In a previous study, we developed a highly performant and clinically-translatable machine learning algorithm for a prediction of three-year conversion to Alzheimer’s disease (AD) in subjects with Mild Cognitive Impairment (MCI) and Pre-mild Cognitive Impairment. Further tests are necessary to demonstrate its accuracy when applied to subjects not used in the original training process. In this study, we aimed to provide preliminary evidence of this via a transfer learning approach.

We initially employed the same baseline information (i.e. clinical and neuropsychological test scores, cardiovascular risk indexes, and a visual rating scale for brain atrophy) and the same machine learning technique (support vector machine with radial-basis function kernel) used in our previous study to retrain the algorithm to discriminate between participants with AD (n = 75) and normal cognition (n = 197). Then, the algorithm was applied to perform the original task of predicting the three-year conversion to AD in the sample of 61 MCI subjects that we used in the previous study.

Even after the retraining, the algorithm demonstrated a significant predictive performance in the MCI sample (AUC = 0.821, 95% CI bootstrap = 0.705–0.912, best balanced accuracy = 0.779, sensitivity = 0.852, specificity = 0.706).

These results provide a first indirect evidence that our original algorithm can also perform relevant generalized predictions when applied to new MCI individuals. This motivates future efforts to bring the algorithm to sufficient levels of optimization and trustworthiness that will allow its application in both clinical and research settings.

Errorless learning is a promising rehabilitation principle for learning tasks in patients with amnesia, including patients with Korsakoff's syndrome. Errorless learning might possibly also contribute to decreases in behavioral and psychiatric problems, as patients in long-term care facilities become more independent after training. The aim of this study was to examine the effects of errorless learning on potential changes in psychotic and affective symptoms, aggression and apathy, in contrast with a control group who received care as usual.

The current study is a quasi-experimental study on errorless learning and psychotic and affective symptoms, aggression, and apathy in patients with Korsakoff's syndrome, living in long-term care facilities for patients with Korsakoff's syndrome (KS) in the Netherlands. The GIP-28, HoNOS−ABI, and NVCL−20 were administered to a group of patients with KS who received errorless learning training (n = 51) and a patient control group who received care as usual (n = 31). Wilcoxon Signed-Rank Tests were performed to examine psychotic and affective symptoms, aggression, and apathy at baseline and at follow-up in the errorless learning group and the control group.

Errorless learning training effectively reduced psychotic symptoms (including provoked confabulations), affective symptoms, and agitation/aggression. There were no significant changes (increases nor decreases) in the control group. Levels of apathy were stable over time in both groups.

Results with respect to psychotic and affective symptoms, aggression, and apathy are discussed in depth. Patients with KS can become more autonomous in a cared for setting using errorless learning principles. This might also result in decreases in behavioral and psychiatric problems in patients.

We aimed to critically evaluate decision aids developed for practitioners and caregivers when providing care for someone with dementia or for use by people with dementia themselves. Decision aids may be videos, booklets, or web-based tools that explicitly state the decision, provide information about the decision, and summarize options along with associated benefits and harms. This helps guide the decision maker through clarifying the values they place on the benefits or harms of the options.

We conducted a systematic review of peer-reviewed literature in electronic databases (CINAHL, The Cochrane Library, EMBASE, MEDLINE, and PsychINFO) in March 2018. Reference lists were searched for relevant papers and citations tracked. Data were synthesized with meta-analysis and narrative synthesis. Papers were included if they met the following criteria: 1) the focus of the paper was on the evaluation of a decision aid; 2) the decision aid was used in dementia care; and 3) the decision aid was aimed at professionals, people with dementia, or caregivers.

We identified 3618 studies, and 10 studies were included, covering three topics across six decision aids: 1) support with eating/feeding options, 2) place of care, and 3) goals of care. The mode of delivery and format of the decision aids varied and included paper-based, video-based, and audio-based decision aids. The decision aids were shown to be effective, increasing knowledge and the quality of communication. The meta-analysis demonstrated that decisions are effective in reducing decisional conflict among caregivers (standardized mean difference = −0.50, 95% confidence interval [ − 0.97, − 0.02]).

Decision aids offer a promising approach for providing support for decision-making in dementia care. People are often faced with more than one decision, and decisions are often interrelated. The decision aids identified in this review focus on single topics. There is a need for decision aids that cover multiple topics in one aid to reflect this complexity and better support caregivers.

Both morbidity and mortality are elevated for individuals with subsyndromal depression (SSD) compared to non-depression (ND) in those of younger ages, but scientific studies are scarce for very old individuals. The aim of this study was therefore to compare the morbidity and mortality in very old individuals with SSD and ND.

An 8-year prospective population-based study was undertaken on 85-year-old individuals in Sweden.

Data were collected from postal questionnaires and clinical assessments at baseline, after 1, 5, and 8 years. Depressive symptoms were measured with Geriatric Depression Scale and the results were classified into ND, SSD, and syndromal depression. Mortality was investigated using multivariable cox regressions, and variables of morbidity were investigated using linear mixed models.

Compared to ND, in people with SSD, mortality was elevated in the univariate regression, but this association vanished when controlling for relevant covariates. Morbidity was elevated with regard to basic activities of daily living (ADLs), instrumental ADLs, loneliness, self-perceived health, and depressive symptoms for individuals with SSD compared to ND, whereas cognitive speed, executive functions, and global cognitive function were not significantly impaired when adjusting for covariates.

SSD among very old individuals is longitudinally associated with elevated morbidity but not mortality, when controlling for relevant covariates. Considering the high prevalence of SSD and the demographic development of increasing numbers of very old people, the findings highlight the need to develop clinical and societal strategies to prevent SSD and associated negative outcomes.

Nursing home (NH) residents with dementia commonly exhibit persistent vocalizations (PVs), otherwise known in the literature as disruptive or problematic vocalizations. Having a better understanding of PVs and the research completed to date on this phenomenon is important to guide further research and clinical practice in NHs. This integrative review examines the current literature on the phenomenon of PVs among NH residents with dementia.

We conducted a search in the PubMed, Scopus, Ovid Medline, and CINAHL databases for articles published in English. Articles were included if the focus was specifically on research involving vocal behaviors of older adults with dementia residing in NHs.

Our literature search revealed eight research articles that met the inclusion criteria. These studies were published in 2011 or earlier and involved small sample sizes. Seven of these studies were descriptive and the eighth was a non-pharmacological intervention study for PVs exhibited by NH residents with dementia. These studies were vastly different in their labeling, definitions, and categorization of the PVs as well as methods of measuring PVs.

The heterogeneity of the evidence limits the ability to make recommendations for practice. Given the paucity of research on this phenomenon; recommendations for additional research are given.

Previous research shows that museum programs can be beneficial for the quality of life of people with dementia. This study evaluated the implementation of “Unforgettable,” an interactive museum program for people with dementia and their caregivers in the Netherlands, and investigated the impact of the program's implementation on the museums as an organization and on the attitudes toward dementia of the museum staff.

Semi-structured interviews were held with 23 stakeholders to identify facilitators and barriers to the implementation of the Unforgettable program in 12 Dutch museums. Based on the model of Meiland et al. (2004), an overview is made of factors influencing the different levels and phases of the implementation process. The impact of Unforgettable on the attitudes of the museum staff was assessed using the Approaches to Dementia Questionnaire (n = 176).

The training in the Unforgettable method, regular evaluation with the program guides and hosts, and cooperation with other organizations appeared essential for successful implementation of Unforgettable. A lack of promotional activities was an impeding factor. Compared to before the implementation, the museum employees’ attitudes toward people with dementia became more positive.

Both successful dissemination of the Unforgettable program and the more positive attitudes toward dementia of employees in museums implementing this program can contribute to the social participation of people with dementia and thereby to their quality of life.

To compare and validate neurocognitive tests in the Harmonized Cognitive Assessment Protocol (HCAP) for the China Health and Retirement Longitudinal Study (CHARLS), and to identify appropriate tests to be administered in future waves of CHARLS.

We recruited 825 individuals from the CHARLS sample and 766 subjects from hospitals in six provinces and cities in China. All participants were administered the HCAP-neurocognitive tests, and their informants were interviewed regarding the respondents’ functional status. Trained clinicians administered the Clinical Dementia Rating scale (CDR) to assess the respondents’ cognitive status independently.

The testing protocol took an average of 58 minutes to complete. Refusal rates for tests of general cognition, episodic memory, and language were less than 10%. All neurocognitive test scores significantly correlated with the CDR global score (correlation coefficients ranged from 0.139 to 0.641). The Mini-Mental State Examination (MMSE), the Health and Retirement Study (HRS) - telephone interview for cognitive status (TICS), community screening instrument for dementia (CSI-D) for respondent, episodic memory and language tests each accounted for more than 20% of the variance in global CDR score (p < 0.001) in bivariate tests. In the CHARLS subsample, age and education were associated with neuropsychological performance across most cognitive domains, and with functional status.

A brief set of the CHARLS-HCAP neurocognitive tests are feasible and valid to be used in the CHARLS sample and hospital samples. It could be applied in the future waves of the CHARLS study, and it allows estimating the prevalence of dementia in China through the population-based CHARLS.

How cognitive impairment and frailty combine to impact on older adults’ Quality of Life (QoL) is little studied, but their inter-relationships are important given how often they co-occur. We sought to examine how frailty and cognitive impairment, as well as changes in frailty and cognition, are associated with QoL and how these relationships differ based on employment status and social circumstances.

Using the Survey of Health, Ageing, and Retirement in Europe data, we employed moderated regression, followed by simple slopes analysis, to examine how the relationships between levels of health (i.e., of frailty and cognition) and QoL varied as a function of sex, age, education, social vulnerability, and employment status. We used the same analysis to test whether the relationships between changes in health (over two years) and QoL varied based on these same moderators.

Worse frailty (b = −1.61, p < .001) and cognitive impairment (b = −0.08, p < .05) were each associated with lower QoL. Increase in frailty (b = −2.17, p < .001) and cognitive impairment (b = −0.25, p < .001) were associated with lower QoL. The strength of these relationships varied depending on interactions with age, sex, education, social vulnerability, and employment status. Higher social vulnerability was consistently associated with lower QoL in analyses examining both static health (b = −3.16, p < .001) and change in health (b = −0.66, p < .001).

Many predictors of QoL are modifiable, providing potential targets to improve older adults’ QoL. Even so, the relationships between health, cognition, and social circumstances that shape QoL in older adults are complex, highlighting the importance for individualized interventions.

Being a family caregiver, and in particular giving care to someone with dementia, impacts mental and physical health and potentially reduces the ability of caregivers to “live well.” This paper examines whether three key psychological resources—self-efficacy, optimism, and self-esteem—are associated with better outcomes for caregivers of people with dementia.

Caregivers of 1,283 people with mild-to-moderate dementia in the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) project responded to measures of self-efficacy, optimism, and self-esteem, and “living well” (quality of life, life satisfaction, and well-being). Multivariate linear regression was used to examine the association between psychological resources and “living well”.

Self-efficacy, optimism, and self-esteem were all independently associated with better capability to “live well” for caregivers. This association persisted when accounting for a number of potential confounding variables (age group, sex, and hours of caregiving per day).

Low self-efficacy, optimism, and self-esteem might present a risk of poor outcomes for caregivers of people with dementia. These findings encourage us to consider how new or established interventions might increase the psychological resilience of caregivers.

Loneliness and social networks have been extensively studied in relation to cognitive impairments, but how they interact with each other in relation to cognition is still unclear. This study aimed at exploring the interaction of loneliness and various types of social networks in relation to cognition in older adults.

a cross-sectional study.

face-to-face interview.

497 older adults with normal global cognition were interviewed.

Loneliness was assessed with Chinese 6-item De Jong Gierverg’s Loneliness Scale. Confiding network was defined as people who could share inner feelings with, whereas non-confiding network was computed by subtracting the confiding network from the total network size. Cognitive performance was expressed as a global composite z-score of Cantonese version of mini mental state examination (CMMSE), Categorical verbal fluency test (CVFT) and delayed recall. Linear regression was used to test the main effects of loneliness and the size of various networks, and their interaction on cognitive performance with the adjustment of sociodemographic, physical and psychological confounders.

Significant interaction was found between loneliness and non-confiding network on cognitive performance (B = .002, β = .092, t = 2.099, p = .036). Further analysis showed a significant interaction between loneliness and the number of family members in non-confiding network on cognition (B = .021, β = .119, t = 2.775, p = .006).

Results suggested that a non-confiding relationship with family members might put lonely older adults at risk of cognitive impairment. Our study might have implications on designing psychosocial intervention for those who are vulnerable to loneliness as an early prevention of neurocognitive impairments.

Prior research and theories established the link between care environments and apathy. Yet, empirical evidence on how environmental stimulation impacts apathy is lacking. This study examined the association between environmental stimulation and apathy in nursing home residents with dementia.

This repeated-measure study analyzed 104 video observations of staff caregiver–resident interactions.

12 nursing homes.

63 unique staff caregiver–resident dyads that involved 42 caregivers and 44 residents with moderate to severe dementia.

Second-by-second behavioral coding using Noldus Observer software was conducted to assess apathy and environmental stimulation, using the Person-Environment Apathy Rating scale. The environment subscale includes six items: stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback. The apathy subscale includes six items: facial expression, eye contact, physical engagement, purposeful activity, verbal tone, and verbal expression. Multilevel linear models were used for analysis.

Results showed that apathy was not associated with the overall quality of environmental stimulation but was significantly associated with stimulation specificity (coefficient = −2.23, p = 0.049). However, the association was not significant after controlling for resident characteristics (p = 0.082). In addition, higher levels of environmental feedback were associated with lower apathy levels (coefficient = −2.14, p = 0.001). The association remained significant after controlling for resident characteristics (coefficient = −1.65, p = 0.014).

Findings reveal that when environmental stimulation is individually tailored and prompts engagement, residents are less apathetic. This study highlights the effect of environmental stimulation on apathy. Future research should explore interventions that modify environmental stimulation to reduce apathy and improve dementia care.

Psychological and social resources such as extraversion, optimism, social support, or social networks contribute to adaptation and to successful aging. Building on assumptions derived from successful aging and from the developmental adaptation models, this study aims to analyze the joint impact of different psychosocial resources, such as personality, social relations, health, and socio-demographic characteristics on life satisfaction in a group of people aged 65 years-old and older from Spain.

A cross-sectional survey using non-proportional quota sampling was carried out. The sample comprised 406 community-dwelling older adults (M = 74.88, SD = 6.75). In order to collect the data, face-to-face interviews were individually conducted. A structural equation model (SEM) was carried out using the PLS software.

The results of the SEM model showed that, within this sample, psychosocial variables explain 47.4% of the variance in life satisfaction. Social relations and personality, specifically optimism, were strongly related with life satisfaction, while health status and socio-demographic characteristics were modestly associated with life satisfaction.

Findings support the view that psychosocial resources are important for successful aging and therefore should be included in successful aging models. Furthermore, interventions aimed at fostering successful aging should take into account the role of psychosocial variables.

In order to evaluate interventions promoting social health in people with dementia it is essential to have reliable and valid measures. The present review aims to provide an overview of available instruments for the assessment of two domains of social health in community-dwelling people with mild dementia, i.e., the ability to manage life with some degree of independence (self-management) and participation in social activities.

An electronic search was conducted in the following databases: PubMed, CINAHL, and PsycINFO. Characteristics of the instruments, feasibility and psychometric properties of the instruments included are reported on.

We identified eight instruments measuring aspects of self-management and three instruments measuring social participation. Validity and reliability of self-management instruments varied between moderate and good. Little information was found on the psychometric properties of the instruments for social participation. In general, feasibility and responsiveness data regarding application in community-dwelling people with dementia were scarce for both types of instruments.

Future research into assessment tools for social health should focus on the development of instruments for self-management that also cover the areas of coping with and adapting to the emotional consequences of the disease; instruments for social participation covering the involvement in social interactions that are experienced as meaningful by the person; and on the psychometric properties and responsiveness of instruments. More attention should also be given to the feasibility (ease of use) of these instruments for people with mild dementia, professionals, and researchers.

The main objective of this study was to conduct a meta-analysis to identify the effects of reminiscence therapy in people with dementia (PWD).

A systematic search of randomized controlled trials (RCTs) was conducted using bibliographic databases. A total of 157 original published studies were identified in the search, and 24 complete articles were included in the final review to check for the level of evidence. Two of the study authors independently assessed the quality of the included studies using the “Risk of Bias” (ROB) tool developed by the Cochrane Collaboration. Depression, quality of life, and behavioral and psychological symptoms of dementia (BPSD) were selected to measure the effect of reminiscence therapy. To determine the effects of reminiscence therapy on these variables, each individual study was analyzed using Comprehensive Meta-Analysis Software® (Biostat, Englewood, NJ, USA).

The overall effect size was presented using standardized mean differences (SMDs) and 95% confidence intervals. Cohen’s d effect size for depression was −0.541 (95% CI: −0.847 to −0.234, Z = −3.730, p<0.001), indicating that depression was significantly reduced in the reminiscence group compared to the control group. Increased quality of life and decreased BPSD were also found in the reminiscence group compared to the control group.

Reminiscence therapy has a moderate effect on depression and can be broadly used to decrease depression as an alternative to antipsychotics, which can have harmful side effects and high cost.

To develop and validate a new scale to assess music therapy engagement in persons with dementia (PWDs).

A draft scale was derived from literature review and >2 years of qualitative recording of PWDs during music therapy. Content validity was attained through iterative consultations, trial sessions, and revisions. The final five-item Music Therapy Engagement scale for Dementia (MTED) assessed music and non-music related elements. Internal consistency and inter-rater reliability were assessed over 120 music therapy sessions. MTED was validated with the Greater Cincinnati Chapter Well-being Observation Tool, Holden Communication Scale, and Participant Engagement Observation Checklist – Music Sessions.

A total of 62 PWDs (83.2 ± 7.7 years, modified version of the mini-mental state examination = 13.2/30 ± 4.1) in an acute hospital dementia unit were involved.

The mean MTED score was 13.02/30 ± 4.27; internal consistency (Cronbach's α = 0.87) and inter-rater reliability (intra-class correlation = 0.96) were good. Principal component analysis revealed a one-factor structure with Eigen value > 1 (3.27), which explained 65.4% of the variance. MTED demonstrated good construct validity. The MTED total score correlated strongly with the combined items comprising Pleasure, Interest, Sadness, and Sustained attention of the Greater Cincinnati Chapter Well-being Observation Tool (rs = 0.88, p < 0.001).

MTED is a clinically appropriate and psychometrically valid scale to evaluate music therapy engagement in PWDs.

Theory of Mind reasoning, which plays a pivotal role in social interaction, is required to detect deception. Empirically, those with cognitive decline are vulnerable to deception.

Participants were 45 healthy elderly adults with clinical dementia rating (CDR) 0, and 76 outpatients: 25 with amnestic mild cognitive impairment (aMCI, CDR 0.5), 34 with mild Alzheimer's disease dementia (ADD, CDR 1), and 17 with moderate ADD (CDR 2). The task consisted of two single-frame cartoons that depicted a character with an intention to deceive another character using social signs of gaze and pointing, and participants are provided clue questions to detect the character's intentions.

The percentage of participants who detected the character's intention decreased with ADD progression (CDR 0, 82.2%; CDR 0.5, 48.0%; CDR 1, 29.4%; and CDR 2, 0%). Total score (0–6) also decreased with ADD progression (CDR 0, 4.4 +/−1.1; CDR 0.5, 3.0 +/−1.3; CDR 1, 2.9 +/−1.5; and CDR 2, 1.6 +/−0.9).

The present study demonstrated that those with aMCI have difficulty in detecting other's deceiving intentions, when the intention was shown implicitly using social signs. In a previous study, we have reported that mild ADD showed difficulties in detecting intention, while aMCI succeeded in detection when the intention was depicted explicitly. These results together suggested that those with aMCI is vulnerable to deception when the intention was shown implicitly using non-verbal cues, while ADD may fail to detect the intention even when the intention was shown explicitly.

Traditional perspectives conceptualize resilience as a trait and depression as resulting from resilience deficiency. However, research indicates that resilience varies substantially even among adults who are clinically depressed, as well as across the lifespan of an individual. Few studies have investigated resilience in depression, and even fewer have examined resilience in depressed older adults.

Three hundred thirty-seven adults ≥60 years with major depressive disorder completed the Connor–Davidson Resilience Scale (CD-RISC) and measures of mental health, quality of life (QOL), and medical comorbidity. Exploratory factor analysis was used to explore the factor structure of the CD-RISC. Correlations and general linear models were used to examine associations between resilience and other variables.

The rotated component matrix indicated a four-factor model. Sorting of items by highest factor loading revealed constructs associated with (1) grit, (2) active coping self-efficacy, (3) accommodative coping self-efficacy, and (4) spirituality. Resilience was significantly correlated with increased age, lower cognitive functioning, greater cerebrovascular risk, and greater medical comorbidity. Resilience was negatively associated with mental health symptoms (depression, apathy, and anxiety) and positively associated with QOL. The final optimal model identified less depression, less apathy, greater medical comorbidity, higher QOL, and minority (non-White) race as factors that significantly explained variability in resilience.

Resilience was significantly associated with a range of mental health constructs in a sample of older adults with depression. Future clinical trials and dismantling studies may help determine whether interventions targeting grit, active coping, accommodative coping, and spirituality can increase resilience and help prevent and treat depression in older adults.

Alzheimer’s Disease (AD), characterized by deficits in memory and cognition and by behavioral impairment, is a progressive neurodegenerative disorder that influences more than 47 million people worldwide. Currently, no available drug is able to stop AD progression. Therefore, novel therapeutic strategies need to be investigated.

We analyzed the RNA sequencing data (RNA-seq) derived from the Gene Expression Omnibus (GEO) database to identify the differentially expressed mRNAs in AD. The AD mouse model Tg2576 was used to verify the effects of IGF-2. The Morris Water Maze was administered to test the role of IGF-2 in memory consolidation. In addition, we quantified cell apoptosis by the TUNEL assay. The levels of amyloid plaques and the levels of Aβ40 and Aβ42 in the hippocampus were also determined by immunohistochemistry and ELISA, respectively.

RNA-seq analysis revealed that IGF-2 was remarkably reduced in AD. The expression of the upstream genes PI3K and AKT and the downstream gene CREB in the PI3K signaling pathway was significantly increased in the hippocampus of Tg2576 mice cells treated with IGF-2. The Morris water maze test showed that IGF-2 improved memory consolidation in Tg2576 mice. The activity of caspase-3 was decreased in Tg2576 mice treated with IGF-2. Amyloid plaques in the hippocampus were reduced, and the levels of Aβ40 and Aβ42 were decreased. The above effects of IGF-2 on AD were blocked when the PI3K signaling pathway inhibitor wortmannin was added.

IGF-2 attenuates memory decline, oxidative stress, cell apoptosis and amyloid plaques in the AD mouse model Tg2576 by activating the PI3K/AKT/CREB signaling pathway.

Little is known about the combined use of benzodiazepines and antidepressants in older psychiatric patients. This study examined the prescription pattern of concurrent benzodiazepines in older adults treated with antidepressants in Asia, and explored its demographic and clinical correlates.

The data of 955 older adults with any type of psychiatric disorders were extracted from the database of the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) project. Demographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. Both univariate and multiple logistic regression analyses were performed.

The proportion of benzodiazepine and antidepressant combination in this cohort was 44.3%. Multiple logistic regression analysis revealed that higher doses of antidepressants, younger age (<65 years), inpatients, public hospital, major comorbid medical conditions, antidepressant types, and country/territory were significantly associated with more frequent co-prescription of benzodiazepines and antidepressants.

Nearly, half of the older adults treated with antidepressants in Asia are prescribed concurrent benzodiazepines. Given the potentially adverse effects of benzodiazepines, the rationale of benzodiazepines and antidepressants co-prescription needs to be revisited.