International psychogeriatrics最新文献

Objectives: Dementia prevalence is higher among Aboriginal and Torres Strait Islander peoples than in the non-Indigenous population, however, reported risk factors vary across studies. This study aimed to elucidate factors associated with dementia and Cognitive Impairment Not Dementia (CIND) in a harmonised dataset of Aboriginal and Torres Strait Islander participants.

Design: Univariable and multivariable logistic regression was used to assess cross-sectional factors associated with dementia and/or CIND diagnoses (N = 898). Multinomial logistic regression was applied in a longitudinal subsample (n = 354) to account for the competing risk of death when examining incident dementia/CIND.

Results: Of 898 participants, 13% had a diagnosis of dementia and 15% had CIND. Cross-sectional risk factors included age, lower educational attainment, stroke, head injury with loss of consciousness, epilepsy, no obesity and antidepressant use. Hearing impairment, urinary incontinence, mobility impairment and difficulties with certain activities of daily living were associated with a greater risk of incident dementia/CIND.

Conclusions: This study identified several factors associated with dementia and CIND among Aboriginal and Torres Strait Islander peoples. Findings from this observational study may support clinical awareness and inform future research; however, causal relationships cannot be inferred. Further longitudinal studies are needed to clarify these associations.

Background: Depression is a major mental health challenge among older adults in China. Community senior canteens have been promoted as a way to support physical and psychological well-being, but their impacts and underlying mechanisms are not fully understood.

Methods: We used data from three waves (2018, 2020, 2023) of the China Longitudinal Aging Social Survey, focusing on adults aged 60 and older. Fixed effects regression models estimated the associations between canteen availability, integrated service environments, use, affordability, and depressive symptoms. Mediation analysis examined the roles of personal and volunteer-based social participation. Subgroup analyses considered gender, urban-rural status, and age groups.

Results: Community canteen availability was significantly associated with lower depressive symptoms. The effect was stronger in amenity-rich communities. Mediation analysis showed that personal and volunteer-based social participation partly explained the mental health benefits of canteen availability, with the indirect effect of personal participation being larger. The protective effects were especially notable among women, rural residents, and younger elderly.

Conclusion: Community senior canteens can play a key role in reducing depressive symptoms in later life, particularly when integrated into rich service environments. Enhancing opportunities for informal social participation may further strengthen these benefits. Policymakers should focus on both expanding service coverage and tailoring interventions to the needs of vulnerable groups.

Objectives: Too little is known about the mood and functioning of older adults at elevated risk for attention deficit/hyperactivity disorder (ADHD). We aimed to examine the clinical characteristics of individuals aged 65 + years with higher polygenic risk scores (PRS) for ADHD.

Design, setting, participants: A population-based cohort of 1471 dementia-free adults with median age 72 years.

Measurements: We calculated the ADHD-PRS and examined its cross-sectional associations with Clinical Dementia Rating (CDR), and individual CDR domains, depression and anxiety scores, individual depression symptoms, independence in everyday activities of daily living (ADL) and instrumental ADL (IADL), self-rated health.

Results: After adjusting for covariates, a one-unit increase in the ADHD-PRS was significantly associated with mild cognitive impairment (CDR=0.5) in the overall CDR rating and specifically in the memory and judgment/problem-solving domains. Higher ADHD-PRS was also associated with worse self-rated health and greater difficulty independently carrying out ADLs and IADLs. In exploratory item-level analyses, associations with poor appetite and difficulty focusing lost significance after False Discovery Rate (FDR) adjustment.

Conclusion: In this population-based sample of older adults, greater genetic risk for ADHD was associated with higher odds of mild cognitive impairment, difficulty with memory and judgment/problem-solving, worse self-rated health, difficulty in performing ADLs and IADLS, poor appetite and difficulty focusing. The presence of these difficulties in an older population highlights a need for greater recognition of the long-term impact of ADHD on cognitive and functional wellbeing across the lifespan.

Background: People with dementia and their carers often face barriers during diagnosis and accessing post-diagnostic care, causing avoidable inequalities in health outcomes. Without any previous synthesis to date to help improve people with dementia's health outcomes, the aim of this systematic review was to identify and synthesise existing solutions to increase equity in dementia diagnosis and care.

Methods: A search was conducted across five databases in March 2025. All abstracts and full texts were independently screened by two researchers, with a third researcher sorting through any conflicts. Data were extracted by two public advisor researchers and reviewed by a senior research team member, who synthesised the data into solutions on individual, community, and system and infrastructure levels.

Findings: Forty-three studies (42 from High Income Countries) comprising solutions from 13 countries, were included in this systematic review. The majority of studies focused on access to care, with most solutions centering on system-level change. Only one study was conducted in two middle-income countries. Evidence is diverse and minimal for most types of solutions, with a lack of cost-effectiveness data. There are clear indications for key solutions including dementia link workers, communities of practice and wider networks, as well as one-stop memory clinics providing same day diagnostic assessments in rural countries or regions.

Conclusions: Whilst this review highlights a diversity in solutions, more research needs to be conducted that uses clear measurements of health and social care usage and health economics. Importantly, research needs to be undertaken across different countries, particularly lower- and middle-income countries.

Background: The intricate interplay between socioeconomic status (SES) and healthy lifestyle behaviors in the development of frailty remains incompletely understood.

Methods: Using data from two nationally representative cohort studies: the Health and Retirement Study (HRS, 2008-2020; n = 23,183) and the English Longitudinal Study of Ageing (ELSA, 2004-2018; n = 11,182). SES was derived using latent class analysis (LCA) incorporating education level, total household income and wealth. A composite healthy lifestyle score included four factors: never smoking, low to moderate alcohol consumption, top tertile of physical activity, and active social contact.

Results: Participants with low SES had significantly increased risks of developing frailty compared to those with high SES (HRS: HR: 2.03; 95 % CI, 1.86-2.21; ELSA: HR: 4.58; 95 % CI, 3.84-5.45). The mediating effect of a lifestyle on the SES-frailty association accounted for 5.3 % (95 % CI, 1.9-8.8) in HRS and -2.3 % (95 % CI, -3.3 to -1.3) in ELSA. Compared to individuals with both high SES and a favorable lifestyle, those with low SES and an unfavorable lifestyle exhibited a markedly elevated risk of frailty (HRS: HR: 3.70; 95 % CI, 3.20-4.27; ELSA: HR: 6.18; 95 % CI, 3.61-10.56), and persistently higher frailty index scores.

Conclusions: Among older adults in the U.S. and U.K., favorable lifestyle behaviors modestly attenuated-but did not eliminate-the impact of socioeconomic disadvantage on frailty risk. Structural interventions targeting social determinants are warranted to reduce disparities in late-life health.

Background: Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) share overlapping cognitive and neuropsychiatric symptoms, complicating early differential diagnosis. This study aimed to compare multidimensional impairment patterns in AD and DLB and develop a simple, interpretable classification model based on clinical scales.

Methods: A total of 249 participants were included: 84 patients with AD, 82 with DLB, and 83 participants with normal cognition (NC). Participants completed assessments covering global cognition, six cognitive domains, neuropsychiatric and depressive symptoms. Missing values in cognitive scales were handled using multiple imputation, and results were pooled across all imputations. Then, Least Absolute Shrinkage and Selection Operator (LASSO), Support Vector Machine (SVM), and Random Forest (RF) were used to identify key variables. A final set of six scales was selected to build a logistic regression model distinguishing DLB from AD. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) in the entire cohort, mild stage and dementia stage.

Results: DLB patients showed greater deficits in attention, visuospatial processing, and neuropsychiatric symptoms; AD patients exhibited more pronounced memory impairment. At mild stage, DLB displayed more depressive symptoms and attention deficits but milder memory decline than AD. At dementia stage, DLB presented broader impairments in executive, visuospatial, attentional, with similar global cognition. The six-feature model achieved high diagnostic accuracy in the entire cohort (AUC=0.879, 95%CI: 0.802-0.957), mild stage (AUC=0.866, 95% CI: 0.788-0.943) and dementia stage (AUC=0.939, 95% CI: 0.839-0.999).

Conclusion: The study identified distinct cognitive profiles of DLB and AD, and developed a concise, clinically practical model with robust diagnostic utility across disease stages, supporting its use in outpatient and resource-limited settings.

Retaining autonomy in medical decision-making is challenging for people with dementia as decision-making capacity becomes increasingly impaired. Advance directives can help preserve autonomous treatment decisions, and approaches such as advance care planning and supported decision-making may facilitate the completion of such documents. This study examined supported decision-making within an advance care planning approach adapted for people with dementia, referred to as supported advance care decision-making (sACD). The effects of a sACD intervention were examined in memory clinic patients using a comparative, non-randomized design with a baseline phase (n = 154) and an intervention phase (n = 135). Results indicated that the sACD intervention was associated with a higher proportion of advance directives meeting the informed consent standard, but not with overall advance directive status. Effects on patient-reported satisfaction were uncertain due to missing data and ceiling effects. Given the study design, causal inferences are limited. Overall, the findings suggest that supported decision-making has the potential to promote patient autonomy in advance care planning for people with dementia.

Objectives: This study evaluated the effectiveness of a multicomponent dementia education and support program on dementia knowledge, attitudes, empathy, self-efficacy in managing behavioral and psychological symptoms of dementia (BPSD), and caregiver burden among family caregivers.

Design: An assessor-blind randomized controlled trial.

Setting: Dementia community day service centers.

Participants: Ninety-two family caregivers were recruited from dementia community day service centers. Eligible participants were aged 20 years or older and had provided care to a relative with dementia living at home for at least 3 months.

Intervention: Participants were randomly assigned to either the intervention group, which received a multicomponent dementia education and support program comprising 360-degree video-based virtual reality (VR) activities, and self-guided dementia care e-book modules, in addition to the routine dementia care manual and support group meetings (n = 46), or the active control group, which received the routine dementia care manual and support group meetings without VR or e-book components (n = 46).

Measurements: Participants were assessed for dementia knowledge, attitudes toward people with dementia, empathy, self-efficacy in managing BPSD, and caregiver burden were assessed at baseline, immediately after the intervention, and at the 1-month follow-up.

Results: GEE analysis showed significant overall group × time interactions for dementia knowledge, Self-efficacy in managing BPSD, and caregiver burden. No significant overall group × time interaction was observed for attitudes toward people with dementia or empathy; however, a significant between-group difference in attitudes was observed at T2 only, whereas empathy showed comparable patterns of increase over time between groups.

Conclusions: This multicomponent dementia education and support program incorporating 360-degree video-based VR activities can improve dementia knowledge, positive attitudes toward people with dementia, and self-efficacy in managing BPSD, and reduce caregiver burden among dementia family caregivers. This study was registered at ClinicalTrials.gov (NCT05475002).