Search Results (561)

Alzheimer’s disease (AD) and related dementias (ADRD) are neurodegenerative conditions that cause gradual deterioration of cognition, memory and language in the elderly. AD has been declared as a health priority by the World Health Organization (WHO) considering its severity and unavailability of a permanent cure. Although the global AD/ADRD population is made up of many ethno-racial groups, the majority of AD studies have focused on the Caucasian population. The few AD studies conducted on minority populations in the US have found that significant AD health disparities exist, demonstrating that African Americans and Hispanics have a significantly higher prevalence of AD and related dementias, with their risk often approaching twice that of White individuals. For the past few years, epigenomic research has played an important role in understanding health disparities among diverse racial and ethnic groups. Unlike genetic studies, which focus on the DNA sequence that one is born with, epigenomics investigates how changes in gene expression due to extrinsic environmental exposures may impact disease pathophysiology. Recent epigenomic studies appear to be promising in not only understanding disease pathology but also in developing diagnostic and therapeutic tools for AD with population specificity. However, there is only a handful of studies and review articles available addressing the epigenomic applications in irradicating racial disparities in AD/ADRD. Therefore, the aim of this review is to discuss the recent findings of epigenomic studies in AD and related dementias, their contribution in irradicating racioethnic disparities and insights into the future direction of their application in precision medicine. Full article

Background/Objectives: Alzheimer’s disease (AD) is the leading cause of dementia, which is an inevitable consequence of aging. Early detection of AD, or detection during the pre-AD stage, is beneficial, as it enables timely intervention to reduce modifiable risk factors, which may help prevent or delay the progression to dementia. On the one hand, plasma biomarkers have demonstrated great promise in predicting cognitive decline. On the other hand, in recent years, ocular imaging features, particularly the thickness of retinal layers measured by spectral-domain optical coherence tomography (SD-OCT), are emerging as possible non-invasive, non-contact surrogate markers for early detection and monitoring of neurodegeneration. This pilot study aims to identify retinal layer thickness changes across the entire retina linked to plasma AD biomarkers in cognitively healthy (CH) elderly individuals at risk for AD. Methods: Eleven CH individuals (20 eyes total) were classified in the pre-AD stage by plasma β-amyloid (Aβ)42/40 ratio < 0.10 and underwent SD-OCT. A deep-learning-derived automated algorithm was used to segment retinal layers on OCT (with manual correction when needed). Multiple layer thicknesses throughout the entire retina (including the inner retina, the outer retina, and the choroid) were measured in the inner ring (1–3 mm) and outer ring (3–6 mm) of the Early Treatment Diabetic Retinopathy Study (ETDRS). Relationships between retinal layers and plasma biomarkers were analyzed by ridge regression/bootstrapping. Results: Results showed that photoreceptor inner segment (PR-IS) thinning had the largest size effect with neurofilament light chain. Additional findings revealed thinning or thickening of the other retinal layers in association with increasing levels of glial fibrillary acidic protein and phosphorylated tau at threonine 181 and 217 (p-tau181 and p-tau217). Conclusions: This pilot study suggests that retinal layer-specific signatures exist, with PR-IS thinning as the largest effect, indicating neurodegeneration in pre-AD. Further research is needed to confirm the findings of this pilot study using larger longitudinal pre-AD cohorts and comparative analyses with healthy aging adults. Full article

Background: We report UK findings from Music Interventions for Depression and Dementia in Elderly care (MIDDEL), a cross-national, clustered, randomised trial undertaken in 2018–2023 to evaluate the effectiveness of music interventions for depression symptoms in care home residents living with dementia (NCT03496675, clinicaltrials.gov (accessed on 1 December 2024)). The trial compared the effects of Group Music Therapy (GMT) with Recreational Choir Singing (RCS); GMT and RCS combined; and treatment as usual (TAU). Methods: In the intervention arms, the protocolized music interventions were delivered in care home units twice per week for three months, then once per week for three months. The primary outcome was depressive symptoms after six months, measured by MADRS. Secondary outcomes included well-being—EQ-5D-5L, Visual Analogue Scale (VAS); quality of life—QOL-AD; symptoms of dementia—SIB-8, NPI-Q; and caregiver distress—NPI-Q. The change in MADRS score from baseline to 6 months was assessed using a linear mixed-effects model. We report the multivariate model having both treatments as predictors, both unadjusted and adjusted, for the interaction between the treatments. Results: The UK trial started in 2022 after the pandemic lockdown, when 16 care home units were recruited and randomised, four per arm; 192 residents aged over 65 with depression and dementia participated. An ITT analysis of 146 participants retained at 6 months found neither intervention had a significant positive effect on any outcome. Significant unfavourable effects were found for RCS participants on MADRS, NPI symptom severity, and EQ-VAS. The combination of RCS + GMT had a detrimental effect on caregiver distress. Conclusions: MIDDEL UK findings do not support the use of GMT or RCS to alleviate depression in care home residents with dementia. Full article

Population aging is increasing dementia care demand. We present an audio-driven monitoring pipeline that operates either on mobile phones, microcontroller nodes, or smart television sets. The system combines audio signal processing with AI tools for structured interpretation. Preprocessing includes voice activity detection, speaker diarization, automatic speech recognition for dialogs, and speech-emotion recognition. An audio classifier detects home-care–relevant events (cough, cane taps, thuds, knocks, and speech). A large language model integrates transcripts, acoustic features, and a consented household knowledge base to produce a daily caregiver report covering orientation/disorientation (person, place, and time), delusion themes, agitation events, health proxies, and safety flags (e.g., exit seeking and falling). The pipeline targets real-time monitoring in homes and facilities, and it is an adjunct to caregiving, not a diagnostic device. Evaluation focuses on human-in-the-loop review, various audio/speech modalities, and the ability of AI to integrate information and reason. Intended users are low-income households in remote settings where in-person caregiving cannot be secured, enabling remote monitoring support for older adults with dementia. Full article

Background/Objectives: To investigate the relationship between dementia and hospital outcomes (in-hospital mortality and prolonged length of stay). Methods: A retrospective study was conducted considering all hospital admissions performed between 1st January 2018 and 31st December 2023 in the Abruzzo region, Italy. The study was conducted on a large sample including all elderly patients admitted to hospital in a Southern Italian region during a six year period. To compare outcomes between patients with and without dementia, a propensity score matching procedure was performed using a multivariable logistic model adjusted for age and gender and comorbidities. Odds ratios for primary and secondary outcomes were computed using logistic regression models. Results: After the matching procedure, 25,476 patients were included in the analyses: 12,738 with dementia and 12,738 controls. Logistic regression models showed that dementia was associated with in-hospital mortality (OR: 2.02; 95% CI 1.91–2.18; p < 0.001) and prolonged length of stay (OR: 1.44; 95% CI 1.29–1.58; p < 0.001). Conclusions: In a large cohort of Italian patients, dementia was associated with in-hospital mortality and prolonged length of stay. Full article

Background/Objectives: Chronic subdural hematoma (CSDH) predominantly affects the elderly population. To optimize care and quality in this demographic, tailored, age-specific counseling and therapeutic decision-making are imperative. Accordingly, this study aimed to identify risk factors for in-hospital mortality and functional outcome at discharge following surgery using an age-stratified approach. Methods: We conducted a retrospective analysis of symptomatic CSDH patients who underwent surgery at our institution between June 2012 and December 2023. Subjects were categorized into three age cohorts: younger adults (18–64 years), older adults (65–79 years), and the oldest old (≥80 years). Clinical and neurological statuses at admission and discharge were evaluated using the Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS), with mRS scores > 3 indicating poor functional outcomes. Results: Among 879 CSDH patients (mean age 75 ± 11.9 years), the sex ratio shifted progressively from a male predominance in younger adults (1:3.2) to a more balanced ratio in the oldest old (1:1.7). In the multivariate analysis, poor admission mRS and GCS score ≤ 7 predicted in-hospital mortality for older adults, while atrial fibrillation and postoperative pneumonia were significant in the oldest old. Poor admission mRS and multimorbidity consistently forecast unfavorable outcomes alongside other predictors, such as preoperative altered state of consciousness, epilepsy, dementia, unilateral CSDH, postoperative seizure, bleeding, and pneumonia varying by age cohort. Recurrence-free intervals were significantly extended with increasing age. Conclusions: This large-scale, age-stratified analysis delineates critical predictors of in-hospital mortality and unfavorable functional outcomes in surgically treated CSDH patients. These findings offer valuable guidance for neurosurgeons in preoperative risk assessment and inform age-specific counseling strategies to better communicate prognosis and tailor treatment plans. Full article

Background: Dementia is a common disease in the elderly, and its prevalence continues to increase worldwide. A significant proportion of patients with dementia are hospitalised due to comorbidities. Health-related quality of life (HRQoL) reflects overall health and is used in clinical trials, economic evaluations, and population health studies. The aim of this study was to assess the risk of dementia and quality of life related to the health status of patients hospitalised in geriatric wards. Methods: The study was conducted in geriatric wards of hospitals in the Lublin region. A total of 308 patients aged 65–98 years participated in the study. Results: The NOSGER scale evaluation of patients was at the average level of 75.82 points. The seniors showed best functioning in the area of disruptive behaviours (average 9.45 points), and the greatest deficits were found in the area of instrumental activities of everyday life (15.95 points). The cohort of patients assessed their overall quality of life at the average level of 3.16 ± 0.78 points and health status at 2.44 ± 0.77 points. The highest scores were given to the social domain (59.52 ± 13.69) and the environmental domain (56.96 ± 1.95). Conclusions. Psychophysical fitness was shown to decline in correlation with geriatric ward patients’ quality of life self-assessment. Full article

Toxocariasis, a geohelminthiasis caused by Toxocara canis and Toxocara cati nematodes, has an estimated 19% seroprevalence worldwide. Although children have been considered more prone to infection, adults and the elderly may also be considered at risk. Accordingly, the present study aimed to assess the associated risk factors for Toxocara spp. seropositivity in a population of 290 individuals over 50 years old, attended by the Public Health System in western São Paulo state. Socioepidemiological information was obtained by a semi-structured questionnaire, a blood (serum) sample, and a neurocognitive function assessment by the 10-point cognitive screener (10-CS). Overall, 89/290 (30.7%; 95% CI: 25.7–36.2%) individuals presented anti-Toxocara spp. IgG antibodies by ELISA. Multivariate analysis revealed that individuals raising both dogs and cats were 3-fold more likely to be seropositive than the ones without any pet (p = 0.002), while educational level resulted in an associated protective factor (p = 0.001). No seropositivity influence was observed for the other evaluated variables, including age, gender, monthly income, consumption of drinkable water or raw/undercooked meat, having a dirty floor at home, contact with soil, washing vegetables and hands before meals, and onychophagy. Although seropositivity was not statistically associated with dementia (p = 0.198) and neuropsychiatric disorder (p = 0.440), results herein indicated toxocariasis as a likely under-reported and neglected infection in the older human population. As an immunosenescence risk group that should be continuously monitored, elderly pet owners may be at risk and should be extra careful with self-hygiene and pet deworming, particularly when owning multiple pet species, to reduce the risk of toxocariasis infection. Full article

Background: Older adults who are hospitalized in internal medicine wards often present with a challenging interplay of multimorbidity and geriatric syndromes. The timely identification of clinical and geriatric predictors of in-hospital mortality is crucial for guiding individualized care pathways and ensure appropriate resource allocation. In this study, we investigate the prognostic impact of frailty, delirium—including its motor subtypes—and global comorbidity burden on in-hospital mortality in patients aged 70 years and older. Methods: We conducted a retrospective observational study including 556 consecutive patients aged ≥ 70 years who were admitted to the Internal Medicine Unit of the University Hospital of Parma from January 2019 to July 2019. Demographic, clinical, and geriatric data were collected within 48 h of admission, including Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale (CIRS), and delirium diagnosis with the 4AT tool. Multivariate Cox and logistic regression analyses were performed, including sex-stratified models. Results: The median age was 85 years (IQR 80–89), 58% were female, and in-hospital mortality was 11% (n = 61). Non-survivors had higher rates of severe frailty (CFS ≥ 7: 39% vs. 16%, p < 0.001), prevalent delirium (20% vs. 4%, p < 0.001), hypokinetic delirium (20% vs. 5%, p < 0.001), liver disease (23% vs. 11%, p = 0.008), cancer (44% vs. 24%, p < 0.001), and dementia (43% vs. 29%, p = 0.026) and a higher CIRS severity index (≥3:55% vs. 31%, p < 0.001). In Cox regression, independent predictors of death were prevalent delirium (HR 4.66, 95% CI 2.42–8.96), CFS ≥ 7 (HR 2.26, 95% CI 1.32–3.87), CIRS-LIVER ≥ 2 (HR 2.05, 95% CI 1.18–3.56), and cancer (HR 1.83, 95% CI 1.07–3.14). Sex-stratified models showed that in males, prevalent delirium (HR 10.23) and cancer (HR 2.49) predicted mortality, whereas in females, hypokinetic delirium (HR 3.67) and CIRS-LIVER ≥ 2 (HR 2.75) were the strongest predictors. Logistic regression confirmed these associations and additionally identified anemia and CFS ≥ 7 in males and CIRS severity index ≥ 3 in females as significant risk factors. Conclusions: In elderly patients who are admitted to internal medicine wards, prevalent and hypokinetic delirium, severe frailty, and high comorbidity burden, particularly liver disease and cancer, are strong independent predictors of in-hospital mortality, with distinct sex-specific patterns. Early multidimensional geriatric assessment may improve risk stratification and guide targeted interventions. Full article

Background/Objectives: The maintenance of cerebral blood flow (CBF) by managing blood pressure and brain cell activity and avoiding hypocapnia is important when administering anesthesia to patients with dementia. This study aimed to evaluate CBF during general anesthesia in elderly patients with severe dementia while maintaining their physiological parameters within an adequate range. Methods: The patients were anesthetized within a set range of parameters without affecting CBF (mean arterial pressure [MAP] > 50 mmHg; bispectral index [BIS] > 20; percutaneous arterial oxygen saturation [SpO₂] > 95%; end-tidal CO₂ [etCO₂] 35–40 mmHg). The normalized tissue hemoglobin index (nTHI), which reflects CBF, was measured using near-infrared spectroscopy. The parameters were compared between patients with severe dementia (n = 13) and those without cognitive impairment (n = 13). Results: There were no differences in patient background. A similar decline in MAP and BIS values was observed in both groups, but the values remained within the set range. The nTHI decreased significantly to 0.60 in the dementia group and to 0.79 in the non-dementia group after the start of the treatment (p ≤ 0.049). Even when the MAP, BIS, SpO₂, and etCO₂ values were maintained in their adequate ranges during general anesthesia, the nTHI decreased by 40% in the dementia group. Conclusions: These findings indicate that CBF greatly decreases in elderly patients with severe dementia during general anesthesia. Full article

Vascular dementia (VaD) represents the second-most common dementia type after Alzheimer’s disease since it results from complications of cerebrovascular disease. Mixed pathologies combining vascular and neurodegenerative processes are the rule rather than exception in elderly dementia patients. The condition known as VaD includes various types of vascular damage that affect both large and small blood vessels in the brain which results in cerebral hypoperfusion, blood–brain barrier disruption, glymphatic dysfunction, and molecular cascades causing neuronal damage. The mechanisms of VaD include endothelial dysfunction, oxidative stress, chronic neuroinflammation, impaired glymphatic clearance, white matter demyelination, and synaptic failure. The disease susceptibility of individuals depends on genetic factors which include NOTCH3 mutations and vascular risk polymorphisms. The diagnostic field uses neuroimaging tools and fluid biomarkers such as neurofilament light chain, inflammatory markers, and Aβ/tau ratios for mixed pathology. The current practice of vascular risk management combines with new therapeutic approaches that use phosphodiesterase inhibitors for cerebral perfusion and NLRP3 inflammasome inhibitors for neuroinflammation, senolytics for cellular senescence, and remyelination agents for white matter repair. However, the majority of new treatment methods remain investigational with limited Phase III data. Future medical treatment development will depend on precision medicine approaches which use biomarker-guided treatment selection and combination strategies targeting multiple pathological mechanisms. Full article

This study explores the use of deep learning techniques for classifying EEG signals in the context of Alzheimer’s disease (AD) and frontotemporal dementia (FTD). We propose a novel classification pipeline that combines autoencoders for feature extraction and bidirectional long short-term memory (Bi-LSTM) networks for analyzing patterns over time in EEG data. Given the complexity and high dimensionality of EEG signals, we employed an autoencoder to reduce data dimensionality while preserving key diagnostic features. The Bi-LSTM model effectively identified subtle temporal patterns in brain activity that are indicative of AD and FTD. To enhance interpretability, we applied SHapley Additive exPlanations (SHAP), providing insights into how individual features contribute to the model’s predictions. We evaluated our approach on a publicly available EEG dataset from OpenNeuro, which includes resting-state EEG recordings from 88 elderly participants—36 with AD, 23 with FTD, and 29 cognitively normal controls. EEG provides a non-invasive, cost-effective tool for brain monitoring, but presents challenges such as noise sensitivity and inter-subject variability. Despite these challenges, our approach achieved 98% accuracy while maintaining transparency, making it a promising tool for clinical applications in the diagnosis of neurodegenerative diseases. Full article

Background/Objectives: Tinnitus often occurs alongside the emotional symptoms of anxiety and depression. The Ginkgo biloba extract EGb 761^® was shown to be effective in reducing neuropsychiatric symptoms in elderly patients with both dementia and tinnitus, exerting direct effects on tinnitus severity and indirect effects mediated by improvement of anxiety, depression, and cognition. Whether the extent of the effects is influenced by the patient’s sex has not yet been investigated. We performed a conditional process analysis to evaluate this question. Methods: We analyzed the moderating role of sex on the direct and indirect effects of EGb 761^® on tinnitus severity using a first- and second-stage conditional process model. Results: Indirect effects of EGb 761^® on tinnitus severity mediated by improved cognition, anxiety, and depression did not differ between women and men (p > 0.05; all 95% bootstrap confidence intervals overlapped with zero). Moreover, direct treatment effects of EGb 761^® on tinnitus severity were statistically significant for both sexes (women, p < 0.0001; men, p = 0.0279). Conclusions: Beneficial effects of Ginkgo biloba extract EGb 761^® in dementia patients with tinnitus are likely to be unaffected by the patient’s sex. Further research into the influence of patient characteristics on the outcome of tinnitus drug treatment is encouraged. Full article

Background/Objectives: The predominant etiology of healthcare-associated pneumonia (HCAP) that frequently manifests in elderly with advanced dementia is aspiration pneumonia in which the deteriorated upper respiratory protective reflexes are significant responsible triggers. However, the association of HCAP with cerebral degeneration has not been investigated. Therefore, a cross-sectional and retrospective cohort study was conducted to elucidate the association of aspiration pneumonia-related factors with HCAP in elderly with dementia. Methods: Of the 154 participants (87.9 years), 30 of Alzheimer’s type dementia (AD) or 124 of vascular dementia (VaD) were assigned to the pneumonia group or the control group. Participant’s characteristics, including cognition, clinical pattern and stage of dementia, physical and eating abilities, latency of the swallowing reflex (LTSR), threshold of CRS, and tongue moisture (TOM), were evaluated. Result: The progression of dementia and the decline in LTSR, CRS, and TOM were synchronized (p < 0.05). Participants in the pneumonia group who were male, with eating difficulties, prolonged LTSR, lacunar infarction, or a smoking history, were significantly observed. The multiple logistic analysis indicated that the LTSR was a significant independent factor for developing HCAP (p = 0.01). Furthermore, as the possessed number of aspiration pneumonia-related factors increased, the odds ratio for HCAP became significantly higher (p < 0.001). Blunted CRS, male gender, and lacunar infarctions were evident in VaD participants but not in AD participants. Finally, the incidence of HCAP in VaD was 2.11 times higher than that in AD (p = 0.005). Conclusions: The higher incidence of HCAP in VaD than AD may be due to different underlying pathophysiological mechanisms between them. Full article

During the last decade, artificial intelligence (AI) has enabled key technological innovations within the modern dementia and frailty healthcare and prevention landscape. This has boosted the impact of technology in the clinical setting, enabling earlier diagnosis with improved specificity and sensitivity, leading to accurate and time-efficient support that has driven the development of preventative interventions minimizing the risk and rate of progression. Background/Objectives: The rapid ageing of the European population places a substantial strain on the current healthcare system and imposes several challenges. COMFORTage is the joint effort of medical experts (i.e., neurologists, psychiatrists, neuropsychologists, nurses, and memory clinics), social scientists and humanists, technical experts (i.e., data scientists, AI experts, and robotic experts), digital innovation hubs (DIHs), and living labs (LLs) to establish a pan-European framework for community-based, integrated, and people-centric prevention, monitoring, and progression-managing solutions for dementia and frailty. Its main goal is to introduce an integrated and digitally enabled framework that will facilitate the provision of personalized and integrated care prevention and intervention strategies on dementia and frailty, by piloting novel technologies and producing quantified evidence on the impact to individuals’ wellbeing and quality of life. Methods: A robust and comprehensive design approach adopted through this framework provides the guidelines, tools, and methodologies necessary to empower stakeholders by enhancing their health and digital literacy. The integration of the initial information from 13 pilots across 8 European countries demonstrates the scalability and adaptability of this approach across diverse healthcare systems. Through a systematic analysis, it aims to streamline healthcare processes, reduce health inequalities in modern communities, and foster healthy and active ageing by leveraging evidence-based insights and real-world implementations across multiple regions. Results: Emerging technologies are integrated with societal and clinical innovations, as well as with advanced and evidence-based care models, toward the introduction of a comprehensive global coordination framework that: (a) improves individuals’ adherence to risk mitigation and prevention strategies; (b) delivers targeted and personalized recommendations; (c) supports societal, lifestyle, and behavioral changes; (d) empowers individuals toward their health and digital literacy; and (e) fosters inclusiveness and promotes equality of access to health and care services. Conclusions: The proposed framework is designed to enable earlier diagnosis and improved prognosis coupled with personalized prevention interventions. It capitalizes on the integration of technical, clinical, and social innovations and is deployed in 13 real-world pilots to empirically assess its potential impact, ensuring robust validation across diverse healthcare settings. Full article