It is well-known that dementia is undiagnosed, resulting in the exclusion of patients without a formal diagnosis of dementia in many studies. Objectives of the present analyses were (1) to determine healthcare resource utilization and (2) costs of patients screened positive for dementia with a formal diagnosis and those without a formal diagnosis of dementia, and (3) to analyze the association between having received a formal dementia diagnosis and healthcare costs.

This analysis is based on 240 primary care patients who screened positive for dementia. Within the baseline assessment, individual data about the utilization of healthcare services were assessed. Costs were assessed from the perspective of insurance, solely including direct costs. Associations between dementia diagnosis and costs were evaluated using multiple linear regression models.

Patients formally diagnosed with dementia were treated significantly more often by a neurologist, but less often by all other outpatient specialists, and received anti-dementia drugs and day care more often. Diagnosed patients underwent shorter and less frequent planned in-hospital treatments. Dementia diagnosis was significantly associated with higher costs of anti-dementia drug treatment, but significantly associated with less total medical care costs, which valuated to be € 5,123 compared, to € 5,565 for undiagnosed patients. We found no association between dementia diagnosis and costs of evidence-based non-medication treatment or total healthcare cost (€ 7,346 for diagnosed vs. € 6,838 for undiagnosed patients).

There are no significant differences in total healthcare cost between diagnosed and undiagnosed patients. Dementia diagnosis is beneficial for receiving cost-intensive anti-dementia drug treatments, but is currently insufficient to ensure adequate non-medication treatment for community-dwelling patients.

Evidence of impaired decision-making capacity is a legal requirement for adult guardianship. To understand the quality of the evidence health professionals commonly provide in reports submitted to guardianship courts, a systematic review was undertaken to appraise the design and methodological quality of the published literature on health professionals’ written reports of decision-making capacity and to describe the content of these reports.

Electronic searches from 1980 to 2015 identified 1183 articles of which 11 met the inclusion criteria where each evaluated quantitatively the content of health professionals’ written reports submitted to adult guardianship proceedings. Methodological quality of the selected studies was rated using a critical appraisal tool.

Nine studies sourced files from courts in the U.S. and one from Sweden; another reported on guardianship decisions from Australia. Four studies were rated as moderately strong or strong. Strengths included the use of comparison groups and a reliable and valid instrument to code reports. The review showed a person's medical condition was often cited as evidence of impaired decision-making capacity. Cognitive, psychiatric and functional abilities were less often described, and a person's values and preferences were rarely recorded.

It is recommended health professionals describe the process by which a person makes a particular decision (their ability to understand, appreciate, reason and communicate) in addition to providing medical information, including cognitive, psychiatric and functional abilities. This approach provides support for a professional's opinion and evidence for a court. International studies of health professionals’ approach to decision-making capacity evaluation are needed.

The growth among older prisoner populations, including in Australia, necessitates an understanding of this group in order to generate effective management strategies. One particular concern is the mental well-being of older prisoners. This study aimed to determine the level of psychological distress among sentenced prisoners aged 50 years and older, to compare this level to that seen among younger prisoners and older people in the community, and to investigate which mental health history, cognitive functioning, socio-demographic, and criminal justice characteristics were associated with psychological distress.

A cross-sectional survey of 173 older (M = 63 years) and 60 younger prisoners (M = 34 years) in two Australian jurisdictions was conducted. The Kessler Psychological Distress (K10) scale was administered with prisoners and additional data were collected from interviews and participant health and corrections files. K10 scores were compared to community norms using data from the Australian Health Survey.

Average K10 scores of the older prisoners were significantly lower than the younger prisoners’ (p = 0.04), though the effect size was small (r = 0.1). Significantly, higher distress levels were observed in comparison to the general population (p < 0.001), with older prisoners being three times more likely to display very high levels of distress (12.3% vs. 3.7%). Higher psychological distress scores among older prisoners were significantly associated with female gender (p = 0.002) and a history of mental health issues (p = 0.002).

While the levels of distress seen among older prisoners were significantly lower than that of younger prisoners, their higher levels of distress in comparison to community norms demonstrate a need for correctional services to be attuned to the mental health of the expanding older prisoner population.

A wish to die is common in older persons and is associated with increased mortality. Several risk factors have been identified, but the association between religiousness and a wish to die in older adults has been underexplored, and the association between death attitudes and the presence of a wish to die has not been investigated yet. The aim of this study is to explore the relationship between religiousness and death attitudes on the one hand and wish to die on the other hand, adjusting for clinical factors such as the presence of depression or somatic disorder.

The sample comprised 113 older inpatients (from a psychiatric and somatic ward) with a mean age of 74 years. Psychiatric diagnoses were assessed by the Structured Clinical Interview for DSM-IV Disorders, and logistic regression analyses estimated the unique contribution of religiousness and death attitudes to the wish to die, controlling for socio-demographic variables, depressive disorder, and somatic symptoms.

Both religiousness and death attitudes were associated with a wish to die in univariate models. Adding these variables in a multivariate logistic hierarchical model, death attitudes remained significant predictors but religiousness did not; 55% of the pseudovariance of the wish to die was explained by these variables, with an effective size of 0.89. Major depressive episode, somatic symptoms, Fear of Death, and Escape Acceptance were the most important predictors of the wish to die.

This study suggests that how older adults perceive death partly determines whether they have a wish to die. There may be a clinical, patient-oriented benefit in discussing with older patients about how they perceive death, as this can play a role in the early detection (and prevention) of death or suicide ideation and associated behaviors in older adults.

Psychosocial stress has been associated with an increased risk for mental and somatic health problems across the life span. Some studies in younger adults linked this to accelerated cellular aging, indexed by shortened telomere length (TL). In older adults, the impact of psychosocial stress on TL may be different due to the lifetime exposure to competing causes of TL-shortening. This study aims to assess whether early and recent psychosocial stressors (childhood abuse, childhood adverse events, recent negative life events, and loneliness) were associated with TL in older adults.

Data were from the Netherlands Study of Depression in Older Persons (NESDO) in which psychosocial stressors were measured in 496 persons aged 60 and older (mean age 70.6 (SD 7.4) years) during a face-to-face interview. Leukocyte TL was determined using fasting blood samples by performing quantitative polymerase chain reaction (qPCR) and was expressed in base pairs (bp).

Multiple regression analyses, adjusted for age, sex, and chronic diseases, showed that childhood abuse, recent negative life events and loneliness were unrelated to TL. Only having experienced any childhood adverse event was weakly but significantly negatively associated with TL.

Our findings did not consistently confirm our hypothesis that psychosocial stress is associated with shorter TL in older adults. Healthy survivorship or other TL-damaging factors such as somatic health problems seem to dominate a potential effect of psychosocial stress on TL in older adults.

The aim of this study is to examine the long-term association between childhood sexual abuse (CSA) and mental and physical health, especially with conditions related to hypothalamic–pituitary–adrenal axis dysfunction such as mood disorders, cardiovascular disorders, gastrointestinal disorders, pain disorders, and measures of frailty and functional mobility. In addition, we examined the impact of CSA on self-reported health and healthcare utilization.

Data from the Irish Longitudinal Study on Ageing were employed (N = 8,178). The effects of CSA on mental health, physical health, and healthcare utilization in old age population were estimated by ordinal least square, logistic regression, and Poisson regression, controlling for demographic factors, childhood adversities, and behavioral health.

Six percent of respondents reported CSA with little variation by gender. A significant association was found between CSA and mental health. Those who reported CSA were more likely to have depression, anxiety, worry, loneliness, and low quality of life. Poor self-reported health, lung disease, arthritis, peptic ulcer, chronic pain as well as high levels of total cholesterol and low-density lipoprotein were associated with CSA. Further, those who reported CSA were more likely to report doctor and hospital visits than those without a history of CSA.

Findings from the present study show that CSA has significant long-term mental and physical consequences, whereby early life events are linked to later life health outcomes.

Although late-life anxiety occurs frequently and is associated with higher morbidity, few longitudinal studies have been concerned with the evaluation thereof. We investigated the prevalence, incidence, and persistence of anxiety and related factors over a two-year period in community-dwelling Korean elderly individuals.

A total of 1,204 Korean elderly individuals were evaluated at baseline, and 909 were followed up two years later. The community version of the Geriatric Mental State Schedule was used to estimate anxiety at both baseline and follow-up interviews. We defined “prevalence” as the rate of anxiety symptoms (for both anxiety cases and sub-threshold anxiety) at baseline; “incidence” as the rate of anxiety symptoms at follow-up in those without baseline anxiety symptoms; and “persistence” as the rate of anxiety symptoms at follow-up in those with baseline anxiety symptoms. Associations between various covariates and anxiety status were examined using multivariate logistic regression models.

The prevalence, incidence, and persistence of anxiety symptoms were 38.1%, 29.3%, and 41.1%, respectively. Prevalent anxiety symptoms were associated independently with female, rented housing, more stressful life event and medical illness, physical inactivity, depression, insomnia, and lower cognitive function. Incident anxiety symptoms were predicted by older age, female gender, depression, and insomnia; persistent anxiety symptoms were predicted by older age, more medical illness, and baseline depression.

Since depression was associated with prevalent, incident, and persistent anxiety symptoms, effective detection and management thereof is important in older adults to reduce anxiety. Furthermore, preventive collaborative care should be considered, particularly for older, female, insomniac patients.

Sense of Coherence (SOC) and mindfulness are known protective factors against psychopathology, also in older age. We set out to investigate the influence of SOC and mindfulness on posttraumatic symptoms and cognitions in the context of lifetime trauma in elderly persons with a history of childhood war-experiences.

Elderly Austrians (N = 97) filled in questionnaires on traumatic lifetime experiences and posttraumatic symptoms (ETI), posttraumatic cognitions (PTCI), SOC (SOC-13) and mindfulness (FFMQ). We expected the influence of SOC scores on posttraumatic symptoms and cognitions to be on one hand influenced by mindfulness. On the other hand, we expected that both aspects would uniquely explain fewer posttraumatic symptoms and cognitions.

Participants reported various lifetime traumas (M = 2.42), including experiences during World War II (WWII) as children and adolescents. Mindfulness partially mediated the association of SOC scores with posttraumatic cognitions, but not with posttraumatic symptoms. However, in a two-stage mediation model, mindfulness significantly predicted posttraumatic symptoms via its effects on posttraumatic cognitions.

Although SOC was the strongest predictor of posttraumatic symptoms, mindfulness influenced the severity of posttraumatic symptoms via its effects on posttraumatic cognitions. We discuss implications for mindfulness-based interventions on trauma-related cognitions in the elderly.

The validity and reliability of the informant AD8 in primary healthcare has not been established. Therefore, the present study examined the validity and reliability of the informant AD8 in government subsidized primary healthcare centers in Singapore.

Eligible patients (≥60 years old) were recruited from primary healthcare centers and their informants received the AD8. Patient-informant dyads who agreed for further cognitive assessments received the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and a locally validated formal neuropsychological battery at a research center in a tertiary hospital.

1,082 informants completed AD8 assessment at two primary healthcare centers. Of these, 309 patients-informant dyads were further assessed, of whom 243 (78.6%) were CDR = 0; 22 (7.1%) were CDR = 0.5; and 44 (14.2%) were CDR≥1. The mean administration time of the informant AD8 was 2.3 ± 1.0 minutes. The informant AD8 demonstrated good internal consistency (Cronbach's α = 0.85); inter-rater reliability (Intraclass Correlation Coefficient (ICC) = 0.85); and test–retest reliability (weighted κ = 0.80). Concurrent validity, as measured by the correlation between total AD8 scores and CDR global (R = 0.65, p < 0.001), CDR sum of boxes (R = 0.60, p < 0.001), MMSE (R = −0.39, p < 0.001), MoCA (R = −0.41, p < 0.001), as well as the formal neuropsychological battery (R = −0.46, p < 0.001), was good and consistent with previous studies. Construct validity, as measured by convergent validity (R ≥ 0.4) between individual items of AD8 with CDR and neuropsychological domains was acceptable.

The informant AD8 demonstrated good concurrent and construct validity and is a reliable measure to detect cognitive dysfunction in primary healthcare.

Working memory (WM) performance is often decreased in older adults. Despite the growing popularity of WM trainings, underlying mechanisms are still poorly understood. Resistance to proactive interference (PI) constitutes a candidate process that contributes to WM performance and might influence training or transfer effects. Here, we investigated whether PI resistance can be enhanced in older adults using a WM training with specifically increased PI-demands. Further, we investigated whether potential effects of such a training were stable and entailed any transfer on non-trained tasks.

Healthy old adults (N = 25, 68.8 ± 5.5 years) trained with a recent-probes and an n-back task daily for two weeks. Two different training regimens (high vs. low PI-amount in the tasks) were applied as between-participants manipulation, to which participants were randomly assigned. Near transfer tasks included interference tasks; far transfer tasks assessed fluid intelligence (gF) or speed. Immediate transfer was assessed directly after training; a follow-up measurement was conducted after two months.

Both groups similarly improved in PI resistance in both training tasks. Thus, PI susceptibility was generally reduced in the two training groups and there was no difference between WM training with high versus low PI demands. Further, there was no differential near or far transfer on non-trained tasks, neither immediately after the training nor in the follow-up.

PI-demands in WM training tasks do not seem critical for enhancing WM performance or PI resistance in older adults. Instead, improved resistance to PI appears to be an unspecific side-effect of a WM training.

To compare response, remission and switch (to other pulse width and/or electrode placement) rates and number of treatments between groups receiving right unilateral ultra-brief (RUL-UB), Bitemporal brief (BT), Bifrontal Brief (BF) and Right unilateral brief (RUL-B).

Data was collected from case notes in three centers. There were 133 in total, grouped as RUL-UB (50), BT (43), BF (23), RUL-B (17). Two of the three centers had a preferred electrode placement and pulse width.

Apart from age, the groups did not differ significantly on sex distribution, proportion of bipolar depression and psychotic symptoms. 56% of patients in RUL-UB switched compared to 12.5% in RUL-B, 4.9% in BT and none in BF (p value < 0.0001). When we considered patients who switched as treatment failures, remission rates were significantly different (p value < 0.0001) 40% in RUL-UB, 81.3% in RUL-B, 73.9% in BF and 78.0% in BT. Mean number of treatments in each group was significantly different (p value < 0.0001); 12.02 in RUL-UB, 10.2 in RUL-B, 7 in BF and 7.5 in BT. Post-hoc analysis indicated that RUL-UB differed significantly from BT and BF. Final response and remission rates including patients who switched were 98% and 82% in RUL-UB, 100% and 93.8% in RUL-B, 100% and 73.9% in BF and 97.7% and 83.7% in BT.

Majority commencing RUL-UB switched and received 4–5 more treatments compared to bilateral placements. RUL-UB ECT appears less effective and might not be appropriate as first line for all older adults as some patients at higher anaesthetic risk would benefit from having reduced number of treatments.

Deficits in facial emotion recognition (FER) have been shown to substantially impair several aspects in everyday life of affected individuals (e.g. social functioning). Presently, we aim at assessing differences in emotion recognition performance in three patient groups suffering from mild forms of cognitive impairment compared to healthy controls.

Performance on a concise emotion recognition test battery (VERT-K) of 68 patients with subjective cognitive decline (SCD), 44 non-amnestic (non-aMCI), and 25 amnestic patients (aMCI) with mild cognitive impairment (MCI) was compared with an age-equivalent sample of 138 healthy controls all of which were recruited within the framework of the Vienna Conversion to Dementia Study. Additionally, patients and controls underwent individual assessment using a comprehensive neuropsychological test battery examining attention, executive functioning, language, and memory (NTBV), the Beck Depression Inventory (BDI), and a measure of premorbid IQ (WST).

Type of diagnosis showed a significant effect on emotion recognition performance, indicating progressively deteriorating results as severity of diagnosis increased. Between-groups effect sizes were substantial, showing non-trivial effects in all comparisons (Cohen's ds from −0.30 to −0.83) except for SCD versus controls. Moreover, emotion recognition performance was higher in women and positively associated with premorbid IQ.

Our findings indicate substantial effects of progressive neurological damage on emotion recognition in patients. Importantly, emotion recognition deficits were observable in non-amnestic patients as well, thus conceivably suggesting associations between decreased recognition performance and global cognitive decline. Premorbid IQ appears to act as protective factor yielding lesser deficits in patients showing higher IQs.

The diagnostic relevance of subjective memory complaints (SMCs) in mild cognitive impairment (MCI) remains to be unresolved. The aim of this study is to determine clinical correlates of SMCs in MCI. Furthermore, we examined whether there are the differences due to different aspects of complaints (i.e. prospective memory (PM) versus retrospective memory (RM) complaints).

We examined the cross-sectional associations between SMCs and depressive symptoms, instrumental activities of daily living (IADL), and cognitive measures in sixty-six individuals with MCI (mean age: 65.7 ± 8.01 years). The criteria for MCI included SMCs, objective cognitive impairment, normal general cognitive function, largely intact functional activities, and absence of dementia. SMCs were assessed using the Prospective and Retrospective Memory Questionnaire (PRMQ), which contains 16 items describing everyday memory failure of both PM and RM.

SMC severity (i.e. PRMQ total score) was associated with stronger depressive symptoms and worse IADL performance. SMCs were not related to cognitive measures. For PM and RM subscores, both depressive symptoms and IADL were related to the PRMQ-PM and -RM scores. The main contributors to these PM and RM scores were depressive symptoms and IADL impairment, respectively.

This study suggests that SMCs are more associated with depressive symptoms and IADL problems than with cognitive performance in individuals with MCI. Furthermore, while PM and RM complaints are related to both depressive symptoms and IADL, the differences between these main contributors suggest that RM complaints based on IADL could be more associated with the organically driven pathological features of MCI.

There is a lack of knowledge regarding the information and support needs of people with dementia with Lewy bodies (DLB) and their families around the time of diagnosis.

A volunteer sample of patients with DLB and their family members completed a web survey hosted by the UK based Lewy Body Society in May 2014. This focused on past experiences of information and support received and what information and support needs would have been beneficial at the time of diagnosis.

One hundred and twenty five adults responded to the survey. The majority were first degree relatives or spouses of people with DLB (n = 107, 86%). Approximately 50% (n = 61) reported they had not received any tangible support at diagnosis. Thirteen categories of information needs were identified.

People with DLB and their family members are currently inadequately supported at diagnosis. There is a need to address information needs related to symptomology, medication and prognosis, including provision of emotional and instrumental social support. Seeking the views of recipients of information and support is important in ensuring relevance and appropriateness prior to the development of interventions to improve the knowledge and coping skills of people with DLB and caregivers.

This study aimed to determine Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychological Assessment Battery total score diagnostic accuracy in the diagnosis of mild cognitive impairment (MCI) and dementia in familial Alzheimer's disease (FAD) with E280A mutation on presenilin-1 gene (PSEN1).

A cross-sectional study was conducted in a cohort of PSEN1 E280A carriers and non-carriers assessed between January 1995 and February 2013. During the first neuropsychological assessment, 76 were having dementia, 46 had MCI, and 1,576 were asymptomatic. CERAD cut-off points were established for MCI and dementia using a Receiver Operating Characteristics (ROC) analysis, and were further analyzed according to education level in two groups: low education level (eight years or less), and high education level (over eight years).

The area under curve–ROC CERAD total score for dementia was 0.994 (95% CI = 0.989–0.999), and that for MCI was 0.862 (95% CI = 0.816–0.908). The dementia diagnosis cut-off point for the low education group was 54, (98.4% sensitivity, 92.6% specificity), and that for the high education group was 67 (100% sensitivity, 94.1% specificity). The MCI diagnosis cut-off point for the low education group was 66 (91.2% sensitivity, 56.4% specificity), and that for the high education group was 72 (91.7% sensitivity, 76.3% specificity).

The CERAD total score is a useful screening tool for dementia and MCI in a population at risk of FAD.

Patients with Alzheimer's disease (AD) manifest various impairments in eating behavior. However, few previous studies have directly investigated the gustatory function of AD patients, and results have been inconsistent.

Thirty-two AD patients (Clinical Dementia Rating (CDR) 0.5/1/2, respectively 11/15/6 patients) and 22 normal control participants were examined to measure detection and recognition thresholds of the four elemental tastes (sweet, salty, sour, and bitter), and their ability to discriminate between tastes. Effects of demographic and clinical factors (age, sex, histories of alcohol and tobacco consumption, and CDR grade) on gustatory threshold were examined using ordinal logistic regression analysis. Performance was compared between AD and control groups.

Total threshold values (the sum of threshold grades for the four tastes) for detection and recognition of tastes were significantly higher in the AD group. Detection thresholds for sweet, salty, and bitter, and recognition thresholds for sweet and sour, were also significantly higher in the AD group. Ordinal logistic regression analysis revealed that CDR grade was the only factor that significantly affected both total threshold values. Regarding taste discrimination, there were no significant differences between the AD group and control group.

These findings suggest that progression of dementia severity accompanies gustatory decline. Although it seemingly paradoxical, weight loss and preference for sweet tastes are frequently, often simultaneously, observed in AD. Gustatory dysfunction may be partially involved in these symptoms. Thus, the nutritional care of patients with AD could be improved by making the taste of meals stronger, while controlling calorie and mineral intake.