J. Dement. Alzheimer's Dis., Volume 2, Issue 1 (March 2025) – 6 articles

Aim: Our aim was to survey people with dementia and their carers with respect to their propensity to join a randomized trial of community singing in dementia, in the context of uncertainty following the COVID-19 pandemic. Method: We employed an online anonymous questionnaire, comparing activities before and after lockdown, worries about COVID-19, whether people would attend a singing group and what measures might make this more likely. With a target sample of 100, the survey was distributed to the general population of people with dementia and carers in the UK between June and August 2022. Results: We had a total of 168 respondents, of whom 30% were people living with dementia and 70% were carers. Those who were not worried (roughly 62%) were more likely to go out to groups. Worries about COVID-19 affected 38% of respondents but some judged the risk of going out to be worthwhile. Most felt able to take adequate precautions against infection. However, COVID-19 transmission was not the main impediment to attending a singing group and 19% of respondents were simply not interested in doing so, while mobility and shyness deterred others. Conclusions: Given recruitment problems, quantitative studies of singing in dementia need to take account of individual preferences as well as contextual barriers, including fear of virus transmission, individual perceptions of the intervention and logistical obstacles to participation. Full article

Introduction: Percutaneous endoscopic gastrostomy (PEG) placement does not generate consensus in palliative care, given the existing doubts about whether it significantly contributes to an improvement in patient outcomes such as survival, quality of life and symptomatic control. Objective: This study explored the impact of percutaneous endoscopic gastrostomy placement on survival and quality of life in patients under community palliative care in Northern Portugal. Methods: This observational, retrospective cohort study involved 54 patients monitored by a specialized palliative care team between March 2020 and December 2023. The key outcomes assessed included the survival rates, the main diagnoses leading to PEG requests, and the influence of PEG placement on survival and the place of death. Results: The statistical analysis revealed that the survival time was significantly longer in females compared to males (p = 0.003). The main reason for PEG requests was dysphagia, especially in patients with dementia and oncological diseases. No significant correlations were found between PEG placement and the age at death, survival time, or palliative performance scores (PPS). However, the study identified a moderate positive correlation between the follow-up time and survival after PEG placement (r = 0.457, p < 0.001) and a low rate of complications (11% of patients with minor complications and none with severe complications). Conclusions: This study emphasizes the role of timely PEG placement and social support in improving patient outcomes. Additionally, patients whose PEG was requested by the study’s palliative care team demonstrated better survival outcomes compared to those referred by other teams. The findings underscore the need for individualized decision-making in PEG placement and suggest that this procedure is safe and increases patient longevity and quality of life, avoiding the high rate of complications associated with nasogastric tubes in fragile patients in need of specialized palliative care. Full article

(1) Background: Alterations in brain functional connectivity (FC) precede clinical symptoms of Alzheimer’s disease (AD) by decades, presenting opportunities for early diagnosis. However, conventional FC analyses measure correlations between brain regions and do not provide insights into directional, causal interactions. Causal functional connectivity (CFC), which infers directed interactions between regions, addresses this limitation. This study aims to identify disrupted CFC networks in AD compared to cognitively normal (CN) individuals. (2) Methods: The recently developed Time-aware PC (TPC) algorithm was employed to infer directed CFC from functional magnetic resonance imaging (fMRI) data. These results were compared with traditional correlation-based FC obtained via sparse partial correlation. Network-based Statistics (NBS) for directed networks was used to identify altered CFC sub-networks, with corrections for multiple comparisons applied at the 5% significance level. (3) Results: Key causal networks, including the inferior frontal gyrus, superior temporal gyrus, middle temporal gyrus, and cerebellum, showed significantly reduced strength in AD compared to CN (p = 0.0299; NBS corrected). Instead of detecting disruptions at the level of individual edges, this study identifies network-level alterations, revealing systemic disruptions in brain connectivity. (4) Conclusions: This study demonstrates the utility of CFC analysis in uncovering network-level disruptions in AD. The identified disrupted networks align with published medical literature and provide a framework for future studies with larger datasets. Full article

Introduction: Obstructive sleep apnea syndrome (OSAS) is characterized by intermittent hypoxia, sleep fragmentation, daytime sleepiness, cognitive impairment, and brain cell damage due to brain blood flow reduction, with ischemic damage, increased microvascular reactivity, and brain tissue damage. OSAS is strongly linked to chronic, neurodegenerative, and inflammatory cerebrovascular disease and cognitive impairment. Continuous positive airway pressure (CPAP) is the first-line treatment for OSAS. Objective: This article aims to evaluate the effect of CPAP treatment on neurocognitive performance in OSAS patients with mild cognitive impairment or dementia by reviewing the literature. Methods: We performed a comprehensive review of the Portuguese and English languages without a time limit using the following Mesh terms: dementia, mild cognitive impairment, obstructive sleep apnea, and CPAP. We included randomized controlled trials (RCTs), meta-analyses, and systematic reviews (SRs) where the impact of CPAP on neurocognitive performance was addressed. Results: Five SRs and three RCTs reported significant improvements in neurocognitive performance, especially in verbal, visuospatial, and working memory. Conclusion: CPAP treatment seems to improve cognitive defects associated with OSA. Full article

Alzheimer’s disease (AD) is the most common cause of dementia, and no cure is currently available. The β-amyloid cascade of AD and neurofibrillary tangles are the basis of the current understanding of AD pathogenesis, driving drug investigation and other discoveries. Up until now, no AD models have entirely validated the β-amyloid cascade hypothesis. AD models must be capable of recapitulating the critical events of this pathology, including β-amyloid plaques and neurofibrillary tangles. The development of plaques is probably derived from the amyloid precursor protein (APP) and presenilin 1 (PS1) familial Alzheimer’s disease (FAD) mutations, while the tangle-like pathology is determined by tau mutations. Transgenic mouse models struggle to replicate the entire spectrum of AD, particularly neuronal death stemming from β-amyloid and tau pathologies. Furthermore, the success of these transgenic mice often relies on the overexpression of APP transgenes enclosing FAD-associated mutations at levels beyond physiological. Ultimate species-specific discrepancies in genome and protein composition between the human and the mouse may hinder the accurate recapitulation of AD pathological events in mouse models. Although none of the AD models fully mirrors human pathology, these experimental in vivo animal models have provided valuable insights into β-amyloid toxicity and the overall pathophysiological basis of AD. Therefore, these experimental models have been widely used in the preclinical evaluation of therapeutic strategies and have played a pivotal role in the development of immunotherapies for AD. In this review, we sum up the main transgenic mouse models used for AD research, whether they are APP mutation-based mice, APP plus presenilin mutation-based mice, or tau mutation-based mice. The specific characteristics of each mouse model and the significance of their use for AD research, focusing on their current advantages and disadvantages, as well as on the progress made and the forthcoming challenges in replicating this neurodegenerative disease, are also highlighted. Full article

Context: The systematic evaluation of a practitioner’s adherence to and competence in delivering psychotherapeutic interventions can be complex. This study describes the development of a fidelity assessment tool for the Reitman Centre CARERS Program (RCCP), a carer group-psychotherapy intervention with multiple didactic and clinical components. The tool’s value in informing psychotherapy training and best practices for practitioners from diverse professional settings is examined. Methods: The RCCP Fidelity Assessment Tool (RCCP-FAT) was developed following an iterative process of item writing and checking. Seven components of the RCCP—Group Structure, Dementia Education, Problem-Solving Techniques, Therapeutic Simulation, Vertical Cohesion, Horizontal Cohesion, and Overall Global Rating—were assessed, with three to eight items, and a “global score” assigned to each. Fifteen trained raters were paired up to rate 36 RCCP sessions using the RCCP-FAT. Rater agreement, correlation between itemized and global scores, and correlation between global ratings and RCCP participants’ satisfaction were calculated. Results: A total of 1188 RCCP-FAT items were rated by each of the two rater groups. Rater agreement was calculated to be 54.3% (κ = 0.32; 95% CI, 0.02681–0.3729). A positive correlation was found between the itemized and global scoring for four RCCP components evaluated (R = 0.833 to 0.929; p < 0.01). The global score and the participants’ satisfaction with “Simulation” was also positively correlated (R = 0.626, p < 0.01). Conclusions: The study provided evidence for fair rater agreement for all RCCP-FAT assessment items. More importantly, the process of developing the tool systematically crystallized the clinical elements of the RCCP and helped to standardize the training methods by creating a framework for providing feedback to learners that matches the items on the RCCP-FAT. The use of the RCCP-FAT to guide the training and mentoring of incoming group leaders is essential in the scaling and dissemination of a complex training method like the RCCP to ensure fidelity to the original evidence-based intervention. Full article