Frontiers in dementia最新文献

Background: Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are two of the most common neurodegenerative diseases in older adults, and both show well-documented sex-specific differences in terms of clinical presentation, prevalence, and progression trajectories. However, the underlying neurobiological substrates that underpin these differences are poorly understood. In vivo biomarkers are well-suited to yield insights into how biological sex may shape disease pathophysiology in AD and DLB, and thus inform future research and precision medicine. The objective of this review is to synthesize recent evidence on sex differences related to biomarkers of AD and DLB.

Methods: We conducted a literature search of PubMed for studies published between January 2000 and May 2025 examining sex differences in neuroimaging and biofluid markers of mild cognitive impairment (MCI), AD, and/or DLB. Eligible studies were required to include sex-stratified or sex-interaction analyses in human participants with clinically defined MCI (due to AD or DLB), AD, or DLB.

Results: Of a total of 261 articles imported for screening, 63 met inclusion criteria, comprising 50 cross-sectional and 13 longitudinal investigations across biofluid markers (n = 18) studies, structural imaging (n = 18), functional imaging (n = 16), and molecular imaging (n = 11) studies. Women demonstrated initial cortical structural and metabolic advantages followed by accelerated decline. In MCI and AD, women were generally more susceptible to tau pathology and APOE ε4-related risk. In contrast, men with DLB showed greater metabolic and dopaminergic abnormalities, though women with DLB frequently exhibited mixed biomarker profiles. APOE ε4 conferred increased vulnerability in women for both conditions. Biofluid markers also revealed sex-specific expression patterns and associations with clinical outcomes.

Discussion: There is growing evidence that biological sex significantly influences the pathophysiology of AD and DLB as captured by in vivo biomarkers. These findings highlight the growing importance of analyses that consider sex differences in biomarker research and support the development of personalized diagnostic and therapeutic strategies in neurodegeneration. Future research should prioritize longitudinal studies to define optimal biomarker sequencing and therapeutic windows for each sex, while also investigating the genetic, hormonal, metabolic, pharmacological, and environmental mechanisms that underlie these sex differences, ultimately advancing precision medicine in neurodegenerative disease.

Background: With the rapid aging of Canada's population, more older adults are choosing to "aging in place," yet they face challenges of social isolation and health risks. Emerging social robots are considered to have potential in reducing loneliness and promoting intergenerational communication.

Objective: This study aimed to explore how two tiny social robots (EMO and AIBI) support intergenerational interactions between older adults and university students, focusing on their emotional value, functionality, and perceived risks or limitations.

Methods: We applied the Interpretive Description qualitative methodology. Three focus groups were conducted in community settings, including 13 older adults (aged 51-81 years, including two in their early fifties who were active members of the lab's older adult partner group) and 13 university students (>18 years). The study involved separate introductions to the robots for each group, intergenerational joint sessions, and thematic analysis, following COREQ guidelines.

Results: Three key themes emerged: (1) Emotional and companionship value-older adults highlighted improved mood, reduced loneliness, and practical benefits such as reminders; (2) Concerns about limitations and risks-students emphasized technical challenges, sustainability, and risks including over-reliance, communication barriers, and maintenance; (3) Bridging generations-both groups recognized the robots' role in fostering shared engagement and emotional resonance across age groups.

Conclusion: Tiny social robots show promise in enhancing older adults' emotional well-being and fostering intergenerational connections. Differences in perspectives underscore the need for co-design approaches that integrate older adults lived experiences with younger people' concerns for usability and safety.

Objective: Improvisational storytelling can encourage older adults to reflect on their meaning and purpose in life by creatively bringing up valuable patterns and themes from their memories and experiences. Robots for storytelling with older adults have so far aimed to boost their cognitive function and social interactions, rather than a pursuit of meaning and personal reflection.

Methods: We used empirical analysis of expert storytelling facilitators to design a Wizard-of-Oz (WoZ) operated robot that engages older adults in improvisational storytelling to tap into their meaning and purpose in life.

Results: Our analysis of stories created by 16 participants and their interactions with the robot suggests that older adults reflected on family, relationships, and activities meaningful to them and engaged with the robot as a companion during the activity.

Discussion: We provide design implications for an autonomous storytelling robot and discuss the potential for information collected during the storytelling activity to further foster exploration of meaning and purpose among older adults.

Background: While non-pharmacological dementia prevention is increasingly prioritized in research and policy, intersectional perspectives remain underrepresented. These are essential to address structural determinants of health and persistent diversities and inequities. This scoping review aimed to synthesize the existing amount of research on dementia risk and prevention in relation to migration background, focusing on three questions: (1) dementia risk and associated risk factors, (2) prevention, and (3) evidence concerning the most marginalized migrant populations.

Methods: A systematic search was conducted in PubMed, PsycInfo, and Web of Science following PRISMA guidelines. The Population-Concept-Context (PCC) framework was used to define inclusion and exclusion criteria. Two researchers independently screened abstracts and full texts; discrepancies were resolved through discussion with a third reviewer. The included studies were synthesized and discussed.

Results: Thirty-nine studies met the inclusion criteria for (1), including some known risk factors and relevant migration background factors, such as language barriers, discrimination, and mental health. Regarding prevention (2), only a few studies addressed migration-related aspects, including faith, internet use, or diagnosis. Evidence on asylum seekers, undocumented individuals, or those with irregular status was absent (3).

Conclusion: This review highlights significant knowledge gaps in dementia research concerning people with a migrant background. However, risk and preventive factors were summarized and partially combined regarding targeted, sensible prevention. Nevertheless, migration might modify dementia risk across multiple levels, yet preventive efforts remain sparse. Addressing these gaps is essential to designing equitable strategies for reducing dementia risk and inclusive implementation in research and practice.

Systematic review registration: identifier: OSF.IO/YHVAW.

Introduction: In recent years, the disclosure of Alzheimer's disease (AD) biomarkers has become increasingly common, offering critical insights into disease risk and progression. However, in low-resource settings, where healthcare access, provider training, and patient support are often limited, disclosing AD biomarkers presents unique ethical, logistical, and psychological challenges.

Objective: This perspective explores the implications of AD biomarker disclosure in these settings, highlighting the potential risks of patient distress, misinformation, and inadequate follow-up care. For this purpose, we conducted a review of available literature, peer-reviewed studies, regional reports, and policy documents addressing AD in Latin America. Our literature search prioritized diagnostic advances, biomarker disclosure, treatment access, and health system challenges, providing a focused evidence base to frame the discussion of regional gaps and opportunities.

Discussion: We discuss strategies to support responsible disclosure practices, including culturally sensitive participant education, enhanced provider training, and policy adaptations to improve accessibility and support systems. Ultimately, we advocate for a careful, context-specific approach to AD biomarker disclosure that prioritizes patient well-being and equity in low-resource environments.

Background: Agitation is a common neuropsychiatric symptom of Alzheimer's dementia. Limited qualitative evidence is available to characterize the clinical meaningfulness of changes in agitation behaviors, as assessed by the Cohen-Mansfield Agitation Inventory (CMAI).

Objective: To collect qualitative data to characterize the magnitude of change in CMAI scores required to represent a clinically meaningful improvement in agitation behaviors from the perspectives of physicians and professional caregivers.

Materials and methods: One-on-one qualitative interviews were conducted with 15 physicians treating Alzheimer's dementia and 15 professional caregivers. Nine patient vignettes depicting observed changes in CMAI score profiles over a 12-week study period were used as examples of different magnitudes of change in the CMAI total score.

Results: The proportion of participants affirming clinical meaningfulness varied for both physicians and caregivers within and across the nine vignettes presented; however, the four vignettes corresponding to a CMAI total score reduction of 14 or greater were considered clinically meaningful to all participants. Most physicians (8/13) and caregivers (7/13) found a total score reduction of 5 to be clinically meaningful, and some participants (2 caregivers; 0 physicians) articulated that even minimal changes could be clinically meaningful depending on the type of behavior.

Conclusion: Participants who regularly treat people with Alzheimer's dementia described a significant burden associated with agitation behaviors and provided qualitative examples highlighting that even minor reductions in the frequency of such behaviors can have meaningful benefits for the patient's care and the burden on professional caregivers and family members.

Affective prosody, the expression of emotion via speech, is critical for successful communication. In dementia of the Alzheimer's type (DAT), impairments in expressive prosody may contribute to interpersonal difficulties, yet the underlying acoustic and neural mechanisms are not well understood. This exploratory study examined affective prosody production and cortical activation in individuals with DAT using a multimodal approach. Ten participants with DAT completed three speech tasks designed to elicit happy, sad, and neutral emotional tones. Acoustic features were extracted using Praat software, and cerebral hemodynamics were recorded using functional near-infrared spectroscopy (fNIRS), focusing on oxygenated (HbO) and total (HbT) hemoglobin levels across hemispheres. Multinomial logistic regression showed that initial fundamental frequency and speech rate significantly predicted emotional condition. Paired-sample t-tests revealed hemispheric differences in HbO and HbT during affective speech, particularly in the happy and neutral conditions. These findings suggest that individuals with DAT may exhibit reduced modulation of affective prosody and altered patterns of hemispheric activation during emotionally expressive speech. While preliminary and limited by the absence of a control group, this study highlights behavioral and neural features that may contribute to communication challenges in DAT and provides a foundation for future research on affective prosody as a potential target for intervention or monitoring.

[This corrects the article DOI: 10.3389/frdem.2025.1601462.].