Journals
2025 EN
LaCasse Abigail · Scher Natalie R · Fu Jessie Fanglu
+11 more
Abstract Background The Digital Clock Test (DCT) is a novel, computerized version of the clock drawing test (CDT). It has been shown to discriminate well between mild cognitive impairment and Alzheimer's disease (AD) dementia and has been associated with AD biomarkers (i.e., amyloid, tau), similar to widely used screening batteries such as the Preclinical Alzheimer's Cognitive Composite (PACC5) and Mini Mental Status Exam (MMSE). As mood symptoms (e.g., anxiety, depression) are common in older adults and can impact cognition, it is important to determine whether such symptoms impact scores on the DCT relative to other measures/batteries. We sought to examine whether mood symptoms are associated with lower DCT scores and/or impaired performance and compare relationships to the MMSE and PACC5. Method All participants were older adults ( n = 241, mean age=77.60, 80.10% cognitively normal) enrolled in the Harvard Aging Brain Study. Participants completed neuropsychological assessments (i.e., DCT, PACC5, MMSE; lower scores=worse performance) alongside self‐report questionnaires: the 30‐item Geriatric Depression Scale (GDS) and the 20‐item Geriatric Anxiety Inventory (GAI) (higher scores = greater symptoms for both measures). Separate cross‐sectional linear regression models assessed whether GDS/GAI score predicted DCT, MMSE, and PACC5 scores. Separate ordinal regression models were used to determine whether GDS/GAI score predicted impaired DCT (<75), MMSE (<27), and PACC5 (<‐1.5) scores. Analyses controlled for age, sex, and education. Result Higher GDS scores, but not GAI scores, were associated with lower scores on all cognitive measures (Figure 1). Higher GDS scores were also associated with increased odds of having impaired MMSE and PACC5 scores, but not impaired DCT scores (Table 1). Additionally, higher GAI scores were significantly associated with increased odds of an impaired PACC5 score, but not impaired MMSE or DCT scores (Table 2). Conclusion In older adults, greater depressive symptoms were associated with worse performance on both the DCT and standard cognitive screens (MMSE, PACC5). In contrast, both depressive and anxiety symptoms were associated with “impaired” scores on PACC5 and/or MMSE, but not on the DCT. This could suggest that the DCT is a sensitive cognitive screen for AD and related dementias in clinical settings where patients present with co‐occurring mood disturbances.
Journals
2025 EN
Gershon Richard C. · Dworak Elizabeth M · Kim Jiwon
+3 more
Abstract Background Despite Spanish being the second most spoken language in the U.S., few cognitive assessments are available in Spanish for large‐scale studies with older adults. Culturally inclusive measures that promote early diagnosis and identify modifiable risk factors for Alzheimer's Disease and ADRD are of utmost importance. The Mobile Toolbox (MTB) provides brief, sensitive measures for assessing neurological and behavioral functions across the adult lifespan, aiding large‐scale studies on cognitive functioning and the development of ADRD. MTB integrates with the REDCap system and MyCap Mobile App, used by over 7,600 institutions in 160 countries for remote study management and delivery. The English MTB tests, released in 2024, are valid and reliable across diverse samples. In January 2025, Spanish cognitive measures were added. In this presentation, we introduce the new Spanish tests, present the Spanish Word Meaning calibration study results, and demonstrate platform usage. Method Seven of the eight English versions of the MTB cognitive measures were deemed suitable for adaptation and developed into Spanish using a team of native Spanish speakers. When appropriate, test stimuli were updated to be more culturally sensitive. A calibration study with 1,620 Spanish‐speaking adults (Mean Age = 43.79, SD = 14.45) refined the Spanish Word Meaning item bank, crucial for developing an accurate computer adaptive test (CAT) for Spanish vocabulary. Result The MTB library includes Spanish cognitive tests assessing language (Word Meaning), executive functioning (Arrow Matching; Shape‐Color Sorting), associative memory (Faces and Names), episodic memory (Arranging Pictures), working memory (Sequences) and processing speed (Numbers Symbol Match). The Spanish Word Meaning test used the Rasch model for consistency with its English counterpart, after removing 88 poorly fitting items. The final pool contained 515 items, with difficulty parameters ranging from ‐1.896 to 2.074. Conclusion The MTB addresses various scientific, practical, and technical challenges in cognitive assessment by leveraging advances in technology, measurement, and cognitive research. It is suitable for a wide range of studies, including large‐scale research, clinical research, and pharmaceutical studies, particularly those interested in incorporating point‐in‐time and burst designs, as well as ecological momentary assessment (EMA). By offering tests in English and Spanish, MTB can support research with diverse populations.
Journals
2025 EN
Brewster Glenna S · Robinson Janelle · Higgins Melinda
+6 more
Abstract Background Psychoeducational interventions for caregivers of persons living with dementia (PLwD) are well‐documented in high‐income countries but are scarce in low‐ and middle‐income countries (LMICs). This study explored the feasibility of virtually delivering the Savvy Caregiver Program (SCP) to Jamaican caregivers of PLwD. Method Thirty‐one caregivers in Jamaica participated in a virtual SCP intervention, consisting of 12 hours delivered over six weeks in two‐hour group sessions. Measures assessing perceived stress, mastery, depression, and burden were collected pre‐ and post‐intervention. Paired t‐tests were conducted to examine changes in caregiver outcomes. Result Caregivers (mean age = 53.5 years) were predominantly female (87.1%) and children of PLwD (71.0%), while PLwD had a mean age of 80.2 years. Results showed a significant reduction in perceived stress scores (mean change = ‐3.32 ± 6.89, p = .017), with a moderate effect size (Cohen's d = 0.482). No significant changes were observed in caregiver mastery, burden, or depression. Conclusion Virtual delivery of SCP moderately reduced perceived stress among Jamaican caregivers, demonstrating its feasibility and potential as a valuable intervention in LMIC settings. However, the lack of significant improvements in other caregiver outcomes highlights the need for culturally tailored interventions to address the broader needs of Jamaican caregivers. Further research with larger samples and longer follow‐up periods is warranted to examine long‐term benefits and enhancements of SCP in Jamaica and similar settings.
Journals
2025 EN
Lee DenChing Angel · Devanny Catherine · Hill Keith
+10 more
Abstract Background Rehabilitation plays a crucial role in dementia care by addressing functional decline and enhancing quality of life. Despite growing evidence and international guidelines supporting rehabilitation, access remains limited for patients with dementia due to knowledge gaps and systemic barriers. The INCLUDE initiative was developed to address these challenges through interdisciplinary training and a Community of Practice (CoP) for allied health professionals (AHPs). This study aimed to evaluate the impact of the INCLUDE initiative, which includes online training modules and a CoP focussed on dementia rehabilitation, on AHPs' knowledge, attitudes, confidence, and practices. Method A longitudinal pre‐post study design was employed. Group 1 (first intake) completed online modules and participated in CoP activities, while Group 2 (second intake) completed only the online modules. Data were collected at three time‐points: baseline (T1), post‐training (T2, 1‐2 months), and for Group 1 only, a 10‐month follow‐up (T3). Measures included the Dementia Attitude Scale (DAS), Dementia Knowledge Assessment Scale (DKAS), confidence ratings, and the Dementia Rehabilitation Scale Questionnaire. Social Network Analysis was used to map changes in professional connections within Group 1's CoP. Result Preliminary analysis of combined data from Group 1 ( n = 103) and Group 2 ( n = 373) ( N = 476) between T1 and T2 revealed significant improvements in dementia knowledge (DAS mean change: 3.5; p <0.001), social comfort (mean change: 6.9; p <0.001), and confidence in providing rehabilitation (mean change: 2.0; p <0.001). Additional insights from the T3 follow‐up with Group 1 are anticipated, offering further data on these measures with an emphasis on professional collaboration and workplace advocacy. Conclusion The INCLUDE initiative enhances AHPs' knowledge, confidence, and interdisciplinary collaboration, addressing barriers to dementia rehabilitation. Anticipated T3 results will further illuminate the program's longer‐term impact on advocacy and practice change. This study highlights the value of ongoing education and peer collaboration in fostering inclusive dementia care.
Journals
2025 EN
GillChawla Navjot · Heckman George · McAiney Carrie A
+1 more
Abstract Background Dementia care in Canada must address the unique needs of South Asian Canadians, a growing population facing cultural and systemic barriers. Cultural stigma, language challenges, and a lack of culturally appropriate resources delay dementia recognition, diagnosis, and access to services. These barriers burden care partners, who navigate caregiving within cultural expectations and limited formal support. While some experiences of individuals living with dementia and their care partners are shared across communities, South Asian Canadians face additional challenges, including stigma rooted in cultural beliefs and limited access to culturally aligned services. Despite strong caregiving traditions, there is limited research on shared and culturally specific aspects of their experiences. This research examines the experiences of individuals with dementia, their care partners, physicians diagnosing dementia, and community support organization employees to identify barriers, strengths, and strategies for improving culturally inclusive dementia care. Method A qualitative, interpretive phenomenological approach was used through three interconnected studies conducted in Alberta, British Columbia, and Ontario. Study 1 examines the experiences of 16 participants (14 care partners and two individuals living with dementia) across stages of recognizing symptoms, obtaining a diagnosis, and accessing services. Study 2 investigates the perspectives of 13 physicians on diagnosing dementia in South Asian Canadians. Study 3 captures the insights of 14 employees from community support organizations providing dementia services. Semi‐structured interviews were conducted in English, Hindi, and Punjabi, and reflexive thematic analysis was applied to identify recurring and distinct themes. Result Study 1 found barriers to recognizing dementia, challenges in obtaining a diagnosis, and difficulties in accessing services post‐diagnosis, which were exacerbated by cultural beliefs, stigma, and unfamiliarity with healthcare systems. Study 2 revealed barriers to diagnosis, cultural and generational influences, and language challenges. Study 3 emphasized cultural sensitivity, trust‐building, and the importance of partnerships with cultural organizations while highlighting systemic funding gaps. Conclusion This research demonstrates the need for cultural humility in dementia care practices and policies. Findings underscore the importance of early diagnosis, community engagement, and developing culturally tailored resources to support families. Addressing systemic barriers and increasing funding for culturally sensitive services is essential to providing equitable dementia care for Canada's diverse population.
Journals
2025 EN
Hughes Alex · Zhou Yuxin · Moore Kirsten
+10 more
Abstract Background Informal caregivers play a critical role in supporting people with dementia nearing the end of life and are at risk of stress, burden and depression. Despite this, evidence gaps exist on the optimal interventions for caregivers. This meta‐review aimed to identify, appraise and synthesise evidence on interventions designed to improve the quality of life of informal caregivers. Method Epistemonikos, MEDLINE, and ASSIA were searched for reviews published between 1980 and April 2024. Quality was assessed using AMSTAR 2, and a narrative synthesis was performed. Analysis was conducted through a palliative care lens and involved charting concepts and components of dementia palliative care to caregiver interventions. Outcomes were then categorised based on whether dementia care or palliative care was the main approach and then linked to intervention concepts and evidence strength. Implementation requirements were mapped to the Consolidated Framework for Implementation Research (CFIR), culminating in the development of a system‐based logic model. Result Ten systematic reviews, covering 138 primary studies with 4,000 participants were included. Seven reviews had palliative care as the main approach and three were dementia focused. Interventions were grouped into three categories: psychosocial, educational and decision‐making. These interventions aligned with almost all the identified key concepts of dementia palliative care, particularly holistic assessments, person‐centered care and education. Caregiver outcomes were identified and grouped into five categories: (1) psychosocial, (2) skills (3) relationships, (4) communication, and (5) care planning. Palliative care focused reviews emphasised communication and decision‐making, whereas dementia focused reviews were more concerned with skills and coping. Meta‐analyses supported educational interventions in reducing depression, and decision‐making aids in lowering decisional conflict. The overall evidence quality was low and the reported strategies for implementing interventions were limited. A logic model was developed which detailed the essential context, processes and outcomes for implementing integrated dementia palliative care. Conclusion Integrated dementia palliative care for caregivers requires multifaceted interventions. Combining dementia care and palliative care approaches addresses the distinct yet complementary concepts of dementia palliative care, while also impacting a broader range of caregiver outcomes and offering a more holistic approach. Future research is required on developing standardised outcome measures, cost effectiveness and implementation.
Journals
2025 EN
Dominguez Jacqueline C · Arsenal Jiil · Marra Kate
+9 more
Abstract Dementia incidence is rising in low‐middle‐income countries (LMIC), majority of economic burden is indirect cost. In the Philippines, informal care by family members is the cornerstone of dementia care, yet programs for dementia education and training are lacking. The Institute for Dementia Care Asia (IDCA) formally initiated a partnership with the Technical Education and Skills Development Authority (TESDA) to create local Dementia Care Competency Standards (CS). Functional analysis was done to define the primary purpose, function, and required skills aligned with industry standards. Key steps were undertaken: a) Industry and Job Analysis to define roles and competencies care workers, focusing on technical, behavioral, and communication skills. b) Development of Units of Competencies (UCs), and c) External Validation. Twenty industry stakeholders including health and allied health professionals, therapists, educators, environmental design, community workers, and family members with knowledge and experience in dementia care underwent orientation in CS development by TESDA. Since there is a CS on general care for the elderly, skills mapping identified core competencies critical for dementia care which were discussed in bi‐weekly consensus meetings from February to December 2024. Six competencies were derived: 1. Perform Health Assessment on People Living with Dementia (PLwD), 2. Apply Treatment Plan Based on the Determined Level of dementia care 3. Respond to and Manage Behavioral and Psychological Symptoms of Dementia (BPSD), 4. Facilitate Engagement in Recreational and Therapeutic Activities, 5. Facilitate End‐of‐Life Care Planning, and 6. Perform Self‐Care. Descriptors for the work performance such as elements, functions, performance criteria, required knowledge and required skills under each UC were prescribed to ensure standards in training and assessment. The UCs were then presented to experts for external validation. In conclusion, we have created the first Dementia Care Competency Standard in the Philippines. A competency‐based training program will be part of TESDA course offering. Given the constraints of economic its resources but wealth of human resource in the country, this partnership is a big step towards improving dementia care, and the competency standards and qualification is an opportunity for middle‐skilled workers to upskill or reskill for an occupation in the fast‐growing global dementia care industry.
Journals
2025 EN
Jiang Harmony · McCrone Paul · Carr Catherine
+1 more
Abstract Background Interacting with or contemplating space or ‘dark nature’ can increase wellbeing through mechanisms such as increasing feelings of awe or wonderment. However, this has not been explored for people living with mild cognitive impairment or dementia in previous published research. Method 53 participants (56‐90 years old, 39.6% female) with a self‐reported diagnosis of mild cognitive impairment or dementia completed a one‐off online/remote mixed‐methods survey asking about their demographics, and views and experiences of space or ‘dark nature’, and space‐related activities. Qualitative data was analysed via thematic analysis and quantitative data was analysed using Excel. Result Participants described space through physical and psychological/emotional/social aspects. Thinking about space and our place in the universe elicited feelings of awe for some participants. Participants were also concerned about space littering and preserving space. Though some participants described space as being mysterious and not fully knowing ‘what is up there’, others expressed excitement or contentment. Some participants felt more negative feelings such as anxiety, frustration and shame when thinking about space. Most of the participants (58.5%) said they would go stargazing now and 60.4% said they would attend a talk on space. Facilitators for space‐related activities included an easy to travel to and accessible location, option to join remotely and low cost. Conclusion This study provides novel insights into how people living with mild cognitive impairment or dementia conceptualise space or ‘dark nature’, and the universe. It suggests potential mechanisms of action for the positive effects of contemplating space or carrying out space‐related activities, and barriers and facilitators to space‐related activities. This could help future researchers develop space‐related or ‘dark nature‐based’ interventions tailored for this population.
Journals
2025 EN
Chapin Benjamin A · Pendleton Kathryn · Kimmet Faith
+4 more
Abstract Background Preexisting cognitive impairment is a significant risk factor for post operative delirium (POD), and POD increases morbidity and mortality. Disturbances of attention and awareness are necessary for delirium diagnosis, suggesting dysfunction in frontoparietal networks, which control visuospatial attention. However, preoperative visual attention has not been systematically investigated as a risk factor for delirium and adverse longitudinal outcomes in at‐risk adults. We provide an update from the study “Visual Attention and Postoperative Delirium” (AACSF‐22‐928731). Methods In this prospective observational study, participants aged 65 years and older undergoing elective orthopedic surgery completed preoperative visuospatial attention measures, including the Posner cueing task. Our primary outcome was maximum POD severity, measured by the Confusion Assessment Method Severity (CAM‐S) short form. Secondary outcomes included falls, hospital readmission, and Zarit caregiver burden rating, measured three‐months post‐surgery. Data were summarized (i.e., frequencies, mean (SD), and median [Q1, Q3]) and analyzed (i.e., Spearman correlational testing). Results The majority of the 45 participants were female (58%) and white (93%), with mean (SD) age 74.2 (5.4) years and 15.6 (2.7) years of education. 69% were not delirious post‐surgery, 18% were classified as subsyndromal (CAM‐S > 1), and 13% had POD. The delirium score's median [Q1, Q3] value was 0 [0, 2.0]. The median [Q1, Q3] value for stimulus reaction time was 510 ms [463,558]. The correlation coefficient ( p ‐value) between delirium and Posner stimulus reaction time was 0.45 ( p < 0.001). Correlation coefficients were in the expected direction but not significant between Posner stimulus reaction time and three‐month outcomes. Delirium severity was correlated with caregiver burden (0.34, p = 0.044). Conclusion Data continues to demonstrate that preoperative measures of visual attention predict POD. Additionally, POD measured in this study predicts caregiver burden at three months, supporting the importance of this finding. Further studies with more participants can help to determine how to apply measures of visual attention to better predict and monitor the effects of delirium on cognition and neurodegeneration. Understanding this relationship provides a basis for future research on strategies to prevent, mitigate, or rehabilitate the effects of delirium, improving hospital outcomes and potentially delaying or preventing dementia. Funding AACSF‐22‐928731; K07AG066813
Journals
2025 EN
Butt Maayra I · Chow Carolyn · Rosa Paola
+11 more
Abstract Background Persons living with dementia (PWD) and their family care partners may prioritize possible treatment outcomes differently. We sought to understand how PWD and their family care partners value hypothetical treatment outcomes relative to one other using a point allocation task. Method Participants distributed 100 points across six potential outcomes based on perceived relative importance. Outcomes included slowed decline in brain function, reduced agitation and combativeness, reduced family caregiver stress, prolonged independence in performing activities of daily living, increased time living at home, and increased socialization and engagement. Equality of distributions between outcome scores and between subgroups were compared using Wilcoxon signed‐rank and rank‐sum tests, respectively. To ensure comprehension and understanding of rationale for point distribution, we engaged participants in a “think out loud” approach as they completed the point allocation task. Qualitative data was documented in field notes and reviewed by the research team independently and during consensus meetings to identify relevant themes. Result 201 individuals participated ( n = 154 [77%] care partners and n = 47 [23%] PWD; Table 1). Across all participants, slowing declines in brain function scored highest (20 [IQR 10, 30], p < .05 for all pair‐wise comparisons). Care partners compared to patients more highly valued reduced agitation and combativeness (15.5 [IQR 10, 25] vs 10 [IQR 3, 16)], p < .001). Patients compared to care partners more highly valued reducing family caregiver stress (16 [IQR 10, 30] vs 10 [IQR 5, 20], p = .003). Among care partners, those whose loved one had mild dementia more highly valued slowing declines in brain function (20 [IQR 10, 37.5] vs 15 [IQR 10, 25], p = .02). Conversely, care partners of those with moderate or severe dementia more highly valued reducing agitation and combativeness (20 [IQR 10, 25] vs 12.5 [IQR 7.5, 21] p = 0.007). Qualitative analysis revealed key themes regarding participant rationale for prioritizing certain outcomes over others (Table 2). Conclusion PWD and dementia care partners expressed differing values when considering treatment outcomes. The development of future treatments should incorporate measurement of a range of valued outcomes critical to patients across the spectrum of impairment and their families.