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OBJECTIVES: To identify research and practice gaps to establish future research priorities to advance the detection of cognitive impairment and dementia in the emergency department (ED). DESIGN: Literature review and consensus-based rankings by a transdisciplinary, stakeholder task force of experts, persons living with dementia, and care partners. SETTING AND PARTICIPANTS: Scoping reviews focused on adult ED patients. METHODS: Two systematic scoping reviews of 7 medical research databases focusing on best tools and approaches for detecting cognitive impairment and dementia in the ED in terms of (1) most accurate and (2) most pragmatic to implement. The results were screened, reviewed, and abstracted for relevant information and presented at the stakeholder consensus conference for discussion and ranked prioritization. RESULTS: We identified a total of 1464 publications and included 45 to review for accurate tools and approaches for detecting cognitive impairment and dementia. Twenty-seven different assessments and instruments have been studied in the ED setting to evaluate cognitive impairment and dementia, with many focusing on sensitivity and specificity of instruments to screen for cognitive impairment. For pragmatic tools, we identified a total of 2166 publications and included 66 in the review. Most extensively studied tools included the Ottawa 3DY and Six-Item Screener (SIS). The SIS was the shortest to administer (1 minute). Instruments with the highest negative predictive value were the SIS (vs MMSE) and the 4 As Test (vs expert diagnosis). The GEAR 2.0 Advancing Dementia Care Consensus conference ranked research priorities that included the need for more approaches to recognize more effectively and efficiently persons who may be at risk for cognitive impairment and dementia, while balancing the importance of equitable screening, purpose, and consequences of differentiating various forms of cognitive impairment. CONCLUSIONS AND IMPLICATIONS: The scoping review and consensus process identified gaps in clinical care that should be prioritized for research efforts to detect cognitive impairment and dementia in the ED setting. These gaps will be addressed as future GEAR 2.0 research funding priorities.

ObjectivesWe aimed to describe emergency department (ED) care transition interventions delivered to older adults with cognitive impairment, identify relevant patient-centered outcomes, and determine priority research areas for future investigation.DesignSystematic scoping review.Setting and participantsED patients with cognitive impairment and/or their care partners.MethodsInformed by the clinical questions, we conducted systematic electronic searches of medical research databases for relevant publications following published guidelines. The results were presented to a stakeholder group representing ED-based and non-ED-based clinicians, individuals living with cognitive impairment, care partners, and advocacy organizations. After discussion, they voted on potential research areas to prioritize for future investigations.ResultsFrom 3848 publications identified, 78 eligible studies underwent full text review, and 10 articles were abstracted. Common ED-to-community care transition interventions for older adults with cognitive impairment included interdisciplinary geriatric assessments, home visits from medical personnel, and telephone follow-ups. Intervention effects were mixed, with improvements observed in 30-day ED revisit rates but most largely ineffective at promoting connections to outpatient care or improving secondary outcomes such as physical function. Outcomes identified as important to adults with cognitive impairment and their care partners included care coordination between providers and inclusion of care partners in care management within the ED setting. The highest priority research area for future investigation identified by stakeholders was identifying strategies to tailor ED-to-community care transitions for adults living with cognitive impairment complicated by other vulnerabilities such as social isolation or economic disadvantage.Conclusions and implicationsThis scoping review identified key gaps in ED-to-community care transition interventions delivered to older adults with cognitive impairment. Combined with a stakeholder assessment and prioritization, it identified relevant patient-centered outcomes and clarifies priority areas for future investigation to improve ED care for individuals with impaired cognition, an area of critical need given the current population trends.

Introduction Increasingly, older adults are turning to emergency departments (EDs) to address healthcare needs. To achieve these research demands, infrastructure is needed to both generate evidence of intervention impact and advance the development of implementation science, pragmatic trials evaluation and dissemination of findings from studies addressing the emergency care needs of older adults. The Geriatric Emergency Care Applied Research Network (https://gearnetwork.org) has been created in response to these scientific needs—to build a transdisciplinary infrastructure to support the research that will optimise emergency care for older adults and persons living with dementia.Methods and analysis In this paper, we describe our approach to developing the GEAR Network infrastructure, the scoping reviews to identify research and clinical gaps and its use of consensus-driven research priorities with a transdisciplinary taskforce of stakeholders that includes patients and care partners. We describe how priority topic areas are ascertained, the process of conducting scoping reviews with integrated academic librarians performing standardised searches and providing quality control on reviews, input and support from the taskforce and conducting a large-scale consensus workshop to prioritise future research topics. The GEAR Network approach provides a framework and systematic approach to develop a research agenda and support research in geriatric emergency care.Ethics and dissemination This is a systematic review of previously conducted research; accordingly, it does not constitute human subjects research needing ethics review. These reviews will be prepared as manuscripts and submitted for publication to peer-reviewed journals, and the results will be presented at conferences.Open Science Framework registered DOI: 10.17605/OSF.IO/6QRYX, 10.17605/OSF.IO/AKVZ8, 10.17605/OSF.IO/EPVR5, 10.17605/OSF.IO/VXPRS.

Abstract Introduction Understanding of the natural history of apathy and its impact on patient function is limited. This study examines, in a large, national sample of Alzheimer's disease (AD) patients with long follow‐ups: (1) prevalence, incidence, and persistence of apathy, and (2) impact of apathy on function across dementia severity. Methods A longitudinal study of 9823 well‐characterized AD patients in the National Alzheimer's Coordinating Center Uniform Data Set. Results Apathy was highly prevalent across disease severity with cumulative prevalence of 48%, 74%, and 82% in Clinical Dementia Rating (CDR) 0.5, 1.0, and 2.0, respectively. Persistence of apathy from clinician judgment varied from visit to visit at earlier disease stages but remained high at moderate dementia. Independent of cognition, persistent apathy was strongly associated with accelerated rate of functional decline. Discussion Findings point to important targets for the treatment and management of apathy, include functional outcomes, and study designs that account for variable persistence of the apathy syndrome.

Background: Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease (AD) and have significant impact on patients, caregivers, and families. Worse NPS scores are associated with worse function and higher need for care. It is unclear if individual NPS symptoms may differentially affect functional decline and may be more effectively targeted to improve patient outcomes. Method: Data are drawn from participants enrolled in the National Alzheimer's Coordinating Center Uniform Data Set (9/2005‐11/2022). Participants were diagnosed with Mild Cognitive Impairment or AD at baseline, had a primary etiologic diagnosis of AD, and had at least one annual follow‐up visit (average follow‐up = 4 years). Participants' function was measured using the Functional Assessment Questionnaire (FAQ). NPS were reported by ADC study clinicians using the "Clinician Judgment of Symptoms" (Form B9) evaluating whether each of the following symptoms manifested as a meaningful change in behavior (yes = 1, no = 0): apathy‐withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, agitation, and anxiety. Dementia severity was measured using the CDR. Multivariable analyses of the effects of each NPS on decline in function were performed using linear mixed models. Covariates included baseline age, gender, race/ethnicity, education, referral source, number of visits, comorbidities, APOE genotype, and number of medications. Result: Baseline sample characteristics (N = 9,358): mean age = 74±9, 47% male, 78% non‐Hispanic white, 11% black, 8% Hispanic, education = 15±4; 52% CDR = 0.5, 35% CDR = 1, and 13% CDR≥2; FAQ = 12±9. Baseline presence of NPS: apathy (34%), depressed mood (33%), anxiety (31%), irritability (28%), agitation (13%), disinhibition (10%), delusions (9%), and hallucinations (5%). Apathy was the most persistent of NPS with 37% of all participants had clinician endorsed apathy in ≥50% all of their visits, followed by depressed mood (28%), irritability (27%), anxiety (21%), agitation (14%), disinhibition (11%), delusions (9%), and hallucinations (5%). Functional decline was faster in those with persistent (≥50% of all visits) apathy, agitation, and delusions. Conclusion: Different behavioral symptoms have differential effects on functional decline, a major driver of caregiver stress and institutionalization. Better understanding of these differential effects on function is crucial in designing trials for treatment in AD. Assessing for these behavioral symptoms should be a standard component of cognitive evaluations. [ABSTRACT FROM AUTHOR]

Introduction: This pilot study aims to explore the psychometric properties of the Cognitive Function Instrument (CFI) as a measure of subjective cognitive complaints (SCC) and its performance in distinguishing mild cognitive impairment (MCI) from normal control (NC) compared to an objective cognitive screen (Montreal Cognitive Assessment [MoCA]). Methods: One hundred ninety‐four community‐dwelling non‐demented older adults with racial/ethnic diversity were included. Unidimensionality and internal consistency of the CFI were examined using factor analysis, Cronbach's alpha, and McDonald's omega. Logistic regression models and receiver operating characteristic (ROC) analysis were used to examine the performance of CFI. Results: The CFI demonstrated adequate internal consistency; however, the fit for a unidimensional model was suboptimal. The CFI distinguished MCI from NC alone or in combination with MoCA. ROC analysis showed comparable performance of the CFI and the MoCA. Discussion: Our findings support the use of CFI as a brief and easy‐to‐use screen to detect MCI in culturally/linguistically diverse older adults. Highlight: What is the key scientific question or problem of central interest of the paper?Subjective cognitive complaints (SCCs) are considered the earliest sign of dementia in older adults. However, it is unclear if SCC are equivalent in different cultures. The Cognitive Function Instrument (CFI) is a 14‐item measure of SCC. This study provides pilot data suggesting that CFI is sensitive for detecting mild cognitive impairment in a cohort of older adults with racial/ethnic diversity. Comparing performance, CFI demonstrates comparable sensitivity to the Montreal Cognitive Assessment, an objective cognitive screening test. Overall, SCC may provide a non‐invasive, easy‐to‐use method to flag possible cognitive impairment in both research and clinical settings. [ABSTRACT FROM AUTHOR]