOE ε4 alleles among White Americans who descended from Northern, Central or Southern Europe without overlap. We also assessed the moderation of European descent groups in the association between APOE ε4 and 3 dementia-related outcomes. AmEuro-N had 60% higher odds of having 1 APOE ε4 allele and 121% of 2 than AmEuro-S ( P <0.001). European descent moderated associations between APOE ε4 allele frequency and 2 dementia-related outcomes (interaction P ≤0.10). The prevalence of APOE ε4 among AmEuro-S was lower than AmEuro-N and associations with some dementia-related outcomes varied. Studies need to confirm these findings with probabilistic samples.
BACKGROUND: Data on risk factors for dementia in the MENA region and specifically in the UAE are limited. METHODS: A case-control study of dementia patients and age-matched controls identified over 10 years at a quaterna...BACKGROUND: Data on risk factors for dementia in the MENA region and specifically in the UAE are limited. METHODS: A case-control study of dementia patients and age-matched controls identified over 10 years at a quaternary care hospital network in Abu Dhabi. Historic data on cardiovascular, neurological, psychiatric, and nutritional risk factors were collected for patients and controls. RESULTS: A total of 281 dementia patients (mean age 74.9 ± 9.2 y, 46.3% females) and 281 age-matched controls (mean age 74.3 ± 4.6 y, 55.9% females) were included. Patients with dementia were more likely to have heart failure, cerebrovascular disease, chronic anemia, chronic kidney disease, Parkinson disease, other neurodegenerative changes, mood disorders, psychotic disorders, and vitamin D deficiency, and less likely to have hyperlipidemia compared with controls. On logistic regression, only cerebrovascular disease (OR: 6.578, 95% CI: 2.163-20.004, P = 0.001) and mood disorders (OR: 10.046, 95% CI: 2.255-44.751, P = 0.002) were significantly and independently associated with dementia, while hyperlipidemia was protective (OR: 0.531, 95% CI: 0.360-0.783, P = 0.001). CONCLUSION: Cerebrovascular disease and mood disorders are potential risk factors for dementia in the MENA region, while a protective role for hyperlipidemia warrants further investigation.
PURPOSE: There are important discrepancies between self-reported and objectively measured data of physical activity (PA). This study investigated the association between PA and cognitive performance using self-reported a...PURPOSE: There are important discrepancies between self-reported and objectively measured data of physical activity (PA). This study investigated the association between PA and cognitive performance using self-reported and objectively measured PA and compared if differences between measures were associated with cognitive performance. METHODS: We used data from the 2017 to 19 wave of the Brazilian Longitudinal Study of Adult Health. PA was self-reported using the International Physical Activity Questionnaire and evaluated objectively with a triaxial accelerometer. The discrepancy between self-reported and objectively measured PA was calculated as the difference between the two measures. Cognitive assessment evaluated memory, verbal fluency, and executive function. Linear regression evaluated the associations of self-reported, objectively measured, and the difference between these two measures with cognitive performance. RESULTS: In 8873 participants (56% women, 41% Black/Mixed race, and 58% college educated), the mean self-reported and objectively measured time engaged in PA was 2.7 hours/week and 5.6 hours/week, respectively. There was no association of self-reported or objectively measured PA with cognitive performance. There was no association of under-reporting or over-reporting of PA with cognitive performance. CONCLUSION: This study highlights the importance of accurate PA assessment in epidemiological studies investigating its association with cognitive health.
OBJECTIVE: Previous research has shown that exercise can produce cognitive benefits through neuroplastic mechanisms in older adults with mild cognitive impairment (MCI). This study builds on prior research by identifying...OBJECTIVE: Previous research has shown that exercise can produce cognitive benefits through neuroplastic mechanisms in older adults with mild cognitive impairment (MCI). This study builds on prior research by identifying biomarkers of neurological-related proteins that mediate improvement in processing speed in different exercise environments, water-based and land-based, in older adults with MCI. METHODS: Plasma protein levels were measured using SomaScan's Neuroscience panel, which includes 1316 analytes. Processing speed was measured using well-validated neuropsychological measures, including the Trail Making Test Trails A (TMT-A), the Stroop Color (SC) and Word (SW) trials, and the Symbol Digit Modalities Test (SDMT). Primary analyses consisted of linear mixed effects models to determine the impact of exercise-induced proteomic changes on processing speed measures. RESULTS: After water-based exercise, KIF3C and TBX3 were found to mediate improvement in SC, a rapid automatic color-naming task. By contrast, after land-based exercise, none of the proteins analyzed were found to mediate improvement in processing speed. CONCLUSIONS: These findings support the continued exploration of water-based exercise as a cognitive intervention for older MCI adults. In addition, these results suggest differences in underlying neuroplasticity-related mechanisms in land-based and water-based exercise.
BACKGROUND: Lecanemab is the first disease-modifying therapy for Alzheimer disease (AD) approved in China. However, the factors affecting patient and caregiver willingness to adopt this novel treatment have not been asse...BACKGROUND: Lecanemab is the first disease-modifying therapy for Alzheimer disease (AD) approved in China. However, the factors affecting patient and caregiver willingness to adopt this novel treatment have not been assessed yet. OBJECTIVE: To investigate the factors influencing both treatment willingness and willingness-to-pay for lecanemab among Chinese AD patients and their caregivers. METHODS: We surveyed 195 AD patients and their caregivers using structured questionnaires assessing key factors influencing treatment willingness, including efficacy (W efficacy ), adverse effects (W adverse ), inconvenience (W inconvenience ), cost (W cost ), overall willingness to treat (W treat ), and amount willing to pay (W amount ). Additional variables included income, cognitive and functional assessments, caregiver burden (ZBI), health status (HS), education levels (patient/caregiver: edu, edu.c), psychiatric symptoms (PSY), and satisfaction with conventional treatments (effect). Network analysis mapped variable inter-relationships. RESULTS: W treat showed a strong direct association with W cost (0.99). W efficacy and W inconvenience indirectly influenced W treat through W cost (W efficacy -W inconvenience : 1.5, W inconvenience -W cost : 1.12, W cost -W treat : 0.99). Income (0.48) and effect (0.51) directly impacted W treat . Edu, edu.c, CDR, PSY, ZBI, and HS were indirectly correlated with W treat . W amount was directly associated with W treat (0.31), W cost (0.68), and W adverse (0.16). W efficacy and W inconvenience indirectly influenced W amount through W cost (W efficacy - W inconvenience : 1.5, W inconvenience -W cost : 1.12, W cost -W amount : 0.68). Network stability tests (CS >0.50) confirmed robustness. CONCLUSION: This study demonstrates that reducing payment barriers has a greater impact on real-world adoption of innovative therapies than clinical efficacy alone. Addressing financial constraints also enhances patients' willingness to pay. These findings provide evidence-based insights for developing patient-centered clinical decision pathways.
Alzheimer Dis Assoc Disord
· 2025 · PMID 40843066
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We tested the efficacy of docosahexaenoic acid (DHA) supplementation on aggressive behavior among people with dementia. We used secondary data from a randomized, double-blind, placebo-controlled trial. Analyses included...We tested the efficacy of docosahexaenoic acid (DHA) supplementation on aggressive behavior among people with dementia. We used secondary data from a randomized, double-blind, placebo-controlled trial. Analyses included 402 individuals with dementia. We compared group differences in mean aggressive behavior change at baseline vs six (primary), 12, and 18 months (secondary outcome). We used independent samples t-tests with the aggressive behavior item from the Neuropsychiatric Inventory Questionnaire. We stratified group differences by ApoE-ε4 status, gender, baseline aggressive behavior, and dementia severity. All tests favored DHA but no differences reached statistical significance. For example, the group differences between baseline and month 6 aggressive behavior were 0.11 (p=0.22). Group differences nearly reached statistical significance with clinically important effect sizes when excluding participants without baseline aggressive behavior. Despite obtaining null results, these trends suggest avenues for future research that includes participants with higher baseline aggressive behavior levels and more sensitive outcome scales.
BACKGROUND: We assessed the cost-benefit of person-centered care education for direct care staff of an Australian subacute rehabilitation hospital, with respect to clinical outcomes and service costs of persons with deme...BACKGROUND: We assessed the cost-benefit of person-centered care education for direct care staff of an Australian subacute rehabilitation hospital, with respect to clinical outcomes and service costs of persons with dementia. METHODS: In a nonrandomized pre/post/follow-up design, clinical outcomes and service use were evaluated for matched comparison (n=77) and intervention (n=80) groups for delirium incidence, accidents/injuries, injury treatment, psychotropic medicines, length of stay, hospital readmissions and discharge destination. Group-level outcomes were monetized and included in a cost-benefit analysis (present value of benefits/present value of education and service costs). RESULTS: Relative to the comparison group, there were significant reductions in intervention group delirium (P=0.001), accidents/injuries (P=0.007), treatment for injuries (P=0.007), psychotropic medicines (P=0.030) and hospital readmission within 30 days (P=0.002). After adjusting for the longer length of stay of the intervention subgroup who contracted COVID-19 (n=10), there were no group differences in length of stay (P=0.83). Per participant service costs for comparison and intervention groups were AU$34,870 and AU$33,969, respectively, equating to a per-participant cost saving of AU$914 (P<0.0001). CONCLUSION: Investment in person-centered care education of direct care staff is warranted from both clinical and economic perspectives.
Pereira da Silva AM, Falcão Carneiro Filho L, Virgilio Ribeiro F
… +8 more, Rodrigues Menezes I, Leite M, Honorato de Farias E, Nascimento MDV, Silva Corin A, Gonçalves Quiroga D, Franco ES, de Sousa Maia MB
BACKGROUND: This systematic review and meta-analysis aimed to evaluate the efficacy, humoral immunogenicity, safety, and tolerability of AADvac1 an active tau-targeted immunotherapy in patients with Alzheimer disease (AD...BACKGROUND: This systematic review and meta-analysis aimed to evaluate the efficacy, humoral immunogenicity, safety, and tolerability of AADvac1 an active tau-targeted immunotherapy in patients with Alzheimer disease (AD) confirmed by amyloid and tau pathology. METHODS: We searched MEDLINE, Embase, Scopus, and CENTRAL from inception to March 2025 for randomized placebo-controlled trials assessing AADvac1 in AD. Eligible studies included adult patients with biomarker-confirmed AD. Risk of bias was assessed using the Cochrane RoB 2 tool. Meta-analyses were conducted using random-effects models. RESULTS: Five trials (n=667) were included, of which 391 received AADvac1 and 276 received placebo. Pooled analyses showed a robust IgG response (IgG seroconversion rate: 99%, 95% CI: 95%-100%) with predominance of IgG1 and IgG3 subclasses. AADvac1 did not improve MMSE (MD: -0.49; 95% CI: -2.40 to 1.41) but showed trends favoring improvement in ADAS-Cog11 and verbal fluency. The vaccine was well tolerated, with injection site reactions being the most frequent adverse event. No increased risk of serious infections, cerebral edema, or mortality was observed. CONCLUSIONS: AADvac1 demonstrates robust immunogenicity and an acceptable safety profile in early-phase trials. Cognitive benefits remain inconclusive. Larger, long-term trials are needed to confirm its clinical efficacy and long-term safety in AD.
Brontsema RJ, Pouw MA, Schokker MC
… +2 more, van Munster BC, Luijendijk HJ
Alzheimer Dis Assoc Disord
· 2025 Oct-Dec 01 · PMID 40794629
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BACKGROUND: Dementia affects millions worldwide, with neuropsychiatric symptoms (NPS) impacting up to 90% of those affected. These symptoms can escalate to crises, which present significant challenges for patients, careg...BACKGROUND: Dementia affects millions worldwide, with neuropsychiatric symptoms (NPS) impacting up to 90% of those affected. These symptoms can escalate to crises, which present significant challenges for patients, caregivers, and health care systems. OBJECTIVE: This study aimed to determine the prevalence of NPS and delirium in patients with dementia during acute crises. METHODS: A comprehensive search was conducted across multiple bibliographic databases. Data extraction included NPS such as aggression and hallucinations, NPS measurement tool, delirium diagnoses, delirium screening tool, and discharge locations. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT), and a meta-analysis was performed. The review was reported following PRISMA guidelines. RESULTS: Nineteen studies published from 1990 to 2023 were included. All were performed in hospitalized patients. Results indicated high heterogeneity in NPS prevalence: on medical wards, aggression 0.47 (95% CI: 0.35-0.59) was the most prevalent, followed by aggression/agitation 0.31 (95% CI: 0.15-0.48). In (gero)psychiatric wards, irritability 0.67 (95% CI: 0.52-0.79), and agitation 0.66 (95% CI: 0.59-0.73) were among the most common symptoms. In addition, 9 studies reported the rate of delirium; the pooled prevalence was 0.24 (95% CI: 0.11-0.38), with studies utilizing a screening tool reporting higher rates. CONCLUSION: These findings highlight the prevalence of NPS during crisis hospitalizations and the critical role of deliberate delirium screening. They enhance understanding of dementia crisis phenomenology and offer a foundation for targeted interventions to improve care quality. More research about crises in patients with dementia at home need to be performed.