Alzheimer Dis Assoc Disord
· 2025 · PMID 40777151
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Individuals with Lewy body dementia (LBD) rely on family caregivers. Caregiving demands limit caregivers' ability to attend to their own health needs, increasing their vulnerability to the psychological effects of caregi...Individuals with Lewy body dementia (LBD) rely on family caregivers. Caregiving demands limit caregivers' ability to attend to their own health needs, increasing their vulnerability to the psychological effects of caregiving. We previously piloted a peer mentoring intervention with experienced (mentor) and less experienced (mentee) LBD caregivers. Matched mentor-mentee dyads spoke weekly for 16 weeks, guided by an intervention handbook. LBD knowledge and attitudes towards dementia improved post-intervention. We hypothesized that caregiver health status moderates response to peer mentoring. Post hoc analyses (N = 30 dyads) showed that 75% of mentees and 66% of mentors endorsed ≥1 comorbidity. Mentees and mentors with comorbidities showed greater improvement in LBD knowledge postintervention ( = 0.039) and dementia attitudes post-training ( = 0.016), respectively. Caregivers with comorbidities and thus greater exposure to health care may derive excess benefit from an effective LBD caregiver intervention than healthier counterparts, enhancing both the objective knowledge and their confidence in caring for their loved ones.
Duarte CD, Hebert J, Glymour MM
… +7 more, Hill-Jarrett TG, Manly JJ, Mujahid MS, Ahern J, Yen IH, Cohen AK, Vable AM
Alzheimer Dis Assoc Disord
· 2025 Jul-Sep 01 · PMID 40767852
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INTRODUCTION: Suspension and expulsion are common in US schools and disproportionately target structurally marginalized children. No research has examined whether these punitive practices may have long-term cognitive-agi...INTRODUCTION: Suspension and expulsion are common in US schools and disproportionately target structurally marginalized children. No research has examined whether these punitive practices may have long-term cognitive-aging implications. METHODS: In the prospective National Longitudinal Survey of Youth 1979 data (N=8021), we used confounder-adjusted linear models to investigate associations between early-life suspension or expulsion and global cognition, memory, and attention z -scores at age 50. Using interaction terms, we tested for additive scale effect modification by race, gender, and at their intersections. RESULTS: In all, 21.5% of participants had been suspended and 4.4% expelled, with Black men and women overrepresented among these early-life experiences. Punitive school discipline was associated with lower midlife global cognition, memory, and attention z -scores (eg, global cognition, suspension: : -0.21; 95% CI: -0.26, -0.15; expulsion: :-0.27; 95% CI: -0.38, -0.16). The expulsion-cognition association was stronger for men than women. DISCUSSION: Punitive school discipline-an exposure modifiable at multiple policy levels-is associated with lower cognitive performance in midlife, decades after school completion.
INTRODUCTION: Metamemory is the ability to monitor and control one's own memory. The objective of our study was to investigate the estimated and actual performance of metamemory in older adults with dementia compared wit...INTRODUCTION: Metamemory is the ability to monitor and control one's own memory. The objective of our study was to investigate the estimated and actual performance of metamemory in older adults with dementia compared with healthy older controls. In addition, we examined whether cognition, awareness, neuropsychiatric symptoms, functionality, and executive functions influence metamemory functioning. METHOD: We conducted a cross-sectional evaluation of 126 participants. Memory and metamemory were assessed in each group and compared using a memory test combined with a prediction task administered before and after exposure to the scale. RESULTS: Individuals with dementia presented impaired metamemory functioning in both short- and long-term memory evaluations. There was a general disconnect between perceived and actual performance across both groups, albeit to a lesser extent in the control group. In the control group, we found impaired metamemory when evaluating short-term memory. However, no alterations in metamemory were observed regarding long-term memory after this group had been exposed to the task. Regression analysis revealed that only awareness influenced metamemory when associated with short-term memory. CONCLUSIONS: Individuals with dementia tend to present impaired metamemory functioning, and awareness of disease appears to be a factor that can influence this impairment.
Alzheimer Dis Assoc Disord
· 2025 Jul-Sep 01 · PMID 40673737
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BACKGROUND: Etalanetug (E2814), an anti-tau monoclonal antibody (mAb), is intended to inhibit spreading of pathologic tau species by binding to the microtubule binding region (MTBR). It is being developed as a potential...BACKGROUND: Etalanetug (E2814), an anti-tau monoclonal antibody (mAb), is intended to inhibit spreading of pathologic tau species by binding to the microtubule binding region (MTBR). It is being developed as a potential disease-modifying therapy for Alzheimer disease. METHODS: This randomized, placebo-controlled study comprised of 2 parts: single ascending doses evaluating 5 etalanetug doses and multiple ascending doses evaluating 4 fixed doses in each cohort, 8 healthy subjects were randomized (3:1) to single etalanetug dose or placebo. Safety, pharmacokinetics (PK), antidrug antibodies (ADA), and target engagement (TE) were assessed. RESULTS: Etalanetug was safe and well-tolerated following single and multiple infusions. After single-dose and multiple-dose administration, serum exposure of etalanetug increased in a dose-related manner. Serum-to-cerebrospinal fluid (CSF) concentration ratio at week 12 was ∼0.1% to 0.3% and ∼1% following single and multiple dosing, respectively. Mean t ½ was ∼19 to 25 days independent of dose and time. etalanetug immunogenicity was minimal, with low titers and no impact on PK. TE was demonstrated; CSF concentrations of etalanetug between 100 and 200 ng/mL saturated binding of MTBR-tau299 at 82.1% and binding of MTBR-tau354 at 64.9%. CONCLUSION: Etalanetug presented an adequate safety and immunogenicity profile in healthy adults. PK was comparable to other mAbs. Etalanetug demonstrated target engagement by binding to MTBR tau species.
BACKGROUND: Metformin has been suggested as a possible strategy for the prevention of Alzheimer disease (AD) and AD related dementias. An early phase II clinical trial of short acting metformin versus placebo showed prel...BACKGROUND: Metformin has been suggested as a possible strategy for the prevention of Alzheimer disease (AD) and AD related dementias. An early phase II clinical trial of short acting metformin versus placebo showed preliminary evidence of efficacy and safety in slowing cognitive decline among persons with amnestic mild cognitive impairment (aMCI) without diabetes. OBJECTIVE: To conduct a phase II/III randomized clinical of extended-release metformin versus placebo in participants with aMCI without diabetes. METHODS: Ratio of 1:1 randomized placebo-controlled trial of extended-release metformin in 326 persons with aMCI without diabetes, aged 55 to 90 years, lasting 18 months, with 4 visits every 6 months including baseline. The primary outcome is changes in total recall in the Free and Cued Selective Reminding Test. Secondary outcomes include (1) changes in global cognitive performance, measured with the Alzheimer Disease Cooperative Study Preclinical Alzheimer Cognitive Composite (ADCS-PACC); (2) changes in neurodegeneration, ascertained as cortical thickness in areas affected by AD on brain MRI; (3) changes in cerebrovascular disease, ascertained as white matter hyperintensities (WMH) volume on brain MRI; (4) changes in whole brain amyloid ß (Aß) SUVR and in incident amyloid positivity; (5) changes in tau SUVR in a composite brain region comprising medial and inferolateral temporal cortex; (6) changes in plasma AD biomarkers. CONCLUSION: Observational studies and pilot trials suggest that metformin may help prevent cognitive decline in neurodegenerative disorders. This clinical trial aims to assess metformin's potential in preventing cognitive decline in at-risk individuals and its impact on biomarkers indicative of disease modification.
INTRODUCTION: Cognitive disorders are often accompanied by depression and anxiety. The Mild Behavioral Impairment Checklist (MBI-C) was developed to capture neuropsychiatric symptoms that predict risk for dementia and in...INTRODUCTION: Cognitive disorders are often accompanied by depression and anxiety. The Mild Behavioral Impairment Checklist (MBI-C) was developed to capture neuropsychiatric symptoms that predict risk for dementia and includes questions on mood, but has not been validated for identifying significant depression or anxiety symptoms. Our objective was to determine whether MBI-C mood domain scores predict responses on 2 previously validated scales: the Cornell Scale for Depression in Dementia (CSDD) and the Penn State Worry Questionnaire-Abbreviated version (PSWQ-A) scales. METHODS: We performed a cross-sectional analysis of consenting patients from a memory clinic who completed the MBI-C along with the CSDD (n=80) or PSWQ-A (n=92). RESULTS: MBI-C mood scores and the MBI-C depression subscore were moderately to strongly correlated with the CSDD (r=0.72) and the PSWQ-A (r=0.66). An MBI-C mood score of ≥5 or anxiety or depression subscore ≥2 predicted clinically relevant depressive and anxiety symptoms on the CSDD and PSWQ, respectively, with AUCs between 0.80 and 0.85. CONCLUSIONS: This study supports the MBI-C mood score as a valid tool for screening for mood-related neuropsychiatric symptoms in individuals with cognitive impairment.
The prevalence of major neurocognitive disorders (MNCD) increases to 30% after 80 years of age. Vulnerability often goes unnoticed for a long time, and patients are seldom subject to legal protection (LP), creating an et...The prevalence of major neurocognitive disorders (MNCD) increases to 30% after 80 years of age. Vulnerability often goes unnoticed for a long time, and patients are seldom subject to legal protection (LP), creating an ethical and legal dilemma. The French National Alzheimer's Database (BNA) is a national network set up in 2005 to collect data on neurocognitive disorders from all memory clinics in France. Data extraction from the BNA in 2022 produced a sample of 1,187,199 patients. We retained 795,953 patients, with a mean age of 78 years, and approximately two-thirds of the patients were women. We excluded patients with no medical assessment (n=135,810), without MNCD (n=237,209), birth year ≥1981 (n=18,189), and consultation date <2005 (n=38). A total of 32,593 patients (4.09%) have had LP during the 15-year study period. They have lower MMSE scores than others (17.9±6.6 vs. 20.6±6.5 P<0.01), more likely to live alone (45.25% vs. 36,1% P<0.01) or at nursing home (22.83% vs. 8.35% P<0.01). The low prevalence of LP among persons with MNCD emphasizes the potential vulnerability and legal risk of this group.
OBJECTIVE: Currently available literature on the relationships between cerebrospinal fluid (CSF) biomarkers and cognitive performance in frontotemporal dementia (FTD) is very limited and inconclusive. In this study, we i...OBJECTIVE: Currently available literature on the relationships between cerebrospinal fluid (CSF) biomarkers and cognitive performance in frontotemporal dementia (FTD) is very limited and inconclusive. In this study, we investigated the association of cognitive symptoms, as measured with Montreal Cognitive Assessment (MoCA), with CSF levels of total tau (t-tau), phosphorylated tau at threonine 181 (p-tau181), and amyloid β 1-42 (Aβ1-42) in a group of patients with probable FTD and Alzheimer disease (AD). METHODS: We conducted a retrospective cohort study with participants selected from the electronic records of patients seen at Yale New Haven Hospital's Memory Clinic, CT. A total of 61 patients, 28 with FTD (mean age=64.1) and 33 with AD (mean age=66.8), with available CSF results and cognitive test scores in their chart were included in analyses. RESULTS: T-tau levels negatively and significantly correlated with total MoCA scores as well as the different MoCA index scores in patients with FTD (r=-0.47, P=0.04). There were no significant associations between MoCA scores and p-tau181 levels in patients with FTD (r=-0.22, P=0.25). Patients with AD exhibited significant correlations between MoCA scores and both t-tau (r=-0.54, P<0.01) and p-tau (r=-0.55, P<0.01) levels. Also, Aβ1-42 levels were not significantly correlated with MoCA scores in either of the FTD and AD groups. CONCLUSION: CSF concentrations of t-tau are inversely correlated to cognitive performance in patients with FTD and both t-tau and p-tau181 in AD. This study provides valuable insights into the relationship between clinical cognitive performance and tau-related pathology in FTD in comparison with AD.
Kessels RPC, van Bergen FS, Harmsen IJ
… +3 more, Sleutjes DKL, Dautzenberg PLJ, Oosterman JM
Alzheimer Dis Assoc Disord
· 2025 Apr-Jun 01 · PMID 40371631
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OBJECTIVE: Cognitive screens to diagnose mild cognitive impairment (MCI) or dementia require supervision and cannot be easily administered in primary care. Here, we validated the Self-Administered Gerontocognitive Examin...OBJECTIVE: Cognitive screens to diagnose mild cognitive impairment (MCI) or dementia require supervision and cannot be easily administered in primary care. Here, we validated the Self-Administered Gerontocognitive Examination (SAGE), investigating the alternate version equivalence, the convergent validity using neuropsychological tests, and its diagnostic accuracy. PATIENTS: Thirty-two MCI patients and 34 with dementia were recruited from a memory clinic in the Netherlands, and 69 healthy controls over the age of 50. METHODS: The 4 alternate versions of the SAGE were compared. Receiver operating characteristic (ROC) analyses were performed, comparing the controls to the MCI and dementia groups. Associations between SAGE scores and standard neuropsychological tests were examined. RESULTS: No performance differences were found between the alternate versions. Performance differences were found on the SAGE between the 3 groups, with fair to good areas under the curve. A cutoff score of <18 had the best diagnostic accuracy for controls versus dementia, <20 for controls versus MCI and <19 for controls versus cognitively impaired. SAGE scores correlated with standard neuropsychological tests. DISCUSSION: The SAGE is a valid tool for distinguishing cognitively unimpaired individuals from people with dementia or MCI.
BACKGROUND: Genetic testing for dementia has drawn public attention in recent years, albeit with concerns on its appropriate use. This study leveraged Twitter data to analyze public perceptions related to genetic testing...BACKGROUND: Genetic testing for dementia has drawn public attention in recent years, albeit with concerns on its appropriate use. This study leveraged Twitter data to analyze public perceptions related to genetic testing for dementia. METHODS: English tweets from January 1, 2010 to April 1, 2023, containing relevant terms, were extracted from Twitter API. A Bidirectional Encoder Representations from Transformers (BERT) model was used with Named Entity Recognition (NER) to identify individual and organizational users. BERT-based topic modeling was applied to identify the themes for relevant source tweets. Topic coherence was assessed through manual inspection, complemented by the Silhouette Coefficient. Manual thematic analysis, following Braun and Clarke's approach, refined the topics and themes. RESULTS: The analysis of 3045 original/source tweets identified 9 topics (Silhouette Coefficient=0.19), categorized into 3 main themes: (1) opinions on the appropriateness of genetic testing in dementia diagnosis; (2) discussion on the psychosocial impact; (3) discussion on genetic testing's role in Alzheimer disease treatment and prevention. Theme 1 comprised 90.6% of source tweets, demonstrating prevailing contentions. Tweets in theme 2 were increasingly contributed by organization users over time and included tweets containing misinformation about genetic testing in children. Tweets in theme 3 were increasingly contributed by individual users, possibly suggesting rising public interest in the treatment and prevention of dementia. CONCLUSION: The study highlighted limited public understanding of the nondeterministic nature of genetic testing for dementia, with concerns about unsupervised direct-to-consumer genetic test marketing, emphasizing the need to counter misinformation and raise public awareness.
Malek-Ahmadi M, Schack K, Duff K
… +4 more, Koppelmans V, King JB, Su Y, Schaefer SY
Alzheimer Dis Assoc Disord
· 2025 Apr-Jun 01 · PMID 40358086
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PURPOSE: Determine whether regional measures of cortical thickness are associated with functional task performance. PATIENTS: One hundred six older adults who were classified as either cognitively unimpaired (CU), mild c...PURPOSE: Determine whether regional measures of cortical thickness are associated with functional task performance. PATIENTS: One hundred six older adults who were classified as either cognitively unimpaired (CU), mild cognitive impairment (MCI), or Alzheimer disease (AD) completed a performance-based functional task. METHODS: The SD of completion times of 6 consecutive trials within a session of the functional task was used as the primary measure for each participant, reflecting intraindividual variability. Regression tree analysis identified cortical gray matter thickness measures that best predicted intraindividual variability on the functional task. RESULTS: Cortical thickness measures from temporal, parietal, frontal, and occipital regions best predicted intraindividual variability on the task, which are cortical regions associated with learning, executive function, and visuospatial function. Specifically, the fusiform gyrus was featured prominently in these and prior regression tree results, suggesting its possible involvement in this behavioral task. CONCLUSION: These analyses suggest a mechanistic focus of variability on this functional task, which could serve as an outcome in clinical trials.
PURPOSE: This systematic review and meta-analysis aimed to explore differences in optical coherence tomography (OCT) findings between cognitively healthy individuals with Alzheimer disease (AD) biomarkers and healthy con...PURPOSE: This systematic review and meta-analysis aimed to explore differences in optical coherence tomography (OCT) findings between cognitively healthy individuals with Alzheimer disease (AD) biomarkers and healthy controls. METHODS: A thorough literature review was conducted on February 6, 2023, in PubMed, Embase, Cochrane Library, LILACS, and DANS EASY Archive. Studies that involved cognitively healthy individuals with AD biomarkers undergoing OCT or OCT angiography were included. The risk of bias was assessed using validated tools. A narrative synthesis and meta-analysis were performed with standardized mean differences and I2 heterogeneity assessments. RESULTS: Seventeen studies comprising 601 participants with positive AD biomarkers and 881 controls were included. The reviewed studies varied in design, with notable findings indicating a reduction in retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness, alongside an increase in inner plexiform layer (IPL) thickness. In addition, OCT angiography revealed reduced vascular density and an enlarged foveal avascular zone-however, variations and inconsistencies in results led to inconclusive outcomes for RNFL and GCL-IPL meta-analyses. CONCLUSION: In summary, cognitively healthy individuals with positive AD biomarkers demonstrated RNFL, GCL thinning, and IPL thickening trends. Future longitudinal studies using standardized methods are critical to validate these OCT changes as potential early indicators for AD.
INTRODUCTION: Sporadic Creutzfeldt-Jakob disease (sCJD) is one of the common causes of rapidly progressive dementia. However, because of the variety of its clinical presentations, a definite diagnosis in public hospitals...INTRODUCTION: Sporadic Creutzfeldt-Jakob disease (sCJD) is one of the common causes of rapidly progressive dementia. However, because of the variety of its clinical presentations, a definite diagnosis in public hospitals is not always possible. Therefore, this study will provide more information about the clinical data of probable sCJD cases in Thailand. METHODS: This case series of probable sCJD patients who visited the Neurological Institute of Thailand during 2018 to 2023 was conducted. Demographic data, clinical presentations, brain MRI, EEG, CSF analyses, and clinical course were reviewed. RESULTS: A total of 17 probable sCJD cases were studied. Eleven patients were female (64.71%) with a median age of 62 (IQR: 14.5) years. The median onset of symptoms was 2 months (IQR: 2) before hospital visit, in which cognitive impairment was the most common first presentation (29.41%) followed by ataxia (23.53%), and visual disturbances (17.65%). Most patients had typical high signal intensities at both caudate/putamen and cortical regions (76.47%). Generalized periodic discharges with triphasic morphology were found in 11/14 patients with EEG results (78.57%). CONCLUSION: sCJD has a diverse clinical presentation that resembles other cognitive disorders. Detailed assessment of signs and symptoms, together with proper investigations, could help to differentiate this condition in a resource-limited setting.
Ryman SG, Verney SP, Quam M
… +11 more, Ghahate D, Prestopnik J, Partridge E, Adair J, Abrams-Silva L, Knoefel J, Pankratz VS, Erhardt E, Unruh M, Rosenberg G, Shah V
Alzheimer Dis Assoc Disord
· 2025 Apr-Jun 01 · PMID 40346835
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To address disparities in dementia diagnosis and care in American Indian and Alaska Native communities, it is crucial to understand how sociocultural factors, such as language dominance and education, impact performances...To address disparities in dementia diagnosis and care in American Indian and Alaska Native communities, it is crucial to understand how sociocultural factors, such as language dominance and education, impact performances on standardized neuropsychological assessments. We discuss sociocultural considerations that are important to consider when evaluating cognition in American Indians. We conducted t tests/Kruskal-Wallis tests and correlation analyses to evaluate the impact of language and education factors on performances on the National Alzheimer Coordinating Center's Uniform Data Set Version 3 Neuropsychological assessments in a community of Southwestern American Indians. There were no significant differences in cognitive performances between the Zuni (Shiwi)-dominant and English-dominant individuals. Number of years of education had a greater effect on cognitive performances relative to language dominance, particularly for the common cognitive screening measure, the Montreal Cognitive Assessment. Our results highlight that education factors have a greater effect on cognitive performances relative to language dominance in this unique cohort. The associations with the Montreal Cognitive Assessment raise concerns for the use of this tool in this population, highlighting a need to develop culturally appropriate cognitive testing tools as well as ensuring comprehensive, culturally competent neuropsychological assessments are accessible.
OBJECTIVE: Safety net enclosures are used in addition to (non-) pharmacological interventions in patients suffering from neuropsychiatric symptoms in dementia. However, no data on effectiveness are available. METHODS: In...OBJECTIVE: Safety net enclosures are used in addition to (non-) pharmacological interventions in patients suffering from neuropsychiatric symptoms in dementia. However, no data on effectiveness are available. METHODS: In a prospective observational cohort study of 81 patients diagnosed with dementia, and admitted to a geriatric ward of a psychiatric hospital, available behavioral assessment scores were used to compare 45 patients who used safety net enclosures with 36 patients who never used safety net enclosures. Behavior was evaluated weekly using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) at admission, start of the enclosure, and before discharge. RESULTS: At baseline, the intervention group had a significantly higher CMAI and NPI-Q-score. At follow-up, the intervention group showed a greater improvement in CMAI [median -13.0 (interquartile range: -27.3 to 0.05) vs 0.0 (interquartile range: -6.0 to 2.5); Mann-Whitney U = 338.5 ( P = 0.005)] compared with the comparison group. Only some NPI-Q subscales showed significantly greater improvement during the intervention than in the comparison group. CONCLUSIONS: Our observational study is the first to present effectiveness data on Neuropsychiatric symptoms in persons suffering from dementia and suggests significantly greater improvement in CMAI scores when using safety net enclosures. However, almost no significant differences were found in other outcomes.
Adrien TV, Hirst AK, Turney IC
… +11 more, Peterson RL, Zahodne LB, Chen R, Crane PK, Levy SA, Andrews RM, Mayeda ER, Whitmer RA, Gilsanz P, Jackson JW, Hayes-Larson E
Alzheimer Dis Assoc Disord
· 2025 Jan-Mar 01 · PMID 39927472
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BACKGROUND: Parental education is an important determinant of late-life cognition, but the extent to which intervening on midlife risk factors, such as hypertension, mitigates the impact of early-life factors is unclear....BACKGROUND: Parental education is an important determinant of late-life cognition, but the extent to which intervening on midlife risk factors, such as hypertension, mitigates the impact of early-life factors is unclear. Novel methodological approaches, such as causal decomposition, facilitate the assessment of contributors to health inequities through hypothetical interventions on mediating risk factors. METHODS: Using harmonized cohorts (Kaiser Healthy Aging and Diverse Life Experiences Study; Study of Healthy Aging in African Americans) and a ratio of mediator probability weights decomposition approach, we quantified disparities in late-life cognitive test scores (semantic memory, executive function, and verbal memory z -scores) across high versus low parental education, and evaluated whether socioeconomic disparities in late-life cognitive test scores would change if the corresponding disparity in midlife hypertension were eliminated. RESULTS: We observed substantial disparities across levels of parental education in late-life cognitive test scores (eg, =-0.72 95% CI: -0.84 to -0.60 for semantic memory). Hypothetical intervention on midlife hypertension did not substantially reduce disparities in any cognitive domain. Patterns were similar when stratified by race. CONCLUSIONS: Future work should evaluate other points of intervention across the lifecourse (eg, participant education) to reduce late-life cognitive disparities across levels of parental education.
BACKGROUND: We previously reported that social restrictions due to the COVID-19 pandemic led to a decline in cognitive function in patients with Alzheimer disease (AD). Here, we assessed the effects of COVID-19 restricti...BACKGROUND: We previously reported that social restrictions due to the COVID-19 pandemic led to a decline in cognitive function in patients with Alzheimer disease (AD). Here, we assessed the effects of COVID-19 restrictions on the activities of daily living (ADL) and disease severity in patients by comparing them to a control group. METHODS: We examined the impact on ADL, evaluated using disability assessment for dementia (DAD), and disease severity, evaluated using the ABC dementia scale, in patients with mild-to-moderate AD. We conducted a post hoc subgroup analysis of a double-blinded, noninferiority study of donepezil 27.5 mg patches and donepezil hydrochloride 5 mg tablets (JapicCTI-194582). After showing the noninferiority of both treatments, we combined the data from both groups for analysis. RESULTS: The subpopulation of the per-protocol set grouped by completing the double-blinded evaluation before and on/after the mild lockdown was balanced (n=136 and n=120). Patient demographics were similar between the subgroups. The decline in the DAD and ABC dementia scale scores [least-squares mean (SE)] was ameliorated by social restriction [-3.810 (0.743) and -1.871 (0.697) and -1.147 (0.285) and -0.419 (0.267), respectively (not significant)]. CONCLUSION: Normalcy and expectation biases can affect the evaluation of ADL and disease severity by caregivers under high stress and deterioration of mental conditions.
INTRODUCTION: We previously followed Emory patients with neurodegenerative disease from 1993 to 2006. Here, we follow survivor and new patients for 2007 to 2018. METHODS: We studied mortality from 10 different diagnostic...INTRODUCTION: We previously followed Emory patients with neurodegenerative disease from 1993 to 2006. Here, we follow survivor and new patients for 2007 to 2018. METHODS: We studied mortality from 10 different diagnostic groups among 4322 research volunteers, and compared mortality rates to controls with normal cognition, using Cox regression. We assessed mortality through the National Death Index, controlling for sex, education, race, comorbidities, and age. Supplemental analyses considered APOE and cognitive test scores. RESULTS: Fifty-nine percent of patients died during follow-up. Mortality rate ratios, compared with controls (n=641) in descending order were 12.54, 6.61, 4.77, 4.92, 3.36, 2.25, 2.21 1.71, 1.39, and 1.17 for diagnostic groups ALS, (n=571), FTD (n=197), LBD (n=134), PD (n=584), AD (n=1118), MCI/dementia (n=82), dementia not specified (n=165), PD symptoms (n=256), vascular dementia (n=234), and MCI (n=340), respectively. Women, non-whites, those with higher education, with no comorbidities, and lower ages had lower mortality rates for most diagnostic groups. Mortality rates were higher in the presence of APOE4 variants for several diagnostic groups. Lower MMSEs predicted worse survival for most diseases. Overall, 41% of patients survived during 12 years of follow-up, compared with an expected 75% in the US population. CONCLUSION: Survival times for different diagnostic groups have changed little over several decades.
Armstrong MJ, Galvin JE, Manning C
… +6 more, Boeve BF, Pontone GM, Taylor AS, Patel B, Fleisher JE, Maixner SM
Alzheimer Dis Assoc Disord
· 2025 Jan-Mar 01 · PMID 39878295
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OBJECTIVES: Many individuals with dementia with Lewy bodies (DLB) die of disease-related complications, but predicting the end of life can be challenging. We identified a phenotype associated with approaching end of life...OBJECTIVES: Many individuals with dementia with Lewy bodies (DLB) die of disease-related complications, but predicting the end of life can be challenging. We identified a phenotype associated with approaching end of life. METHODS: We present 4 exemplar cases where individuals with DLB experienced refractory psychosis before death. We reviewed codebooks and quotes from 3 studies regarding end-of-life experiences in DLB to identify experiences that aligned with this phenotype. RESULTS: In addition to the 4 cases, family caregivers in prior studies described prominent worsening of psychosis before death in some individuals with DLB. The worsening often occurred several months before death and was sometimes associated with rapid deterioration. Worsening psychosis was the prominent symptom and was not initially accompanied by cognitive or physical decline. In many cases, the refractory psychosis resulted in inpatient psychiatric hospitalization or residential care, but these scenarios were challenging because of the individual's behavior. CONCLUSION: Refractory psychosis in DLB, particularly out of proportion to other symptoms, may be a signal of approaching the end of life. More research is needed to understand this phenomenon and to develop effective and safe treatments for psychosis in DLB.
OBJECTIVE: To establish whether a virtual dementia awareness course is feasible for caregivers of people with dementia in Brazil and India. METHODS: A pre/posttest single group, multisite feasibility study, mixed methods...OBJECTIVE: To establish whether a virtual dementia awareness course is feasible for caregivers of people with dementia in Brazil and India. METHODS: A pre/posttest single group, multisite feasibility study, mixed methods exploratory design was applied. Primary caregivers of people with dementia in Brazil and India took a 3 to 4-hour course adapted for online delivery, with 10 to 15 caregivers. Measurements encompassed self-reports of carer competence, attitudes to dementia, and caregiver burden; satisfaction questionnaire completed immediately after the intervention; open-ended questions at 1-month follow-up to assess if caregivers applied information to caregiving role; semistructured interviews about how the intervention changed caregivers' behavior and attitudes towards dementia. RESULTS: Of the 70 caregivers who received the intervention (Brazil = 34; India = 36), 54 (77.1%) completed postintervention outcomes, and 39 (55.7%) completed questionnaires at 1-month follow-up assessment. Significant improvements were observed in attitudes to dementia in both countries and self-perceived carer competence (in India) postintervention. The themes from the 9 semistructured interviews were: acceptability, feasibility, change of behavior/attitude, and suggestions for future sessions. CONCLUSIONS: Dementia awareness course was a feasible online intervention to improve dementia awareness among family caregivers across countries. It offers a standardized yet flexible methodology, with promising outcomes that need to be evaluated in a full randomized controlled trial.