Dementia and Geriatric Cognitive Disorders最新文献

Introduction: Stem cell-based regenerative medicine has provided an excellent opportunity to investigate therapeutic strategies and innovative treatments for Alzheimer's disease (AD). However, there is an absence of visual overviews to assess the published literature systematically.

Methods: In this review, the bibliometric approach was used to estimate the searched data on stem cell research in AD from 2004 to 2022, and we also utilized CiteSpace and VOSviewer software to evaluate the contributions and co-occurrence relationships of different countries/regions, institutes, journals, and authors as well as to discover research hot spots and encouraging future trends in this field.

Results: From 2004 to 2022, a total of 3,428 publications were retrieved. The number of publications and citations on stem cell research in AD has increased dramatically in the last nearly 20 years, especially since 2016. North America and Asia were the top 2 highest output regions. The leading country in terms of publications and access to collaborative networks was the USA. Centrality analysis revealed that the UCL (0.05) was at the core of the network. The Journal of Alzheimer's Disease (n = 102, 2.98%) was the most productive academic journal. The analyses of keyword burst detection indicated that exosomes, risk factors, and drug delivery only had burst recently. Citations and co-citation achievements clarified that cluster #0 induced pluripotent stem cells, #2 mesenchymal stem cells, #3 microglia, and #6 adult hippocampal neurogenesis persisted to recent time.

Conclusion: This bibliometric analysis provides a comprehensive guide for clinicians and scholars working in this field. These analysis and results hope to provide useful information and references for future understanding of the challenges behind translating underlying stem cell biology into novel clinical therapeutic potential in AD.

Introduction: Hearing loss (HL) is considered a potentially modifiable risk factor for dementia. We aimed to examine the relationship between HL and incident dementia diagnosis in a province-wide population-based cohort study with matched controls.

Methods: Administrative healthcare databases were linked to generate a cohort of patients who were aged ≥40 years at their first claimed hearing amplification devices (HAD) between April 2007 and March 2016 through the Assistive Devices Program (ADP) (257,285 with claims and 1,005,010 controls). The main outcome was incident dementia diagnosis, ascertained using validated algorithms. Dementia incidence was compared between cases and controls using Cox regression. Patient, disease, and other risk factors were examined.

Results: Dementia incidence rates (per 1,000 person-years) were 19.51 (95% confidence interval [CI]: 19.26-19.77) and 14.15 (95% CI: 14.04-14.26) for the ADP claimants and matched controls, respectively. In adjusted analyses, risk of dementia was higher in ADP claimants compared with controls (hazard ratio [HR]: 1.10 [95% CI: 1.09-1.12, p < 0.001]). Subgroup analyses showed a dose-response gradient, with risk of dementia higher among patients with bilateral HADs (HR: 1.12 [95% CI: 1.10-1.14, p < 0.001]), and an exposure-response gradient, with increasing risk over time from April 2007-March 2010 (HR: 1.03 [95% CI: 1.01-1.06, p = 0.014]), April 2010-March 2013 (HR: 1.12 [95% CI: 1.09-1.15, p < 0.001]), and April 2013-March 2016 (HR: 1.19 [95% CI: 1.16-1.23, p < 0.001]).

Conclusion: In this population-based study, adults with HL had an increased risk of being diagnosed with dementia. Given the implications of HL on dementia risk, understanding the effect of hearing interventions merits further investigation.

Introduction: This paper provides a summary of findings on the public's knowledge and attitudes towards dementia. We aim to investigate if the attitudes of Singaporeans towards dementia have changed over the years by adopting a questionnaire used in a similar study in 2012.

Methods: A cross-sectional, descriptive study was conducted through the dissemination of an existing, online questionnaire to participants above 16 years of age. Out of 1,500 subjects, results from 1,373 participants were analysed. Descriptive statistics were used to analyse and compare results from the 2012 study while a latent class analysis was performed to understand the categories of study participants based on varying levels of attitudes, knowledge and stigma.

Results: The mean age of study participants was 43.8 (SD = 15.7). Majority of the participants were females (76.5%), between 51 and 60 years of age (29.6%) and belonged to the Chinese ethnic group (77.8%). Results demonstrated that there were significant differences in attitudes towards dementia between 2012 and 2021. There was a 70.2% improvement in stigma-associated attitudes and an increase in correct responses to 4 out of 5 questions in the knowledge section.

Conclusion: Findings of this study suggest that the general public has a better knowledge and more positive attitude towards dementia. This could have been attributed to higher literacy levels of the current study population and effectiveness of established outreach initiatives in Singapore. However, further research with a more balanced representation of ethnic and cultural groups would offer more comprehensive insights into dementia health literacy.

Introduction: The study aimed to explore longitudinal cognitive outcomes and to ascertain predictors of conversion to dementia in a hospital-based mild cognitive impairment (MCI) cohort classified according to the neuropsychological phenotype at baseline.

Materials and methods: Subjects aged >55 years who had a clinical diagnosis of MCI at initial visit between 2010 and 2018, with at least one formal neuropsychological assessment at baseline and follow-up of a minimum of 2 years were included. The prospective study was completed based on evaluation at last follow-up to gauge conversion to dementia, quantification of performance on activities of daily living and when available, longitudinal neuropsychological test scores.

Results: Ninety-five patients with MCI met the inclusion criteria with a mean age of 68.4 ± 6.4 years at baseline and a mean duration of follow-up for 6.4 ± 3.2 years. The cumulative conversion rate to dementia was 22.2% (21/95) and the annualized conversion rate was 3.3% per year of follow-up. The majority of subjects who had converted had multidomain MCI (66%). Only white matter changes on MRI brain revealed correlation with baseline neuropsychology tests. The multivariate logistic regression analysis revealed the utility of lower baseline list recognition (adjusted odds ratio: 0.735 [95% confidence interval: 0.589-0.916]; p 0.006), lower immediate logical memory (0.885 [0.790-0.990]; p 0.03), and high perseverative error scores on set shifting (3.116 [1.425-6.817]; p 0.004) as predictors of conversion. A model score of +2.615 could predict conversion with sensitivity of 72% and specificity of 98% over 6.4 years follow-up.

Conclusion: There was a higher risk of conversion associated with multidomain MCI. Logistic regression-based estimations of dementia risk utilizing domain-based neuropsychology test scores in MCI have high specificity for diagnosis at baseline.

Introduction: Depression is often under-detected in long-term care (LTC) patients with major neurocognitive disorders (MNCD) and is associated with important morbidity, mortality, and costs. Observer-rated outcome measures (ObsROMs) could help resolve this problematic; however, evidence on their accuracy is scattered in the literature. This systematic review aimed at summarizing this evidence.

Methods: A literature search was conducted in 7 databases using keywords, MeSHs, and bibliographic searches. We included studies published before January 2022 and reporting on the accuracy of a depression ObsROM used in LTC patients with MNCD. Data extraction, analysis, synthesis, and study methodological quality assessments were done by two authors, and discrepancies were resolved by consensus.

Results: Among 9,660 articles retrieved, 8 studies reporting on 11 depression measures were included. Scales were classified as patient-reported outcome measures used as Obs-ROMs or true ObsROMs. Among the first category, the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Asberg Depression Rating Scale (MADRS) performed best (area under the curve [AUC]: 0.73-0.87), although both presented with low positive predictive values and high negative predictive values. Among the second category, the Nursing Homes Short Depression Inventory (NH-SDI) performed best, with an AUC of 0.93 and ≥85% sensitivity, specificity, and predictive values.

Conclusion: The CSDD and MADRS may be useful to rule out depression in LTC patients with MNCD, whereas the NH-SDI may be useful to rule in and out depression within this same population. Before recommending their use, adequately powered studies to further examine their accuracy in different contexts are necessary.

Introduction: The Memory Complaint Scale (MCS-15) is a 15-item instrument to explore frequent forgetfulness in daily life in people with possible cognitive impairment. However, knowledge about its psychometric performance is limited.

Objective: The objective of this study was to know the dimensionality and internal consistency of the MCS-15 in Colombian older adults.

Methods: A probabilistic sample of 1,957 older adults from the general Colombian population was taken, aged between 60 and 98 years (mean = 71.0 ± 7.9), and 62.2% were women. Internal consistency (Cronbach's alpha and McDonald's omega) and dimensionality (exploratory and confirmatory factor analysis) were calculated for the original and ten-item versions.

Results: The 15-item version showed Cronbach's alpha and McDonald's omega of 0.91, and one dimension accounted for 45.3% of the variance. A version of ten items showed Cronbach's alpha and McDonald's omega of 0.89 and a single factor that explained 50.9% of the variance with better indicators in the confirmatory factor analysis. Convergence with the shortened Mini-Mental State Examination was rs = 0.43 (p < 0.001), and the Montreal Cognitive Assessment test was rs = 0.38 (p < 0.001). The nomological validity with the geriatric depression scale was rs = 0.44 (p < 0.001), and women scored higher than men (p < 0.001).

Conclusions: The MCS-15 shows high internal consistency with poor dimensionality. However, a ten-item version shows high internal consistency and a clear one-dimensional structure. More research is needed: testing the performance against a structured interview for major cognitive impairment.

Introduction: Literature shows poor dementia training and competencies among health and social professionals. Due to the growing prevalence of people with dementia and all the related care demands, specialized training is increasingly needed but must be effective in terms of impact on knowledge, behaviors, and attitudes. We aimed to analyze the impact of a first-level dementia training course for staff of a new specialized center for people with dementia, considering the first three levels of Kirkpatrick's evaluation framework, namely, staff reaction (satisfaction), skills and learning (knowledge and dementia attitudes), and behavior changes.

Methods: This is a single-center group pre-post design study of a 12-session online course. An online questionnaire was administered to measure satisfaction, expectations, knowledge/learning, attitudes (Dementia Attitude Scale), and new behaviors/practices. We compared perceived knowledge (Wilcoxon signed-rank test) and attitudes (paired t test). Thematic analysis explored new behaviors/practices.

Results: Eighty-five professionals and 1 volunteer were included (median age 31, 92% female). Satisfaction with the training was high (median 4/5). Perceived knowledge improved (median 3-4; p < 0.001). The knowledge test median score was 70.8%. After training, participants showed better attitudes toward dementia (mean 116.5, SD 10.3, to mean 122.2, SD 11.5; p < 0.001). Most (93%) said their behavior/practice changed. Thematic analysis yielded four new behavior/practice dimensions: care provision/interaction, communication, family/caregivers, and self-confidence.

Conclusions: The course improved all dimensions evaluated, suggesting it effectively provides first-level dementia training. This may be transferable to similar settings.

Introduction: Nursing home (NH) staff mention knowledge deficits regarding the management of behavioural and psychological symptoms of dementia (BPSDs) in residents with neurocognitive disorders (NCDs). Staff training therefore appears to be necessary. However, existing evidence on best training practices and their outcomes remains scattered. This systematic review aimed to (1) identify the best clinical practices and theoretical bases of staff training interventions on BPSD management in NHs and (2) summarize the effects of these interventions on resident and staff outcomes.

Methods: A mixed methods systematic review was conducted. Two nurse researchers independently searched nine electronic databases to identify studies on the efficacy of staff training interventions aimed at BPSD management in NHs, on a variety of resident and staff outcomes. The search was conducted for articles published between 1996 and 2022, using selected keywords, MeSH terms, and predefined eligibility criteria. The methodological quality of the retrieved studies was assessed using JBI checklists.

Results: Overall, 39 studies in 47 articles were included. Ten categories of trainings were identified, of which three demonstrated the most promising results on both residents and staff: (1) structured protocols and models, (2) person-centred bathing, and (3) communication techniques. The methodological quality of the retrieved studies was generally weak. Issues with intervention feasibility and reproducibility were also noted.

Conclusion: Training interventions incorporating structured protocols and models, person-centred bathing, and communication techniques are associated with better staff and resident outcomes. However, there is a strong need for high-quality research to strengthen existing evidence and ensure feasibility and reproducibility.