Search

Objectives: Problem adaptation therapy (PATH) is a relatively new psychotherapy that recognises the importance of simultaneously targeting cognitive impairment and functional disability in the treatment of late‐life depression. This is the first systematic review to examine the effectiveness of PATH. Methods: Ageline, Embase, Medline, PsycINFO, Scopus and ProQuest databases were searched from 2010 until 5 April 2024, for studies that evaluated PATH for older people. Where possible, effect sizes (Hedges' g) with 95% confidence intervals and p values were calculated and pooled using a random effects model. The reporting quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tools and certainty of the evidence behind each result assessed with The Grading of Recommendations Assessment, Development and Evaluation method. Results: Twelve papers, from seven independent studies and a pooled sample of 579 older adults with multiple comorbidities, were included in this review. PATH participants experienced immediate reductions in depression symptom ratings (gw = 0.72, p < 0.01, Nstudies = 5), alongside small improvements in disability (gw = 0.61, p = 0.04, Nstudies = 4) compared to peers that received supportive therapy, brief psychoeducation, or usual care. The overall evidence quality was, however, characterised by bias, inconsistency, and imprecision in effect estimates. Positive participant feedback and low dropout rates (15%–31%) suggested treatment satisfaction, although these data were not routinely provided. Conclusions: PATH may be a viable treatment for older people living with mental and cognitive disorders, however there is a need for more rigorous research incorporating follow‐up assessments to consolidate the effectiveness of PATH relative to other treatments. Incorporating measures of treatment fidelity are also critical to interpreting and generalising these data. The protocol for this study was prospectively published on the Open Science Framework (https://osf.io/gx57a). [ABSTRACT FROM AUTHOR]

Objectives: For many people with dementia and unpaid carers, using technology for care and support has become essential. Rapid proliferation of technology highlights the need to understand digital access to health and social care services for dementia. This mixed‐methods systematic review aims to explore digital access to health and social care services for dementia, from the perspective of people with dementia and unpaid carers. Methods: Nine electronic databases were searched in May 2023 for qualitative, quantitative, or mixed‐method studies, published in English or German, focused on experiences of using technology‐delivered health and social care services for people with dementia and unpaid carers. After removal of duplicates and screening, 44 empirical papers were included. Results: From the 44 studies, findings were grouped into five categories, highlighting experiences for people with dementia and unpaid carers: (1) Adapting to technology, (2) Inequalities and variations in outcomes, (3) Impact on caring, (4) Impact on health, and (5) Impact on relationships. Proliferation of technology in care access emphasised the need for quick adaptation to technology and examination of its impact. The impact of such service delivery has evidenced mixed findings. There were improvements in the health and wellbeing of people with dementia and unpaid carers, and benefits for their dyadic relationship. However, using technology for health and social care access is not always possible and is often reliant on unpaid carers for support. Lower tech‐literacy, lack of equipment or money to buy equipment and poor internet connection can impact the potential for positive outcomes. Conclusions: Technology can bring great benefits: social inclusion, improved service access and care. However, using technology in service delivery in dementia needs careful thought. Professionals and service providers need to be cognizant of the complex nature of dementia, and the benefits and challenges of hybrid service delivery. Key points: Evidence emphasises benefits and challenges to the availability, implementation, use, of technology in health and social care access in dementia.Though there are issues, technology can help improve quality of life for people with dementia, can support carers to care, and facilitate positive relationships between unpaid carers and people with dementia.Proliferation of technology for care access was expedited during COVID‐19, but has not been equally rolled out, making remote and disadvantaged groups less well‐served.A hybrid delivery of services in which people are given choice of delivery method, and are supported in accessing and using technology, will better serve people with dementia and unpaid carers. [ABSTRACT FROM AUTHOR]

The central nervous system (CNS) is widely recognized as the only organ system without lymphatic capillaries to promote the removal of interstitial metabolic by‐products. Thus, the newly identified glymphatic system which provides a pseudolymphatic activity in the nervous system has been focus of latest research in neurosciences. Also, findings reported that, sleep stimulates the elimination actions of glymphatic system and is linked to normal brain homeostatis. The CNS is cleared of potentially hazardous compounds via the glymphatic system, particularly during sleep. Any age‐related alterations in brain functioning and pathophysiology of various neurodegenerative illnesses indicates the disturbance of the brain's glymphatic system. In this context, β‐amyloid as well as tau leaves the CNS through the glymphatic system, it's functioning and CSF discharge markedly altered in elderly brains as per many findings. Thus, glymphatic failure may have a potential mechanism which may be therapeutically targetable in several neurodegenerative and age‐associated cognitive diseases. Therefore, there is an urge to focus for more research into the connection among glymphatic system and several potential brain related diseases. Here, in our current review paper, we reviewed current research on the glymphatic system's involvement in a number of prevalent neurodegenerative and neuropsychiatric diseases and, we also discussed several therapeutic approaches, diet and life style modifications which might be used to acquire a more thorough performance and purpose of the glymphatic system to decipher novel prospects for clinical applicability for the management of these diseases. Key points: Age‐associated dementia is growing rapidly leading to various neurological diseases and is currently one of the prime reasons for diseases and related morbidity which impacts a wide range of populations.Recently discovered glymphatic system, through which CNS is cleared of potentially harmful substances and plays a significant role in modulating various neurodegenerative and neuropsychiatric illnesses.To avert these diseases various natural interventions like traditional herbal medicine, non‐invasive neurological stimulation, regular sleep cycle and dietary additives may ameliorate disease pathogenesis by improving glymphatic activity are recently identified.Furthermore, investigations are going on the role of nutrigenomics and micronutrients in boosting the activity of glymphatic clearance in various neurological diseases. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review and meta‐analysis aimed to determine the prevalence of loneliness and social isolation among informal carers of individuals with dementia and to identify potential influencing factors. Methods: We conducted a comprehensive search across 10 electronic databases, including PubMed, Cochrane, Embase, Web of Science, PsycINFO, CINAHL, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG. Our search strategy covered the inception of the databases up to September 16, 2023, with an updated search conducted on March 8, 2024. Prevalence estimates of loneliness and social isolation, presented with 95% confidence intervals, were synthesized through meta‐analysis. Subgroup analyses and meta‐regression were employed to explore potential moderating variables and heterogeneity. Results: The study encompassed 27 research papers involving 11,134 informal carers from 17 different countries. The pooled prevalence of loneliness among informal carers of individuals with dementia was 50.8% (95% CI: 41.8%–59.8%), while the pooled prevalence of social isolation was 37.1% (95% CI: 26.7%–47.6%). Subgroup analyses and meta‐regression indicated that various factors significantly influenced the prevalence of loneliness and social isolation. These factors included the caregiving setting, study design, the intensity of loneliness, geographical location (continent), data collection time, and the choice of assessment tools. Conclusions: This study underscores the substantial prevalence of loneliness and social isolation among informal carers of individuals with dementia. It suggests that policymakers and healthcare providers should prioritize the development of targeted interventions and support systems to alleviate loneliness and social isolation within this vulnerable population. Key points: Informal carers of people with dementia contend with unique circumstances that render them susceptible to both loneliness and social isolation.There is a significant prevalence of loneliness and social isolation in informal carers of individuals with dementia.Several significant moderators influence the prevalence of loneliness and social isolation among informal carers of individuals with dementia.Moderator analysis can guide targeted interventions and support systems for at‐risk informal carers of people with dementia to alleviate loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Background: Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts. Methods: The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non‐clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst. Results: We included 14 papers reporting on six studies. All services were US‐based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well‐being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages. Conclusions: DCN services have the potential to effectively provide non‐clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required. Key points: Evidence on the impact of Dementia Care Navigators (DCNs) is limited but shows promising benefits for people living with dementia and their carers.More research needs to be conducted in countries other than the US, where all evidence was reported, and with similar outcome measures to allow comparison.DCNs are a highly useful professional group without medical training, who can navigate people living with dementia and their carers to support and provide support themselves. [ABSTRACT FROM AUTHOR]

Background: Researchers are increasingly being called upon to involve people with dementia in research that pertains to them. Participatory Action Research (PAR) has been one of the approaches that has been utilized to do this. How people understand and apply the ideas behind this approach however has often been atheoretical and diverse. This has implications for how purpose, power, voice and agency are conceived and actualized. Objectives: This paper will examine how theoretical construction of PAR can inform the process of meaningfully involving people living with dementia in research. Specifically, drawing on the work of Paulo Freire, this paper will articulate a way of conceptualizing PAR that is explicitly critical and then demonstrate how these ideas informed a PAR study focused on addressing stigma and discrimination with people living with dementia. Conclusion: The purpose of the paper is to engage researchers and people with lived expertise in critical reflection of what it actually means to involve people with dementia in research. Key points: The importance of meaningfully engaging people with dementia in research about and for them is becoming well‐accepted but an understanding of what this means and how to do this is far less developed.Paulo Friere's critical pedagogy provides a useful framework for conceptualizing and carrying out reflective and empowering Participatory Action Research (PAR) that challenges oppression and discrimination.A Frierien‐based approach challenges conventional research relationships, promotes critical awareness of the link between personal experiences and broader structural systems of oppression and discrimination, focuses on developing a collective understanding of issues, and prioritizes the voices of those with lived experience of oppression to take action.The project provides an example of how these ideas were put into practice to take action against dementia‐based stigma and discrimination. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic impacted on the provision of care and routine activity of all National Health Service (NHS) services. While General Practitioner referrals to memory services in England have returned to pre‐pandemic levels, the estimated dementia diagnosis rate (DDR) fell by 5.4% between March 2020 and February 2023. Methods: In this paper we explore whether this reduction is accurate or is an artefact of the way the NHS collects data. Results: We explore the processes that may have affected national dementia diagnosis rates during and following the COVID‐19 pandemic. Conclusions: We discuss what action could be taken to improve the DDR in the future. Key points: Despite General Practitioner (GP) referrals to memory services in England returning to levels seen before the pandemic, there was a decline of 5.4% in the estimated dementia diagnosis rate (DDR) from March 2020 to February 2023.This paper explores the factors which may have affected the national DDR reduction. These include a backlog in dementia referrals, a reduction in coding of diagnoses, or a decrease in true dementia prevalence secondary to excess COVID‐19 deaths which has yet to be reflected in the DDR denominator.Further work is suggested to accurately capture dementia prevalence in the United Kingdom (UK). These include an up‐to‐date multicentre population‐based cohort study and adjusting the DDR denominator for factors known to affect dementia susceptibility such as deprivation, rurality, and ethnicity. [ABSTRACT FROM AUTHOR]

Background: Psychiatric comorbidity is high in adults with posttraumatic stress disorder (PTSD), with up to 90% having at least one additional condition, and two‐thirds having two or more other diagnoses. With an increasing aging population in industrialized counties, knowing which psychiatric disorders frequently co‐occur in older adults with PTSD can have implications to improve diagnosis and treatment. This systematic literature review explores the current empirical literature on psychiatric comorbidity in older adults with PTSD. Method: Literature databases PubMed, Embase, PsycINFO, and CINAHL were searched. The following inclusion criteria were applied: research done since 2013, PTSD diagnosis based on diagnostic criteria according to Diagnostic and Statistics Manual‐Fifth Edition, International Classification of Diseases—10th Revision (ICD‐10), or ICD‐11, and studies include individuals aged 60 years or older. Results: Of 2068 potentially relevant papers identified, 246 articles were examined based on titles and abstracts. Five papers met the inclusion criteria and were included. Major depressive disorder and alcohol use disorder were the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD. Conclusions and implications: Screening for depression and substance use in older adults should include an assessment of trauma and PTSD. Additional studies in the general older adult population with PTSD and a broader range of comorbid psychiatric disorders are needed. Key points: Major depressive disorder and alcohol use disorders are the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD.Based on this, screening for trauma and PTSD should be included in older adults with depression and substance useQualitative epidemiological studies on psychiatric comorbidities, such as personality disorders, in older adults with PTSD are limited and needed. [ABSTRACT FROM AUTHOR]

Objectives: DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) is designed to address fundamental, and, as yet unanswered questions about inequalities, outcomes and costs following diagnosis with dementia. These answers are needed to improve the quality of care and equity of access to care, and therefore the quality of life, of people with dementia and their carers.Method: DETERMIND is a programme of research consisting of seven complementary workstreams (WS) exploring various components that may result in unequal dementia care: WS1: Recruitment and follow-up of the DETERMIND cohort-900 people with dementia and their carers from three geographically and socially diverse sites within six months following diagnosis, and follow them up for three years. WS2: Investigation of the extent of inequalities in access to dementia care. WS3: Relationship between use and costs of services and outcomes. WS4: Experiences of self-funders of care. WS5: Decision-making processes for people with dementia and carers. WS6: Effect of diagnostic stage and services on outcomes. WS7: Theory of Change informed strategy and actions for applying the research findings.Outcomes: During the life of the programme, analysing baseline results and then follow-up of the DETERMIND cohort over 3 years, we will establish evidence on current services and practice. DETERMIND will deliver novel, detailed data on inequalities in dementia care and what drives positive and negative outcomes and costs for people with dementia and carers, and identify factors that help or hinder living well with dementia. [ABSTRACT FROM AUTHOR]

Objectives: This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities. Methods: Forty‐six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis. Results: Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia. Discussion: The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home. Key points: Neighbourhoods begin within homes and are interconnected. This relationship has important implications for the discourse of ageing in place.'Home' for people living with dementia holds the same meanings for those without dementia, but with some notable differences. It is important to recognise the shifting dynamics of home and to recognise the complexity of home in the context of dementia. There is not a fixed solution to the challenges of ageing at home with dementia, but support and understanding need to evolve alongside people with lived experience.Homes are a site of renegotiation where new meanings are created to reflect the changing nature of home and the lived experience of home for those with dementia.The study has provided findings through innovation in the research design. The employment of creative methods enabled people living with dementia to participate in sharing their own narratives of home.The work provides evidence where there is a current gap in understanding 'what matters' about home for people living with dementia. [ABSTRACT FROM AUTHOR]

Objectives: Research priority setting aims to collate stakeholder opinion to determine the most pressing research questions. Priority setting exercises influence decisions around research funding, development and policy. We compared published dementia research priority setting exercises from international healthcare systems.Methods: Four multidisciplinary, international, electronic databases were searched for relevant studies (2010 until 2021). Priorities were extracted, coded and assigned to categories using thematic analysis. The Nine Common Themes of Good Practice (9CTGP) and the Reporting guideline for priority setting of health research (REPRISE) checklists were used to assess methodological and reporting quality respectively.Results: From 265 titles, 10 priority setting exercises (1179 participants, 147 priorities) were included. Studies spanned four continents and the majority included people living with dementia and their care-givers in the priority setting process (68%). Only one paper met all the best practice indicators. Issues around inclusiveness, implementation and evaluation of the priorities were apparent in nine papers. We categorised priorities under eight themes: caregivers (25%, n = 37), support (24%, n = 35), awareness and education (16%, n = 24), drugs and interventions (14%, n = 21), diagnosis (8%, n = 12), pathology (6%, n = 9), research design (5%, n = 7), and prevention (1%, n = 2). Priorities varied by geographical region, with awareness and education of higher priority in low-middle income countries, compared to caregivers and support in high income countries.Conclusions: Key priorities were identified with some commonality around themes considered of greatest importance. There is scope to improve the process and reporting of priority setting. Priorities differed according to contextual factors and so, priorities specific to one healthcare setting may not be applicable to others. [ABSTRACT FROM AUTHOR]

Background: This is a methodological paper that aims to advance the conceptualisation of participatory research by focusing on the value of capturing and understanding movement as a vital means of communication for older people with dementia in a general hospital ward. Qualitative research involving people with dementia tends to be word‐based and reliant upon verbal fluency. This article considers a method for capturing and understanding movement as a vital means of communication. Method: This narrative enquiry is underpinned by the model of social citizenship that recognises people with dementia as citizens with narratives to share. The study focused on spontaneously produced conversations that were video recorded and analysed through a lens of mobility. This enabled each participant to share what was important to them in that moment of time without always using words. Findings: The study findings showed that people with dementia have narratives to share, but these narratives do not fit the bio‐medically constructed model that is generally expected from patients. Utilising a mobilities lens enabled the narratives to be understood as containing layers of language. The first layer is the words; the second layer is gestures and movements that support the words; and the third layer is micro movements. These movements do not only support the words but in some cases tell a different story altogether. Conclusion: This methodology brings attention to layers of communication that reveal narratives as a mobile process that require work from both the teller and the listener to share and receive. Movements are shown to be the physical manifestations of embodied language which when viewed through a lens of mobility enable a deeper understanding of the experience of living with dementia when an inpatient. Viewing narratives through a mobilities lens is important to the advancement of dementia and citizenship practices. Key points: Movement and micro‐movements are a vital form of communication for people living with dementia.Viewing narratives through a lens of mobility enables a more nuanced understanding of people's narratives than just words alone.Qualitative methods based on communication strategies other than words have the potential to promote inclusion.An acknowledgement of the juxta positioning of hypermobility and micro‐mobility may help in providing quality healthcare for people living with dementia. [ABSTRACT FROM AUTHOR]

Background: Autobiographical memory (AM) is valuable not only as an indicator of mental health and cognitive function, but also as a target of therapeutic intervention for older adults. In the context of the COVID‐19 pandemic, the demand for online psychosocial interventions and assessment services has sharply increased. Thus, the present study examined the effectiveness of videoconferencing AM (vAM) intervention using the Ecological Momentary Assessment (EMA) method in addition to the traditional paper‐and‐pencil assessment among samples of community dwelling older adults. Methods: Twenty‐seven older adults (aged 66–86 years) participated in a vAM intervention composed of 4 weekly 90‐min sessions. The primary outcome was AM specificity, with secondary outcomes as depressive symptom and cognitive function, measured before and after the intervention. In addition, daily emotions were measured through EMA over 4 weeks of intervention. The EMA data were analyzed using a multilevel analysis. Results: The results showed low dropout rates (7%) and high EMA response rates (85%). Autobiographical memory specificity increased (Cohen's d = 0.678), and the level of depression declined significantly (Cohen's d = 0.375) after the program. Additionally, measures assessing cognitive function, such as Seoul Verbal Learning Test and DSC (Digit Symbol Coding), showed significant improvements. The EMA results indicated a decrease in the intensity and proportion of negative emotions experienced during the program. Conclusions: This study is the first to utilize videoconferencing and EMA to deliver an AM intervention targeting older adults. The intervention was effective in improving mental health and cognitive function, including AM in older adults. Additionally, EMA was found to be a feasible tool for use in older adults. Key points: Video‐conferencing intervention and Ecological Momentary Assessment (EMA) were feasible for older adults.After video‐autobiographical memory intervention, the older adults showed significant improvements in Autobiographical memory (AM), cognitive function, and depressive symptoms.During the intervention, participants experienced a reduction in negative affects in their daily lives. [ABSTRACT FROM AUTHOR]

Objectives: Assessing for recovery in delirium is essential in guiding ongoing investigation and treatment. Yet, there is little scrutiny and no research or clinical consensus on how recovery should be measured. We reviewed studies which used tests of neuropsychological domains and functional ability to track recovery of delirium longitudinally in acute hospital settings. Methods/Design: We systematically searched databases (MEDLINE, PsycInfo, CINAHL, Embase, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials), from inception to October 14th, 2022. Inclusion criteria were: adult acute hospital patients (≥18 years) diagnosed with delirium by a validated tool; 1+ repeat assessment using an assessment tool measuring domains of delirium/functional recovery ≤7 days from baseline. Two reviewers independently screened articles, performed data extraction, and assessed risk of bias. A narrative data synthesis was completed. Results: From 6533 screened citations, we included 39 papers (reporting 32 studies), with 2370 participants with delirium. Studies reported 21 tools with an average of four repeat assessments including baseline (range 2–10 assessments within ≤7 days), measuring 15 specific domains. General cognition, functional ability, arousal, attention and psychotic features were most commonly assessed for longitudinal change. Risk of bias was moderate to high for most studies. Conclusions: There was no standard approach for tracking change in specific domains of delirium. The methodological heterogeneity of studies was too high to draw firm conclusions on the effectiveness of assessment tools to measure delirium recovery. This highlights the need for standardised methods for assessing recovery from delirium. Key points: Assessing for recovery is an essential part of delirium care, to guide clinicians' ongoing investigation and treatment and to provide accurate information to patients and carers.It is unclear what assessment tools are used to measure delirium recovery on a longitudinal basis, specifically which neuropsychological and functional domains should be assessed.A total of 21 assessment tools measuring 15 different symptom domains of delirium were used in the included studies, however, there was no standard approach for tracking change in these domains over time.The symptom domains most frequently assessed for longitudinal change in the included studies were general cognition, functional ability, arousal, attention and psychotic features. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies highlight the negative impact of social isolation and involvement in leisure activities on enhanced well‐being of individuals. However, there is dearth of evidence on relationship between social isolation and leisure activities on cognitive abilities and depression of older adults in the Indian context. The paper reports the impact of social isolation and leisure activities on cognitive functioning and depression of older adults. Methods: Data were collected from the Longitudinal Ageing Study of India (LASI), and 63,806 participants aged 45 years or above were considered for the study with adherence to the exclusion criteria. Multivariate analysis was carried out to analyse the group‐based differences. Results: Social isolation (F = 102.09, p < 0.01; η2 = 0.09) and leisure (F = 224.54, p < 0.01; η2 = 0.07) had a statistically significant impact on the cognition and depressive symptoms of participants. Socially isolated older adults with little involvement in leisure activities had the worst cognitive functioning (M = 32.76, SD = 4.41), whereas middle‐aged adults who were actively involved in leisure activities and experienced the least social isolation exhibited the best cognitive functioning (M = 32.76, SD = 4.41). However, leisure and age as independent factors did not have a significant impact on depression. Conclusion: Socially isolated participants, irrespective of age, and involvement in leisure activities exhibit poor cognitive functioning and are more likely to suffer from depression as compared to their counterparts. The findings of the study can be used to design intervention strategies aimed at reducing social isolation by incorporating leisure activities to ensure the optimal functioning of middle‐aged and older adults. Key points: Socially isolated older adults with least involvement in leisure activities reported the worst cognitive functioning.Socially isolated participants reported a positive association with depressive symptomatology.Both middle‐aged and older adults who engaged in leisure activities reported better cognitive functioning as compared to their counterparts who did not engage in any form of leisure activities.Leisure as an independent factor is not significantly associated with depressive symptoms. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive frailty combines physical frailty and cognitive impairment in the absence of dementia. The prompt detection of cognitive frailty and early implementation of preventive interventions may reduce the incidence of dementia. However, intervention studies of exergaming in older adults with cognitive frailty are scant. Therefore, we aim to investigate the effectiveness of exergaming on cognitive functions and loneliness among older adults with cognitive frailty. Design: Quasi‐experimental design. Methods: Participants were recruited from four community settings. The experimental group participated in two 40‐min group exergaming sessions weekly for eight weeks; the control group received usual care. The outcome measures were the Montreal Cognitive Assessment (MoCA) and the Chinese Version of the Loneliness Scale. Analyses of covariance were conducted to analyze whether exergaming influenced participants' cognitive functions and loneliness. In addition, the effect size of the posttest of the experimental group relative to its baseline value was calculated to determine the effectiveness of the intervention. Result: 69 older adults with cognitive frailty were included, and 35 and 34 were assigned to the experimental and control groups, respectively. The exergaming effectively improved the cognitive function of older adults with cognitive frailty. Conclusions: Exergaming interventions can effectively improve the cognitive functions of older adults with cognitive frailty but do not positively affect loneliness. We provide evidence to healthcare workers to apply exergaming interventions for older adults with cognitive frailty to improve cognitive function. Key points: This paper highlights that an exergaming intervention can effectively improve the cognitive functions of older adults with cognitive frailty.Older adults with cognitive frailty are a crucial group in the gerontology field, and this study emphasizes that healthcare workers can apply exergaming to achieve improvements in cognitive function based on our research results. [ABSTRACT FROM AUTHOR]

Objectives: There is no consensus as to whether people with advanced dementia can create a narrative identity. It is most often thought to be disturbed due to autobiographical memory disorders. In this paper, we examined how people with advanced dementia constructed their narrative identities in relation to their professional experience. Methods: This qualitative study used data obtained from 8 semi‐structured interviews. The interviewees were people with advanced dementia aged between 66 and 89 years. We analyzed the dataset based on the textual‐oriented discourse analysis. Results: The study participants created narrative identities. Their narrative identities were constructed within residual professional discourses learned during their lifespan. These discourses blended their narrative identities into coherent stories about who they are now, offered languages to describe current experiences, and emphasized important values for their self‐image. The participants built narrative identities by referring to the past and imagining a better present with the omission of the future. The past was valued positively and was a source of positive nostalgia. Projections of a better present served to reveal their needs and assess ways to meet them. Conclusions: We argue that people with advanced dementia can create complex and coherent narrative identities. They are constructed around discourses and not only using autobiographical memories. Encouraging them to create narrative identities in the dialogue can be a simple therapeutic method by which they can maintain a sense of self‐cohesion and belonging to the world. [ABSTRACT FROM AUTHOR]

Objectives: To describe and explain the outcomes of community dementia friendly initiatives (DFIs) for people with dementia and their caregivers to inform the development and tailoring of DFIs. Methods: Literature searches on DFIs were performed through two systematic online database searches of PubMed, Embase, ASSIA, CINAHL and Google scholar. Papers were only included if they evaluated outcomes using empirical data from people with dementia or caregivers. Data collection and analysis were guided by the categorization in the DEM‐FACT taxonomy and RAMESES guidelines for realist reviews. Results: Of 7154 records identified, 22 papers were included with qualitative, mixed method and quantitative study designs. The synthesis led to a description of programme theories addressing caring, stimulating and activating communities. Outcomes for people with dementia and caregivers included having contact with others, enjoyment and decrease of stress and, lastly, support. This synthesis also indicated how people with dementia participated in a specific role in DFIs, such as patient, team member or active citizen. Conclusions: DFIs generate different outcomes for people with dementia and caregivers, depending on the kind of initiative and the specific role for people with dementia. These findings could be a catalyst for initiation and further development of DFIs in a dementia friendly community (DFC). This draws attention to the multiple aspects of DFCs and supports reflection on their essential principles. Key points: This is the first synthesis of the outcomes and mechanisms of dementia friendly initiatives (DFIs) using studies with empirical data from the perspective of people with dementia or caregivers.DFIs generate different outcomes for both people with dementia and caregivers.DFIs have different outcomes for people with dementia participating in different specific roles (i.e. patient, team member or active citizen).DFI outcomes according to people with dementia and caregivers support both the practical development and research of how dementia friendly communities (DFCs) succeed in fulfilling their purpose. [ABSTRACT FROM AUTHOR]

Objectives: Positron emission tomography–magnetic resonance imaging (PET/MRI) is an emerging hybrid imaging system in clinical nuclear medicine. Research demonstrates a comparative utility to current unimodal and hybrid methods, including PET‐computed tomography (PET/CT), in several medical subspecialities such as neuroimaging. The aim of this review is to critically evaluate the literature from 2016 to 2021 using PET/MRI for the investigation of patients with mild cognitive impairment or dementia, and discuss the evidence base for widening its application into clinical practice. Methods: A comprehensive literature search using the PubMed database was conducted to retrieve studies using PET/MRI in relation to the topics of mild cognitive impairment, dementia, or Alzheimer's disease between January 2016 and January 2021. This search strategy enabled studies on all dementia types to be included in the analysis. Studies were required to have a minimum of 10 human subjects and incorporate simultaneous PET/MRI. Results: A total of 116 papers were retrieved, with 39 papers included in the final selection. These were broadly categorised into reviews (12), technical/methodological papers (11) and new data studies (16). For the current review, discussion focused on findings from the new data studies. Conclusions: PET/MRI offers additional insight into the underlying anatomical, metabolic and functional changes associated with dementia when compared with unimodal methods and PET/CT, particularly relating to brain regions including the hippocampus and default mode network. Furthermore, the improved diagnostic utility of PET/MRI, as reported by radiologists, offers improved classification of dementia patients, with important implications for clinical management. Key Points: Combined positron emission tomography–magnetic resonance imaging (PET/MRI) is an emerging imaging technique in clinical nuclear medicine.PET/MRI is predominantly used as a research tool in dementia.Improved diagnostic accuracy of PET/MRI compared to unimodal methods and PET/CT is demonstrated in other subspecialities.Awareness of the clinical utility of PET/MRI in dementia is growing, with earlier diagnosis having important implications for patient management. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the effectiveness of a cognitive intervention based on modern board and card games. Methods: We conducted two two‐arm parallel‐group, randomized controlled trials. The first one (pilot study) was nonblind. The second one (main study) was a double‐blind design. Participants (14 in a pilot study and 35 in the main study) were healthy older adults over 65 years old who were assisting to adult care institutions. In the pilot study, participants in the experimental group (n = 6) played modern board and card games which activated cognitive processes; whereas the control group (n = 6) was in the wait‐list condition. In the main study, participants in the experimental group (n = 12) also played modern board and card games; whereas the control group (n = 15) performed standardized paper‐and‐pencil cognitive tasks. Psychologists specialized in older‐people conducted all the interventions. In both studies, intervention sessions were bi‐weekly for 5 weeks. The outcomes of both studies were cognitive status and executive functioning, depressive symptomatology, and quality of life measures. All assessment and intervention sessions took place in their habitual centers. Results: In the pilot study, participants in the games intervention showed a significant improvement in semantic verbal fluency. In the main study, both interventions showed significant improvements in phonemic verbal fluency. Whilst board and card games maintained motor impulsivity control, paper‐and‐pencil tasks improved speed in an inhibition task. Conclusions: Modern board and card games could be an effective cognitive intervention to maintain some cognitive functions. Key Points: Modern board and card game and paper‐and‐pencil trainings improved verbal fluency, but only game training group maintained this benefit 3 months laterModern board and card game training maintained levels of motor impulsivity control, while paper‐and‐pencil training decreasedThe modern board and card games may be useful as a cognitive training in healthy older institutionalized adults [ABSTRACT FROM AUTHOR]

Introduction: People from ethnic minority backgrounds living with dementia are more likely to be diagnosed later and have less access to health and social care support than their White counterparts in the United Kingdom (UK). Covid‐19 has exacerbated health inequalities and diminished trust from underserved communities in the government and health services. The wider aim of the study was to explore the impact of covid‐19 on Black and South‐Asian people living with dementia and their carers as well as exploring the experiences of dementia care. The present paper specifically explores their views on trust and mistrust using an ecological model. Method: Semi‐structured interviews were conducted with 11 family carers and four people living with dementia from South Asian or Black communities living in the community. Thematic analysis was used to analyse data. Design: An exploratory qualiative design was used. Results: Four main themes were developed exploring trust at the structural, organisational, community and individual level. At the structural level, participants discussed the inequity of Covid‐19, some lack of trust in the UK Government and confusion in its messaging, and the anxiety sometimes leading to curtailment of media usage. At the organisational level, there was some evidence of a perceived lack of person‐centred and culturally sensitive care from healthcare professionals, as well as concerns around care homes as places of safety. At the neighbourhood community level, participants discussed both a distrust as well as a strengthening of relationships and, at the individual level, factors such as knowledge of services, identity, and faith influenced their experience of the pandemic. Conclusions: People living with dementia need support at all levels and this study highlights how the pandemic impacted each level. Ways to improve trust in the Government and health professionals alongside culturally adapted health messaging should be explored. Alongside this, an examination of how cultural values and norms may influence help‐seeking responses to dementia and increase trust in services may be helpful post‐pandemic. Key points: The pandemic impacted people from ethnic minority backgrounds living with dementia and their carers at each level of the socioecological modelA lack of trust in the Government and an increase in anxiety due to the media was reportedThere was a perceived lack of person‐centred and culturally sensitive care from healthcare professionals and concerns around care homes as places of safetyParticipants relationships with their community, knowledge of services, identity, and faith influenced their experience of the pandemic [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to evaluate studies which employed routine and cohort data sets to understand inequalities in dementia care pathways. Methods: We identified 27 research papers using routine data sets to investigate inequalities in dementia care pathways through electronic and grey literature searches. Papers were independently assessed by two reviewers for inclusion based on defined criteria. Included papers were quality rated using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Data was extracted based on stage(s) in dementia care pathway and socio‐economic factors investigated. Results: Inequalities were noted across dementia care pathways. Socio‐economic and protected characteristics were shown to impact the likelihood of people with dementia moving into institutional nursing care, the quality and consistency of their treatment, need for emergency and urgent healthcare, the rate of illness progression and their long‐term survival. Research was often disparate ignoring the multiple parts of the dementia care pathway, or the impact of specific factors across multiple stages. Conclusions: Our study highlights issues in dementia care pathways based on socio‐economic or protected characteristics. Equitable service provision, more culturally appropriate services, improved health literacy and increased provision for both early diagnosis and care at home can help narrow the gap in dementia care inequalities. There is greater need for research investigating dementia care pathways as something greater than the sum of its parts; exploring the influence of socio‐economic factors from a person's entrance into the system and throughout. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive stimulation therapy (CST) is one of the few non‐pharmacological interventions for people living with dementia shown to be effective and cost‐effective. What are the current and future cost and health‐related quality of life implications of scaling‐up CST to eligible new cases of dementia in England? Methods/design: Data from trials were combined with microsimulation and macrosimulation modelling to project future prevalence, needs and costs. Health and social costs, unpaid care costs and quality‐adjusted life years (QALYs) were compared with and without scaling‐up of CST and follow‐on maintenance CST (MCST). Results: Scaling‐up group CST requires year‐on‐year increases in expenditure (mainly on staff), but these would be partially offset by reductions in health and care costs. Unpaid care costs would increase. Scaling‐up MCST would also require additional expenditure, but without generating savings elsewhere. There would be improvements in general cognitive functioning and health‐related quality of life, summarised in terms of QALY gains. Cost per QALY for CST alone would increase from £12,596 in 2015 to £19,573 by 2040, which is below the threshold for cost‐effectiveness used by the National Institute for Health and Care Excellence (NICE). Cost per QALY for CST and MCST combined would grow from £19,883 in 2015 to £30,906 by 2040, making it less likely to be recommended by NICE on cost‐effectiveness grounds. Conclusions: Scaling‐up CST England for people with incident dementia can improve lives in an affordable, cost‐effective manner. Adding MCST also improves health‐related quality of life, but the economic evidence is less compelling. Key points: There are few evidence‐based non‐pharmacological interventions for people living with dementia. Cognitive stimulation therapy (CST) is both effective and cost‐effective, but current availability is constrainedThis paper reports the cost and health‐related quality of life implications of scaling‐up cognitive stimulation therapy to eligible people with dementia in England over a 25 year periodScaling‐up CST would improve general cognitive functioning and health‐related quality of life, but also increase costs for health and social care services, and for family and other unpaid carers. Adding maintenance CST would also improve health‐related quality of life, with even greater cost increasesThe higher costs of scaling‐up CST to the full eligible population over a 25 year period would be considered worth paying by reference to criteria used by the National Institute for Health and Care Excellence (NICE) in England. The economic evidence for adding maintenance CST is less compelling [ABSTRACT FROM AUTHOR]

The 10/66 Dementia Research Group has been formed to promote good-quality, internationally comparable research into dementia in developing countries through active research collaboration. In this position paper, we review existing research into dementia prevalence in developing regions of the world. Seven methodologically robust studies were identified. The prevalence of dementia, age-adjusted to the age structure of the Kerala population, ranged from 1.3% to 5.3% for all those aged 60 or over and from 1.7% to 5.2% for all those aged 65 and over. Two studies, from Ibadan, Nigeria and Ballabgarh, India, reported strikingly low prevalence figures. The reported prevalence for most studies was somewhat lower than the consistent figures for Europe reported by the EURODEM concerted action. Based on critical review of the literature, and on the practical research experience of members of the 10/66 group, recommendations have been made for procedure in the following areas: age limits for inclusion in dementia surveys, age ascertainment, sampling, scope for incidence studies, functional assessment and culture- and education-fair dementia diagnosis. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Virtual reality (VR) technology is a potential method to use in cognitive intervention, but the use of VR in cognitive stimulation intervention for older adults has not been investigated. Therefore, the aim of this study was to investigate the mood change of older adults after participating in the VR cognitive stimulation activity.Methods: This is a multicenter randomized controlled, cross-over trial. The intervention was a VR cognitive stimulation activity, and the control was a paper-and-pencil activity. The participants were older adults with age over 60 and recruited in the elderly community centers. The Positive and Negative Affect Score (PANAS) was used to measure mood change. Mean difference (MD) with 95% confidence interval (95% CI) was calculated. The Simulator sickness questionnaire was used to measure adverse events.Results: A total of 236 participants from 19 community centers were recruited. After the VR activity, the participants had a significant increase in total PANAS positive affect score (MD = 2.09, 95% CI = 0.69 to 3.49), and a significant reduction in total negative affect score (MD = -1.99, 95% CI = -2.55 to -1.43). The reduction in negative affect score was significantly larger in VR activity than paper-and-pencil activity (MD = -0.48, 95% CI = -0.98 to 0.00). Besides, only three participants reported severe advance events after VR activity.Conclusions: The use of VR technology is well accepted by older adults. Therefore, the use of VR technology through smartphone and a mobile app can be a potential method for future cognitive training interventions. [ABSTRACT FROM AUTHOR]

Objectives: The number of older adults with severe mental health problems such as schizophrenia is likely to double in the next 20 years. The needs of this patient group change across the life course, but difficulties with social functioning persist into older age. Poorer social functioning is associated with poorer outcomes and has been identified as a priority for intervention by patients themselves. This paper systematically reviews studies examining the effectiveness of psychosocial interventions on social functioning for people with severe mental health problems in later life.Methods: A systematic review of peer-reviewed journal articles was conducted and databases were searched from inception to December 2017. The review was limited to psychosocial interventions, for mid to older aged adults (≥40 years of age) with severe mental illness that included a validated measure of social functioning.Results: Fifteen studies (17 papers) met inclusion criteria. There was evidence to support skills training interventions that primarily focused on social skills training or integrated mental and physical health interventions. There was not sufficient evidence to recommend any other interventions.Conclusions: The results highlight the limited nature of interventions designed specifically for older people with severe mental health problems that target social functioning and the need for more robust, large-scale studies in the area. Current evidence suggests that cognitive behaviour therapy can be effective in targeting social functioning in younger age groups, but, as yet, there is insufficient evidence to recommend this intervention for an older population. [ABSTRACT FROM AUTHOR]

The 10/66 Dementia Research Group has been formed to promote good-quality, internationally comparable research into dementia in developing countries through active research collaboration. In this position paper, we review existing research into dementia prevalence in developing regions of the world. Seven methodologically robust studies were identified. The prevalence of dementia, age-adjusted to the age structure of the Kerala population, ranged from 1.3% to 5.3% for all those aged 60 or over and from 1.7% to 5.2% for all those aged 65 and over. Two studies, from Ibadan, Nigeria and Ballabgarh, India, reported strikingly low prevalence figures. The reported prevalence for most studies was somewhat lower than the consistent figures for Europe reported by the EURODEM concerted action. Based on critical review of the literature, and on the practical research experience of members of the 10/66 group, recommendations have been made for procedure in the following areas: age limits for inclusion in dementia surveys, age ascertainment, sampling, scope for incidence studies, functional assessment and culture- and education-fair dementia diagnosis. [ABSTRACT FROM AUTHOR]

Background: The characteristics of this pandemic increase the potential psychological impact on care homes workers (CHWs). The aims of this study were to analyse the mental health and health‐related quality of life (HRQoL) of a broad sample of CHWs in Spain and to identify potential factors that have a significant effect on their mental health and HRQoL. Method: This descriptive study comprised 210 CHWs who completed the Generalized Anxiety Disorder 7‐item Scale, the Patient Health Questionnaire‐9, the Impact Event Scale‐Revised, the Insomnia Severity Index, and the Health‐related Quality of Life Questionnaire. Sociodemographic and clinical data in relation to COVID‐19 were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were applied to identify factors associated with mental health and HRQoL. Results: Of total, 86.19% of participants were female; 86.67% were aged under 55 years; 11% were physicians and 64.19% were nurses or auxiliaries; 77.62% have themselves tested positive for Covid‐19; and 67.94% of CHWs have directly treated patients with Covid‐19. 49.28% had clinical depression; over half (58.57%) had clinical anxiety; 70.95% had clinical stress; and 28.57% had clinical insomnia. Increased use of tranquilizers/sedatives appears to be an explanatory variable of suffering greater anxiety, depression, stress and insomnia, and of having a worse HRQoL amongst our CHWs. Conclusions: Our study confirms that symptomatology of anxiety, depression, stress, insomnia and HRQoL were affected amongst CHWs during the Covid‐19 pandemic. Key points: Despite the enormous burden of distress and potentially traumatic events experienced by care home workers, almost no studies have yet been carried out documenting the prevalence of mental health problems amongst this population group.Symptomatology of anxiety, depression, stress, insomnia and health‐related quality of life were affected amongst care homes workers during the COVID‐19 pandemic. Why do this paper matter?It will be necessary to monitor care homes workers—particularly those most at risk—and our data, together with other current studies, can help to establish screening, support and treatment strategies for improving their mental health. [ABSTRACT FROM AUTHOR]

Objectives To examine the acceptability of fluoxetine in elderly depressed patients with chronic obstructive pulmonary disease (COPD). Setting A university teaching hospital. Method Single-blinded (open) study. One hundred and thirty-seven outpatients (69 male) with symptomatic irreversible, moderate to severe COPD were recruited. Major depression was diagnosed using the Geriatric Mental State Schedule. Quality of life was assessed by the Breathing Problems Questionnaire, physical disability by the Manchester Respiratory Activities of Daily Living Questionnaire and severity of depression using the Montgomery Asberg Depression Rating Scale. Exclusion criteria were: use of oral steroids within 6 weeks, acute or chronic confusion, known cancer and known psychosis. Results Fifty-seven patients (42%) (25 males) with a mean age of 72 years (range 60–89 years) were depressed. Fourteen (six male) agreed to undergo therapy with fluoxetine 20 mg/day for 6 months, while 36 (72%) refused antidepressant drug therapy. Only seven subjects completed the trial; of these, four (57%) responded to fluoxetine therapy. Five subjects withdrew because of side-effects. Twenty-two of those who refused treatment (61%) agreed to be interviewed, and of these 19 (86%) were still depressed. Conclusion Patient acceptance of fluoxetine was poor. The reasons for refusing treatment varied but were largely due to misapprehension by the patient. Untreated depression became chronic. Offering antidepressants to COPD patients with depression is not an effective strategy. Why this might be so is discussed. Copyright © 2001 John Wiley & Sons, Ltd [ABSTRACT FROM AUTHOR]

Background: Physical exercise is effective in protecting against age-related neurodegeneration and cognitive decline. Although there are many neuroimaging studies to evaluate the effect of physical exercise on aging brains, consistent conclusions are limited due to the wide variety of measuring techniques and small sample sizes. Objective: Identify brain regions that show exercise-induced neuroplasticity consistently across various imaging modalities and correlate regional neuroplasticity with cognitive changes in older adults. Methods: An electronic literature search for randomized controlled trials with magnetic resonance imaging measures was performed. We conducted a series of quantitative meta-analyses using activation likelihood estimation on included studies with voxel-based neuroimaging findings. Nonvoxelbased findings were summarized as a descriptive review. Results: Out of 839 publications identified from the literature search, 30 experiments including 2670 participants from 22 papers met the criteria of meta-analyses. Overall, physical exercise consistently results in structural and functional changes in the hippocampus/parahippocampusl area and a cluster within the cerebellum. Although changes of medial/superior prefrontal cortex did not pass the stringent threshold, they were associated with cognitive changes. Conclusions: This study highlights the effectiveness of physical exercise in inducing hippocampus plasticity, which may be crucially relevant for maintaining memory function in older adults. [ABSTRACT FROM AUTHOR]

Objectives: Dementia remains a clinical diagnosis with a degree of subjective assessment and potential for interrater disagreement. We described interrater agreement of clinical dementia diagnosis for various diagnostic criteria. Methods: We conducted a PROSPERO-registered (CRD42020168245) systematic review and meta-analysis. We searched multiple cross-disciplinary databases from inception until April 2020 for relevant papers, extracted data and described study quality in duplicate. Study quality was assessed using the Guidelines for Reporting Reliability and Agreement Studies. We used random-effects models to obtain summary estimates of interrater agreement using kappa and, where possible, Gwet's AC1/2 coefficients. Results: We found 7577 titles and 22 eligible studies. Meta-analysis was possible for all-cause dementia using the Diagnostic and Statistical Manual of Mental Disorders third edition revised (DSM-III-R) criteria (kappa = 0.66, 95% CI = [0.53,0.78]), Alzheimer's disease using the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's disease and Related Disorders Association (NINCDS-ADRDA) criteria (kappa = 0.71, 95% CI = [0.65,0.77] for presence/absence and AC2 = 0.61, 95% CI = [0.53,0.70] when distinguishing probable/possible cases), and vascular dementia using the International Classification of Diseases version 10 (ICD-10) criteria kappa = 0.79 (95% CI = [0.70,0.87]). Data was more limited for other criteria and dementia types. AC1/2 coefficients generally indicated higher agreement. One study was rated as high quality. Conclusions: Diagnostic criteria for clinical dementia may have good but imperfect agreement. This has important implications for clinical practice and research studies, which frequently assume these criteria are perfect tests, such as diagnostic test accuracy studies frequently conducted for biomarkers and neuropsychological tests, and for trials where incident dementia is the outcome. [ABSTRACT FROM AUTHOR]

Objective: There is a growing interest in how people living with dementia may achieve good outcomes and be resilient despite their health challenges. Understanding what might be important for resilience in this population is largely untested theory.Methods: The analysis draws a subsample with cognitive impairment (N = 579) from two waves of the Cognitive Function and Ageing Studies Wales study, a nationally representative study of community-dwelling people aged 65+ in Wales. We constructed a measure of mental health resilience (MHR) defined as no depression, no anxiety and high well-being. Drawing on a resilience framework, we tested univariate and cumulative effects models of the factors that enable MHR, and then examined whether MHR is important for reducing loneliness over time.Results: Across both waves of data 22% (n = 121) met the criteria for MHR. The cumulative effects model found the odds of MHR were greater for male gender, higher self-esteem, greater social resources and no subjective memory complaints. Controlling for these significant predictors, MHR significantly predicted lower total and sub-scale scores for loneliness at wave 2. Sensitivity analysis shows these effects held at lower levels of cognitive function when the Mini-Mental State Examination score was <25, but not at <23.Conclusions: This paper addresses a gap in research regarding the conceptualisation and measurement of resilience when facing cognitive impairment. Understanding what aspects of a person's life might enable good mental health despite cognitive impairment-to be resilient-could inform effective strategies for friends and families, along with health, and social policy and practice. [ABSTRACT FROM AUTHOR]

The effects of coronavirus disease 2019 (COVID‐19) have been well documented across the world with an appreciation that older people and in particular those with dementia have been disproportionately and negatively affected by the pandemic. This is both in terms of their health outcomes (mortality and morbidity), care decisions made by health systems and the longer‐term effects such as neurological damage. The International Dementia Alliance is a group of dementia specialists from six European countries and this paper is a summary of our experience of the effects of COVID‐19 on our populations. Experience from England, France, Germany, the Netherlands, Spain and Switzerland highlight the differential response from health and social care systems and the measures taken to maximise support for older people and those with dementia. The common themes include recognition of the atypical presentation of COVID‐19 in older people (and those with dementia) need to pay particular attention to the care of people with dementia in care homes; the recognition of the toll that isolation can bring on older people and the complexity of the response by health and social services to minimise the negative impact of the pandemic. Potential new ways of working identified during the pandemic could serve as a positive legacy from the crisis. [ABSTRACT FROM AUTHOR]

Objectives This study examines the correlation between actigraphic measures and a validated assessment scale of agitated behaviour in dementia, the Cohen-Mansfield Agitation Inventory (CMAI). Methods A total of 110 patients were included. Patients either suffered from Alzheimer dementia (AD), mixed dementia (MXD), frontotemporal dementia (FTD) or diffuse Lewy body disease (DLB). All patients underwent actigraphic recordings for 48 h. CMAI was scored by professional caretakers, who were responsible for the patient during his or her actigraphic recording. Results Patients with high total CMAI scores (≥ 50) clearly had higher levels of activity during the day as measured by means of actigraphy than patients with low total CMAI scores (ANOVA, F = 126.75, p < 0.0001). Patients with low MMSE scores (< 20) also had higher activity levels during the day than patients with higher MMSE scores (ANOVA, F = 85.74, p < 0.0001). Correlations between actigraphic data and CMAI total scores were moderate but highly significant. Conclusion We conclude that actigraphy is a useful tool to examine agitated behaviour in dementia. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Discusses information on a proposal for the classification of neuropsychiatric disturbance in patients with Alzheimer's disease. Method of empirical categorization of disturbances; Comparison of the frequency of individual neuropsychiatric symptoms with or without dementia based on the Cache County study of memory and aging in Utah; List of the proposed diagnostic criteria for Alzheimer's disease-associated neuropsychiatric disturbance; Relevance of the proposed criteria to clinical research and practice.

Objectives To investigate whether Galantamine significantly improves the core symptoms of Alzheimer's disease (AD). Background Galantamine is a reversible, competitive, selective inhibitor of acetylcholinesterase (AChE) that also allosterically modulates nicotinic acetylcholine receptors. This dual mechanism of action provided the rationale for a phase II trial of galantamine in AD. Method A multicentre, randomized, parallel, double-blind, placebo-controlled trial was carried out to evaluate the efficacy and tolerability of galantamine 18, 24 and 36 mg/day administered for 3 months in 285 patients with mild-to-moderate probable AD. The primary outcome measure was the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog); secondary outcome measures were the Clinical Global Impression of Change (CGIC) and the Progressive Deterioration Scale (PDS). Results Patients treated with galantamine 24 mg/day had a significantly better outcome than placebo on ADAS-cog; the treatment difference was 3 points on the intention-to-treat (ITT) analysis ( p = 0.01) and 4.2 points on per protocol analysis ( p = 0.001). Per protocol analysis showed that galantamine had a significantly better outcome than placebo on PDS ( 24-mg/day dose, p < 0.05) and CGIC (36-mg/day dose, p < 0.05). Galantamine was well tolerated at the lower doses of 18 and 24 mg/day where it produced mild, transient effects typical of cholinomimetic agents. Conclusion This study shows that, relative to placebo, galantamine significantly improves the core symptoms of Alzheimer's disease. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Presents an article on pressing issues in the dementia and dementia services symposium at the Royal College of Physicians in London, England on January 28 to 29, 1999. Geographical inequities involving care for the elderly; Information on a survey conducted by the Alzheimer's Disease Society on Health Authorities' plans and purchasing intentions for dementia services.

Less than one-tenth of all population-based research into dementia is directed towards the two-thirds or more of cases living in developing parts of the world. The 10/66 Dementia Research Group has been formed to redress this imbalance, encouraging active research collaboration between centres in different developing countries and between developed and developing countries. The 10/66 group consisted initially of researchers attending a symposium on dementia research in developing countries, held at the 1998 Alzheimer's Disease International conference. They noted a growing interest in this area, with many active researchers and others wishing to start new studies. There was felt to be an urgent need for more research: quantifying prevalence and incidence, exploring regional variations in international collaborations using harmonized methodologies, describing care arrangements for people with dementia, quantifying the impact on caregivers and evaluating the effectiveness of any newly implemented services. Methodological problems need to be addressed, particularly development of culture- and education-fair dementia diagnostic procedures. Good-quality research can generate awareness, pioneer service development and influence policy. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents research papers on clinical observations and follow-up patients at the Bethlem Royal Hospital in London, England. There are eight chapters that presents background, aims, method and clinical characteristics of patients. In the first chapter, Felix Post summarizes present knowledge of late paraphrenia, drawing on the clinical descriptions of earlier workers and emphasizing the relative rarity of descriptions of schizophrenia occurring after the age of 50 or 60 and the difficulty early nosologists had in making the differentiation from senile psychosis.

This article introduces key papers in old age geriatric psychiatry related to peripheral motor nerve conduction in elderly demented and non-demented psychiatric patients. The authors note that studies of patients suffering from dementia in old age have ignored the peripheral nervous system. They note that it is unclear whether dementia in elderly subjects results from some special selective disturbance in an otherwise intact and well preserved nervous system or might merely represent one prominent facet of disturbance in a nervous system with widespread defects a rising from a generalised disruptive process.

Background: Predementia is a heuristic umbrella concept to classify older adults with cognitive impairment who do not suffer dementia. Many diagnostic entities have been proposed to address this concept, but most of them have not had widespread acceptance. Aims: To review clinical definitions, epidemiologic data (prevalence, incidence) and rate of conversion to dementia of the main predementia constructs, with special interest in the two most frequently used: mild cognitive impairment (MCI) and minor neurocognitive disorder (miNCD). Methods: We have selected in three databases (MEDLINE, Web of Science and Google scholar) the references from inception to 31 December 2019 of relevant reviews, population and community‐based surveys, and clinical series with >500 participants and >3 years follow‐up as the best source of evidence. Main results: The history of predementia constructs shows that MCI is the most referred entity. It is widely recognized as a clinical syndrome harbinger of dementia of several etiologies, mainly MCI due to Alzheimer's disease. The operational definition of MCI has shortcomings: vagueness of its requirement of "preserved independence in functional abilities" and others. The recent miNCD construct presents analogous difficulties. Current data indicate that it is a stricter predementia condition, with lower prevalence than MCI, less sensitivity to cognitive decline and, possibly, higher conversion rate to dementia. Conclusions: MCI is a widely employed research and clinical entity. Preliminary data indicate that the clinical use of miNCD instead of MCI requires more scientific evidence. Both approaches have common limitations that need to be addressed. Key points: This paper is a narrative review of the many predementia entities proposed since the Kral concept of "benign" and "malignant" senescent memory loss until the recent minor neurocognitive disorder (miNCD) of the DSM‐5. The discussion is mainly focused on mild cognitive impairment (MCI), the most referred entity, and the miNCDMCI and miNCD entities have many similarities and both have some shortcomings, the lack of a clear operational definition of functional deficit in their respective diagnostic criteria is the most critical pointMCI is a concept widely employed both in research and clinical settings. The clinical use of miNCD instead of MCI requires more evidence of its propertiesCurrent data indicate that miNCD is more restrictive than MCI and, consequently, it is, less sensitivity to cognitive decline and has lower prevalence, but shows a higher conversion rate to dementia [ABSTRACT FROM AUTHOR]

Objectives: Altered awareness of cognitive and neuropsychiatric symptoms is a common feature of neurodegeneration, which can significantly impact on quality of life, medication concordance and personal safety. Elucidating how awareness is affected by common alpha‐synucleinopathies therefore has significant clinical relevance. We performed a systematic review of the literature on awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies. Methods: Searches of PubMed and Web of Science were carried out, using keywords and MeSH subheadings, limited to papers in English dealing with humans. The terms "Parkinson's" or "Lewy body" were used to denote the disease of interest, combined with either "agnosia", "anosognosia", "insight", "metacognition", or "neuropsychology" to denote the neuropsychological area of interest. Results: 21 publications investigating awareness of cognitive symptoms, and 18 publications on awareness of neuropsychiatric symptoms were identified. The large majority focused on Parkinson's disease rather than Dementia with Lewy Bodies. Cognitively intact people with Parkinson's disease may over‐report cognitive symptoms, whilst those with cognitive impairment under‐report symptoms. Awareness of neuropsychiatric symptoms is likely to decline over time, particularly in those with progressive cognitive impairment. Conclusions: Altered awareness of cognitive and neuropsychiatric symptoms is common in Parkinson's disease. Symptom awareness varies significantly between individuals, and appears to be influenced by mood and global cognitive functioning, with executive functioning specifically implicated. There are gaps in our understanding of how dopaminergic medications influence symptom awareness, and a need for longitudinal studies of how awareness changes over time in Parkinson's disease and Dementia with Lewy Bodies. [ABSTRACT FROM AUTHOR]

Keywords: COVID-19; older adults; psychiatry; remote health care; telehealth; telemedicine EN COVID-19 older adults psychiatry remote health care telehealth telemedicine 1427 1430 4 11/30/20 20201201 NES 201201 Key points The COVID-19 pandemic and the need to ensure public and health care provider safety and continuity of mental health care provision has necessitated alternative strategies for service delivery. At the same time there has been recognition that quality provision of Telehealth is contingent upon a skill-base, regulatory framework, and commensurate funding and compensation.1 For the purpose of this paper, we define Telehealth as the use of telecommunication techniques for patient care and medical education, 2 usually remotely and with minimal or no direct patient contact from the health professional. CHALLENGES OF TELEHEALTH IN THE OLDER ADULT POPULATION Assessment Undertaking mental health assessment and providing treatment and care remotely has its challenges. Given the complexity of the risks and balances involved, including but not limited to the deprivation of liberty and other rights, minimum standards and safeguards for mental health professionals carrying out their duties under these Acts have been developed.10,11 Physical examination Perhaps the component of assessment most limited by Telehealth is physical examination. [Extracted from the article]

Objectives: Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally. Methods: Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800). Results: Twenty‐nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT‐based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community‐, culture‐ and language‐focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self‐efficacy. Conclusions: To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross‐cultural challenges into caregiving interventions for deep‐level adaptations that could potentially be more effective to engage and support Chinese caregivers. [ABSTRACT FROM AUTHOR]

Objectives: Qigong has been shown to effectively reduce depressive symptoms in older adults with chronic physical illness. Here, we sought to evaluate the effects of qigong on serotonin, cortisol, and Brain-derived Neurotropic Factors (BDNF) levels and test their roles as potential mediators of the effects of qigong on depressive symptoms.Methods: Thirty older adults with chronic physical illness participated in a randomized clinical trial. They were randomly assigned to a qigong group (n = 14) or a control group for cognitive training of executive function and memory (n = 16). The participants provided blood and saliva samples at baseline and post-intervention. Levels of cortisol were measured from the salvia samples, and serotonin and BDNF were measured from the blood samples.Results: Consistent with the study findings presented in the primary outcome paper, a significant Group × Time interaction effect emerged on depressive symptoms, explained by greater reductions in the qigong group than the control group. Qigong participants had significantly larger increases in serotonin and BDNF, and decreases in cortisol levels, compared with control group participants. Moreover, treatment-related changes in cortisol levels (but not serotonin or BDNF) fully mediated the beneficial effects of qigong on depressive symptoms.Conclusion: The findings provide preliminary evidence that treatment-related changes in cortisol may mediate the benefits of qigong on depressive symptoms. Given the limitation of small sample size of the present study, future studies with larger sample sizes and more extended follow-up assessment are warranted to determine the reliability of these findings. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effects of a 10-day course of bilateral anodal transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) on working memory and global cognition in elderly participants with remitted major depressive disorder at 14 days (primary outcome) and 90 days (secondary outcome) post intervention.Design: Randomized double blind controlled trial (clinicaltrials.gov # NCT02212366).Setting: Community dwelling outpatient setting.Participants: Sixty or older with previous single or recurrent episodes of major depression currently in full remission.Intervention: A 10 day course of active or sham bilateral DLPFC anodal tDCS.Measurements: (a) Working memory assessed by a computerized N back task, and (b) global cognition assessed by a standard paper and pencil neuropsychological test battery.Results: Thirty-three participants, (mean (SD) age = 66. 5 (5.7) year) were enrolled, out of which 18 (mean (SD) age = 66. 3 (5.8) year) were randomized to active tDCS and 15 (mean (SD) age = 66. 7 (5.8) years) to sham tDCS. All randomized participants except one from the sham group -completed the tDCS course. There were no differences between the groups on working memory performance or global cognition at 14 or 90 days post intervention. Both groups showed promising changes in working memory and global cognition over time.Conclusions: tDCS was well tolerated in older patients with remitted MDD, however, as compared to the sham group, it did not improve working memory or global cognition. Future studies should investigate tDCS with alternative parameters to enhance cognition in this population. [ABSTRACT FROM AUTHOR]

Objectives: The Comprehensive Process Model of Group Engagement posits that personal factors (eg, cognitive function), stimulus factors (eg, group activity content and group size), and environmental factors (eg, light and noise) impact the response to group activities. This paper reports the impact of environmental and group characteristics on engagement, mood, and sleepiness of persons with dementia attending group activities.Methods/design: The sample included 69 nursing home residents. Environmental contexts of activities included time of day, location, noise, light, and temperature. Outcome variables captured engagement, mood, and sleepiness, observed during 20 group activity sessions. Mixed model analyses were used to examine the impact of environmental and group attributes on the outcome variables.Results: Background noise and time of day significantly affected outcome variables after controlling for participants' cognitive functioning and group topic. Background noise was related with decreased engagement and increased sleepiness. Activities conducted before noon were associated with increased sleepiness. Group size did not affect the outcome variables. There was little variation concerning temperature and light.Conclusions: These findings have implications for architectural and ongoing planning. The methodology presents a model for continuous quality improvement. The main components of the Comprehensive Process Model of Group Engagement significantly impacted group activity engagement. [ABSTRACT FROM AUTHOR]

Focuses on the use of computed tomography (CT) in geriatric psychiatry. Application of CT to discriminate patients with dementia from normal elderly controls; Evolution of medical diagnostic imaging systems; Significance of CT to dementia management.

Discusses the development and use of the Mini-Mental State (MMS) Examination in diagnosing cognitive disorders. Method used in assessing the validity of MMS results; Background on different versions of MMS tests; Applications of MMS.

This article presents information on research work related to geriatric psychiatry. The depressed subjects for this study were drawn from two groups. The first consisted of 100 elderly patients referred to the psychogeriatric service at Goodmayes and the London Hospital, all of whom had experienced onset of depression in the year prior to interview. To this group was added 19 who were found in the general population sample, drawn from local General Practitioners' lists, with a similar psychiatric history. The comparison group (controls) consisted of elderly subjects on this list who were free of psychiatric disorder. In view of the well identified influence on depression of age and sex, the groups were matched on those variables.