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Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient. [ABSTRACT FROM AUTHOR]

Spatial orientation is based on a complex cortical network with input from multiple sensory systems. It is affected by training, sex and age as well as cultural and psychological factors, resulting in different individual skill levels in healthy subjects. Various neurological disorders can lead to different patterns or specific deficits of spatial orientation and navigation. Accordingly, numerous tests have been proposed to assess these abilities. Here, we compare the results of (1) a validated questionnaire-based self-estimate of orientation/navigation ability (Santa Barbara Sense of Direction Scale, SBSODS) and (2) a validated pen-and-paper two-dimensional perspective test (Perspective Taking Spatial Orientation Test, SOT) with (3) a newly developed test of finger-arm pointing performance in a 3D real-world (3D-RWPT) paradigm using a recently established pointing device. A heterogeneous group of 121 participants (mean age 56.5 ± 17.7 years, 52 females), including 16 healthy volunteers and 105 patients with different vestibular, ocular motor and degenerative brain disorders, was included in this study. A high correlation was found between 2D perspective task and 3D pointing along the horizontal (azimuth) but not along the vertical (polar) plane. Self-estimated navigation ability (SBSODS) could not reliably predict actual performance in either 2D- or 3D-tests. Clinical assessment of spatial orientation and memory should therefore include measurements of actual performance, based on a 2D pen-and-paper test or a 3D pointing task, rather than memory-based questionnaires, since solely relying on the patient's history of self-estimated navigation ability results in misjudgments. The 3D finger-arm pointing test (3D-RWPT) reveals additional information on vertical (polar) spatial performance which goes undetected in conventional 2D pen-and-paper tests. Diseases or age-specific changes of spatial orientation in the vertical plane should not be clinically neglected. The major aim of this pilot study was to compare the practicability and capability of the three tests but not yet to prove their use for differential diagnosis. The next step will be to establish a suitable clinical bedside test for spatial memory and orientation. [ABSTRACT FROM AUTHOR]

Digital drawing tests have been proposed for cognitive screening over the past decade. However, the diagnostic performance is still to clarify. The objective of this study was to evaluate the diagnostic performance among different types of digital and paper-and-pencil drawing tests in the screening of mild cognitive impairment (MCI) and dementia. Diagnostic studies evaluating digital or paper-and-pencil drawing tests for the screening of MCI or dementia were identified from OVID databases, included Embase, MEDLINE, CINAHL, and PsycINFO. Studies evaluated any type of drawing tests for the screening of MCI or dementia and compared with healthy controls. This study was performed according to PRISMA and the guidelines proposed by the Cochrane Diagnostic Test Accuracy Working Group. A bivariate random-effects model was used to compare the diagnostic performance of these drawing tests and presented with a summary receiver-operating characteristic curve. The primary outcome was the diagnostic performance of clock drawing test (CDT). Other types of drawing tests were the secondary outcomes. A total of 90 studies with 22,567 participants were included. In the screening of MCI, the pooled sensitivity and specificity of the digital CDT was 0.86 (95% CI = 0.75 to 0.92) and 0.92 (95% CI = 0.69 to 0.98), respectively. For the paper-and-pencil CDT, the pooled sensitivity and specificity of brief scoring method was 0.63 (95% CI = 0.49 to 0.75) and 0.77 (95% CI = 0.68 to 0.84), and detailed scoring method was 0.63 (95% CI = 0.56 to 0.71) and 0.72 (95% CI = 0.65 to 0.78). In the screening of dementia, the pooled sensitivity and specificity of the digital CDT was 0.83 (95% CI = 0.72 to 0.90) and 0.87 (95% CI = 0.79 to 0.92). The performances of the digital and paper-and-pencil pentagon drawing tests were comparable in the screening of dementia. The digital CDT demonstrated better diagnostic performance than paper-and-pencil CDT for MCI. Other types of digital drawing tests showed comparable performance with paper-and-pencil formats. Therefore, digital drawing tests can be used as an alternative tool for the screening of MCI and dementia. [ABSTRACT FROM AUTHOR]

Background: With the increase in the aging population, informal caregivers have become an essential pillar for the long-term care of older individuals. However, providing care can have a negative impact and increase the burden on caregivers, which is a cause for concern. Objective: This study aimed to comprehensively depict the concept of "informal caregiver burden" through bibliometric and content analyses. Methods: We searched the Web of Science (WoS) database to obtain bibliometric data and included only papers published between 2013 and 2022. We used content analysis to extract and identify the core concepts within the text systematically. Results: Altogether, 934 papers were included in the bibliometric analysis, from which we selected 19 highly impactful papers for content analysis. The results indicate that researchers have focused on exploring the factors that impact informal caregiver burden. Meanwhile, there has been a widespread discussion regarding the caregiver burden among those caring for recipients with specific illnesses, such as dementia, Alzheimer's disease, and cancer, as these illnesses can contribute to varying levels of burden on informal caregivers. In addition, questionnaires and interviews emerged as the predominant methods for data collection in the realm of informal caregiver research. Furthermore, we identified 26 distinct assessment tools specifically tailored for evaluating burden, such as caregiver strain index (CSI). Conclusion: For future studies, we suggest considering the intersectionality of factors contributing to the burden on informal caregivers. This approach could enhance the well-being of both caregivers and older care recipients. [ABSTRACT FROM AUTHOR]

Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine. [ABSTRACT FROM AUTHOR]

In elderly persons, antipsychotic drugs are clinically prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications (schizophrenia and bipolar disorder). The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia. In April 2005, the FDA, based on a meta-analysis of 17 double-blind randomized placebo-controlled trials among elderly people with dementia, determined that atypical antipsychotics were associated with a significantly (1.6–1.7 times) greater mortality risk compared with placebo, and asked that drug manufacturers add a ‘black box’ warning to prescribing information for these drugs. Most deaths were due to either cardiac or infectious causes, the two most common immediate causes of death in dementia in general. Clinicians, patients, and caregivers are left with unclear choices of treatment for dementia patients with psychosis and/or severe agitation. Not only are psychosis and agitation common in persons with dementia but they also frequently cause considerable caregiver distress and hasten institutionalization of patients. At the same time, there is a paucity of evidence-based treatment alternatives to antipsychotics for this population. Thus, there is insufficient evidence to suggest that psychotropics other than antipsychotics represent an overall effective and safe, let alone better, treatment choice for psychosis or agitation in dementia; currently no such treatment has been approved by the FDA for these symptoms. Similarly, the data on the efficacy of specific psychosocial treatments in patients with dementia are limited and inconclusive. The goal of this White Paper is to review relevant issues and make clinical and research recommendations regarding the treatment of elderly dementia patients with psychosis and/or agitation. The role of shared decision making and caution in using pharmacotherapy for these patients is stressed.Neuropsychopharmacology (2008) 33, 957–970; doi:10.1038/sj.npp.1301492; published online 18 July 2007 [ABSTRACT FROM AUTHOR]

A panel of Italian neurologists of the Italian Society for the study of Dementias (SINDEM) discussed the recently proposed new lexicon for Alzheimer disease (AD) and the related diagnostic criteria for the different phases of the disease (Preclinical AD, prodromal AD and Alzheimer's dementia) (Dubois et al. in Lancet Neurol 6:734-746, ; in Lancet Neurol 9:1118-1127, ). The aim of this discussion was to reach a consensus, among the Italian neurologists involved in the study and care of persons with dementia, in particular in reference to the potential use of the proposed diagnostic criteria in clinical practice. After having critically revised the scientific evidence related to the new lexicon and to the new proposed diagnostic criteria, the panel concluded that the proposed new diagnostic criteria and the new proposed lexicon for AD are conceptually attractive. However, the evidence about the instrumental and laboratory markers for the diagnosis of the preclinical and asymptomatic states of the disease are, until to now, insufficient to support the routine clinical use of these investigations. [ABSTRACT FROM AUTHOR]

The development of new molecular and neurobiological methods, computer-assisted quantification techniques and neurobiological investigation methods which can be applied to the human brain, all have evoked an increased demand for post-mortem tissue in research. Psychiatric disorders are considered to be of neurobiological origin. Thus far, however, the etiology and pathophysiology of schizophrenia, depression and dementias are not well understood at the cellular and molecular level. The following will outline the consensus of the working group for neuropsychiatric brain banking organized in the Brainnet Europe II, on ethical guidelines for brain banking, clinical diagnostic criteria, the minimal clinical data set of retrospectively analyzed cases as well as neuropathological standard investigations to perform stageing for neurodegenerative disorders in brain tissue. We will list regions of interest for assessments in psychiatric disorder, propose a dissection scheme and describe preservation and storage conditions of tissue. These guidelines may be of value for future implementations of additional neuropsychiatric brain banks world-wide. [ABSTRACT FROM AUTHOR]

The article presents abstracts of psychophysiological research. They include "sLORETA Correlates of Memory Impairment," by Alicia Townsend and Leslie Sherlin, "Computer-Mediated Biofeedback in Managing Acute Post-Operative Pain," by Jonathan Woodhouse, Paul Lynch, Jae Park, Allen Lebortis and Douglas Gentile and "Assessment and Treatment of Emotional Trauma," by Paul G. Swingle.

Background: The number of older people in prison is growing. As a result, there will also be more prisoners suffering from dementia. The support and management of this population is likely to present multiple challenges to the prison system. Objectives: To examine the published literature on the care and supervision of people living in prison with dementia and on transitioning into the community; to identify good practice and recommendations that might inform the development of prison dementia care pathways. Methods: A scoping review methodology was adopted with reporting guided by the PRISMA extension for scoping reviews checklist and explanation. Results: Sixty-seven papers were included. Most of these were from high income countries, with the majority from the United Kingdom (n = 34), followed by the United States (n = 15), and Australia (n = 12). One further paper was from India. Discussion: The literature indicated that there were difficulties across the prison system for people with dementia along the pathway from reception to release and resettlement. These touched upon all aspects of prison life and its environment, including health and social care. A lack of resources and national and regional policies were identified as important barriers, although a number of solutions were also identified in the literature, including the development of locally tailored policies and increased collaboration with the voluntary sector. Conclusion: To our knowledge, this is the most comprehensive and inclusive review of the literature on dementia care pathways in prison to date. It has identified a number of important areas of concern and opportunities for future research across the prison system, and its operations. This will hopefully lead to the identification or adaptation of interventions to be implemented and evaluated, and facilitate the development of dementia care pathways in prisons. [ABSTRACT FROM AUTHOR]

Graphic medicine, an interdisciplinary field situated at the crossroads of comics and healthcare, operates as a medium through which the intricate nature of experiences with illness can be articulated, challenging orthodox medical dogmatism in an engaging and accessible way. Combining the affordances of comics and the narrative power of storytelling, graphic medicine elucidates the socio-cultural stigmatization of dementia influenced by a multitude of discourses. Diverging from existing discourses that depict individuals with Alzheimer's disease (AD) as zombies, brain-dead, or empty shells, graphic memoirs reconstruct these reductive notions and represent them as imaginative, productive, and perceptive. Taking these cues, the present paper close reads some sections of Dana Walrath's (2016) Aliceheimer's: Alzheimer's Through the Looking Glass in order to demonstrate how graphic medicine reconceptualizes the preeminent hallucinatory experiences of her AD-afflicted mother, Alice, as visions. Walrath deploys collage art to epitomize Alice's ordeal with AD. In particular, Walrath deploys thought-provoking fragments from Lewis Caroll's Alice in Wonderland, strategically to proximate Alice's experiences with AD and tackle the problem of dementia and sociality. Additionally, the paper explores how the text fosters interdependence, respect, and trust to recognize and restore Alice's personhood. The paper concludes by discussing how Aliceheimer's operates as an alternative paradigm beyond the confines of biomedical and cultural models of dementia through the use of lexical puissance. [ABSTRACT FROM AUTHOR]

A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier. [ABSTRACT FROM AUTHOR]

This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer’s disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert’s opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP’s intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver’s confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a “case finding” strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies ‘typical’ cases. In typical cases, among older subjects, the diagnosis of “probable AD” can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and “emergency” hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients’ right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force. [ABSTRACT FROM AUTHOR]

Current medical and clinical ecosystem for dementia detection is inadequate for its early detection. Traditional cognitive assessments are introduced after cognitive impairment has begun to disrupt the real-world functioning of the person. Moreover, these tools are paper-pen based and fail to replicate the real-world situations wherein the person ultimately lives, acts and grows. The lack of tools for early detection of dementia, combined with absence of reliable pharmacological cure compound the problems associated with dementia diagnosis and care. Advancement of technology has facilitated early prediction of disease like cancer, diabetes, heart disease, but hardly any such translation has been observed for dementia or cognitive impairment. Given this background, we examine the potential of Virtual Reality (VR) and 3D Mobile-based goal-oriented games for cognitive assessment. We evaluate three games (2 in VR, one in mobile) among 82 young participants (aged 18–28 years) and compare and contrast the game-based results with their Addenbrooke Cognitive Examination (ACE-III) scores. Three main analysis methods are used: Correlative, Z-score and Regression analysis. Positive correlation was observed for ACE-III and game-based scores. Z-scores analysis revealed no difference between the two scores, and stronger statistical significance was found between game scores and cognitive health factors like age, smoking compared to ACE-III. Specific game performances also revealed about real-world traits of participants, like hand-use confusion and direction confusion. Results establish the plausibility of using goal-oriented games for more granular, time-based, and functional cognitive assessment. [ABSTRACT FROM AUTHOR]

The dominant discourse on dementia promotes a view that as individuals progress with the disease, they experience a neurological decline causing a loss of self. This notion, grounded in a Cartesian representation of selfhood, associates a loss of self as directly related to cognition. This paper presents an alternative anthropological framework, embodied selfhood, that challenges this representation. It then examines a potential tool, graphic medicine, to translate this theory into caregiving practice. Through analyzing three graphic novels—Wrinkles, Tangles, and Aliceheimer's—this paper demonstrates how tension exists between different conceptions of selfhood and associated implications for caregivers and patients alike. [ABSTRACT FROM AUTHOR]

The subjectivity and inaccuracy of in-clinic Cognitive Health Assessments (CHA) have led many researchers to explore ways to automate the process to make it more objective and to facilitate the needs of the healthcare industry. Artificial Intelligence (AI) and machine learning (ML) have emerged as the most promising approaches to automate the CHA process. In this paper, we explore the background of CHA and delve into the extensive research recently undertaken in this domain to provide a comprehensive survey of the state-of-the-art. In particular, a careful selection of significant works published in the literature is reviewed to elaborate a range of enabling technologies and AI/ML techniques used for CHA, including conventional supervised and unsupervised machine learning, deep learning, reinforcement learning, natural language processing, and image processing techniques. Furthermore, we provide an overview of various means of data acquisition and the benchmark datasets. Finally, we discuss open issues and challenges in using AI and ML for CHA along with some possible solutions. In summary, this paper presents CHA tools, lists various data acquisition methods for CHA, provides technological advancements, presents the usage of AI for CHA, and open issues, challenges in the CHA domain. We hope this first-of-its-kind survey paper will significantly contribute to identifying research gaps in the complex and rapidly evolving interdisciplinary mental health field. [ABSTRACT FROM AUTHOR]

Alzheimer’s disease (AD) is a growing global concern, exacerbated by an aging population and the high costs associated with traditional detection methods. Recent research has identified speech data as valuable clinical information for AD detection, given its association with the progressive degeneration of brain cells and subsequent impacts on memory, cognition, and language abilities. The ongoing demographic shift toward an aging global population underscores the critical need for affordable and easily available methods for early AD detection and intervention. To address this major challenge, substantial research has recently focused on investigating speech data, aiming to develop efficient and affordable diagnostic tools that align with the demands of our aging society. This paper presents an in-depth review of studies from 2018–2023 utilizing speech for AD detection. Following the PRISMA protocol and a two-stage selection process, we identified 85 publications for analysis. In contrast to previous literature reviews, this paper places a strong emphasis on conducting a rigorous comparative analysis of various Artificial Intelligence (AI) based techniques, categorizing them meticulously based on underlying algorithms. We perform an exhaustive evaluation of research papers leveraging common benchmark datasets, specifically ADReSS and ADReSSo, to assess their performance. In contrast to previous literature reviews, this work makes a significant contribution by overcoming the limitations posed by the absence of standardized tasks and commonly accepted benchmark datasets for comparing different studies. The analysis reveals the dominance of deep learning models, particularly those leveraging pre-trained models like BERT, in AD detection. The integration of acoustic and linguistic features often achieves accuracies above 85%. Despite these advancements, challenges persist in data scarcity, standardization, privacy, and model interpretability. Future directions include improving multilingual recognition, exploring emerging multimodal approaches, and enhancing ASR systems for AD patients. By identifying these key challenges and suggesting future research directions, our review serves as a valuable resource for advancing AD detection techniques and their practical implementation. [ABSTRACT FROM AUTHOR]

Dementia, not a particular disease but rather a gathering of conditions which ascribes the debilitation of atleast two cerebrum capacities, cognitive decline and memory judgment has became ubiquous all over the world. Achieving accuracy and timely diagnosis is a major challenge in dementia detection. The recent advancements in neuroimaging techniques has setup some benchmarks. The amalgamation of computer aided algorithms with various imaging modalities proved their significance in dementia detection and classification. In this paper, a rigrous review of existing work in dementia detection and classification is presented based on the existing literature. Additionally this paper surveys the most important AI (Artificial Intellligence) and profound learning approaches for early identification of dementia. [ABSTRACT FROM AUTHOR]

This in-depth study journey explores the context of natural language processing and text analysis in dementia detection, revealing their importance in a variety of fields. Beginning with an examination of the widespread and influence of text data. The dataset utilised in this study is from TalkBank's DementiaBank, which is basically a vast database of multimedia interactions built with the goal of examining communication patterns in the context of dementia. The various communication styles dementia patients exhibit when communicating with others are seen from a unique perspective by this specific dataset. Thorough data preprocessing procedures, including cleansing, tokenization, and structuring, are undertaken, with a focus on improving prediction capabilities through the combination of textual and non-textual information in the field of feature engineering. In the subsequent phase, the precision, recall, and F1-score metrics of Support Vector Machines (SVM), K-Nearest Neighbours (KNN), Random Forest, and Artificial Neural Networks (ANN) are assessed. Empirical facts are synthesized using text analysis methods and models to formulate a coherent conclusion. The significance of text data analysis, the revolutionary potential of natural language processing, and the direction for future research are highlighted in this synthesis. Throughout this paper, readers are encouraged to leverage text data to embark on their own adventures in the evolving, data-centric world of dementia detection. [ABSTRACT FROM AUTHOR]

Objective: In this systematic review and meta-analysis, we critically evaluate available evidence regarding the association between primary headaches and subsequent decline of cognitive function and dementia. Background: Recent studies suggested that headache disorders may increase the risk for dementia. However, available studies are conflicting. Methods: To identify qualifying studies, we searched scientific databases, including Pubmed, Scopus, Web of Science, Science Direct and BMC, screening for relevant papers. In order to reduce the heterogeneity between different studies, the analyses were further subdivided according to the clinical diagnoses and the study methodologies. Results: We identified 23 studies investigating the association between primary headaches and the risk of dementia. Of these, 18 met our inclusion criteria for meta-analysis (covering 924.140 individuals). Overall effect-size shows that primary headaches were associated with a small increase in dementia risk (OR = 1,15; CI 95%: 1,03–1,28; p = 0,02). Analyzing subgroups, we found that migraine was associated with both a moderate increased risk of all-cause dementia (OR = 1,26; p = 0,00; 95% CI: 1,13–1,40) as well as a moderate increased risk of Alzheimer's disease (OR = 2,00; p = 0,00; 95% CI: 1,46–2,75). This association was significant in both case–control and retrospective cohort studies but not in prospective studies. Conclusions: Our study supports the presence of a link between primary headaches and dementia. However, in the subgroup analysis, only patients with migraine showed a moderate increase risk for all-cause dementia and for Alzheimer's disease. Additional rigorous studies are needed to elucidate the possible role of primary headaches on the risk of developing cognitive impairment and dementia. [ABSTRACT FROM AUTHOR]

Introduction: A new national survey has been carried out by the Italian Centers for Cognitive Disorders and Dementias (CCDDs). The aim of this new national survey is to provide a comprehensive description of the characteristics, organizational aspects of the CCDDs, and experiences during the COVID-19 pandemic. Methods: A list of all national CCDDs was requested from the delegates of each Italian region. The online questionnaire is divided in two main sections: a profile section, containing information on location and accessibility, and a data collection form covering organization, services, treatments, activities, and any service interruptions caused by the COVID-19 outbreak. Results: In total, 511 out of 534 (96%) facilities completed the profile section, while 450 out of 534 (84%) CCDDs also completed the data collection form. Almost half of the CCDDs (55.1%) operated for 3 or fewer days a week. About one-third of the facilities had at least two professional figures among neurologists, geriatricians and psychiatrists. In 2020, only a third of facilities were open all the time, but in 2021, two-thirds of the facilities were open. Conclusion: This paper provides an update on the current status of CCDDs in Italy, which still shows considerable heterogeneity. The survey revealed a modest improvement in the functioning of CCDDs, although substantial efforts are still required to ensure the diagnosis and care of patients with dementia. [ABSTRACT FROM AUTHOR]

Recent studies report doubling numbers of deaths due to dementia. With such an escalating mortality rate related to cognitive decline diseases, like dementia, timely information on contributing factors and knowledge discovery from evidence-based repositories is warranted. A large amount of scholarly knowledge extracted from research findings on dementia can be understood only using human intelligence for arriving at quality inferences. Due to the unstructured data presented in such a massive dataset of scientific articles available online, gaining insights from the knowledge hidden in the literature is complex and time-consuming. Hence, there is a need for developing a knowledge management model to create, query and maintain a knowledge repository of key elements and their relationships extracted from scholarly articles in a structured manner. In this paper, an innovative knowledge discovery computing model to process key findings from unstructured data from scholarly articles by using the design science research (DSR) methodology is proposed. The solution caters to a novel composition of the cognitive script of crucial knowledge related to dementia and its subsequent transformation from unstructured into a structured format using graph-based next-generation infrastructures. The computing model contains three phases to assist the research community to have a better understanding of the related knowledge in the existing unstructured research articles: (i) article collection and construction of cognitive script, (ii) generation of Cypher statements (a knowledge graph query language) and (iii) creation of graph-based repository and visualization. The performance of the computing model is demonstrated by visualizing the outcome of various search criteria in the form of nodes and their relationships. Our results also demonstrate the effectiveness of visual query and navigation highlighting its usability. [ABSTRACT FROM AUTHOR]

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Backgroung: The early identification of cognitive disorder is a primary scope, because it could reduce the rate of severe cognitive impairment and thus contribute to reduce healthcare costs in the next future. Aims: The present paper aimed to build a virtuous diagnostic path of cognitive impairment, highlighting all the professionalism that can serve this purpose. Methods: The Delphi method was used by the experts, who reviewed the information available during each meeting related to the following topics: early diagnosis of cognitive impairment, definition of Mild Cognitive Impairment, unmet needs in post-stroke patients, critical decision-making nodes in complex patients, risk factors, neuropsychological, imaging diagnosis, blood tests, the criteria for differential diagnosis and the possible treatments. Results: The discussion panels analyzed and discussed the available evidences on these topics and the related items. At each meeting, the activities aimed at the creation of a diagnostic-welfare flow chart derived from the proposal of the board and the suggestions of the respondents. Subsequently, the conclusions of each panel were written, and the study group reviewed them until a global consensus was reached. Once this process was completed, the preparation of the final document was carried out. Conclusions: Eventually, we built an algorithm for the early diagnosis and treatment, the risk factors, with the possible differences among the different kinds of dementia. [ABSTRACT FROM AUTHOR]

Background: There has been considerable focus on the use of psychotropic agents in people living with dementia in long-term care. However, psychotropic use often commences well before transitioning to long-term care. Objectives: To synthesize the available literature to identify factors associated with psychotropic medication use in people living with dementia in the community. Methods: This PROSPERO-registered review reports findings from a comprehensive search of Embase, PsycINFO, and PubMed (including MEDLINE) databases according to predefined inclusion and exclusion criteria (2010–2022). Inclusion criteria were original prospective or retrospective design research papers enrolling people diagnosed with dementia utilizing a psychotropic medication and living at home. Quality and risk of bias was assessed Newcastle–Ottawa Quality Assessment Scale. The last search was conducted in November 2022. Thematic analysis was used to synthesize the emergent factors identified, and a meta-analysis was undertaken on suitable data. Results: The search identified 619 articles. After review and exclusions, 39 articles were included for synthesis, including 1,338,737 people. The majority of papers (67%) were rated as low risk of bias and corresponding good quality. Thematic analysis suggested associations between psychotropic prescribing and patient and environmental factors, with little data concerning carer and prescriber factors. Such factors included age (< 75 years, > 90 years), sex, more advanced functional decline, and living alone. Meta-analysis identified significant associations between psychotropic use and respite (temporary full-time care or hospitalization) and comorbid psychiatric illness. Conclusions: While it is clear from this review that there remains a significant lack of clarity as to the reasons why these medications are being utilized in this population, this review provides greater insight and understanding into the context of psychotropic use. The study has highlighted an opportunity for further targeted research to be conducted and provides a much-needed context for this to occur. PROSPERO Registration Number: CRD42021286322. [ABSTRACT FROM AUTHOR]

Upper limb motor function is a potential new biomarker of cognitive impairment and may aid discrimination from healthy ageing. However, it remains unclear which assessments to use. This study aimed to explore what methods have been used and to describe associations between upper limb function and cognitive impairment. A scoping review was conducted using PubMed, CINAHL and Web of Science. A systematic search was undertaken, including synonyms for key concepts 'upper limb', 'motor function' and 'cognitive impairment'. Selection criteria included tests of upper limb motor function and impaired cognition in adults. Analysis was by narrative synthesis. Sixty papers published between 1998 and 2022, comprising 41,800 participants, were included. The most common assessment tasks were finger tapping, Purdue Pegboard Test and functional tasks such as writing. Protocols were diverse in terms of equipment used and recording duration. Most participants were recruited from clinical settings. Alzheimer's Disease was the most common cause of cognitive impairment. Results were mixed but, generally, slower speed, more errors, and greater variability in upper limb movement variables was associated with cognitive impairment. This review maps the upper limb motor function assessments used and summarises the available evidence on how these associate with cognitive impairment. It identifies research gaps and may help guide protocols for future research. There is potential for upper limb motor function to be used in assessments of cognitive impairment. [ABSTRACT FROM AUTHOR]

Purpose: A joint effort of the European Association of Nuclear Medicine (EANM) and the European Academy of Neurology (EAN) aims at clinical guidance for the use of FDG-PET in neurodegenerative diseases. This paper addresses the diagnostic utility of FDG-PET over clinical/neuropsychological assessment in the differentiation of the three forms of primary progressive aphasia (PPA).Methods: Seven panelists were appointed by the EANM and EAN and a literature search was performed by using harmonized PICO (Population, Intervention, Comparison, Outcome) question keywords. The studies were screened for eligibility, and data extracted to assess their methodological quality. Critical outcomes were accuracy indices in differentiating different PPA clinical forms. Subsequently Delphi rounds were held with the extracted data and quality assessment to reach a consensus based on both literature and expert opinion.Results: Critical outcomes for this PICO were available in four of the examined papers. The level of formal evidence supporting clinical utility of FDG-PET in differentiating among PPA variants was considered as poor. However, the consensual recommendation was defined on Delphi round I, with six out of seven panelists supporting clinical use.Conclusions: Quantitative evidence demonstrating utility or lack thereof is still missing. Panelists decided consistently to provide interim support for clinical use based on the fact that a typical atrophy or metabolic pattern is needed for PPA according to the diagnostic criteria, and the synaptic failure detected by FDG-PET is an earlier phenomenon than atrophy. Also, a normal FDG-PET points to a non-neurodegenerative cause. [ABSTRACT FROM AUTHOR]

Fall prevention and management of behavioural and psychological symptoms of dementia (BPSD) in long-term care (LTC) facility is a major challenge. The objective of this systematic review is to assess the evidence of digital technology in their management. All studies of English-language excluding case-reports were eligible for review. Databases chosen were MEDLINE, EMBASE, Scopus, Web of Science and PSYCINFO from January 2000 to June 2020. Downs and Black checklist was used to check for risk of bias. Papers with a focus in LTC setting, using digital technology as intervention for older adults with dementia, and with measurable outcomes (outcomes that are quantified, not descriptive) were included in the final review. Seventeen original papers (8 RCTs, 8 quasi-experimental and 1 mixed method) were included. Three articles examining position-sensor technology for fall prevention showed mixed results. Two showed no difference and 1 showed small reduction in fall after alarm removal but the positive effect might be due to bias. Overall, the sample sizes were too small to draw meaningful conclusion. Fourteen studies (9 pet robots of which 8 were robotic seal/PARO) were identified for BPSD and results were mixed. Overall, PARO might have modest benefit in BPSD compared to usual care but might be no better than plush toy with more hallucinations or delusions seen in advanced dementia. However, the significant heterogeneity in methodology (intervention intensity, lack of record in psychoactive drug use), clinical tools used (different BPSD scales, different digital technologies) and variability in outcomes made it difficult to draw clear-cut conclusion. Studies involving other digital technologies are scarce and in pilot phases; hence, conclusion is premature. One limitation of the review was that only 9 out of 17 studies were of good quality. The limited research work in position-sensors meant insufficient evidence to prove efficacy for their use in LTC setting. The possible modest benefit of PARO in BPSD (e.g. in agitation, apathy or reduction in psychoactive drugs) was off-set by possible adverse events such as delusions or hallucinations in advanced dementia. [ABSTRACT FROM AUTHOR]

The Nun study is a well-known longitudinal epidemiology study of aging and dementia that recruited elderly nuns who were not yet diagnosed with dementia (i.e., incident cohort) and who had dementia prior to entry (i.e., prevalent cohort). In such a natural history of disease study, multistate modeling of the combined data from both incident and prevalent cohorts is desirable to improve the efficiency of inference. While important, the multistate modeling approaches for the combined data have been scarcely used in practice because prevalent samples do not provide the exact date of disease onset and do not represent the target population due to left-truncation. In this paper, we demonstrate how to adequately combine both incident and prevalent cohorts to examine risk factors for every possible transition in studying the natural history of dementia. We adapt a four-state nonhomogeneous Markov model to characterize all transitions between different clinical stages, including plausible reversible transitions. The estimating procedure using the combined data leads to efficiency gains for every transition compared to those from the incident cohort data only. [ABSTRACT FROM AUTHOR]

'Nostalgic environments' are increasingly being created in museums and institutional care settings for people with dementia, to support residents' capacities for memory and recognition. Drawing upon ethnography carried out in a public nursing home specialized in dementia care in Copenhagen, Denmark, this paper engages conceptually the employment of material heritage within dementia care environments, proposing dementia care as a 'curatorial' practice: caregivers act as 'curators' who re-establish and reorganize the 'meaning' of the residents by preserving their individual biographies and societal belonging. The analytical alignment of dementia care with the curating of cultural valuables reveals that the human is not only the subject within—and the creator of—cultural heritage, but also the object: the person with dementia is simultaneously an acting subject in care and an object for performances of the category of the human. As the curatorial care performed in nursing homes preserves not only individual, but also collective memories of what it takes to be human and belong in society, these institutions should be recognized as significant sites within society concerned with the production of meaning, value and cultural heritage. [ABSTRACT FROM AUTHOR]

Purpose: To review literature until November 2015 and reach a consensus on whether automatic semi-quantification of brain FDG-PET is useful in the clinical setting for neurodegenerative disorders.Methods: A literature search was conducted in Medline, Embase, and Google Scholar. Papers were selected with a lower limit of 30 patients (no limits with autopsy confirmation). Consensus recommendations were developed through a Delphi procedure, based on the expertise of panelists, who were also informed about the availability and quality of evidence, assessed by an independent methodology team.Results: Critical outcomes were available in nine among the 17 papers initially selected. Only three papers performed a direct comparison between visual and automated assessment and quantified the incremental value provided by the latter. Sensitivity between visual and automatic analysis is similar but automatic assessment generally improves specificity and marginally accuracy. Also, automated assessment increases diagnostic confidence. As expected, performance of visual analysis is reported to depend on the expertise of readers.Conclusions: Tools for semi-quantitative evaluation are recommended to assist the nuclear medicine physician in reporting brain FDG-PET pattern in neurodegenerative conditions. However, heterogeneity, complexity, and drawbacks of these tools should be known by users to avoid misinterpretation. Head-to-head comparisons and an effort to harmonize procedures are encouraged. [ABSTRACT FROM AUTHOR]

One goal of this paper is to argue that autobiographical memories are extended and distributed across embodied brains and environmental resources. This is important because such distributed memories play a constitutive role in our narrative identity. So, some of the building blocks of our narrative identity are not brain-bound but extended and distributed. Recognising the distributed nature of memory and narrative identity, invites us to find treatments and strategies focusing on the environment in which dementia patients are situated. A second goal of this paper is to suggest various of such strategies, including lifelogging technologies such as SenseCams, life story books, multimedia biographies, memory boxes, ambient intelligence systems, and virtual reality applications. Such technologies allow dementia patients to remember their personal past in a way that wouldn’t be possible by merely relying on their biological memory, in that way aiding in preserving their narrative identity and positively contributing to their sense of well-being. [ABSTRACT FROM AUTHOR]

The efficient detection of neurological abnormalities (disorders) is very important in clinical diagnosis for modern medical applications. As stated by the World Health Organization's (WHO), brain diseases like Alzheimer's disease, epilepsy, and stroke to headache, infected almost one billion people globally. Electroencephalography (EEG) is the current reference standard for diagnosis of most of the neurological diseases as it is inexpensive, bearable, and non-invasive compared to other tests (e.g. computed tomography, positron emission tomography, mini-mental state examination, and magnetic resonance imaging). Many studies are performed using EEG signals to detect the neurodegenerative abnormalities in the preliminary stage. This paper attempts to provide a comprehensive survey on the recent studies which are made using EEG signals to detect the neurological diseases: Dementia, Mild Cognitive Impairment, Alzheimer, Schizophrenia, and Parkinson. This paper focuses on the following key research questions: (1) what are the key components of EEG signal processing, (2) what algorithms have been used in this processing, (3) which signal processing techniques have received more attention? The paper provides a clear description of the mentioned neuro-diseases along with the relevant studies. Moreover, this study presents all the recent efforts of the methods that are obtained various step of signal data processing including feature extraction and classification phases. Finally, an elaborated comparison of the existing efforts with their drawbacks and performance are reported. This will guide the medical field researchers and technology experts to discover more accurate solutions for neuro-diseases and come up with a neurological abnormality detection framework. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of bilateral thalamic infarction (BTI) presenting as progressive thalamic dementia due to a midline tentorial dAVF (TdAVF) and to provide a systematic review of the literature. Methods: We performed a systematic literature review of previously reported cases of bi-thalamic signal changes due to dAVF considering population characteristics, clinical presentation, imaging findings, treatments, and outcomes. Results: We found 29 papers from 1985 until 2021 describing 35 cases of BTI dAVF-related. We analysed 36 cases comprehensive of our case report. The mean age was 58.7 years (range 38–79), 91.6% were males (n=33). Most cases presented with a subacute syndrome. In 86.1% (n=31) of cases a TdAVF was found; 58.3% (n=21) were type 2 Borden-Shucart fistulas, the remaining were mostly type 3. In 80.5% (n=29), a thrombosed sinus was identified. 33.3% of cases (n=12) had bi-thalamic haemorrhages. Endovascular treatment was performed in 83.3% of cases (n=30). A total of 75% (n=27) of cases had a good recovery. Conclusions: BTIs due to dAVFs may present with subacute symptoms overlapping with several differential diagnoses. Prompt identification at MRI, before venous drainage failure and bleeding, is crucial for a good prognosis. [ABSTRACT FROM AUTHOR]

While the prevalence of non-communicable disease risk factors is understood to be higher among migrants than for people born in host nations, little is known about the dementia risk profile of migrants, refugees and asylum seekers. This systematic review examines published literature to understand what is currently reported about 12 identified modifiable risk factors for dementia among migrants, refugees, and asylum seekers residing in Australia. Three literature databases (PubMed/CINAHL/MEDLINE) were systematically searched to find articles reporting excessive alcohol consumption, traumatic brain injury, air pollution, lack of education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and limited social contact in Australia's migrant, refugee and asylum seeker population samples. Papers were systematically reviewed following PRISMA guidelines. A total of 763 studies were found, of which 676 articles were excluded, and 79 articles remained. Despite wide variability in study design, size and purpose, the prevalence and correlates of modifiable risk factors of dementia appears markedly different among the studied samples. Compared with Australian-born participants, migrant samples had a higher prevalence of depression, social isolation, physical inactivity and diabetes mellitus. Insufficient information or conflicting evidence prevented inference about prevalence and correlates for the remaining dementia risk factors. A better understanding of the prevalence and correlates of modifiable dementia risk factors is needed in Australia's migrant, refugee and asylum seeker populations. This information, together with a deeper understanding of the contextual and cultural contributing factors affecting people who arrive in Australia through differing pathways is needed before preventive interventions can be realistically targeted and sensitively implemented. [ABSTRACT FROM AUTHOR]

This paper reports the proceedings of a virtual meeting convened by the European Interdisciplinary Council on Ageing (EICA), to discuss the involvement of infectious disorders in the pathogenesis of dementia and neurological disorders leading to dementia. We recap how our view of the infectious etiology of dementia has changed over the last 30 years in light of emerging evidence, and we present evidence in support of the implication of infection in dementia, notably Alzheimer's disease (AD). The bacteria and viruses thought to be responsible for neuroinflammation and neurological damage are reviewed. We then review the genetic basis for neuroinflammation and dementia, highlighting the genes that are currently the focus of investigation as potential targets for therapy. Next, we describe the antimicrobial hypothesis of dementia, notably the intriguing possibility that amyloid beta may itself possess antimicrobial properties. We further describe the clinical relevance of the gut–brain axis in dementia, the mechanisms by which infection can move from the intestine to the brain, and recent findings regarding dysbiosis patterns in patients with AD. We review the involvement of specific pathogens in neurological disorders, i.e. SARS-CoV-2, human immunodeficiency virus (HIV), herpes simplex virus type 1 (HSV1), and influenza. Finally, we look at the role of vaccination to prevent dementia. In conclusion, there is a large body of evidence supporting the involvement of various infectious pathogens in the pathogenesis of dementia, but large-scale studies with long-term follow-up are needed to elucidate the role that infection may play, especially before subclinical or clinical disease is present. [ABSTRACT FROM AUTHOR]

Background: There is a growing interest in incorporating informal care in cost-of-illness studies as a relevant part of the economic impact of some diseases.Objective: The aim of this paper was to review the recent literature valuating the costs of informal care in a group of selected diseases from 2005 to 2015.Methods: We carried out a systematic review on the economic impact of informal care, focusing on six selected diseases: arthritis or osteoarthritis, cancer, dementia, mental diseases, multiple sclerosis and stroke.Results: We selected 91 cost-of-illness articles. The average weight attributed to the informal care cost over the total cost was highly relevant for dementia, stroke, mental diseases, cancer and multiple sclerosis. The most frequent valuation method applied was the opportunity cost method, followed by the proxy good method. The annual cost of informal care presented a high variability depending on the disease and geographic location. Distinguishing by type of illness, the disease with the highest annual value of informal caregiving was dementia, followed by mental illness and multiple sclerosis. The average hourly unit cost was €11.43 (2015 values), varying noticeably depending on the geographic location.Conclusion: This paper identifies several aspects that should be enhanced to promote comparability between studies and countries, and it sends key messages for incorporating informal care costs to adequately measure the economic impact of diseases. [ABSTRACT FROM AUTHOR]

The world population is aging and more and more people suffer from dementia, which makes remembering and orientation in time and space difficult. Moreover dementia has a strong negative effect on the quality of living of the people suffering from it, but also of their relatives. In this paper, we investigate if and how the playback of carefully chosen and recognizable sounds, such as music, a clock tower, or nature sounds, can help these people and have a positive effect on the behavioral and psychological symptoms of dementia (BPSD). The selection and playback of these sounds, augmenting the existing soundscape, is performed in a personalized manner, since sounds can elicit a different response in different people. Caregivers can provide feedback on the soundscape based on the resident's behavior and response to hearing the sounds. This allows a continuous adaptation of the soundscape. The soundscape system was tested with 19 people suffering from dementia and resident of 6 different nursing homes. Comparison of the nursing home environment before and after installation of the soundscape system showed that most residents (13/19) experienced this as an improvement of the sound environment. [ABSTRACT FROM AUTHOR]

Emerging research confirms the need for technologically enhanced solutions to support non-pharmacological interventions which can improve the quality of life, the mental and physical health of demented people. Several types of research examined if virtual reality can be an effective solution. This paper aims to present the cyclic process of prototyping, testing, analysing, and refining the VR system in real-world clinical settings. Seven people with moderate to severe dementia were recruited. The experiment required the patients to attend three virtual reality iterations of rapid prototyping with user testing. All three iterations involved training activities with upper body movements similar to their usual physical training. A mixed-methods design measured affect and emotional behaviour using the Observed Emotion Rating Scale and the Visual Analog Scale. Content analysis was conducted following observations and interviews. During each iteration of rapid prototyping with user testing, quantitative measurements of performance, independence and time were recorded. Eye tracking and movement information were captured by the system. Finally, a simplified version of the presence and usability scales evaluated the system. The results of this study provide further evidence that virtual reality can play a significant role in the improvement of people's with dementia physical training and emotional health when is appropriately designed. The results present the vital factors which should be incorporated in a virtual reality system which are: 1) a simple interactions modality; 2) visible visual targets and continuous feedback; 3) personalized virtual environments; 4) personalized range of movements. [ABSTRACT FROM AUTHOR]

Dementia has been cited as a critical public health risk in the contemporary world, while few empirical researchers try to reveal the casual relationship between air pollutant concentrations (APCs) and dementia, especially given the increasing prevalence of air pollution on a global scale. Accordingly, this paper tries to infer the causal relationship between APCs and dementia. The 59,605 valid data was compiled through a combination of the statistic from the China Family Panel Study, China Environmental Statistics Yearbook, World Meteorological Association and China National Bureau of Statistics. The RD design of this study utilizes the discontinuous variation in APCs and dementia as one crosses the Huai River boundary, which is an arbitrary heating policy that causes the significant difference in APCs between the north and south of China. We used stata17.0 to analyze the data. The results of the RD regression indicated that a 100 μ g/m3 rise in APCs led to an increase of 42.4% in the hazard ratio of suffering dementia (Coeff=-0.58, SD= 0.23, P < 0.05). Meanwhile, heterogeneous models revealed that the hazard ratio of suffering dementia by APCs was more significant in the older compared to younger (coeff= 1.35 vs coeff= 1.55, P < 0.05), male compared to female (coeff= 1.62 vs coeff= 0.71, P < 0.05), smoking compared to non-smoke (coeff= 2.12 vs coeff= 0.93, P < 0.05), and thin groups compared to medium and obesity (coeff= 2.05 vs coeff= 1.22, coeff= 1.28, P < 0.05). In addition, the O3 and SO2 were the air pollutants with the highest (coeff= 1.54, P < 0.05) and lowest effects (coeff= 0.81, P < 0.05) on the hazard ratio of suffering dementia among the five APCs, respectively. And the robustness of the results was ensured by changing the RD bandwidth, polynomial order. The results indicated that APCs significantly induced the hazard ratio of suffering dementia of Chinese residents, which provides empirical evidence in supporting the Chinese government to invest more in combating air pollution and ensure the public health of Chinese residents. [ABSTRACT FROM AUTHOR]

Background: In this review we discuss how the study of dementia epidemiology in Low- and Middle-Income Countries (LMICs) has changed in the last 20 years, and specifically to review the evidence created by the 10/66 Dementia Research Group (DRG) and discuss future directions for research.Methods: We identified and collated all the papers related to the 10/66 Dementia Research Group, including papers from groups who adopted the 10/66 methodology, that have been published in peer-reviewed journals.Results: Over 200 papers including data from Africa, Asia, Europe and Latin America and the Caribbean were identified by this review. Many of the findings revolved around the epidemiology of dementia, mental health and non-communicable diseases, including the cross-cultural development and validation of measurement tools of cognition and functioning, need for care, care arrangements and mental health. Social ageing, care dependence and caregiver interventions were also topics that the group had published on.Discussion: A body of evidence has been generated that has challenged the view, prevalent when the group started, that dementia is comparatively rare in LMICs. The experience of the 10/66 DRG has shown that descriptive epidemiological research can be important and impactful, where few data exist. Monitoring population trends in the prevalence and incidence of dementia may be our best chance to confirm hypotheses regarding modifiable risk factors of dementia. [ABSTRACT FROM AUTHOR]

Presents a set of papers featured in the December 1999 issue of "Culture, Medicine and Psychiatry," which analyzed narratives of caregivers of elders with dementia in Boston, Massachusetts. Methods shared across the papers; Multidimensional framework for ethnicity; Directions for future research.

Purpose: People with dementia may have indications for aspirin prescription and clinicians are asked to balance the potential risks against benefits. This review examines the evidence for the risk and benefit of long-term aspirin use in people with dementia aged over 65 years, including randomised controlled trials and observational studies. Methods: We searched three databases for research published between 2007 and 2020. Each eligible article was assessed for risk of bias, and confidence in findings was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Four papers met inclusion criteria: one randomised controlled trial, two cohort studies, and one with pooled data. All looked only at dementia of Alzheimer's type, and none addressed myocardial or cerebral infarction as outcomes. Dementia progression was reported by two studies, with conflicting results. The trial found no significant effect of aspirin on mortality (odds ratio aspirin vs. no aspirin 1.07, 95% confidence interval 0.58–1.97) but found more events of severe bleeding with aspirin (OR aspirin vs. no aspirin 6.9, 1.5–31.2). An excess in intracranial haemorrhage in the aspirin group was judged plausible based on two non-randomised studies. Conclusions: The review findings are limited because studies include only people with Alzheimer's-type dementia and lack confirmatory studies, although an increased risk of bleeding events is recognised. Further research that addresses the benefits and risks of aspirin in more representative groups of people with dementia is needed to guide prescribing decisions. [ABSTRACT FROM AUTHOR]

Scholarly communication of knowledge is predominantly document-based in digital repositories, and researchers find it tedious to automatically capture and process the semantics among related articles. Despite the present digital era of big data, there is a lack of visual representations of the knowledge present in scholarly articles, and a time-saving approach for a literature search and visual navigation is warranted. The majority of knowledge display tools cannot cope with current big data trends and pose limitations in meeting the requirements of automatic knowledge representation, storage, and dynamic visualization. To address this limitation, the main aim of this paper is to model the visualization of unstructured data and explore the feasibility of achieving visual navigation for researchers to gain insight into the knowledge hidden in scientific articles of digital repositories. Contemporary topics of research and practice, including modifiable risk factors leading to a dramatic increase in Alzheimer's disease and other forms of dementia, warrant deeper insight into the evidence-based knowledge available in the literature. The goal is to provide researchers with a visual-based easy traversal through a digital repository of research articles. This paper takes the first step in proposing a novel integrated model using knowledge maps and next-generation graph datastores to achieve a semantic visualization with domain-specific knowledge, such as dementia risk factors. The model facilitates a deep conceptual understanding of the literature by automatically establishing visual relationships among the extracted knowledge from the big data resources of research articles. It also serves as an automated tool for a visual navigation through the knowledge repository for faster identification of dementia risk factors reported in scholarly articles. Further, it facilitates a semantic visualization and domain-specific knowledge discovery from a large digital repository and their associations. In this study, the implementation of the proposed model in the Neo4j graph data repository, along with the results achieved, is presented as a proof of concept. Using scholarly research articles on dementia risk factors as a case study, automatic knowledge extraction, storage, intelligent search, and visual navigation are illustrated. The implementation of contextual knowledge and its relationship for a visual exploration by researchers show promising results in the knowledge discovery of dementia risk factors. Overall, this study demonstrates the significance of a semantic visualization with the effective use of knowledge maps and paves the way for extending visual modeling capabilities in the future. [ABSTRACT FROM AUTHOR]

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Theories of personal identity in the tradition of John Locke and Derek Parfit emphasize the importance of psychological continuity and the abilities to think, to remember and to make rational choices as a basic criterion for personhood. As a consequence, persons with severe dementia are threatened to lose the status of persons. Such concepts, however, are situated within a dualistic framework, in which the body is regarded as a mere vehicle of the person, or a carrier of the brain as the organ of mental faculties. Based on the phenomenology of embodiment, this paper elaborates a different approach to personal identity in dementia. In this perspective, selfhood is primarily constituted by pre-reflective self-awareness and the body memory of an individual, which consists in the embodiment and enactment of familiar habits, practices and preferences. After describing the different types of body memory, the paper develops a phenomenology of dementia as a loss of reflexivity and meta-perspective. This is contrasted with the preservation of individual forms of body memory even in the later stages of the illness. The ethical consequences of an embodied approach to dementia are outlined. A final look is given to narrativistic and constructionist concepts of the self in dementia. [ABSTRACT FROM AUTHOR]

Background: The NHS dementia strategy identifies patient and carer information and support (PCIS) as a core component of gold-standard dementia care. This is the first systematic review of PCIS, performed to analyse the literature and evidence for these interventions. Aims: To systematically review literature evaluating the effectiveness of the provision of PCIS for people with dementia and their informal carers, in inpatient and outpatient settings. Methods: Searches of four online biomedical databases, accessed in September 2018. Studies were selected if they were: relating to people with dementia or their informal carers, based in inpatient or outpatient settings, published in English-language peer-reviewed journals no earlier than the year 2000 and assessed dementia-related information or social support interventions, by measuring qualitative or quantitative carer or patient-reported outcomes. Standardised data extraction and quality appraisal forms were used. Results: 7 of 43 full-text papers analysed were eligible for analysis. 3 papers were different arms of one original study. Trends were present in the quantitative results towards reduced patient and carer depression and anxiety and the themes in the qualitative analysis were in favour of the intervention. Conclusions: The studies analysed were too heterogeneous in design, population and outcomes measured to make a conclusive opinion about the efficacy of these interventions. It is surprising that for such a common condition, a gold-standard evidence-based intervention and standardised delivery for provision of PCIS for people living with dementia in the UK does not exist. Further research is therefore vital. [ABSTRACT FROM AUTHOR]

Background: FDG-PET is frequently used as a marker of synaptic damage to diagnose dementing neurodegenerative disorders. We aimed to adapt the items of evidence quality to FDG-PET diagnostic studies, and assess the evidence available in current literature to assist Delphi decisions for European recommendations for clinical use.Methods: Based on acknowledged methodological guidance, we defined the domains, specific to FDG-PET, required to assess the quality of evidence in 21 literature searches addressing as many Population Intervention Comparison Outcome (PICO) questions. We ranked findings for each PICO and fed experts making Delphi decisions for recommending clinical use.Results: Among the 1435 retrieved studies, most lacked validated measures of test performance, an adequate gold standard, and head-to-head comparison of FDG-PET and clinical diagnosis, and only 58 entered detailed assessment. Only two studies assessed the accuracy of the comparator (clinical diagnosis) versus any kind of gold−/reference-standard. As to the index-test (FDG-PET-based diagnosis), an independent gold-standard was available in 24% of the examined papers; 38% used an acceptable reference-standard (clinical follow-up); and 38% compared FDG-PET-based diagnosis only to baseline clinical diagnosis. These methodological limitations did not allow for deriving recommendations from evidence.Discussion: An incremental diagnostic value of FDG-PET versus clinical diagnosis or lack thereof cannot be derived from the current literature. Many of the observed limitations may easily be overcome, and we outlined them as research priorities to improve the quality of current evidence. Such improvement is necessary to outline evidence-based guidelines. The available data were anyway provided to expert clinicians who defined interim recommendations. [ABSTRACT FROM AUTHOR]

Due to society aging, age-related issues such as mild cognitive impairments (MCI) and dementia are attracting the attention of health professionals, scientists and governments. Seniors suffering from such impairments notice a slight deterioration in their cognitive abilities, which may lead to memory loss and behavioural disorders. In consequence, such seniors refrain from doing their everyday outdoor activities. Technology, e.g. smartphones, wearables and artificial intelligence, can provide seniors and their relatives with a variety of monitoring tools. In a nutshell, locations are analysed and, under specific situations, alarms are raised so that caregivers urgently informed. In this context, the discovery and prediction of trajectories and behaviours play a key role in deploying effective monitoring solutions. In this paper, we present a real-time smartphone-based monitoring system, called SafeMove, to discover and predict elderly people behaviours by analyzing outdoor trajectories. This is achieved by firstly analysing the elder's mobility data previously collected using the proposed model called SpaceTime-Convolutional Neural Network (ST-CNN) in order to predict the most popular locations he/she might visit in the next time. Based on the predicted locations, the elder can be monitored in bounded region. Time and space-related variables, such as the distance traversed, the direction of the movements and the time spent, are analyzed in our abnormal behaviour detection (ABD) model that takes advantage of recurrent neural networks (RNNs). The effectiveness and the efficiency of our system for predicting the next location and detection the abnormal behaviors are evaluated using different datasets comprising real-world GPS trajectories. [ABSTRACT FROM AUTHOR]