Journal of Dementia and Alzheimer's Disease

Background: Dementia is a chronic, multifactorial syndrome with a high incidence and prevalence worldwide. The clinical assessment of these patients is challenging, imposing several barriers related to the system, the healthcare professional and the patient. While numerous assessment tools exist for dementia, few are specifically validated or widely used in palliative care. This study evaluates the relevance of using the Integrated Palliative Outcome Scale for Dementia (IPOS-Dem) in Portugal. The primary objective is to synthesize evidence on the implementation and clinical performance of IPOS-Dem in people with dementia receiving palliative care—including feasibility, acceptability, validity, reliability, and clinical applicability—while the secondary objective is to assess the instrument’s relevance and potential for cultural/linguistic adaptation to context. Methods: A systematic review of the literature was carried out, with research in evidence-based medicine databases on the use of the Integrated Palliative Outcome Scale for Dementia (IPOS-Dem) in palliative care, using the terms “dementia”, “alzheimer”, “lewy body”, “cognitive impair”, “outcome”, “IPOS-Dem”, “patient outcome assessment”, “outcome assessment”, “scale”, “palliative care”, and “palliative outcome scale”. Results: The IPOS-Dem was considered to be a useful tool for monitoring patients with dementia while receiving palliative care, allowing for a comprehensive and systematic evaluation of symptoms, as well as involving family members in the care process. It facilitates the identification of previously unknown symptoms and issues, particularly emotional and social concerns. Its use led to an improvement in symptom control and greater family involvement in care. The reduction in missing response rates and the time required to complete the scale with repeated use indicated good adaptation to the scale’s implementation. Difficulties were reported in assessing patients with communication impairments. Some staff also highlighted the need for training in using the scale. The Swiss Easy-Read IPOS-Dem showed significant variation in scores between evaluators, which raises concerns about the reliability and consistency of the scale, indicating that the tool requires further validation. Digital models, although they may present some inconveniences, were suggested as a potential improvement in acceptability. Conclusions: Our review suggests that IPOS-Dem provides initial evidence of feasibility, acceptability, and potential clinical usefulness in dementia palliative care, making its implementation beneficial for the Portuguese population. Translation and adaptation to the Portuguese population and culture will be necessary, but the scale is promising, and we recommend its national use.

Alzheimer’s disease (AD) pathology is marked by the deposition of amyloid-β plaques and hyperphosphorylated tau neurofibrillary tangles. This pathology begins years before the first clinical symptoms emerge and progresses through several stages before clinical diagnosis. AD’s pathology alters the brain’s functional connectivity (FC) patterns and these altered FC patterns may serve as imaging markers to diagnose and assess the progression of AD. In this review, we summarize the recent literature investigating connectome alterations across the AD spectrum, spanning preclinical, prodromal, and clinical stages. We identify specific regions and functional connections that are altered across different stages of AD and discuss their relevance to cognition. We also highlight the potential of connectome-based predictive modeling as an individual-specific method in the quest for early diagnosis of AD. The default mode network (DMN) shows significant changes across stages, and its core hubs consistently exhibit reduced connectivity with the medial temporal lobe in association with disease pathology. From a dynamic FC point of view, the flexibility of different networks, especially DMN, was reduced as a result of AD onset and persisted across the stages. These disruptions were also linked to reduced cognitive performance, particularly in domains such as memory and executive function. By bringing together evidence on both disease-specific and stage-specific alterations in FC, this review aims to identify patterns that are most informative for understanding AD progression and their potential for advancing early diagnosis.

Background: Postoperative delirium (POD) is commonly observed after surgical aortic valve replacement (SAVR) and could have serious consequences. Its prevalence varied among prior published series. With increasing patient age, a worsening of this problem can be expected. Methods: The association between POD and other adverse events, as well as its effect on 30-day mortality, long-term survival, and later dementia development, was investigated in 1500 consecutive patients (1527 operations) undergoing SAVR with a biological prosthesis, with or without concomitant procedures. An observational retrospective file analysis was performed, using chi-square, Student’s t-test, logistic regression, and Kaplan–Meyer analyses. Results: POD was recorded in 183/1527 (12.0%) of the patient files. Its independent predictors were need for reintervention, age over 80 years, male gender, peripheral artery disease, smoking, need for non-elective SAVR, atrial fibrillation, and a prior TIA. POD was associated with all other postoperative adverse events and increased need for resources. Thirty-day mortality was almost four times higher with POD: 35/182 (19.1%) vs. 59/1345 (4.4%), p < 0.001. Five-year survival was significantly reduced in patients with POD: 79.8 ± 1.2% versus 59.5 ± 4.3%, p < 0.001. The mean time to occurrence of dementia was 89 (84–95) months in patients without POD versus 60 (50–71) months in patients with POD. Five-year freedom from dementia was 69.1 ± 2.9% versus 44.4 ± 6.8%, p < 0.001. Conclusions: POD is associated with short-term complication rates, increased need for resources and hospital mortality, a reduced long-term survival rate, and an increased risk of dementia development. The limitations of this investigation include its retrospective and observational nature; in addition, it did not detect preoperative mild cognitive impairment.