Dementia and Geriatric Cognitive Disorders最新文献

Introduction: The aging of family caregivers and the growing number of older adults living alone have intensified concerns about dementia care in Japan. Early and effective assessment of caregiving competence is essential for providing timely support. This study aimed to develop the Caregiving Competence Scale for Dementia (CCSD) for primary family caregivers.

Methods: A two-phase scale development study was conducted. In phase 1, potential items were generated through a literature review and refined with feedback from experienced family caregivers. In phase 2, a questionnaire survey assessed construct validity using exploratory and confirmatory factor analyses and examined reliability through internal consistency.

Results: Analyses supported a five-factor solution comprising 27 items (7/5/6/3/6 per factor). Sampling adequacy was high (Kaiser-Meyer-Olkin = 0.851), and model fit indices indicated acceptable fit (χ2/df = 1.838; Comparative Fit Index = 0.905; Tucker-Lewis Index = 0.893; root mean square error of approximation = 0.072). Internal consistency was strong (Cronbach's α = 0.892), and concurrent validity was demonstrated by correlations with measures of behavioral and psychological symptoms of dementia and depressive symptoms.

Conclusion: The CCSD is a reliable and valid tool for assessing caregiving competence among family caregivers of individuals with dementia, enabling the development of targeted support strategies and appropriate interventions.

Introduction: This study aimed to evaluate the long-term risk of stroke following dementia diagnosis and compare stroke risk across dementia subtypes using nationwide cohort data.

Methods: We performed a retrospective cohort study using Korean National Health Insurance Service data (2002-2013). Patients with newly diagnosed dementia (n = 2,820) were matched 1:10 with controls (n = 28,200) by age, sex, and health screening year. Stroke incidence was evaluated over up to 10 years of follow-up. Adjusted hazard ratios (aHRs) were calculated using Cox regression.

Results: During a mean follow-up of 2.49 years (median, 1.99; standard deviation, 2.07; interquartile range, 2.66), dementia was significantly associated with increased stroke risk (aHR, 3.19; 95% confidence interval, 2.84-3.57). The highest risk was observed in patients with vascular dementia (VaD; aHR, 3.58), followed by Alzheimer's disease (AD; aHR, 2.73) and other dementias (aHR, 2.61). Ischemic stroke (IS) was more common than hemorrhagic stroke (HS) across all subtypes. The relative risk was greater in individuals aged <60 years and in males with AD or other dementias, whereas sex differences were not evident in VaD.

Conclusion: Dementia, especially VaD, is a strong risk factor for both IS and HS. These findings support the need for dementia subtype-specific cerebrovascular risk assessment and long-term prevention strategies.

Introduction: High plasma homocysteine (Hcy) is a well-established risk factor for cardiovascular disease and stroke, but its role in cognitive impairment (CogI) remains unclear. This study investigated the relationship between plasma Hcy levels and CogI in middle-aged and elderly Chinese adults.

Methods: This community-based cross-sectional study included 1,805 participants (≥40 years) from a village in Xi'an, China. CogI was diagnosed using a three-step protocol. Plasma Hcy was measured via chemiluminometric assay and categorized into tertiles: low-level group (<12.50 μmol/L), moderate-level group (12.5-16.10 μmol/L), and high-level group (>16.10 μmol/L). Multivariable logistic regression and subgroup analyses were performed to assess the relationship between Hcy and CogI. Nonlinear relationships were explored using restricted cubic splines (RCSs).

Results: Among 1,805 subjects, 145 (8.0%) met the criteria for CogI. The prevalence of CogI increased across Hcy tertiles (low-level group: 4.9%; moderate-level group: 7.0%; high-level group: 12.2%). Multivariable logistic regression analysis showed that each 1 μmol/L increase in Hcy was associated with a 3.1% higher risk of CogI (OR = 1.031, 95% CI: 1.013-1.049, p < 0.001). Participants in the high-level Hcy group had a significantly higher risk than the low-level group (OR = 1.894, 95% CI: 1.162-3.055, p = 0.010). RCS analysis indicated no significant nonlinear relationship (p_nonlinear = 0.317). Interaction analyses showed sex, age, stroke history, diabetes, BMI, and SBP did not modify this association.

Conclusion: Elevated plasma Hcy is independently associated with increased risk of CogI in middle-aged and elderly adults. Further cohort and interventional studies are needed to confirm these findings.

Introduction: Cognitive decline is a pressing public health concern in older adults. The recently proposed Life's Crucial 9 (LC9) score, which integrates cardiovascular and mental health metrics, may offer a novel framework for predicting cognitive impairment.

Methods: We analyzed data from 2,180 participants aged ≥60 years from 2011 to 2014 National Health and Nutrition Examination Survey (NHANES). LC9 was computed based on eight cardiovascular health metrics and depressive symptoms. Cognitive performance was assessed using the Animal Fluency Test (AFT), Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, and Digit Symbol Substitution Test (DSST). Biological age (BA) and biological age acceleration (BAcel) were derived using a validated algorithm. Weighted logistic regression, receiver operating characteristic (ROC), restricted cubic spline (RCS) models, and mediation analyses were performed to evaluate the associations.

Results: Higher LC9 scores were significantly associated with lower odds of poor performance on the AFT (p = 1.5 × 10-2) and DSST (p = 1.4 × 10-2), but not CERAD (p = 1.2 × 10-1). ROC analysis showed that LC9 significantly outperformed Life's Essential 8 (LE8) in predicting low AFT and DSST performance (AUC: 0.599 vs. 0.588 for AFT; 0.632 vs. 0.614 for DSST). The RCS models indicated no statistically significant nonlinear relationship between the LC9 and cognitive performance. Mediation analysis revealed that BA and BAcel accounted for 7.48% and 4.53% of the total effect of LC9 on DSST performance, respectively. The subgroup and sensitivity analyses confirmed the robustness of these findings.

Conclusion: LC9 is significantly associated with cognitive performance in older adults. This association with DSST is partially mediated by biological aging.

Introduction: Despite less education being common in Latin America, there is no systematic review on the use of brief cognitive screening (BCS) tools in illiterate and low-educated adults in the region. We systematically reviewed brief cognitive tests used to identify dementia in illiterate or low-educated adults from South America (SA).

Methods: A systematic review was conducted according to the PRISMA and Cochrane guidelines. We searched four major databases: PubMed, Scopus, Web of Science, and Embase, for studies up to September 2023, and included observational studies that reported at least sensitivity, specificity, area under the receiver operating characteristic (ROC) curve, positive predictive value, or negative predictive value of dementia screening tools in illiterate or low-educated (less than 6 years of education) adults from SA.

Results: Most studies in samples with illiteracy or low education across SA used BCS tools adapted to the local population's language. Seventeen tests were identified; among them, the Mini-Mental State Examination (MMSE) and Rowland Universal Dementia Assessment Scale (RUDAS) were the more common tools with good diagnostic accuracy in people with dementia. The sensitivity and specificity of reported BCS tools were at least 90%, and the area under the ROC curve was higher than 0.95.

Conclusions: The cutoff points for detecting dementia in illiterates and the low-educated adult population of SA should be adjusted for most brief cognitive tests. Developing specific and sensitive cognitive batteries for our region for cognitive evaluation in low-educated/illiterate participants is mandatory, including specific functionality evaluation.

Introduction: Mild cognitive impairment (MCI) and mild dementia are critical stages at which non-pharmacological strategies may help delay further cognitive decline. While multimodal interventions show short-term benefits, evidence on long-term cognitive trajectories, particularly regarding adherence, remains limited. We examined 5-year changes in cognitive function among individuals with MCI or mild dementia participating in a multimodal day-care program, focusing on adherence levels.

Methods: This single-arm longitudinal observational study was conducted at the University of Tsukuba Hospital (April 2013-February 2020). The multimodal program (exercise, cognitive training, music and art therapy) was conducted 3 days/week in two 2-h sessions (morning and afternoon). Most participants (approximately 94%) attended once weekly; some attended more often. Cognitive function was assessed annually using the Japanese version of the Mini-Mental State Examination (MMSE-J). Participants were grouped according to attendance thresholds (i.e., the proportion of sessions attended out of the total sessions scheduled: 50%, 60%, 70%, and 80%) to examine the association with cognitive outcomes. Mixed-effects models adjusted by propensity scores evaluated longitudinal MMSE-J changes.

Results: Among 96 participants (mean age: 71.4 years; baseline MMSE-J: 26.2; mean participation: 3.8 years), the average annual MMSE-J decline was 0.53 points (95% confidence interval [95% CI]: -0.70, -0.36). At the 60% threshold, ≥60% attendance was associated with a 2.3-point decline (vs. 6.6 points for <60%), yielding a -4.6-point difference (95% CI: -7.38, -1.73). Similar findings appeared at 70% (-4.2 points; 95% CI: -6.78, -1.55) over 5 years. No significant interactions were observed at the 50% or 80% threshold.

Conclusion: Consistent participation - attending at least 60% of sessions - in a multimodal day-care program was associated with relatively stable cognitive trajectories over 5 years, indicating the importance of sustained engagement. The findings support the potential value of continued participation and warrant further investigation in controlled settings.

Introduction: This study aimed to comprehensively assess the impact of caregiver, environmental, and individual factors on agitation symptoms in patients with Alzheimer's disease (AD) and identify key modifiable factors.

Methods: From October 2022 to June 2023, 220 participants (110 patients with AD and their caregivers) were recruited from the Shanghai Mental Health Center. Patients with AD completed demographic, lifestyle, medical history, and neuropsychological tests, such as the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS). The caregivers completed the Neuropsychiatric Inventory, environmental factor questionnaire, and emotional state assessments (Hamilton Depression and Anxiety Scales). Agitation severity was assessed using the Cohen-Mansfield Agitation Inventory (CMAI). Group differences and relationships between potential factors and agitation were also analyzed.

Results: Among the 110 patients with AD, 56.36% exhibited agitation. The agitation group had more male patients (p = 0.012) and female caregivers (p = 0.003), lacked courtyard/garden views (p = 0.007), and had lower MMSE (p = 0.005) and GDS (p = 0.012) scores. After adjusting for variables, access to rooms with courtyard/garden views (OR = 0.256, p = 0.042), male caregivers (OR = 0.246, p = 0.005), and higher MMSE scores (OR = 0.194, p = 0.007) were protective factors against agitation. Male caregivers' presence was associated with a lower incidence of agitation.

Conclusions: Improving living environments, promoting male caregivers, enhancing caregiver support, and early cognitive intervention may reduce agitation in AD patients.

Introduction: We aimed to explore the performance of the Kimberley Indigenous Cognitive Assessment - Cognitive component (KICA-Cog) and the Clock Drawing Test (CDT) in older Aboriginal and Torres Strait Islander adults with dementia and without dementia in the Let's CHAT Dementia study.

Methods: In this cross-sectional diagnostic test accuracy study, participants completed Comprehensive Geriatric Assessments. Demographic, health, cognitive, and functional histories, and cognitive assessments (KICA-Cog and CDT) were recorded. The reference standard was consensus diagnosis by two geriatricians blinded to KICA-Cog and CDT performance. Binary logistic regression and receiver operating characteristic curve analyses explored accuracy against a diagnosis of dementia.

Results: Seventy-five adults with a median age of 74 years (interquartile range 65, 78) were assessed, of whom 39 (52.0%) were women. Forty-seven (62.7%) had normal cognition, 15 (20.0%) had cognitive impairment no dementia, and 13 (17.3%) had dementia. Sixty-one (81.3%) participants had completed primary school, and 13 (17.3%) had completed secondary school. People with dementia were older (p = 0.046), but no differences were found for gender, comorbidities, or education. KICA-Cog and CDT scores were inversely associated with dementia in unadjusted and fully adjusted models (adjusted odds ratio [OR] = 0.43, 95% CI [0.26-0.71] and OR = 0.18 [0.07-0.51], respectively). The KICA-Cog was superior to the CDT for classifying dementia in participants, with area under the curve (95% CI) = 0.98 (0.95-1.00); versus 0.79 (0.64-0.93), respectively, p < 0.001. The optimal KICA-Cog cutpoint for classifying dementia was ≤34, with 92.3% sensitivity and 90.3% specificity.

Conclusions: KICA-Cog is superior to CDT at classifying dementia when used with older Aboriginal and Torres Strait Islander adults and should, therefore, be prioritised over the CDT for cognitive screening in older Aboriginal and Torres Strait Islander peoples.

Introduction: Memory impairment in Parkinson's disease (PD) is characterized mainly by impaired recall with preserved recognition. Despite its clinical importance, there are only a limited number of simple bedside memory tests that can assess both recall and recognition memory together, and that can also be used to detect the neuroanatomical changes in PD. To address this issue, we examined whether a simple memory test that can evaluate both recall and recognition memory can detect cortical abnormalities related to memory impairment in PD.

Methods: We designed a composite recall and recognition memory score using the Mini-Mental Statement Examination to reflect recall and recognition memory. We assessed memory impairment in 210 patients with PD using this test and investigated the neuroanatomical correlations with the test results.

Results: This simple memory test showed that recognition memory was generally preserved in PD, and furthermore, the test results were significantly correlated with atrophy of the limbic and frontal cortices.

Conclusions: Adding recognition evaluation to a simple memory test can detect abnormalities in memory-related brain regions in PD.

Introduction: Falls are a critical public health issue, with executive function (EF) impairment being a contributing factor. However, whether apolipoprotein E4 (ApoE4) influences the relationship between EF and falls is unclear. This study investigated the potential moderating effect of ApoE4 on the EF and falls relationship in older adults with unimpaired cognition, mild cognitive impairment (MCI), and Alzheimer's disease (AD) dementia.

Methods: We analyzed cross-sectional data from 486 participants in the Brain and Body Donation Program of the Arizona Study of Aging and Neurodegenerative Disorders database. EF was assessed through a composite latent variable using the Trail Making Test, Stroop Interference, Digit Span, Clock Drawing test, and verbal fluency tests. ApoE genotypes were categorized as carriers and noncarriers of ApoE4. Logistic regression was used with fall history and future falls as outcomes.

Results: ApoE4 did not moderate the EF and falls relationship (p ≥ 0.05). A significant interaction effect revealed that EF is associated with fall history for individuals with unimpaired cognition and MCI but not with AD dementia (OR = 1.658, p = 0.032). Significantly associated covariates with fall history included elements from the Unified Parkinson's Disease Rating Scale, medical conditions, and depression (p < 0.05), while medical conditions and fall history were significantly associated with future falls (p < 0.05).

Conclusion: ApoE4 did not significantly moderate the relationship between EF and falls. However, EF's impact on falls varied by cognitive status.