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INTRODUCTION: There is limited evidence about factors related to the timeliness of dementia diagnosis in healthcare settings. METHODS: In five prospective cohorts at Rush Alzheimer's Disease Center, we identified participants with incident dementia based on annual assessments and examined the timing of healthcare diagnoses in Medicare claims. We assessed sociodemographic, health, and psychosocial correlates of timely diagnosis. RESULTS: Of 710 participants, 385 (or 54%) received a timely claims diagnosis within 3 years prior to or 1 year following dementia onset. In logistic regressions accounting for demographics, we found Black participants (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.21 to 3.82) and those with better cognition at dementia onset (OR = 1.48, 95% CI: 1.10 to 1.98) were at higher odds of experiencing a diagnostic delay, whereas participants with higher income (OR = 0.89, 95% CI: 0.81 to 0.97) and more comorbidities (OR = 0.94, 95% CI: 0.89 to 0.98) had lower odds. DISCUSSION: We identified characteristics of individuals who may miss the optimal window for dementia treatment and support. Highlights: We compared the timing of healthcare diagnosis relative to the timing of incident dementia based on rigorous annual evaluation.Older Black adults with lower income, higher cognitive function, and fewer comorbidities were less likely to be diagnosed in a timely manner by the healthcare system. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Poor social connection is considered a risk factor for dementia. Since socializing behaviors may cluster together or act compensatorily, we aimed to investigate social connection patterns and their association with dementia, for men and women separately. METHODS: A total of 12,896 community‐dwelling older adults (mean ± SD age: 75.2 ± 4.3 years, 54% women) without major cognitive impairment were included. Latent class analysis was conducted using 24 baseline social connection indicators. Cox proportional hazards regression was used to estimate the association between latent classes and incident dementia over 12 (median: 8.4) years follow‐up. RESULTS: Three distinct classes were identified in both genders: strong social connections with an intermediate friend‐relative network (Class 1: men, 43.8%; women, 37.9%), weak social connections (Class 2: men, 29.6%; women, 27.4%), and strong social connections with a larger friend‐relative network (Class 3: men, 26.6%; women, 34.7%). Compared to Class 1, men in Class 2 (HR: 1.38, 95% CI: 1.08‐1.77) and women in Class 3 (HR: 1.27, 95% CI: 1.01‐1.60) had an increased risk of dementia. DISCUSSION: Dementia risk varies with different social connection patterns among older men and women. Highlights: Three distinct social connection patterns were identified based on 24 indicators.These patterns were related to dementia risk differently in men and women.In men, a weak social connection pattern was associated with a higher dementia risk.In women, a strong social connection with a relatively larger friend‐relative network was associated with a greater dementia risk. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Recent genome‐wide association studies identified new dementia‐associated variants. We assessed the performance of updated polygenic risk scores (PRSs) using these variants in an independent cohort. METHODS: We used Cox models and area under the curve (AUC) to validate new PRSs (PRS‐83SNP, PRS‐SBayesR, and PRS‐CS) compared with an older PRS‐23SNP in 12,031 initially‐healthy participants ≥70 years of age. Dementia was rigorously adjudicated according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) criteria. RESULTS: PRS‐83SNP, PRS‐SBayesR, and PRS‐CS were associated with incident dementia, with fully adjusted (including apolipoprotein E [APOE] ε4) hazard ratios per standard deviation (SD) of 1.35 (1.23–1.47), 1.37 (1.25–1.50), and 1.42 (1.30–1.56), respectively. The AUC of a model containing conventional/non‐genetic factors and APOE was 74.7%. This was improved to 75.7% (p = 0.007), 76% (p = 0.004), and 76.1% (p = 0.003) with addition of PRS‐83SNP, PRS‐SBayesR, and PRS‐CS, respectively. The PRS‐23SNP did not improve AUC (74.7%, p = 0.95). CONCLUSION: New PRSs for dementia significantly improve risk‐prediction performance, but still account for less risk than APOE genotype overall. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cardiovascular disease (CVD) is a recognized risk factor for dementia. Here we determined the extent to which an incident CVD event modifies the trajectory of cognitive function and risk of dementia. METHODS: 19,114 adults (65+) without CVD or dementia were followed prospectively over 9 years. Incident CVD (fatal coronary heart disease, nonfatal myocardial infarction [MI], stroke, hospitalization for heart failure) and dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) were adjudicated by experts. RESULTS: Nine hundred twenty‐two participants had incident CVD, and 44 developed dementia after CVD (4.9% vs. 4.4% for participants without CVD). Following a CVD event there was a short‐term drop in processing speed (−1.97, 95% confidence interval [CI]: −2.57 to −1.41), but there was no significant association with longer‐term processing speed. In contrast, faster declines in trajectories of global function (−0.56, 95% CI: −0.76 to −0.36), episodic memory (−0.10, 95% CI: −0.16 to −0.04), and verbal fluency (−0.19, 95% CI: −0.30 to −0.01) were observed. DISCUSSION: Findings highlight the importance of monitoring cognition after a CVD event. [ABSTRACT FROM AUTHOR]

Background: Whether socially and mentally stimulating activities in older age can contribute to cognitive reserve and influence dementia risk remains unclear. This study investigated the association between lifestyle enrichment and dementia risk in older individuals, after adjusting for education, socioeconomic status and a range of health‐related factors. Method: Data came from a cohort of community‐dwelling adults aged 70+ recruited in Australia, who were generally healthy and without major cognitive impairment at baseline. Exploratory factor analysis was performed using 19 individual measures of leisure activities and social networks. The adjusted association between seven composite factors of lifestyle enrichment and incident dementia was examined using Cox proportional hazards regression. Result: Among 10,318 participants, more frequent engagement in adult literacy (writing, computer usage and education classes) and active mental activities (games/cards/chess, crosswords/puzzles) was associated with an 11% (95% CI: 0.85‐0.93) and a 9% (95% CI: 0.87‐0.95) lower risk of dementia respectively. To a lesser extent, participation in creative artistic (craftwork/woodwork/metalwork, painting/drawing) (HR: 0.93, 95% CI: 0.88‐0.99) and passive mental activities (reading, watching television, music/radio listening) (HR: 0.93, 95% CI: 0.86‐0.99) were also associated with reduced dementia risk. In contrast, interpersonal networks, social activities and external outings were not associated with dementia risk in this sample. Conclusion: These findings may guide policies for geriatric care and interventions targeting dementia prevention for older adults. Engagement in adult literacy, creative art, as well as active and passive mental activities, may help reduce dementia risk in late life. [ABSTRACT FROM AUTHOR]

Background: Risk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether commonly used CVD risk scores are associated with dementia in older adults who do not have a history of CVD remains unclear. The aim of this study was to determine whether CVD risk scores are associated with subsequent cognitive decline and dementia in initially healthy older men and women. Method: Participants were from a prospective cohort of 19,114 individuals aged 65+ years without prior CVD event or major cognitive impairment. The Atherosclerotic Cardiovascular Disease risk score (ASCVDRS) and the Framingham risk score (FRS) were calculated at baseline, with women and men analysed separately due to large differences in overall level of CVD risk. Dementia was adjudicated by clinical experts according to DSM‐IV criteria. Cognitive decline was defined as a >1.5 SD decline in cognitive score from their own baseline value on any of the four cognitive tests looking at global cognition, episodic memory, psychomotor speed or verbal fluency. Result: Over a median follow‐up of 6.4 years, 4,325 individuals had cognitive decline and 850 individuals developed dementia. ASCVDRS, was associated with dementia and cognitive decline, in men and women, whether considered as a continuous measure and as tertiles. For example, men and women in the highest ASCVDRS tertile had a 41% and 45% increased risk of dementia compared to the lowest tertile respectively (HR [95%CI] men: 1.41 [1.08,1.85], women: 1.45 [1.11,1.89]). However, higher FRS was not associated with incident dementia and only associated with an increased risk of cognitive decline among women (FRS continuous: 1.08 [1.01,1.26]; highest vs. lowest tertiles: 1.13 [1.01‐1.26]). Conclusion: These results provide some evidence for ASCVDRS as a measure of shared CVD risk factors for identifying/predicting risk of dementia and cognitive decline in healthy older adults regardless of sex. Further research is needed to confirm the findings and to validate these results in more heterogeneous populations. [ABSTRACT FROM AUTHOR]

Background: Dual decline in gait speed and cognition is associated with an increased risk of dementia. However, it is unclear if risks are conferred by decline in domain‐specific cognition and gait. We aimed to examine associations between dual decline in gait speed and cognition (global cognition, memory, processing speed and verbal fluency) with risk of dementia. Methods: Prospective cohort study. Participants were from the ASPREE (ASPirin in Reducing Events in the Elderly) study, a double‐blind, randomized, placebo‐controlled trial of low dose aspirin in older adults (≥70 years; ≥65 if US minority). Of 19,114 randomized participants, 16,855 (88%) had longitudinal gait and cognitive data. Gait speed was measured at 0, 2, 4, 6 years and close‐out. Cognitive measures included Modified Mini‐Mental State examination (3MS, global cognition), Hopkins Verbal Learning Test‐Revised (HVLT‐R, memory), Symbol Digit Modalities (SDMT, processing speed) and Controlled Oral Word Association Test (COWAT‐F, verbal fluency), assessed at years 0, 1, 3, 5, and close‐out. Participants were classified into four groups: 1) dual decline in gait and cognition; 2) gait decline only; 3) cognitive decline only and 4) non‐decliners. Cognitive decline was defined as membership of the lowest tertile of annual change. Gait decline was defined as decline in gait speed ≥0.05 m/s per year across the study. Dementia (DSM‐IV criteria) was adjudicated by an expert panel using cognitive tests, functional status and clinical records. Cox proportional hazard models were used to estimate risk of dementia adjusting for covariates with death as competing risk. Results: The mean age of participants was 75.0 (SD4.4) years. Compared with non‐decliners, risk of dementia was highest in the gait+HVLT‐R decliners (HR 24.7; 95% CI 16.3‐37.3), followed by the gait+3MS (HR 22.2; 95% CI 15.0‐32.9), gait+COWAT‐F (HR 4.66 95%; CI 3.5‐6.3) and gait+SDMT (HR 4.3 95% CI 3.2‐5.8) groups. Dual decliners also had higher risk of dementia than those with either gait or cognitive decline alone for 3MS and HVLT‐R. Conclusion: The combination of decline in gait speed and memory may be the best suited to predict future dementia risk. [ABSTRACT FROM AUTHOR]

Background: No existing therapies for Alzheimer's disease and related dementias fundamentally alter the trajectory of the disease. While observational data suggests statins may reduce cognitive and functional decline in older adults, randomized evidence is lacking. Method: The PRagmatic EValuation of evENTs And Benefits of Lipid‐lowering in oldEr adults (PREVENTABLE) trial is funded by the National Institute on Aging, National Heart, Lung, and Blood Institute, and supported by the Alzheimer's Association. The trial will test the primary hypothesis that randomization to atorvastatin 40 mg versus placebo results in superior survival free of incident dementia or persistent physical disability over 5 years. The development of mild cognitive impairment (MCI) is a secondary endpoint. The target sample size is 20,000 participants ≥75 years without dementia recruited from 90 sites across the US from the National Patient‐Centered Clinical Research Network and the Veterans Affairs system. The trial will use a pragmatic, standardized telephone‐based cognitive battery, centrally administered annually, which includes a cognitive screener, the Telephone Interview for Cognitive Status‐modified (TICSm). Based on TICSm scoring, an extended phone cognitive battery will be performed that includes measures of attention/executive function, verbal memory, language, and mood. In addition, the Functional Activities Questionnaire will be administered to a trusted contact. A telephone assessment of physical and functional status will also be administered annually. Cognitive and functional data will be adjudicated by a panel of experts, blinded to treatment assignment, to determine the occurrence of MCI (and subtype) or probable dementia. Result: PREVENTABLE will utilize pragmatic data sources (electronic health records and administrative claims) to obtain relevant medical data; however, these mechanisms are unreliable at identifying incident dementia and MCI. The pandemic required modification of cognitive testing, embracing a purely telephonic approach at baseline, which will nonetheless permit cognitive adjudication of participants. Recruitment will be ongoing through April 2023 with results available in 2026. Conclusion: PREVENTABLE represents the largest randomized pragmatic trial examining cognitive outcomes associated with statin use in older adults. Launching during the pandemic required adaptation to remote assessment, which will facilitate progress towards efficient and novel methods for pragmatic clinical trials aimed at preventing dementia. [ABSTRACT FROM AUTHOR]

Background: Linkage of Medicare claims records to cohort studies of aging provides the opportunity to study misdiagnosis of dementia in clinical settings for older adults. Methods: We linked 1991‐2016 fee‐for‐service Medicare Part A&B claims to data from 5 RADC cohorts (MAP, ROS, MARS, Clinical Core, and Latino Core). We assigned dementia status based on annual detailed cognitive evaluation and assigned clinical dementia diagnosis status using ICD‐9/ICD‐10 codes from Medicare claims (primary or secondary diagnoses) during participants' study enrollment period. We classified persons as underdiagnosed if they did not have a clinical dementia diagnosis in 2 or more Medicare claims recorded up to 3 years leading to, and 1 year following the date of the first RADC assessment indicating dementia, and overdiagnosed if they did not have any RADC assessments indicating dementia but had a clinical dementia diagnosis in 2 or more claims recorded during the study period. Results: Of the total 3,533 participants, 78% received the correct clinical diagnosis, 11% were underdiagnosed in Medicare claims, and 11% were overdiagnosed. Of the 703 persons who developed dementia, 381 (54%) were clinically underdiagnosed (i.e., sensitivity=46%), while 389 (14%) of 2,830 persons who did not develop dementia were overdiagnosed (specificity=86%). Conclusions: This preliminary analysis corroborates previous findings from the Health and Retirement Study (HRS) and others that there is substantial misdiagnosis of dementia in clinical settings as recorded in fee‐for‐service Medicare claims when compared to comprehensive assessment for research, especially in regards to low sensitivity. Future work will examine predictors and consequences of clinical misdiagnosis. [ABSTRACT FROM AUTHOR]