Frontiers in dementia最新文献

Neurodegenerative diseases represent an expanding global health challenge, with rapidly increasing prevalence and substantial economic impact. The therapeutic clinical approach continues to seek solutions through pharmacological means-such as inhibitors and antibodies-which, while sometimes controlling symptoms, have not addressed the underlying pathophysiology. By integrating advanced genomics with selected biochemical markers, under the continuous oversight of a multidisciplinary team working in consensus, it is possible to achieve a more comprehensive understanding of individual phenotypes, enabling the design of truly personalized neurogenomics-based functional plans. This article outlines the steps of the proposed integrative neurogenomics workflow, discussing its advantages and limitations, and presents highlights from an illustrative case intended as a potential reference model to establish the foundation for a new standard of personalized genomic medicine in neurodegeneration. The workflow underscores the importance of considering the additive burden of genetic variants typically classified as benign-beyond the ACMG pathogenicity framework-for accurate phenotypic assessment. It further demonstrates the feasibility of developing actionable and highly precise functional interventions by integrating genomic and biochemical data. Findings from the case example reveal correlations between genetic variants and biochemical markers, providing the basis for personalized recommendations in nutrition, lifestyle, and supplementation. This framework aims to establish the foundations of personalized genomic medicine in neurodegenerative diseases, underscoring the urgent need to move beyond one-size-fits-all approaches.

Military veterans have higher aggregate prevalence of risk factors for cognitive decline than non-veterans. This includes risk factors like diabetes, chronic pain, smoking, depression, and more. The disparity in prevalences is due in part to the unique experiences and exposures of their military service. Alzheimer's disease and other dementias are debilitating diseases with large financial and logistical burdens. These burdens are held by the patient, their family, friends, and caregivers, as well as healthcare professionals, and healthcare systems. Standardized screening for these risk factors may be helpful for understanding risk profiles that lead to cognitive decline. Additionally, screening must occur early to encourage early intervention and behavioral modifications and to reduce these burdens. This perspective presents the prevalence of risk factors for cognitive decline in the Veteran and non-veteran populations and proposes an approach to managing risk factors in Veterans.

Background: Illiteracy may overestimate screening test interpretation for older adults with suspected cognitive decline. In rural areas of Brazil, the illiteracy rate and the lack of valid cognitive instruments may postpone the diagnosis of cognitive disorders.

Objective: To determine the diagnostic accuracy of the Addenbrooke's Cognitive Examination (ACE-R) and Mini-Mental State Exam (MMSE) as well as the prevalence of mild cognitive impairment (MCI) for older adults with low education in a Quilombola community placed in Northeast Brazil, compared to cognitively healthy.

Methods: 204 participants were collected from a sociodemographic and clinical evaluation and were subsequently the ACE-R and MMSE. Among them, 25 subjects presented MCI, and 179 were classified as cognitively healthy.

Results: The prevalence of MCI was 12.3%; optimal accuracy yielded highest values for the comparison between controls and MCI for both ACE-R [Area Under the Curve (AUC) = 0.96] and MMSE (AUC = 0.96).

Conclusion: These findings support establishing reliable cutoff scores for cognitive assessment of older adults with low educational attainment, living in rural areas.

Background: Alzheimer's disease (AD) is a continuum between normal health and dementia with a long preclinical phase, during which AD pathologies start to emerge, but where there are not yet any overt symptoms. The hallmark pathologies of AD are extracellular β-amyloid (Aβ) plaques and intra-neuronal neurofibrillary tangles (NFTs). Aβ deposition is present at the preclinical stage. Additionally, raised microglial activation is a key factor in AD. However, its exact timing and role is still unclear. This exploratory study investigated the prevalence of microglial activation and its association with Aβ deposition and memory impairment in preclinical AD.

Methods: A total of 19 preclinical AD subjects with no cognitive complaints but abnormal Aβ deposition present on ¹¹C-Pittsburgh Compound B (¹¹C-PiB PET) and 10 healthy subjects with no cognitive complains or abnormal Aβ deposition on ¹¹C-PiB PET underwent ¹¹C-PK11195 PET (¹¹C-PK). Additionally, the preclinical AD subjects underwent formal cognitive testing with sensitive memory tests, including the Rey Auditory Verbal Learning Test, the Rey Complex Figure Test, and the Face-Name Associative Memory Exam.

Results: Microglial activation was raised in occipital and parietal cortices in preclinical AD subjects compared to healthy controls (p < 0.01). In the preclinical subjects there were significant positive correlations between Aβ load and microglial activation in parietal areas (p < 0.01). Finally, in the preclinical subjects, there were significant negative correlations between microglial activation and memory test performance in selected cortical areas (p < 0.01).

Conclusion: Microglial activation was significantly raised in preclinical AD cases with no cognitive complaints and associated with impaired memory test performance. This suggests that microglial activation is present before overt clinical symptoms emerge and may be detrimental to cognition even at this early stage.

Objective: To examine the evidence regarding to the use of headphones in music programs for people with dementia in long-term care homes (LTC) and identify enablers and barriers to its implementation.

Introduction: Headphones can provide an immersive auditory experience, powerfully stimulating memories and evoking emotional expression. However, reviews on factors influencing their implementation in LTC settings are limited.

Methods: This review followed the Joanna Briggs Institute methodology and was reported according to the PRISMA-ScR Checklist. A search was conducted across databases, including PubMed, CINAHL, Embase, Web of Science, Scopus, PsycINFO, and ProQuest. Studies were included if they explicitly delivered the music program using headphones for people with dementia in LTC homes. Data were extracted and thematically synthesized to identify key enablers and barriers to headphone use and program implementation.

Results: A total of 21 studies were included. Music delivered via headphones demonstrated significant potential to pain relief, reduce the behavioral and psychological symptoms, delirium, control hyperactive behavior, and improve sleep quality. The key enablers for its implementation included (1) Comfortable and immersive experience, (2) Good accessibility and sustainability, (3) Enhanced engagement and interactions and (4) Appropriate staff training and collaboration. Barriers included (a) Less optimal headphone options in dementia care, (b) Staff burden and shortage, (c) Operational challenges, and (d) Music selection and personalization challenges.

Conclusion: This scoping review identifies key enablers and barriers to implementing headphone-based music programs for people with dementia in LTC homes. Future research should develop strategies for optimal headphone use, staff collaboration, and personalized music delivery to support sustainable and effective implementation.

This perspective brings together authors from care aesthetics, dementia studies, mental health nursing, and clinical psychology to explore how aesthetics and Polyvagal Theory intersect in dementia care. Across these fields, there is growing recognition that wellbeing is shaped not only by clinical interventions but also by the subtle, embodied cues that create a sense of safety, connection, and belonging for patients. Concepts such as aesthetic care, in-the-moment practices, and everyday aesthetics emphasize how lived experience and wellbeing is grounded in the sensory and relational details of everyday life. In parallel, Polyvagal Theory provides a psychophysiological framework for understanding how people respond to such cues through the process of threat detection, co-regulation, and social engagement. By placing these perspectives side-by-side, we explore the currently untapped benefits of developing a cross disciplinary therapeutic toolkit for clinicians working with people living with dementia. Looking ahead, integrating aesthetics and Polyvagal-informed approaches could reshape dementia care into a practice that values safety, connection, and meaning as core clinical outcomes. Although further research is needed to translate this integrated model into practice, the work of the authorship in both research and clinical practice with people with dementia illustrate that such approaches are already ongoing and can bring tangible benefits for several stakeholders, including people living with dementia.

Alzheimer's disease (AD) is a complex neurodegenerative disorder influenced by various factors, including genetic and exposure-related. Certain combinations of these factors may promote AD more substantially than others. APOE4 is the strongest genetic risk factor for AD. Traffic-related air pollution (TRAP) and infections are important exposure-related AD risk factors. Here we investigated how the interplay between a history of infections and chronically high exposure to TRAP (highTRAP) impacts the subsequent risk of AD and other dementias (AD+) in carriers and non-carriers of APOE4 in UK Biobank (UKB) participants aged 60-75 years. HighTRAP was approximated by the proximity (50 meters or less) of a participant's primary residence to a major road. Chi-square, Wilson score interval, Wald interval, Wald risk ratio, Welch tests, and regression were used to examine statistical significance. We found that UKB participants with a history of various infections (by ICD-10 codes), but without highTRAP, had a 54% increase in AD+ risk. HighTRAP alone did not significantly influence AD+ risk. Individuals with both a history of infections and highTRAP had a 164% higher risk of AD+ compared to those without either factor. That risk was much higher (349%) in non-carriers of APOE4 but became non-significant in APOE4 carriers. We conclude that avoiding high exposure to TRAP may significantly reduce the risk of AD in non-carriers of APOE4 with a history of infections but not in carriers. One potential explanation could be that APOE4 is a stronger AD risk factor, whose AD-promoting effects may outweigh those of other risk factors.

Dementia care in the United Kingdom (UK) faces vast and complex systemic challenges, impacting not only individuals with dementia but also their families, communities, and the broader healthcare system. We outline these challenges and advocate for a transformative shift towards proactive and integrated community-anchored models of care. We highlight the UK-based Community Health and Wellbeing Workers (CHWW) model, which already delivers universal, holistic household-level support and is uniquely positioned within the communities to address dementia care gaps. Building on this foundation, we introduce ComPROACT, a CHWW-led outreach approach targeting cognitive decline and dementia across the care continuum. This initiative integrates both pre- and post-diagnostic dementia care support, particularly in underserved communities, not by creating new parallel services but by reimagining existing neighbourhood-based roles. Empowering CHWWs to be dementia-capable offers a sustainable pathway to better bridge the systemic gap between primary care, community, and dementia services.

Introduction: Population aging increases the coexistence of geriatric syndromes, including sarcopenia and cognitive impairment, which negatively affect functional prognosis and clinical outcomes. Evidence on the association between sarcopenia and cognitive performance in hospitalized elderly individuals, particularly across cognitive domains, remains limited. Therefore, the objective of this study was to investigate the association between sarcopenia and cognitive performance, both globally and across specific cognitive domains, in hospitalized elderly individuals.

Methods: This observational cross-sectional study included elderly patients hospitalized in a medium-sized hospital in São Paulo, Brazil, from 2024 to 2025, evaluated within the first 48 hours of admission. Exclusion criteria included weight-loss diets, chronic renal failure on dialysis, paresis or hemiparesis due to stroke, altered body fluid levels, pacemaker use, and chronic corticosteroid therapy. Sarcopenia screening and diagnosis followed the European Consensus criteria, and cognitive performance was assessed using the Mini-Mental State Examination (MMSE). Comparative analyses were conducted among non-sarcopenic, sarcopenia risk, and sarcopenic groups, including correlations with sociodemographic variables.

Results: Eighty-four older adults were assessed (54.76% women; mean age 68.1 ± 6.7 years). Sarcopenia risk was identified in 29.76% and confirmed sarcopenia in 19.05%. MMSE scores showed a moderate negative correlation with age (r = -0.48; p < 0.0001) and positive correlations with education (r = 0.58; p < 0.0001), physical activity (r = 0.31; p = 0.0038), and income (r = 0.23; p = 0.0326). Mean MMSE scores differed significantly among groups: non-sarcopenic (26.84 ± 3.24), sarcopenia risk (22.32 ± 5.86), and sarcopenic (18.69 ± 7.98) (p < 0.0001). Worse performance in orientation, attention/calculation, and language was observed in the sarcopenia risk and sarcopenia groups (p < 0.001).

Conclusion: Sarcopenia, even at early stages, is associated with reduced global cognitive performance and specific impairments in orientation, attention/calculation, and language in hospitalized elderly individuals. These findings underscore the importance of early screening and targeted interventions to preserve both muscle and cognitive health, reinforcing the need for integrated care strategies in hospital settings.