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Background: The COVID-19 pandemic is affecting people with dementia in numerous ways. Nevertheless, there is a paucity of research on the COVID-19 impact on people with dementia and their care partners., Objective: Using Twitter, the purpose of this study is to understand the experiences of COVID-19 for people with dementia and their care partners., Methods: We collected tweets on COVID-19 and dementia using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets., Results: From the 5063 tweets analyzed with line-by-line coding, we identified 4 main themes including (1) separation and loss; (2) COVID-19 confusion, despair, and abandonment; (3) stress and exhaustion exacerbation; and (4) unpaid sacrifices by formal care providers., Conclusions: There is an imminent need for governments to rethink using a one-size-fits-all response to COVID-19 policy and use a collaborative approach to support people with dementia. Collaboration and more evidence-informed research are essential to reducing COVID-19 mortality and improving the quality of life for people with dementia and their care partners., (©Juanita-Dawne Bacsu, Megan E O'Connell, Allison Cammer, Mahsa Azizi, Karl Grewal, Lisa Poole, Shoshana Green, Saskia Sivananthan, Raymond J Spiteri. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 03.02.2021.)

Remote approaches for dementia research are required in the era of COVID-19, but moving a research program from in person to remote involves additional considerations. We recommend using outcome measures that have psychometric properties for remote delivery, and we recommend against adapting in-person scales for remote delivery without evidence for psychometric equivalency. We suggest remote research designs that maximize benefit for participants, which could have implications for control groups. Researchers should plan for flexibility in their methods for remote research and must not assume all participants will be able to videoconference; telephone-only research is possible. We recommend performing an assessment of information communication technology infrastructure and prior exposure to this technology with each participant before making a final choice on remote methods for research. In general, researchers should adapt their methods for remote research to each participant rather than requesting participants to adapt to the researchers. Screening for sensory loss should be conducted, and the impact of this on the use of technology for remote research should be considered. In this viewpoint, we detail how individualized training is required prior to engaging in remote research, how training plans interact with cognitive impairments and, finally, the steps involved in facilitating technology-based remote data collection., (©Megan E O'Connell, Shirin Vellani, Sheryl Robertson, Hannah M O'Rourke, Kathy S McGilton. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 27.01.2021.)

Introduction: Despite the urgent need for remote neurobehavioral assessment of individuals with cognitive impairment, guidance is lacking. Our goal is to provide a multi-dimensional framework for remotely assessing cognitive, functional, behavioral, and physical aspects of people with cognitive impairment, along with ethical and technical considerations., Methods: Literature review on remote cognitive assessment and multidisciplinary expert opinion from behavioral neurologists, neuropsychiatrists, neuropsychologists, and geriatricians was integrated under the auspices of the Alzheimer Society of Canada Task Force on Dementia Care Best Practices for COVID-19. Telephone and video approaches to assessments were considered., Results: Remote assessment is shown to be acceptable to patients and caregivers. Informed consent, informant history, and attention to privacy and autonomy are paramount. A range of screening and domain-specific instruments are available for telephone or video assessment of cognition, function, and behavior. Some neuropsychological tests administered by videoconferencing show good agreement with in-person assessment but still lack validation and norms. Aspects of the remote dementia-focused neurological examination can be performed reliably., Discussion: Despite challenges, current literature and practice support implementation of telemedicine assessments for patients with cognitive impairment. Convergence of data across the clinical interview, reliable and brief remote cognitive tests, and remote neurological exam increase confidence in clinical interpretation and diagnosis., Competing Interests: The authors have no conflicts of interest to declare., (© 2020 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)

Background and Objectives: The 12-item Short Form Health Survey (SF-12) is a widely used measure of health related quality of life, but has been criticized for lacking an empirically supported model and producing biased estimates of mental and physical health status for some groups. We explored a model of measurement with the SF-12 and explored evidence for measurement invariance of the SF-12., Research Design and Methods: The SF-12 was completed by 429 caregivers who accompanied patients with cognitive concerns to a memory clinic designed to service rural/remote-dwelling individuals. A multi-group confirmatory factor analysis was used to compare the theoretical measurement model to two empirically identified factor models reported previously in general population studies., Results: A model that allowed mental and physical health to correlate, and some items to cross-load provided the best fit to the data. Using that model, measurement invariance was then assessed across sex and metropolitan influence zone (MIZ; a standardized measure of degree of rurality)., Discussion: Partial scalar invariance was demonstrated in both analyses. Differences by sex in latent item intercepts were found for items assessing feelings of energy and depression. Differences by MIZ in latent item intercepts were found for an item concerning how current health limits activities., Implications: The fitting model was one where the mental and physical health subscales were correlated, which is not provided in the scoring program offered by the publishers. Participants' sex and MIZ should be accounted for when comparing their factor scores on the SF-12. Additionally, consideration of geographic residence and associated cultural influences is recommended in future development and use of psychological measures with such populations.

Objective: We detail a new approach to the creation of normative data for neuropsychological tests. The traditional approach to normative data creation is to make demographic adjustments based on observations of correlations between single neuropsychological tests and selected demographic variables. We argue, however, that this does not describe the implications for clinical practice, such as increased likelihood of misclassification of cognitive impairment, nor does it elucidate the impact on decision-making with a neuropsychological battery., Method: We propose base rate analyses; specifically, differential base rates of impaired scores between theoretical and actual base rates as the basis for decisions to create demographic adjustments within normative data. Differential base rates empirically describe the potential clinical implications of failing to create an appropriate normative group. We demonstrate this approach with data from a short telephone-administered neuropsychological battery given to a large, neurologically healthy sample aged 45-85 years old. We explored whether adjustments for age and medical conditions were warranted based on differential base rates of spuriously impaired scores., Conclusions: Theoretical base rates underestimated the frequency of impaired scores in older adults and overestimated the frequency of impaired scores in younger adults, providing an evidence base for the creation of age-corrected normative data. In contrast, the number of medical conditions (numerous cardiovascular, hormonal, and metabolic conditions) was not related to differential base rates of impaired scores. Despite a small correlation between number of medical conditions and each neuropsychological variable, normative adjustments for number of medical conditions does not appear warranted. Implications for creation of normative data are discussed.

Regular physical activity and exercise (PA&E) reduces cognitive aging, may delay dementia onset, and for persons with dementia, may slow progression and improve quality of life. Memory clinic patients and caregivers described their PA&E and completed the Older Persons' Attitudes Toward Physical Activity and Exercise Questionnaire (OPAPAEQ). Caregivers and patients differed in their PA&E attitudes: patients were less likely to believe in the importance of PA&E for health promotion. PA&E attitudes were explored as predictors of self-reported exercise habits. Belief in the importance of high intensity exercise for health maintenance was the only variable that significantly predicted engagement in regular PA&E. Moreover, caregivers' attitudes toward high intensity exercise predicted memory patients' participation in PA&E. These findings may aid in development of exercise interventions for people with memory problems, and suggest that modification of specific attitudes toward exercise is an important component to ensure maximum participation and engagement in PA&E.

Atypical and early-onset dementias can be particularly problematic for family caregivers, and support groups aimed at memory loss and Alzheimer's disease are not always helpful. Unfortunately, little has been developed specifically for caregivers of individuals with atypical dementias such as the frontotemporal dementias. Compounding the lack of access to interventions targeted specifically at caregivers of individuals with atypical and early-onset dementias are the unique needs of rural caregivers. Due to the relative infrequency of these particular dementias and the large geographical distances between rural caregivers, technology-facilitation is required for any group-based intervention. This paper describes the development of a secure telehealth videoconferenced support group for rural spouses of individuals with atypical and early-onset dementias. In addition, we provide preliminary evidence of effectiveness and describe a template for future groups based on the key therapeutic aspects of this novel technology-facilitated intervention.

Introduction: Worldwide, countries are calling for a chronic disease management approach to people with dementia. In response, 'living well' with dementia and 'supported self-care' frameworks are being adopted by advocacy and volunteer organizations, and more attention is being directed towards health and wellness promotion as a critical component for 'living well'. This exploratory study examined the health and wellness self-management behaviors of patients attending a rural and remote memory clinic; and relationships between engaging in health and wellness behaviors and psychological and neuropsychological function, independence in daily activities, and balance., Methods: The cross-sectional sample comprised 260 patients referred to the Rural and Remote Memory Clinic (RRMC), Saskatchewan, Canada. Patients were diagnosed with amnestic or non-amnestic mild cognitive impairment, Alzheimer's disease (AD), or non-AD dementia. Via questionnaire, patients were asked how many days a week they exercised for at least 20 minutes, if their diet met the Canada's Food Guide to Healthy Eating recommendations, and what they did to maintain their psychological health. Patients completed a depression scale, a neuropsychological battery, and a balance scale. Caregivers completed the Functional Assessment Questionnaire. Questionnaire data were analyzed using descriptive statistics and correlational analyses. Bivariate associations between variables were assessed using point-biserial and Spearman's correlations, where appropriate. Open-ended responses were analyzed thematically., Results: Participants were aged between 44 and 97 years, and had between 0 and 20 years of formal education. About half of those with Alzhemier's disease and more than half of the other diagnostic groups reported having five or more chronic conditions. Over a third of the total sample reported not exercising at all on a weekly basis. Less than half (42.7%) of the Alzhemier's disease group reported exercising for 20 minutes less than three times per week, while more than half of the other groups reported exercising for 20 minutes less than three times per week. Associations between exercise and tests of neuropsychological function and balance were statistically non-significant for the non-AD dementia group. In contrast, for the group with AD, engagement in exercise for 20 minutes for three or more times a week was moderately associated with better Stroop interference test scores and better balance. Seventy-four percent reported they met most or all of the Canada's Food Guide to Healthy Eating dietary recommendations, and 71% indicated they were engaged in activities to maintain their psychological health. Although many who reported engaging in activities to maintain their psychological health reported more than one activity, only 2.1% reported engaging in a combination of physical activities, social activities, and mentally stimulating activities., Conclusions: Patients referred to the RRMC reported good nutrition habits and participating in a variety of activities to maintain psychological health. Engaging in exercise and good nutrition was found to have beneficial effects for the sub-sample of patients with AD. Patients and their caregivers may require additional education and information regarding beneficial health and wellness promoting behaviors related to their diagnosis and concurrent comorbid conditions.

Introduction: Until dementias can be prevented or cured, interventions that maintain or maximize cognitive and functional abilities will remain critical healthcare and research priorities. Best practice guidelines suggest that individualized exercise programs may improve fitness, cognition, and function for people with mild to moderate dementia; however, few high quality exercise intervention trials exist for this population. Increasingly, telehealth is being used to improve the delivery and availability of healthcare services for individuals living in rural areas, including exercise. This article describes the feasibility of a telehealth-delivered exercise intervention for rural, community-dwelling individuals diagnosed with dementia and their caregivers., Methods: A mixed-methods two-phase exploratory approach was used. In phase 1, Rural and Remote Memory Clinic (RRMC; Saskatoon, Saskatchewan, Canada) patients and caregivers were surveyed about current exercise levels, perceptions about exercise, exercise preferences, and perceived barriers to exercise; community resources, acceptability of telehealth exercise interventions, and physical activity and exercise attitudes (Older Persons Attitudes Toward Physical Activity and Exercise Questionnaire). Data were analyzed using descriptive statistics and factors associated with willingness to participate in a telehealth exercise intervention were explored using hierarchical linear regression. In phase 2, acceptability, practicality, and implementation were examined. Two RRMC patient-caregiver dyads completed a 4-week exercise program delivered via telehealth. Observed engagement in the telehealth-based exercise intervention, using a revised version of the Menorah Park Engagement Scale (by Hearthstone Alzheimer Care), and attendance were monitored. Patient-caregiver dyads were interviewed at the end of the intervention phase and completed a telehealth and intervention satisfaction questionnaire. Interviews were thematically analyzed and questionnaire data were analyzed descriptively., Results: Phase 1: Survey response rate was 50% (n=77). Patients (n=42) and caregivers (n=35) were equally likely to express interest in participating in the telehealth-based intervention. Willingness to participate in group exercise was the only significant predictor of willingness to participate in a telehealth-based intervention, accounting for 24.4% of the variance (F-statistic=16.14, p<0.001). Phase 2: Attendance rates were high for the telehealth-delivered exercise sessions. Engagement scale data indicated that the caregivers helped the patient participants during the intervention and that, overall, all participants were engaged in the target activity during the sessions. Ease of getting to the telehealth department, how well privacy was respected, ability to focus without distraction due to telehealth, ability to engage with group, and ability to engage with facilitator over telehealth were rated highly, as was the overall intervention experience. Telehealth voice and visual quality, ease of room set-up and conduciveness of the room to exercise were rated as good. Thematic analysis found that both dyads liked participating in the intervention together as a couple, and that participating in an exercise intervention with persons who were in a similar situations was deemed beneficial., Conclusions: Study results identified that although there are barriers to overcome, the development and evaluation of telehealth-delivered exercise interventions is a timely and important research activity that has the potential to facilitate improved healthcare services for individuals with dementia and their caregivers.

Earlier research suggests that geographic location matters for informal caregivers of persons with dementia: rural caregivers tend to rely on more informal supports and may report more psychological distress and burden than urban caregivers. Differential access to services may underlie these findings, but degree of rurality is typically measured with population size. In contrast, the current article measured degree of rurality with standardized scale of access to metropolitan centers. In a large sample we found nonsignificant and trivial associations between metropolitan access with self-reported caregiver distress, (N = 272; Brief Symptom Inventory), burden (N = 234; Zarit Burden Interview), and coping (n = 46; Jalowiec Coping Scale). The null findings were likely related to the use of a proxy variable for dementia-related caregiver supports (i.e., degree of access to metropolitan centers). In future research, direct measures of access to appropriate dementia related services should be used to study caregiver outcomes.

Demographic corrections for cognitive tests should improve classification accuracy by reducing age or education biases, but empirical support has been equivocal. Using a simulation procedure, we show that creating moderate or extreme skewness in cognitive tests compromises the classification accuracy of demographic corrections, findings that appear replicated within clinical data for the few neuropsychological test scores with an extreme degree of skew. For most neuropsychological tests, the dementia classification accuracy of raw and demographically corrected scores was equivalent. These findings suggest that the dementia classification accuracy of demographic corrections is robust to slight degrees of skew (i.e., skewness <1.5).