American Journal of Alzheimer's Disease & Other Dementias®

This scoping review examines the impact of inappropriate sexual behaviors (ISBs) in people with dementia on their family caregivers. Through synthesizing 15 studies from 8 countries, 6 themes were identified: complex emotional responses, psychological distress, increased caregiver burden, practical caregiving challenges, impaired marital relationships, and social isolation. Findings reveal caregivers frequently experience helplessness, embarrassment, anger, anxiety, depression, and social withdrawal, exacerbated by societal taboos surrounding sexuality and limited professional support. Spousal caregivers are particularly affected, reporting increased emotional strain and marital distress. Practical caregiving difficulties, including safety and privacy concerns, limited access to care services, and challenging institutionalization decisions, further intensify caregiver burden. The review highlights significant research gaps, including the need for specialized assessment tools, broader and culturally diverse studies, and exploration of ISBs as distinct phenomena. Addressing these gaps is crucial for developing targeted interventions and adequately supporting caregivers, particularly within home-based and culturally sensitive dementia care services.

This study examined the associations of activities of daily living (ADL) limitations and depressive symptoms with global and domain-specific cognition among older adults with chronic diseases. Data were drawn from the 2020 wave of the China Health and Retirement Longitudinal Study, including 5,112 participants aged ≥60 years. Functional ability and depressive symptoms were assessed using the ADL scale and CES-D-10, respectively. Cognitive function was assessed using CHARLS cognitive measures, including the Telephone Interview of Cognitive Status-10 and other cognition-related items. Spearman correlation and path analyses were performed using AMOS and Stata. ADL limitations were associated with poorer global and domain-specific cognitive function, and depressive symptoms accounted for part of these associations in the path models. The proportion accounted for by the indirect effect ranged from 17.39% for visuospatial ability to 60.27% for delayed recall. These findings suggest that functional status, depressive symptoms, and cognition are closely interrelated in this population.

Religiosity and spirituality (R/S) encompass organizational activity, private practice, and intrinsic beliefs, which may relate differently to cognitive and mental health outcomes in older adults. This study identified latent R/S profiles among South Korean older adults with mild cognitive impairment (MCI) and Alzheimer’s disease (AD), and examined differences in cognitive function, psychological well-being, and depressive symptoms. Latent profile analysis using Duke University Religion Index indicators was conducted with 518 patients (MCI: n = 224; AD: n = 294). In MCI, three classes that differed in well-being and verbal fluency were identified; they showed no differences in depressive symptoms or other cognitive domains. In AD, four classes were identified that differed in the Short Blessed Test and Word List Recall; in these, well-being, depression, and other cognitive outcomes did not differ across classes. These findings underscore the relevance of diverse R/S patterns in individualized care for older adults with neurocognitive disorders.

Understanding public beliefs about patients at memory centers may inform efforts to promote early diagnosis and guide clinical discussions of Alzheimer’s disease (AD). Adults (N=3,527) read a vignette describing a fictional person at a memory center and rated the person’s condition as a mental illness, part of typical aging, and psychological or biological origins. Vignettes varied by AD biomarker result, symptom stage, and treatment availability. Participants most strongly believed that the condition was part of typical aging and biological in origin, though beliefs varied across subgroups. Black and Asian participants reported stronger beliefs than White participants that the condition was a mental illness (β=0.39, P<0.001) and psychological (β=0.46, P<0.001). Men reported stronger beliefs that the condition was a mental illness (β=0.19, P<0.001), psychological (β=0.14, P<0.001), and part of typical aging (β=-0.08, P=0.04). Biomarker positivity heightened biological and lowered psychological attributions (all P<0.05). The findings offer specific insights to guide intervention.

The increasing incidence of Alzheimer’s disease (AD) coupled with emerging diagnostics and treatments underscores the need for early detection of AD, yet identifying these individuals remains challenging. This US study sought to examine community-based physician attitudes regarding diagnosis and treatment of early AD (mild cognitive impairment [MCI] due to AD and mild AD). A total of 177 primary care physicians (PCPs) and 147 neurologists recruited through a national physician panel were surveyed about early AD diagnostic and treatment processes, and self-confidence in identifying and managing the condition. Physicians identified patient and family/caregiver involvement as critical in triggering the diagnostic process. Patterns of use of neurocognitive assessments, structural imaging tests, and AD-specific biomarkers varied between PCPs and neurologists. Confidence diagnosing and managing early AD was a concern across specialties, although was greater among PCPs. Programs promoting awareness of early AD symptoms, and emerging technologies and treatments are critical to timely management.

Objective: Alzheimer’s disease (AD) continues to be a major challenge because handling high-dimensional data is time-consuming and expensive due to its complexity. A large feature space often increases computational costs and reduces model interpretability. This study addresses this problem by evaluating and comparing multiple feature selection techniques to identify the most informative biomarkers for AD diagnosis.

Methods: Our study used data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to implement and test three feature selection approaches, visualization-based, filter-based, and wrapper-based, within a Naive Bayes (NB) classification framework.

Results: Based on the results of the analysis, the wrapper method achieved 96.77% classification accuracy, outperforming both visualization and filter methods with 86.19 and 91.87%, respectively. Interestingly, even when over 92.5% of the original features were removed the classifier still performed well, indicating that only a small set of features is necessary to ensure reliable diagnosis.

Discussion: This study illustrates that strategically selecting features improves diagnostic accuracy while reducing computational burden, providing a more efficient framework for machine learning applications in Alzheimer's disease research.

This study examined the association between social distancing measures and Quality of Life (QoL), behavioural problems, and cognition among older adults with severe dementia in residential homes. QoL (Chinese version of the Quality of Life for Late-Stage Dementia), behavioural problems (Chinese version of the Neuropsychiatric Inventory), cognition (Chinese version of the Cognitive Test for Severe Dementia), and clinical variables were evaluated at baseline, 6, and 12 months. Activity involvement was recorded on a monthly basis. Sixty-four participants completed the one-year follow-up. QoL worsened continuously from baseline to month-12; correlated with reduced activity involvement and increased depression level. Behavioural problems increased significantly from baseline to month-12; correlated with reduced activity involvement and deteriorated self-care function. Cognition declined significantly from baseline to month-12; correlated with reduced non-sedentary time. The findings suggest that social restrictions may be negatively related to the QoL, behavioural problems, and cognition of residents with severe dementia.

Understanding the clinical utility of patient-reported outcome measures is critical for using these measures in research and clinical practice. Therefore, the purpose of this analysis was to establish the psychometric properties of three TBI-CareQOL measures in caregivers of people living with Alzheimer’s disease or Alzheimer’s disease-related dementias (ADRD): Caregiver Strain, Caregiver-Specific Anxiety, and Feeling Trapped. One-hundred-and-ninety-seven caregivers of individuals living with ADRD (n=197) completed three TBI-CareQOL measures, three additional measures to establish convergent and discriminant validity (NIH Toolbox Perceived Stress, Dementia Management Strategies Scale, PROMIS Pain Intensity), and the Dementia Severity Rating Scale to establish known groups validity. Internal consistency and test-retest reliability of the TBI-CareQOL measures were supported (alphas >.70). The TBI-CareQOL measures were also free of floor and ceiling effects. Convergent, discriminant, and known groups validity were also supported. Taken together, findings support the clinical utility of the TBI-CareQOL measures for caregivers of people living with ADRD.

Subarachnoid hemorrhage (SAH) has been reported to cause glial scarring within a short timeframe. Due to the high mortality rate of SAH, there is limited research on its long-term effects and relation to neurodegenerative disorders. This report aims to investigate a combination of healed SAH and Alzheimer’s Disease (AD) pathology. A 90-year-old female cadaver, in the anatomy laboratory, was found to have an irregular surgical scar in the right frontoparietal bone. Upon dissection, the right frontal lobe was discovered to be atrophic with a concavity. Histopathology exhibited significant gliosis and corpora amylacea (CA). The cause of death was AD, and past medical history revealed an aneurysmal SAH during childbirth 60 years ago. CA and gliosis are common findings in aging, ischemia, and AD. These findings contribute to the knowledge of the long-term effects of SAH and necessitate further research on the pathogenesis of AD in relation to cerebral ischemia.

We aimed to explore the value and interpretability of a multimodal deep learning model integrating optical coherence tomography angiography (OCTA) and electronystagmography (ENG) for the early screening of Alzheimer’s disease (AD) and mild cognitive impairment (MCI). A total of 250 subjects were retrospectively recruited. OCTA images, ENG signals and neurocognitive scores were collected from all subjects. The model had an area under curve of 0.85 for the independent validation cohort, with the sensitivity and specificity of 0.73 and 0.90 at the optimal cut-off of receiver operating characteristic curve, respectively. According to Gradient-weighted Class Activation Mapping analysis, the model focused on regions with reduced microvascular density. SHapley Additive exPlanations analysis revealed that saccade accuracy (left eye), saccade latency (right eye) and smooth pursuit gain (left eye) contributed the most to the model. The multimodal model effectively improves early, non-invasive screening of AD/MCI with good interpretability.

Timely detection of dementia is crucial for reducing its health and societal burden. Standard tools such as the Mini-Mental State Examination (MMSE) and Cognitive Abilities Screening Instrument (CASI), although widely used, are limited by time and resource demands. This study developed and validated a machine learning–based screening tool using the Six-Question Dementia Screening Test (6Q-DS), a brief interview of six items. Data from 533 older adults at a neurology clinic in Taiwan (331 with dementia, 202 without) were analyzed with eXtreme Gradient Boosting. The 6Q-DS achieved an AUC of 0.936, sensitivity 0.879, specificity 0.951, and accuracy 0.907 for dementia vs non-dementia. For identifying very mild dementia vs non-dementia, the AUC was 0.874, with a sensitivity of 0.818, specificity of 0.805, and accuracy of 0.810. Comparable to MMSE and CASI, the 6Q-DS provides a practical, rapid, and user-friendly tool for dementia screening.

Despite comprising the largest segment of the sexual minority population and experiencing unique stressors and health disparities, bi+ dementia caregivers remain underrepresented in health and caregiving research. This secondary analysis of cross-sectional survey data from LGBTQ+ dementia caregivers (bi+, n = 125; gay[g]/lesbian[l], n = 161) examined whether associations between minority and caregiving stressors and global health differed by caregiver group. Bi+ caregivers reported significantly higher minority stress and lower family quality of life but better health than g/l caregivers. Moderation analyses revealed: higher perceived stress predicted worse health for bi+ but better health for g/l; higher family quality of life predicted better health for both groups, with a stronger effect among bi+ caregivers; and more lifetime discrimination predicted worse health for both groups, with a stronger effect among bi+ caregivers. Results underscore the need for inclusive, affirming research and interventions addressing bi+ caregiver stress experiences.