Journals
2025 EN
Schade Rachel N · O'Shea Andrew · Rodriguez Katie
+6 more
Abstract Background Subjective cognitive complaints (SCC) have been associated with decreased hippocampal volume and those with distress about their SCC have a higher risk of preclinical Alzheimer's disease (AD). The current study divided individuals with SCC into “worried” and “non‐worried” groups to determine whether 1) experimental hippocampal tasks and hippocampal volumetrics differ between groups and 2) determine if mood and/or motivation were driving differences. Method Participants were 154 adults (mean age = 71±5 years, mean education = 16±2 years, 62% female, 87% white) with SCC. There were two groups: “worried” ( N = 76) or “non‐worried” ( N = 78) about cognitive changes over the past five years (Cognitive Change Index). Cognitive (two hippocampal‐based experimental tasks: ARENA (spatial navigation) and the Mnemonic Similarity Task (MST; pattern separation)), mood (Beck Depression Inventory‐II (BDI‐II), Apathy Scale (AS), and the State‐Trait Anxiety Inventory (STAI)), and neuroimaging data were drawn from the baseline visit. Hippocampal imaging was performed using high‐resolution T2 sequences (0.39x0.39mm). Whole hippocampal and CA1, CA3, and dentate gyrus volumetrics were analyzed with Freesurfer version 7.1.1. based on proposed neural correlates of ARENA and MST. Data were analyzed with independent t‐tests and ANCOVAs, with demographic and mood/motivation as covariates. Results The worried group performed significantly worse on ARENA learning ( t (152)=‐2.7, p = 0.004), recall ( t (152)=‐2.2, p = 0.02), and overall composite memory z‐scores ( t (152)=3.3, p < 0.001). There were no significant differences observed on the MST or hippocampal volumetrics between groups. The worried group reported greater depression ( t (152)=‐2.4, p = 0.01), trait anxiety ( t (152)=‐2.6, p = 0.01), apathy ( t (152)=‐2.2, p = 0.01) on self‐report measures. ANCOVAs revealed that apathy significantly contributed to ARENA performance on learning ( F (1,152)=6.7, p = 0.01) and recall composites ( F (1,152)=5.4, p = 0.02), reducing group difference on learning composite only. Overall memory composite remained significant without demographic or mood contributions ( F (1,152)=6.9, p = 0.009). Conclusions Older adults with SCC worry exhibit higher levels of mood and motivation symptoms, which may contribute to poorer performance on cognitive tasks. Two hypotheses are possible: 1) greater mood symptoms are driving SCC and ARENA performance, or 2) ARENA may be uniquely sensitive to detect memory changes, as its neural correlates are implicated in early AD. Since mood symptoms are common in preclinical AD, the worried SCC group may reflect this preclinical change.
Journals
2025 EN
Gatchel Jennifer R. · Yu Kexin · Palmer Phebe
+8 more
Abstract Background Neuropsychiatric symptoms (NPS) are common in the preclinical and prodromal stages of Alzheimer's Disease and Related Dementias (ADRD) and are associated with cognitive and functional decline. However, the neurobiology of these symptoms and prognostic markers of their emergence are not well understood. We sought to examine the associations between established baseline plasma biomarkers of ADRD and the longitudinal trajectory of NPS in older adults. Method Participants were from the Massachusetts Alzheimer's Disease Research Center longitudinal research cohort. A subset, spanning consensus diagnoses of cognitively normal (CN)( n = 282, age:68±10) years) to mild cognitive impairment (MCI)( n = 331, age:74±8 years), had baseline plasma samples assayed for phospho‐tau 217 ( p ‐tau 217 ), neurofilament‐light (NfL) and glial fibrillary acidic protein (GFAP) (Table 1). Average follow‐up was 8.6±4.2 years (CN) and 7.2±4.1 years (MCI). NPS were measured annually using the self‐reported Geriatric Depression Scale (GDS‐15) and the study‐partner‐reported Neuropsychiatric Inventory Questionnaire (NPI‐Q). Plasma biomarkers were log‐transformed and z‐scores were derived using baseline values of the study sample. In longitudinal linear mixed‐effects models, we examined the NPS measures as the dependent variable in relation to individual plasma biomarkers, time, and the plasma biomarker × time interaction, controlling for age and sex. Result In CN participants, plasma NfL and GFAP were associated with change in GDS (NfL x time: β=0.02, CI=0.01‐0.03 p = 0.007); GFAP x time: β=0.02, CI=0.01‐0.04, p = 0.002) but not with NPI‐Q ( p >0.05 for all); (Figure 1). In MCI participants, p ‐tau 217 and NfL were associated with change in GDS ( p ‐tau 217 : β=0.02, CI=0‐0.04, p = 0.04; NfL: β=0.02, CI=0‐0.04, p = 0.02) whereas all three biomarkers predicted increasing NPI‐Q score over time ( p ‐tau 217 : β=0.09 CI=0.07‐0.12, p <0.001; NfL: β=0.03, CI=0‐0.06 p = 0.025; GFAP: β=0.07, CI=0.04‐0.10, p <0.001) (Figure 2). In exploratory NPI‐Q analyses, when NfL and GFAP were individually added as predictors alongside p ‐ tau 217 , only p ‐tau 217 remained significant. Conclusion Findings suggest differential plasma biomarker‐NPS associations across the early ADRD spectrum, with a central role of p ‐tau 217 at the stage of MCI. Results also support biomarker signatures of affective vs. overall NPS. Further dissecting plasma biomarker signatures of specific NPS domains will provide insight into the prognostic value of plasma measures in predicting NPS trajectories over the course of ADRD.
Journals
2025 EN
Dhaliwal Ravneet K. · Gehling Jacklyn · Marx Hannah
+4 more
Abstract Background Traditional cognitive assessments for older adults can be time‐consuming, resource‐intensive, and often inaccessible in primary care. The integration of electronic devices into assessment procedures could improve efficiency and access. We investigated the preliminary usability of a novel iPad‐based assessment tool for online self‐administration in an older adult sample with differing technology proficiency. Method Participants were 20 community‐dwelling older adults, free of neurocognitive diagnoses, aged 64‐88 (M=74.15) 65% female, 90% White, with an average of 16.25 years of education. They completed the Mobile Device Proficiency Questionnaire (MDPQ‐16), range 24 to 80 (M=58.35), indicating a wide range of proficiencies. They were provided an iPad and an instructions packet to self‐administer the cognitive assessment in office with supervision ( n = 10) or at home with no supervision ( n = 10). The cognitive assessment (developed with Cogni.Dx) consisted of five tests probing orientation, visuospatial memory, language, and visuomotor speed (trails). Usability was evaluated by thematically analyzing and categorizing researcher observations, participant requests for help, and participant feedback (oral and written) on difficulties encountered during setup and completion. Result Nineteen participants were able to complete the cognitive assessment (9: home, 10: office). Various usability issues emerged that are categorized into four themes: set‐up, interruptions, touchscreen interface, and extraneous concerns. In the home condition, participants had trouble activating or logging into their account and connecting the device to their home WiFi. Three more difficulties were observed in both home and office conditions. One was interrupting the testing despite instructions to complete it in a single sitting. Another challenge was the use of the touchscreen interface, particularly for tests requiring moving shapes or drawing lines where calibrating pressure of touch was observed to be very challenging. Lastly, extraneous concerns, such as pop‐ups, scrolling to see the entire page, closing out of the module by mistake, and re‐navigating to the assessment were also challenges. Conclusion Preliminary findings revealed multiple usability challenges encountered by participants in both home and office conditions. These challenges of set‐up, interruptions, touchscreen interface navigation, and managing extraneous technical issues, underscore the importance of thorough usability investigations before considering validity and widespread implementation.
Journals
2025 EN
Kiselica Andrew M. · Compton Sidonia · Lin Shayne S.H.
+18 more
Abstract Background Cognitive dispersion refers to within person variability in performance across a battery of neuropsychological tests. Measures of dispersion are sensitive to severity of cognitive and functional impairment and predictive of biological and clinical disease progression in Alzheimer's disease (AD). Practical application of cognitive dispersion measures has been limited due to lack of tools to support their implementation. We will present three studies leveraging data from the National Alzheimer's Coordinating Center to 1) develop normed score calculation methods for dispersion measures; 2) assess the stability and test‐retest reliability of normed dispersion scores; and 3) examine the relationships of dispersion scores with Alzheimer's disease (AD) biomarkers. Method Study 1: We developed demographically adjusted regression‐based normed scores for cognitive dispersion in a sample of 4,283 cognitively unimpaired older adults from the Uniform Data Set 3.0. We then examined the ability of these normed scores to differentiate individuals with cognitive impairment due to Lewy body disease ( n = 282) from cognitively unimpaired individuals using receiver operating characteristic curves. Study 2: We assessed mean level stability and test‐retest reliability of dispersion scores in a sample of 2,224 robustly cognitively unimpaired older adults from the Uniform Data Set 3.0. Study 3: We utilized SCAN data from 982 older adult participants with AD biomarker testing available to evaluate the relationship between AD biomarker burden and dispersion. Result Study 1: We created normative tables and an Excel calculator for deriving normed cognitive dispersion scores. Cognitive dispersion scores differentiated individuals with cognitive impairment due to Lewy body disease from cognitively unimpaired individuals with high accuracy (AUC range = .81‐.88; Figure 1). Study 2: Dispersion scores demonstrated high mean level stability ( d rm range = ‐.06‐.01) but poor test‐retest reliability ( r range = .35‐.51; Table). Study 3: Across measures of amyloid, tau, and neurodegeneration, increasing AD biomarker burden was related to increasing cognitive dispersion among individuals with cognitive impairment but not among cognitively unimpaired individuals (e.g., Figure 2). Conclusion Normed cognitive dispersion scores may have limited test‐retest reliability in cognitively unimpaired older adults; however, they appear sensitive to Lewy body disease clinical features and AD biomarker burden.
Journals
2025 EN
Aaronson Anna · Altaras Caroline · Ly Monica T.
+20 more
Abstract Background Subjective cognitive complaints (SCCs) can be an early indicator of Alzheimer's disease and related dementias. SCCs have been shown to be common in people exposed repetitive head impacts (RHI), particularly male former professional American football players. This study characterized participant and informant‐reported SCCs in terms of rate, concordance with standardized neuropsychological measures, and potential associated factors among participants with diverse sources/severity of RHI exposure. Method The sample included participants with ( n = 172) and without ( n = 320) RHI from the Boston University Alzheimer's Disease Research Center Clinical Core. RHI status is based on the 2021 NINDS TES Research Diagnostic Criteria. The Cognitive Change Index (CCI) and BRIEF‐A Meta‐Cognition Index (MI) measured self and informant‐reported SCCs. Participants completed neuropsychological assessments of memory (Craft Story 21 Recall, NAB List Learning Long Delay) and executive function (Trails B). Informants completed the Neuropsychiatric Inventory‐Questionnaire (NPI‐Q). ANCOVAs compared performance of RHI/non‐RHI groups on the SCC measures. Pearson correlation examined agreement between participant/informant responses. Multivariable linear regression models tested associations between SCCs and neuropsychological tests and examined correlates of SCCs. All models controlled for age, sex, race, and education. p ‐values were false discovery rate adjusted. Result Table 1 describes the sample. Compared to non‐RHI, the RHI group was younger, likelier to be male, and likelier to have MCI. The RHI group had significantly higher MI (B=8.084, p = 0.006), informant MI (B=9.014, p = 0.006), CCI (B=5.986, p <0.001), and informant CCI scores (B=7.062, p <0.001. Self/informant CCI and MI scores were more correlated in the RHI ( r = 0.592, 0.540, respectively) vs non‐RHI group ( r = 0.416, 0.373, respectively). Figure 1. Within the RHI group, there were associations between participant/informant SCCs and the objective measures (e.g., B=‐0.086, padj<0.001 for CCI and NAB) (Table 2). We observed fewer, weaker associations between SCCs and neuropsychological measures in the non‐RHI group. NPI‐Q was a consistent correlate of self/informant SCCs. Demographics (e.g., self/informant race) were also associated but to a lesser extent. Conclusion In RHI settings, SCCs might be more frequent and reflect cognitive function. High SCC rates are likely multifactorial, with influence from neuropsychiatric factors. Future research should examine longitudinal change in self/informant SCCs and correlation with disease biomarkers.
Journals
2025 EN
Moses Waiswa · Brunswerk Steven · Kakooza Henry
+2 more
Abstract Background The growing prevalence of dementia is a global concern, especially in the East‐African Uganda, Kenya, Tanzania, where updated economic impact data are scarce. Understanding its prevalence and cost is crucial for effective polices and support systems. Method United Nations population data and dementia prevalence estimates were used to calculate total cases. Direct costs were based on gross domestic product (GDP) per capita (purchasing power parity) and income classification. Indirect caregiver support costs were estimated using average monthly wages and two distinct scenarios. Result The highest dementia prevalence among those aged more than 60 years was in Uganda (4.88%), Tanzania (4.43%) and Kenya (4.19%). The total direct cost in the East African region was $8.18 billion for those over 50 years old. Indirect costs ranged from $2.25 billion (best case) to $5.67 billion (worst case), with a mean value of $3.98 billion. Total dementia care costs (direct and indirect) under the mean scenario for the entire east African region amounted to $12.17 billion, with costs as a percentage of GDP ranging from 0.05% (Uganda) to 0.44% (Kenya Conclusion This study highlights dementia as a growing public health issue in the East African region, with 1 329 729 individuals affected in 2021 and total costs between $10.43 billion and $13.90 billion. The findings emphasize the urgent need for investment in research and specialised services for older adults, particularly those with dementia. With the projected increase in the prevalence of dementia in the coming decades, addressing this public health challenge is critical to ensuring the well‐being of older adults and reducing the economic burden on societies in the region.
Journals
2025 EN
Bethell Jennifer · Stewart Steven · Chapman Hannah
+9 more
Abstract Background Social connection comprises distinct but related aspects of human social relationships. Positive aspects of social connection are associated with better health and, in long‐term care (LTC) homes, represent a key component of quality of life, quality of care and sense of home. Despite its importance, research and reporting on social connection in this setting is limited by a lack of good quality instruments with which to measure it. Our objective was to develop and test a measure of social connection for LTC homes. Method We conducted this study in Canada and the UK. We developed a conceptual model based on research literature and existing measures. We conducted and thematically analysed qualitative interviews with residents, families and staff to identify important aspects of social connection. We created and refined a list of candidate items that we piloted and field‐tested with LTC residents and staff. We examined descriptive statistics (e.g., missing data), dimensionality and internal consistency to further refine the measure. We evaluated the final resident (self‐report) and staff (proxy‐report) measures’ feasibility, acceptability, reliability and validity. We worked with patient and public involvement (PPI) partners in developing our methods and the Social Connection in LTC homes (SONNET) measure. Result We prioritized social engagement and social connectedness (loneliness) from our conceptual model of social connection, based on priorities identified from qualitative interviews ( n = 67) and PPI partners. We developed 58 candidate items for self‐report and proxy‐report which we then reduced to 20 items based on feedback from academic experts and PPI partners and pilot testing ( n = 9). We further reduced this to 12 items based on field‐testing ( n = 111 resident‐staff dyads) results. We tested the measurement properties with 52 resident‐staff dyads, including 33 (65%) residents with dementia. Findings supported the hypothesised two factor structure; that the SONNET scale correlated with related constructs; and good/ acceptable and reliability (internal consistency, test‐retest and inter‐rater). Conclusion The SONNET scale assesses social engagement and social connectedness (loneliness) for LTC home residents, with resident and staff‐reported versions. It is feasible and acceptable to LTC residents and staff with promising reliability and validity, although we recommend further testing.
Journals
2025 EN
Ferguson Steven · Gholizadeh Shadi · Thomas Timothy
+3 more
Abstract Background Innovative technologies such as ambient home sensors have the potential to transform dementia care by offering non‐invasive, low‐cost, and easy‐to‐install solutions. These systems provide actionable insights into critical aspects of daily living, such as nutrition, hygiene, sleep, activity, and medication adherence. This feasibility study aimed to assess the openness of families to integrating this technology into home care practices. Method A feasibility study was conducted with 25 participants across 23 homes who had professional home care for at least one month. Client care managers ( N = 8) provided feedback from five cities: Montreal, Toronto, Winnipeg, Calgary, and Vancouver. Two modes of ambient sensing technology were utilized: one focused on falls and the other on broader monitoring capabilities, including wandering and inactivity detection. Both systems sent notifications to an alert center. Participants were introduced to three proposed use cases for the sensors: 1. Caregiver Oversight Only : Providing insights into professional caregiver behavior and engagement patterns. 2. Person Oversight Only : Delivering person‐specific insights to supplement or replace in‐home care. 3. Dual Oversight : Offering combined insights for both caregivers and people living with cognitive changes. Qualitative feedback was collected through unstructured interviews and assessments with families and client care managers to evaluate preferences, perceived benefits, and potential barriers to adoption. Result The dual oversight model was preferred by most participants due to its ability to enhance safety and provide peace of mind. The caregiver oversight‐only model was valued in scenarios requiring accountability for professional care, while the client oversight‐only model was favored as a standalone monitoring solution. Privacy concerns and the learning curve associated with app usage were identified as key barriers to adoption. Participants also highlighted the importance of customization to meet individual care needs. Conclusion Ambient home sensors are a feasible addition to dementia care practices, with broad support for the dual oversight model among families. Tailored implementation strategies addressing privacy and usability concerns will be crucial for successful adoption. Future research should explore the long‐term impact of these technologies on care outcomes and family satisfaction.
Journals
2025 EN
Taylor Ashley M · Gerardi Steven · DeLucaBerg Elizabeth
Abstract Background Informal caregivers (care partners) are people, such as family members, who provide care to those who cannot care for themselves, including people with dementia (PwD). Care partners assist PwD in their daily occupations, often without training or guidance from healthcare professionals. Informal care partners typically balance multiple roles, such as caregiver, parent, spouse, and worker, which can become increasingly difficult as the disease progresses. Caring for PwD profoundly impacts care partners and can present a range of emotional, physical, financial, and occupational challenges. Occupational therapy (OT) has an important role to play in the care of PwD. However, when treating PwD, if clinicians do not operate from a dyadic model, the needs of the care partners may be overlooked. Although addressing both components of the care partner dyad is important to the delivery of OT services, the role of OT in the care of informal caregivers of PwD is not well articulated in the OT literature, which makes it difficult for OT practitioners to fill this role. As such, conveying the role of OT in the care of care partners can improve the delivery of OT services to PwD. Methods Walker and Avant's eight‐step approach to conduct a concept analysis was used to assess and clarify the role of OT in the care of informal caregivers of PwD. Results The literature on OT with caregivers of PwD was reviewed, which yielded data on the OT treatment of the care partner dyad. Informed by these findings, and the OT practice framework, the defining attributes of the role of OT in the care of informal caregiver of PwD were determined. The model of human occupation was used to frame a model case. A contrary case was described, as well as the attributes of OT that frame its role in caring for the care partner dyad of PwD. Conclusions The role of OT with informal caregivers of PwD is to identify barriers to participation and challenges to effective occupational performance, and to implement interventions to enable participation and enhance performance. By addressing the care partner dyad, better OT services can be provided.
Journals
2025 EN
Ferguson Steven · Gholizadeh Shadi · Thomas Timothy
+3 more
Abstract Background Falls remain a leading cause of injury among individuals with cognitive changes, necessitating reliable detection and response systems. Ambient sensing technology provides 24/7 fall detection capabilities and customizable escalation protocols, aiming to minimize unnecessary calls to emergency dispatch services (911). This study explored the feasibility of implementing escalation processes to manage falls effectively within home care settings. Method A feasibility study was conducted with 25 participants across 23 homes that had care for at least one month. Client care managers ( N = 8) provided feedback from five cities: Montreal, Toronto, Winnipeg, Calgary, and Vancouver. Two modes of ambient sensing technology were utilized: one focused on falls and the other on broader monitoring capabilities, including wandering and inactivity detection. Both systems sent notifications to an alert center. The alert center's process included: 1. Identifying the location and duration of the fall. 2. Checking the home to determine if the individual was alone. 3. Escalating to the “circle of friends,” a pre‐identified contact group, via phone or SMS. 4. If no response was received, the system could escalate to a 911 wellness check or client care manager, based on the families’ preferences. Qualitative feedback was collected from families and care team staff to assess preferences and barriers to implementing the fall detection protocols. Result Nearly all families (24 out of 25) indicated during assessment that they preferred escalation to the “circle of friends” rather than an automatic 911 dispatch, highlighting that emergency response is not always the desired solution. Participants appreciated the flexibility and customization of the escalation process. The inactivity alert system, which learns daily habits, successfully minimized false alarms by sending SMS notifications to confirm well‐being before escalating. Conclusion Ambient sensing technology for fall detection is a feasible and acceptable solution when supported by tailored escalation protocols. The inclusion of a “circle of friends” approach ensures a personalized response, reducing reliance on 911 and addressing concerns about unnecessary interventions. Future research will further refine these protocols and validate their effectiveness in diverse care settings.