Rapid societal changes occurred during the course of the 20th century. Previous literature has found an increase in depression over time for younger and middle- aged populations. Among older adults, the prevalence of major depression has been found to be stable over time, while for the milder forms, the findings are limited by the largely non-representative nature of analyzed samples. Given the dramatic secular changes in several factors linked to old-age depression, a careful examination of depressive symptom burden and prevalence of depression in representative cohorts of similarly-aged older adults separated in time is required.

We will analyze data on 2,041 older adults from the Swedish National Study on Aging and Care in Kungsholmen. Separate individuals, aged 60 and 81 years were assessed with a Comprehensive Psychopathological Rating Scale (CPRS) during detailed clinical examinations, separated in time by 15 years (2001 vs. 2016). Information on 21 depressive symptoms, is subsequently combined into diagnoses of major depression (presence of at least one core symptom [low mood and/or loss of interest], and at least five out of the nine symptoms); minor depression (presence of at least one core symptom, and two to four symptoms in total), and subsyndromal depression (presence of at least two symptoms in the absence of any other depression diagnoses). Psychosocial (loneliness, bereavement), behavioral (alcohol consumption, smoking), and functional factors (impairments in activities of daily living) are used as potential explanatory factors for any observed cohort differences in symptom burden or prevalence of depression.

For the 60-year old age-group, comparison of symptom burden and diagnostic status will be done across 739 participants assessed in 2001 and 677 people assessed in 2013. For the 81-year old age- group, comparisons will involve 236 people assessed in 2001, 194 people assessed in 2010, and 195 people assessed in 2016.

Preliminary results are expected by March, once data entry and cleaning are completed. We hypothesize that the burden of depressive symptoms and the prevalence of depression will be lower in later born cohorts and that explanatory factors may account for some of the cohort effect.

Motoric cognitive risk (MCR) syndrome is characterized by slow gait speed and subjective cognitive decline, which could predict future dementia. Previous research reported the associations between MCR and gray matter volume reduction in total and specific cortical regions and increased white matter hyperintensities in the brain. However, knowledge is scarce on the relationship between MCR and neuroimaging-derived brain age. The present study explored the association between MCR and brain-predicted age differences.

The present study is a cross-sectional study that involved 1,099 community- dwelling older adults in the Arakawa Ward, Tokyo, Japan, who were between 65 to 84 years old in 2016. In defining MCR, subjective cognitive decline was deemed positive for those who answered “Yes” to the question, “Do you feel that you have more problems with memory than most?” in the Geriatric Depression Scale. Slower gait speed was defined as walking slower than the -1 standard deviation of the age- and sex- stratified gait speed. Brain age was predicted on the 1,021 participants with brain magnetic resonance imaging without severe artifacts or lesions. We used the support vector regression algorithm using MATLAB's “fitrsvm” function, applying ten-fold cross-validation to the results of primary component analysis of the spatially normalized gray-matter images. We calculated the brain-predicted age difference (Brain-PAD) by subtracting the chronological age from the predicted brain age. After excluding the participants with dementia (N=23), the difference in the mean Brain-PAD between MCR+ and MCR- was compared with the Student's t-test. The association between MCR and Brain PAD was examined with multiple regression analyses, adjusting for clinical-demographical data.

The median ages were 72 for both MCR+ (N=96) and MCR- (N=902). The mean Brain-PAD was 3.29 for MCR+ and -0.19 for MCR- (p < .001, Hedges' g = -0.504). Multiple regression analysis showed a significant association between Brain- PAD and MCR (standardized β = 0.159, p < .001) after adjusting for covariates.

The present findings suggest that MCR reflects accelerated brain aging, which may increase the risk of neurodegeneration. Future studies should examine the longitudinal trajectories of brain age and incident dementia in participants with MCR.

Since its first implementation in 1998, significant evidence has been presented of the positive impact of the TimeSlips creative expression method for people with dementia in long-term care (LTC) settings. Our research with people with dementia in Colombia extends this evidence in important new directions: it is the longest TimeSlips study to date (at 32 consecutive weeks); it is the first to evaluate the feasibility of the online delivery of the method (in response to the strict COVID-19 quarantine in Colombia); it is the first study to investigate the impact of the TimeSlips method on the personhood, quality of life and psychological well- being of Spanish-speaking participants in non-LTC settings in the Global South.

Trained facilitators provided weekly, one-hour TimeSlips group storytelling sessions via Zoom over 32 consecutive weeks to eight participants with dementia. Semi- structured interviews of participants and care partners were conducted within one week of the final intervention. Thematic analysis evaluated the resultant qualitative data.

Our online implementation of the TimeSlips creative expression method reinforced key facets of participants’ personhood (self-expression and self-perception, which led in turn to increased care partner appreciation), had a positive impact on key domains of quality of life (mood, energy levels and cognitive function) and stimulated a key aspect of psychological well-being (the formation and maintenance of social ties).

Our study demonstrated that the online delivery of the TimeSlips method to participants who remain in their own homes is both feasible and effective. With more than 2.5 million people with dementia in Latin America (most of whom remain at home post-diagnosis) and a predicted 180% increase in prevalence to 2050 (compared with a 70% increase in Europe), our pioneering study offers important precedents for future, related research, in which a direct comparison between the benefits of online versus face-to-face delivery of the method would be important next step.

Although the previous studies indicated that impaired cerebrospinal fluid (CSF) dynamics might contribute to the pathophysiology of Alzheimer’s disease (AD), the longitudinal changes of CSF volumes in AD has been still unclear. In this study, using the methodology of quantitative assessment of CSF volumes in idiopathic normal pressure hydrocephalus (iNPH), we assessed longitudinal changes in CSF volumes in AD patients.

The subjects were the patients with mild cognitive impairment and dementia due to AD who visited Osaka University Hospital from November 2009 to October 2018. We excluded the patients with gait disturbances and MRI findings such as Disproportionately enlarged subarachnoid-space hydrocephalus (DESH), which was the suggestive finding of iNPH. For each subject, MRI was performed in the first visit and 1 year later. We quantitatively measured CSF volumes in DESH-related regions, such as ventricle systems (VS), Sylvian fissures (SF), and sulci at high convexity and the midline (SHM)., using an automatic brain volumetric software program (AVSIS) (Ishii et al. 2006, 2013). The ratio of each regional volume to the intracranial volume was calculated and we compared these parameters between two visits.

We enrolled 98 patients with AD (mean (SD) age = 76.0 (5.7)). Wilcoxon signed rank test revealed that, while the ratios of CSF volumes in VS and SF significantly increased during the one-year observation (VS: 4.01 (1.05) % vs 4.14 (1.09) %, p<0.001 ;SF: 1.40 (0.21) % vs 1.42 (0.22) %, p=0.007), those in SHM significantly decreased (4.30 (0.70) % vs 4.23 (0.69) %, p<0.001). The change ratio of relative volumes in VS was correlated with those in SF and SHM (r=0.451, p<0.001; r=-0.350, p<0.001).

In patients with AD, the CSF volumes in VS and SF increased while CSF volumes in SHM decreased. This trend of the longitudinal change was similar to the change in the patients with iNPH. The finding of this study indicates that, in the patients with AD, CSF dynamics may be impaired like the patients with iNPH.

Personal care interactions can provide important opportunities for caregivers to engage with a person living with advanced dementia but may also prove to be a difficult experience; why this so is not completely understood. We aimed to examine the person’s engagement and refusals of care in personal care interactions and identify both successful and difficult interpersonal dynamics to enable learning from each setting to inform educational resources.

One-off video-recorded observations of personal care interactions between caregivers (care-home staff or family carers) and people with advanced dementia in the UK (total observation time 03:01:52). Observations were analysed using the Menoh Park Engagement Scale (MPES) (Camp et al., 2015) and the Resistance-to-Care scale (RTC-DAT) (Mahoney, 2015) to score 5-minute video sections, and inductively with qualitative content analysis.

Active engagement of people with dementia was observed in 66% of observations. Refusals of care were present in 32% of observation time. Generally, caregivers emanated a nurturing attentiveness and people with dementia were focused and engaged throughout care activities. Rare difficult interactional components were characterised by the person with dementia appearing to show uneasiness and caregivers being flustered and uncertain. However, caregivers from both family and care-home settings were predominantly attuned to the person and skilled in effortlessly supporting them through the care activity.

Findings provide real-world empirical evidence which reenergises the concept of person-centredness in dementia care. Personal care activities typically created opportunities of engagement, rather than sites of conflict, for people with advanced dementia. The findings provide much needed insight into ways to improve care experiences for people with advanced dementia. Appropriate training/guidance for care-home staff and family carers could support more engaged and pleasurable care experiences for people with dementia.

Due to longevity, universal health coverage, declining population, and a stable society, it is estimated that the number of people with dementia will reach 10 million by the mid-21st century, accounting for 10% of the total population in Japan. To move toward a dementia-friendly community, it is essential to develop innovative and effective dementia care. However, human and economic resources are limited. Therefore, we focused on traditional Buddhist denominations that have organizations, educational systems, human resources, networks, and care venues. The fundamental question of this study is: Japanese Buddhism has created basis for mindfulness-based cognitive therapy, but is it also innovative in the care of older people?

We looked for papers that 1) were written in a medical rather than a religious context, 2) were written in English, and 3) dealt with the care of the older people in Japan.

1) Institutional care workers’ need for Buddhist priests for helping anxiety of older residents was reported. 2) Effectiveness of community cafés for the family caregivers of people with dementia in the Buddhist temples were reported. 3) Potentials of monthly visit to bereaved families, Buddhist priests’ tradition, as the outreach of grief care was suggested. 4) Care workers’ own ideas about death after working in the landscape of dying and death was reported by the interview which used Buddhist priests as the interviewers.

Participation of Buddhist priests as 1) spiritual cares for the residents in the institutions, 2) carers for the family carers in the community, 3) carers of the bereaved families in the outreach activity, and 4) carers for the care workers, were reported. However, robust evidence was not enough. From the standpoint of Japanese clinicians, there are too few papers compared to the actual contributions. More studies should be done which might also work as external monitoring. Traditional Buddhism in Japan has a closed membership system which is based on the family gravesite system and is generally not enthusiastic about propagation, which would also be compatible with a secular care system.

Although depression is a common co-morbid disorder in patients with mild cognitive impairment (MCI), not all patients with MCI exhibit depressive symptoms. This study aimed to investigate the effect of depression on cognitive and functional decline in MCI.

281 patients with MCI (MCI) defined by 0.5 score on Clinical Dementia Rating were included in the study. Patients were divided into three groups based on their Geriatric Depression Scale (GDS) scores: MCI without depression (GDS<10, n=50), MCI with mild depression (GDS10~19, n=120), and MCI with severe depression (GDS>20, n=111). Cognitive function tests (cognitive domains in CERAD-K including letter fluency, trail making test-A and B, and verbal learning test) and Blessed Dementia Scale-Activities of Daily Living (BDS-ADL) were measured. Group differences were analyzed using an analysis of variance (ANOVA). Correlation between GDS scores and BDS-ADL were analyzed.

An ANOVA test showed that activities of daily living differed significantly across groups (F(2, 276) = 13.53, p<0.001). Post-hoc analysis showed MCI with severe depression had a significantly higher mean BDS-ADL score compared with both MCI without depression and MCI with mild depression (both, p<0.001). Correlation analysis showed significant positive correlation between GDS and BDS-ADL (r=0.366, p<0.001). However, mean scores of cognitive function tests were not different among three groups.

The present study suggests that co-morbid depressive symptoms may have negative impact on functional status in patients with MCI. This may further suggest the importance of evaluation and treatment of depressive symptoms in patients with MCI.

COVID-19 is notorious for its neuropsychiatric sequelae. Some patients present with anosmia and cognitive and attention deficits, also known as “brain-fog”. In COVID-19 survivors, psychiatric manifestations such as depression, fatigue, anxiety, and neurocognitive impairments, also known as the “post-acute COVID-19 syndrome” or “long COVID”, were reported in 35% of the patients after the infection. New-onset anxiety, depression, psychosis, seizures, and even suicidal behaviors are also reported. Inflammation was proposed to be the pathophysiology.

The 68 year-old married female who lived with her husband did not have psychiatric history before this year. She had covid-19 infection 3 months prior to her psychiatric hospitalization. Although she had recovered, she started to have depressed mood, disrupted sleep and anhedonia since then. She became easily anxious and could hardly feed her cats as usual. She was not able to make decisions. She no longer did house chores that she had been doing. Poor appetite led to a loss of body weight from 46 to 40kgs. She had blunted emotional response, and could not cry after her cat died. She went to clinic for help, BZD and antidepressants were given, but the condition persisted. One week prior to hospitalization, her speech became weak, murmuring and could not finish a long sentence. The physiological change can be observed using wearable device. After 3 weeks of treatment, her heat rate, activity and sleep improved. The progress was also recorded via wearable devices and clinical scales.

In our patient, the depression was associated with circadian rhythm disruption, suicidal ideations and psychomotor slowing. This may reveal some special features of post-COVID depression. In previous studies, antidepressants have proved to be effective in treating post-COVID-19 depression. Sigma receptors are one of the possible mechanisms. Besides, agomelatine, with its melatonergic activity of regulating circadian rhythm, is proposed to have the potential to inhibit the virus from entering CNS. The activity pattern and circadian rhythm change will be discussed.

Social distance can be used to measure degrees of prejudice in people towards other members of a diverse social group. The objective of this study was to explore older adults’ perceptions of social distances toward older adults with depression, suicidal ideas, and suicide attempts.

A cross-sectional survey was conducted. Older adults were recruited by convenience from outpatient clinics of three hospitals in Taiwan.

A total of 327 older adults participated in this study. The mean scores of social distances toward older adults with depression, suicidal ideas, and suicide attempts were 20.8 (SD=4.2), 20.8 (SD=4.2), and 26.8 (SD=5.1), respectively. Participants had significantly higher scores on social distance toward older adults with suicide attempters than with depression (p<0.01) and suicidal ideas (p<0.01). Having them care for my family member was rated as the most disliked situation across three target groups. Participants’ social distances toward older adults with depression and suicidal ideas were influenced by their religious beliefs (p=0.02). Their social distance toward suicide attempters was influenced by their education level (p<0.01). Illiterates and college graduates tended to have significantly higher scores on social distance toward suicide attempters than junior high graduates did.

To the best of our knowledge, it was the first study to explore older adults’ perceptions of social distances toward older adults with depression, suicidal ideas, and suicide attempts. The results of this study can be used for further intervention of older adults to decrease prejudice against older adults with mental illness.

There is a large treatment gap for mental health conditions in sub-Saharan Africa where most of affected persons who receive any care do so from non-physician primary health care workers (PHCW). We examined the experience of PHCW who provide care for older people with depression in Nigerian primary health care (PHC) settings.

Using in-depth key informant interviews, we explored the views of 15 PHCWs, 11 of whom were community health workers (CHWs) and 4 were community health extension workers (CHEWs), selected from 10 rural and urban PHCs in South-Western Nigeria. Two additional focus group discussions, each comprising eight participants drawn from across different cadres of PHCW (N=16), were also conducted. Thematic analysis was carried out using a three-staged constant comparison technique to refine and categorise the data.

Four overall themes were identified around PHCWs’ experience of caring for older people with depression who presented to PHCs: depression presentation, treatment options, community outreach, and value of mobile technology. Participants identified depression in older people as being characterized by a range of behavioural, cognitive, sleep and bodily symptoms, which were often triggered by economic challenges and poor social support. Common treatment options used by PHCW included general advice and counselling, as well as vitamins and occasional sedatives. Although community outreach and follow-ups are parts of their expected work schedule, PHCW rarely implement these due to non-availability of transport facilities. Mobile technology was identified as a possible way of overcoming this constraint to providing community based mental healthcare for older people.

Our findings suggest that mobile technology could be a viable way to expand the quality of service provided to older persons with depression by including community outreach and follow-up.

Older adults are vulnerable to postoperative delirium after surgery and anesthesia, which may affect their cognitive function and increase depressive symptoms. Anesthesia nurses are dominant in the number of anesthesia medical teams. This study aimed to examine the differences between anesthesia nurses' self- perceived roles and competencies and their recognition of the roles and competencies of anesthesia specialty nurses.

A cross-sectional study was conducted. A structured questionnaire based on a guideline of the International Council of Nurses was designed.

The participated anesthesia nurses’ (N=200) scale scores and mean scores for each question on the self-perceived role and competency scales were lower than the scores on their recognition of the roles and competencies of anesthesia specialty nurse scales. Regarding the self-perceived roles, the scholar domain received the lowest score (Mean= 2.99, SD= 1.00), while the self-perceived competencies, the management domain received the lowest score (Mean = 3.81, SD = 0.67). Similarly, the scholar domain received the lowest score (mean = 3.34, SD = 1.068) in recognition of the roles of an anesthetic specialist nurse, while the management domain received the lowest score (mean = 4.18, SD = 0.58) in the recognition of the competencies of an anesthesia specialist nurse. Anesthesia nurses' self-perceived roles were affected by their nursing ladder and the hospital level at which anesthesia nurses work. Their self-perceived competencies were affected by their nursing ladder and salary. In addition, their recognition of the roles as anesthesia specialist nurses was affected by the hospital level at which anesthesia nurses work. The nursing ladder affected their recognition of the competencies of an anesthesia specialist nurse.

This study has demonstrated that anesthesia nurses must improve their self-perceptions of their roles and competencies to satisfy the expectations of their roles and competencies as anesthesia specialty nurses. The findings of this study could be used to develop future anesthesia nurse education and training programs to provide better care to elderly patients.

Psychobehavioral symptoms are one of the main causes of institutionalization. After the first months of institutionalization, it could be a good opportunity to consider deprescribing psychotropics, at the same time person-centered non-pharmacological measures should be implemented. Also, if dementia stage is moderate or advanced, acetylcholinesterase- olyph-inhibitor (AchEI) should be deprescribed.

To evaluate the difference between the number of psychotropic drugs in institutionalized patients and those who are at home.

We selected all the patients admitted in the Acute Geriatric Unit of “Hospital Universitario de Navarra” during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as delirium predisposing factors, drugs on admission and discharge and Drug-Burden-Index (DBI). A descriptive study was carried out and our hypothesis was analyzed.

658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia and 22% were Institutionalized. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities: arterial hypertension (81%), Osteoarthritis (55%), heart failure (51%), dislipemia (47%), chronic kidney disease (42%), auricular fibrillation (39%), osteoporosis (33%) and diabetes (31%). Regarding geriatric syndromes: polypharmacy (87,5%), sleep disturbances (48%), hearing loss (43%), chronic pain (41,5%), visual loss and constipation (38%) and depression (33%). The main delirium predisposing factors were: age more than 80 (93.5%), olypharmacy, neurological disease (47%), altered senses, chronic pain and depression. Comparing psychotropic use between institutionalized and non institutionalized: psychotropics (78%vs69%), night psichotropics (72%vs63%), neuroleptics (37%vs18,5%), AchEI (13%vs6,5%), antiepileptics (21%14%). All of them p<0.05. However, there were no statistically significant differences in the use of benzodiazepines, antidepressant or antiparkinsonian.

Nowadays, institutionalized patients have more phsychotropic drugs than non-institutionalized ones, especially neuroleptics. Moreover, they are more frequent in patients with severe dementia. Maybe, the explanation is DEPRESCRIPTION AVOIDANCE due to an acute fear of a behavioral decompensation. We recommend educating in non-pharmacological measures and insisting on an adequacy of pharmacological prescriptions periodically.

Psychotropics are often used among dementia in order to reduce behavior problems. In patients with dementia, hospital admission is a stressful event, for hospitalization cause as well as for environment change. Consequently, delirium risk is high and this is proportional to dementia stage. In addition, it ́s known psychotropics promote delirium.

To evaluate if the patients admitted to an acute geriatric unit develop more delirium depending on dementia diagnosis and dementia stage and depending on the use of psychotropics. To analize if dementia and psychotropics are two independent risk factors for the development of delirium.

We selected all the patients admitted in the Acute Geriatric Unit of HUN during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as the onset of delirium: delirium signs on admission (DSA) and delirium diagnosis on discharge (DDD) and psychotropics use. A descriptive study was carried out to analyze the relationship between dementia and its stage (GDS), psychotropics use and delirium.

658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities, the most frequent ones were arterial hypertension(81%), Osteoarthritis(55%) and heart failure(51%). The main delirium predisposing factors were: age more than 80(93.5%), polypharmacy(87.5%), and neurological disease(47%). Comparing: -Dementia and non-dementia-patients: DSA(55.7%vs23.7;p0,000), DDD (43.7%vs17.5%;p0.000) -GDS 4-5 and GDS 6-7: DSA(52.7%vs57.2;p0.435), DDD (50.4%vs37.9%;p0.031). -Psychotropics-users and non-psychotropics-users: DSA(42.3%vs27.4%), DDD(31.6%vs22,5%). Night psychotropics DSA(41.8%vs31%), DDD(31.7%vs24%); neuroleptics DSA(53.1%vs33.6), DDD(45.2%vs24.3%); anticholinesterase DSA(51%vs36.9%), DDD(45.1%vs27.7%). All of them p<0.05.

Dementia and psychotropics are predisposing factors for delirium. Its effect is additive. Neuroleptics have the clearest relationship with delirium. We observed, as dementia was more severe, the risk of delirium was greater but the use of neuroleptics decreased. This could be due to the presence of more hypoactive phases in final stages.

Bridging the gap between clinical practice and research in health care is a challenging task. Living Labs are academic practice partnerships to stress the ambition to start up a longstanding collaboration, which have been developed and implemented in the Netherlands (Verbeek et al., 2020). The “PraWiDem” (“Living Lab Dementia”) project aims to adapt the Maastricht Living Lab approach to long-term dementia care in different regions in Germany.

A mixed methods approach was used to guide the adaptation of the Maastricht Living Lab. A focus group study investigated perspectives of people with dementia, informal carers and professionals on expectations and experiences concerning collaboration and networking between research and practice. A scoping review mapped international experiences in knowledge transfer practices and collaboration approaches in nursing care. Experts from the Maastricht Living Lab supported the research team in adapting the approach to the German national context. Parts of the German “Living Lab Dementia” concept were discussed with members of a recently formed research participation group of people with dementia (“experts by experience”).

In total, 10 focus groups and 5 individual interviews were conducted. Key themes include researchers’ and professionals’ skills, participation of people with dementia and informal carers, and multi-professional requirements. The scoping review identified 17 different approaches of knowledge translation and collaboration. Few approaches address the common development and implementation of knowledge and networking. Dutch experts recommend the early development of long-lasting strategies for collaboration. Experts by experience wish to participate, but traditional research methods may need to be adapted to allow their participation.

The “Living Lab Dementia” is currently under investigation in collaboration with institutional and community care services in three regions in Germany.

elderly patients are significantly impacted by MDD and are less responsive to treatment. ECT is used more often in older patients but has its drawbacks. There is a need for for novel antidepressants. Esketamine, is a FDA approved novel treatment to treatment resistant depression(TRD). Studies of esketamine nasal spray administered with a newly initiated oral antidepressant in TRD aged patients 18-64 years demonstrated rapid onset versus a newly initiated oral antidepressant plus placebo, with maintenance of the treatment effects following long term intermittent dosing. Side effects are dose related, psychotomimetic dissociative, elevation in HR+BP, cognitive impairment, hepatotoxicity and inflammation of bladder endothelium.

to review the current data regarding esketimine treatment in elderly TRD patients.

beside several case reports only 2 RCTs checked efficiency and safety in elderly patients. A pilot RCT of titrated subcutaneous ketamine in older patients with TRD was conducted in 2017. 16 participants> 60 years with TRD who relapsed after remission or did not remit in the RCT were than administered an open label phase. Up to 5 doses of ketamine (0.1 to 0.5 mg\kg) were administered with midazolam as an active control, randomly inserted. 12 ketamine treatments were given in separate sessions at least 1 week apart. Remitters in each phase were followed up for 6 months with MADRS scale. Results provided evidence for the efficacy and safety of ketamine in treating elderly depressed. There was a significant improvement in all ketamine dosages apart from 0.1 mg/kg. 7 participants reached remission. 5/7 had relapse than entered open trial and remitted again. Ochs-Ross, et al 2020 study,138 patients with TRD> 65 years received flexibly dosed esketamine nasal spray and new antidepressant or new antidepressant with placebo. The groups did not achieve statistical significance in MADRS score change from baseline to day 28. Patients with earlier onset of depression and younger patients (65-74) showed greater response to treatment.

Esketamine is safe in elderly TRD patients. There is not enough evidence to conclude if it is efficient. It seems that patients younger than 75 and with earlier onset of depression might benefit from esketamine.

A national prevalence study of early-onset dementia in Japan has provided data on their challenges and support needs, as documented by the individual and their family members. This study examined differences between 1) cases that the onset of early-onset dementia was detected by work colleagues, and 2) other cases.

After identifying medical or long-term care service offices used by people with early-onset dementia in 12 regions in Japan, a questionnaire was distributed to the individuals and their family members. The items surveyed were age at the time of the survey, gender, employment at the onset, age when the initial symptoms were detected, the person who detected the initial symptoms, and consideration received at the workplace. In this report, only those who were working at the onset were included in the analysis. Next, they were divided into two groups according to whether the person who detected the initial symptoms was a colleague or not, and a chi-square test was used to compare the two groups. This study was conducted with the approval of the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology and Geriatric Medicine.

Of the 1035 questionnaires collected, 559 were were working at the time of onset of initial symptoms, and 149 (26.7%) of these cases were initially detected by a colleague. Comparison between groups revealed that the cases detected by colleagues 1) were recommended to see an occupational physician (P<0.001), 2) were referred to a specialist (P<0.001), 3) received consideration such as reassignment in the workplace (P<0.001), 4) received consideration regarding transportation (P=0.023), 5) had someone to talk to in the workplace (P<0.001), and 6) were significantly unlikely to receive no consideration at all (P=0.010).

Early-onset dementia was noticed by a colleague due to an increase mistake in the workplace but may have received reasonable accommodations that could have been considered by each workplace. The results of this study may help to promote dementia-friendly workplace strategies.