Because of the complexity of Alzheimer’s Disease (AD) clinical presentations across bio-psycho-social domains of functioning, data-reduction approaches, such as latent profile analysis (LPA), can be useful for studying profiles rather than individual symptoms. Previous LPA research has resulted in more precise characterization and understanding of patients, better clarity regarding the probability and rate of disease progression, and an empirical approach to identifying those who might benefit most from early intervention. Whereas previous LPA research has revealed useful cognitive, neuropsychiatric, or functional subtypes of patients with AD, no study has identified patient profiles that span the domains of health and functioning and that also include motor and sensory functioning.

LPA was conducted with data from the Advancing Reliable Measurement in Alzheimer’s Disease and cognitive Aging study. Participants were 209 older adults with amnestic mild cognitive impairment (aMCI) or mild dementia of the Alzheimer’s type (DAT). LPA indicator variables were from the NIH Toolbox® and included cognitive, emotional, social, motor, and sensory domains of functioning.

The data were best modeled with a 4-profile solution. The latent profiles were most differentiated by indices of social and emotional functioning and least differentiated by motor and sensory function.

These multi-domain patient profiles support and extend previous findings on single-domain profiles and highlight the importance of social and emotional factors for understanding patient experiences of aMCI/DAT. Future research should investigate these profiles further to better understand risk and resilience factors, the stability of these profiles over time, and responses to intervention.

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbances, cognitive impairment and urinary dysfunction. Early diagnosis is essential to ensure timely shunt treatment. However, patient identification remains challenging due to limited studies, mostly from Asia and Europe, which restrict generalizability to other geographic areas. Moreover, demographic factors (age, sex, education) influence cognitive and gait performance in other neurological conditions, but their impact on iNPH remains unclear. This study aimed to characterize the demographic, vascular, cognitive and gait profiles of iNPH patients in Eastern Quebec (Canada) and determine how demographic factors influence performance outcomes.

A retrospective chart review was conducted on 175 patients diagnosed with probable iNPH at a specialized neurology center in Eastern Quebec. Demographic data, vascular risk factors and cognitive and gait outcomes were extracted from medical records. Descriptive statistics were used to characterize the sample, and multiple linear regressions assessed the effect of demographic factors on performance outcomes.

The cohort had a mean age of 73.9 years and a mean education level of 11.9 years. Age and education significantly predicted over half of the cognitive test results, while age was the only significant predictor of gait. Hypertension (58%) and hyperlipidemia (47%) were more prevalent than diabetes (26%), differing from previous studies where diabetes was the second most reported vascular risk factor after hypertension.

Clinical heterogeneity characterizes iNPH patients in Eastern Quebec. Differences in the prevalence of vascular risk factors compared to previous studies may reflect geographic variability in the clinical presentation of this condition.

Climate change is contributing to increased frequency and intensity of wildfires in California. This study evaluated the self-reported impacts of the California Oak Fire on the health of a medically at-risk population and identified their wildfire preparedness and information needs.

A cross-sectional mixed-methods survey was conducted from April-July of 2023 of those with self-identified special needs in emergencies. The survey assessed self-reported wildfire preparedness, information needs, evacuation response, and health impacts.

A total of 53 surveys were completed for a response rate of 23.1%. Most respondents had medical conditions (94%). One-fifth (21%) of respondents reported missed or delayed medical appointments and harm to their health from the Oak Fire; these groups reported significantly more medical conditions (4.1 v. 2.5, P = 0.0055) and use of more medical devices (3.5 v 2, P = 0.007) than those without harm to their health. The most common way respondents learned about the Oak Fire was by seeing fire plumes/smelling smoke (59%); the most trusted information source was county officials (77%). Less than half of respondents (40%) evacuated during the Oak Fire.

Wildfires are associated with interruptions in medical care that harm health, particularly for medically at-risk populations.

To assess for differences in low score frequency on cognitive testing amongst older adults with and without a self-reported history of traumatic brain injury (TBI) in the National Alzheimer’s Coordinating Center (NACC) dataset.

The sample included adults aged 65 or older who completed the Uniform Data Set 3.0 neuropsychological test battery (N = 7,363) and was divided by individuals with and without a history of TBI, as well as cognitive status as measured by the CDR. We compared TBI- and TBI + groups by the prevalence of low scores obtained across testing. Three scores falling at or below the 2nd percentile or four scores at or below the 5th percentile were criteria for an atypical number of low scores. Nonparametric tests assessed associations among low score prevalence and demographics, symptoms of depression, and TBI history.

Among cognitively normal participants (CDR = 0), older age, male sex and greater levels of depression were associated with low score frequency; among participants with mild cognitive impairment (CDR = 0.5-1), greater levels of depression, shorter duration of time since most recent TBI, and no prior history of TBI were associated with low score frequency.

Participants with and without a history of TBI largely produced low scores on cognitive testing at similar frequencies. Cognitive status, sex, education, depression, and TBI recency showed variable associations with the number of low scores within subsamples. Future research that includes more comprehensive TBI history is indicated to characterize factors that may modify the association between low scores and TBI history.

Since cannabis was legalized in Canada in 2018, its use among older adults has increased. Although cannabis may exacerbate cognitive impairment, there are few studies on its use among older adults being evaluated for cognitive disorders.

We analyzed data from 238 patients who attended a cognitive clinic between 2019 and 2023 and provided data on cannabis use. Health professionals collected information using a standardized case report form.

Cannabis use was reported by 23 out of 238 patients (9.7%): 12 took cannabis for recreation, 8 for medicinal purposes and 3 for both purposes. Compared to non-users, cannabis users were younger (mean ± SD 62.0 ± 7.5 vs 68.9 ± 9.5 years; p = 0.001), more likely to have a mood disorder (p < 0.05) and be current or former cigarette smokers (p < 0.05). There were no significant differences in sex, race or education. The proportion with dementia compared with pre-dementia cognitive states did not differ significantly in users compared with non-users. Cognitive test scores were similar in users compared with non-users (Montreal Cognitive Assessment: 20.4 ± 5.0 vs 20.7 ± 4.5, p = 0.81; Folstein Mini-Mental Status Exam: 24.5 ± 5.1 vs 26.0 ± 3.6, p = 0.25). The prevalence of insomnia, obstructive sleep apnea, anxiety disorders, alcohol use or psychotic disorders did not differ significantly.

The prevalence of cannabis use among patients with cognitive concerns in this study was similar to the general Canadian population aged 65 and older. Further research is necessary to investigate patients’ motivations for use and explore the relationship between cannabis use and mood disorders and cognitive decline.

This review provides an overview of patient-reported outcome measure (PROMs) utilized to assess the impact of advance care planning (ACP) among older adults and evaluates their psychometric properties.

The inclusion criteria were as follows: (1) studies that targeted older adults; (2) studies using of any type of measurement tools that measure patient-reported ACP program outcomes; and (3) studies published in English or Korean. Following PRISMA guidelines, a systematic review was conducted, encompassing electronic searches across 5 databases including PubMed, EMBASE, Cochrane Library, CINHAL, and PsycINFO and manual searches of umbrella reviews on ACP interventions. General characteristics of the selected measures were extracted, and their methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

Out of 19,503 studies initially identified, 74 met the inclusion criteria, reporting on a total of 202 measures. These measures were categorized into 4 domains reflecting the targets of ACP interventions: process (n = 56), action (n = 18), process and action (n = 16), quality of care (n = 63), and health status (n = 49). Despite the breadth of measures identified, none fully met all recommended psychometric properties outlined in the checklist.

While this review aids in the selection of measures for both practical and research purposes, it underscores the necessity for further validation of PROMs in assessing ACP outcomes in older adults, advocating for rigorous psychometric evaluations and adherence to standards like the COSMIN checklist to ensure reliable and valid data. It suggests the need for shortened versions and researcher assistance to address the challenges older adults face with self-reported PROMs and improve participation rates.

This methodological study aimed to adapt the DLS, introduced for individuals aged 18-60 years, to those aged 60 years and older and to determine its psychometric properties.

We collected the data between December 15, 2021 and April 18, 2022. We carried out the study with a sample of 60 years and older living in the city center of Burdur, Turkey. The sample was selected using snowball sampling, a non-probability sampling technique. We collected the data using a questionnaire booklet covering an 11-item demographic information form and the DLS. We utilized reliability and validity analyses in the data analysis. The analyses were performed on SPSS 23.0, and a P value < 0.05 was considered statistically significant.

The mean age of the participants was found to be 68.29 (SD = 6.36). The 61-item measurement tool was reduced to 57 items by removing a total of 4 items from the scale. We also calculated Cronbach’s α values to be 0.936 for the mitigation/prevention subscale, 0.935 for the preparedness subscale, 0.939 for the response subscale, and 0.945 for the recovery/rehabilitation subscale.

As adapted in this study, the DLS-S can be validly and reliably used for individuals aged 60 years and older.

This study serves as an exemplar to demonstrate the scalability of a research approach using survival analysis applied to general practice electronic health record data from multiple sites. Collection of these data, the subsequent analysis, and the preparation of practice-specific reports were performed using a bespoke distributed data collection and analysis software tool.

Statins are a very commonly prescribed medication, yet there is a paucity of evidence for their benefits in older patients. We examine the relationship between statin prescriptions for general practice patients over 75 and all-cause mortality.

We carried out a retrospective cohort study using survival analysis applied to data extracted from the electronic health records of five Australian general practices.

The data from 8025 patients were analysed. The median duration of follow-up was 6.48 years. Overall, 52 015 patient-years of data were examined, and the outcome of death from any cause was measured in 1657 patients (21%), with the remainder being censored. Adjusted all-cause mortality was similar for participants not prescribed statins versus those who were (HR 1.05, 95% CI 0.92–1.20, P = 0.46), except for patients with diabetes for whom all-cause mortality was increased (HR = 1.29, 95% CI: 1.00–1.68, P = 0.05). In contrast, adjusted all-cause mortality was significantly lower for patients deprescribed statins compared to those who were prescribed statins (HR 0.81, 95% CI 0.70–0.93, P < 0.001), including among females (HR = 0.75, 95% CI: 0.61–0.91, P < 0.001) and participants treated for secondary prevention (HR = 0.72, 95% CI: 0.60–0.86, P < 0.001). This study demonstrated the scalability of a research approach using survival analysis applied to general practice electronic health record data from multiple sites. We found no evidence of increased mortality due to statin-deprescribing decisions in primary care.

Symptom clustering research provides a unique opportunity for understanding complex medical conditions. The objective of this study was to apply a variable-centered analytic approach to understand how symptoms may cluster together, within and across domains of functioning in mild cognitive impairment (MCI) and dementia, to better understand these conditions and potential etiological, prevention, and intervention considerations.

Cognitive, motor, sensory, emotional, and social measures from the NIH Toolbox were analyzed using exploratory factor analysis (EFA) from a dataset of 165 individuals with a research diagnosis of either amnestic MCI or dementia of the Alzheimer’s type.

The six-factor EFA solution described here primarily replicated the intended structure of the NIH Toolbox with a few deviations, notably sensory and motor scores loading onto factors with measures of cognition, emotional, and social health. These findings suggest the presence of cross-domain symptom clusters in these populations. In particular, negative affect, stress, loneliness, and pain formed one unique symptom cluster that bridged the NIH Toolbox domains of physical, social, and emotional health. Olfaction and dexterity formed a second unique cluster with measures of executive functioning, working memory, episodic memory, and processing speed. A third novel cluster was detected for mobility, strength, and vision, which was considered to reflect a physical functioning factor. Somewhat unexpectedly, the hearing test included did not load strongly onto any factor.

This research presents a preliminary effort to detect symptom clusters in amnestic MCI and dementia using an existing dataset of outcome measures from the NIH Toolbox.

Neuropsychologists have difficulty detecting cognitive decline in high-functioning older adults because greater neurological change must occur before cognitive performances are low enough to indicate decline or impairment. For high-functioning older adults, early neurological changes may correspond with subjective cognitive concerns and an absence of high scores. This study compared high-functioning older adults with and without subjective cognitive concerns, hypothesizing those with cognitive concerns would have fewer high scores on neuropsychological testing and lower frontoparietal network volume, thickness, and connectivity.

Participants had high estimated premorbid functioning (e.g., estimated intelligence ≥75th percentile or college-educated) and were divided based on subjective cognitive concerns. Participants with cognitive concerns (n = 35; 74.0 ± 9.6 years old, 62.9% female, 94.3% White) and without cognitive concerns (n = 33; 71.2 ± 7.1 years old, 75.8% female, 100% White) completed a neuropsychological battery of memory and executive function tests and underwent structural and resting-state magnetic resonance imaging, calculating frontoparietal network volume, thickness, and connectivity.

Participants with and without cognitive concerns had comparable numbers of low test scores (≤16th percentile), p = .103, d = .40. Participants with cognitive concerns had fewer high scores (≥75th percentile), p = .004, d = .71, and lower mean frontoparietal network volumes (left: p = .004, d = .74; right: p = .011, d = .66) and cortical thickness (left: p = .010, d = .66; right: p = .033, d = .54), but did not differ in network connectivity.

Among high-functioning older adults, subjective cognitive decline may correspond with an absence of high scores on neuropsychological testing and underlying changes in the frontoparietal network that would not be detected by a traditional focus on low cognitive test scores.

Diets with a low proportion of energy from protein have shown to cause overconsumption of non-protein energy, known as Protein Leverage. Older adults are susceptible to nutritional inadequacy. The aim was to investigate associations between protein to non-protein ratio (P:NP) and intakes of dietary components and assess the nutritional adequacy of individuals aged 65–75 years from the Nutrition for Healthy Living (NHL) Study.

Cross-sectional. Nutritional intakes from seven-day weighed food records were compared with the Nutrient Reference Values for Australia and New Zealand, Australian Guide to Healthy Eating, Australian Dietary Guidelines and World Health Organisation Free Sugar Guidelines. Associations between P:NP and intakes of dietary components were assessed through linear regression analyses.

NHL Study.

113 participants.

Eighty-eight (59 female and 29 male) with plausible dietary data had a median (interquartile range) age of 69 years (67–71), high education level (86 %) and sources of income apart from the age pension (81 %). Substantial proportions had intakes below recommendations for dairy and alternatives (89 %), wholegrain (89 %) and simultaneously exceeded recommendations for discretionary foods (100 %) and saturated fat (92 %). In adjusted analyses, P:NP (per 1 % increment) was associated with lower intakes of energy, saturated fat, free sugar and discretionary foods and higher intakes of vitamin B12, Zn, meat and alternatives, red meat, poultry and wholegrain % (all P < 0·05).

Higher P:NP was associated with lower intakes of energy, saturated fat, free sugar and discretionary. Our study revealed substantial nutritional inadequacy in this group of higher socio-economic individuals aged 65–75 years.

The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS).

The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery was used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data.

For the eight domains of cognitive functioning identified (orientation, memory [immediate, delayed, and recognition], set shifting, attention/speed, language/fluency, and visuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where fit must be perfect and is not informative. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94).

The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used to operationalize notions of neurocognitive impairment, and as a starting point for prioritizing pre-statistical harmonization and evaluating configural invariance in cross-national research.

Hearing impairment in older adults may affect cognitive function and increase the risk of dementia. Most cognitive tests are delivered auditorily, and individuals with hearing loss may fail to hear verbal instructions. Greater listening difficulty and fatigue in acoustic conditions may impact test performance. This study aimed to examine the effect of decreased audibility on cognitive screening test performance in older adults.

Older adults (n = 63) with different levels of hearing loss completed a standard auditory Mini-Mental State Examination test and a written version of the test.

Individuals with moderate to moderately severe hearing loss (41–70 dB) performed significantly better on the written (24.34 ± 4.90) than on the standard test (22.55 ± 6.25), whereas scores were not impacted for mild hearing loss (less than 40 dB).

Hearing evaluations should be included in cognitive assessment, and test performance should be carefully interpreted in individuals with hearing loss to avoid overestimating cognitive decline.

Prevalence of cognitive decline and dementia is rising globally, with more than 10 million new cases every year. These conditions cause a significant burden for individuals, their caregivers, and health care systems. As no causal treatment for dementia exists, prevention of cognitive decline is of utmost importance. Notably, alcohol is among the most significant modifiable risk factors for cognitive decline.

Longitudinal data across 15 years on 6,967 individuals of the Survey of Health, Ageing and Retirement in Europe were used to analyze the effect of alcohol consumption and further modifiable (i.e., smoking, depression, and educational obtainment) and non-modifiable risk factors (sex and age) on cognitive functioning (i.e., memory and verbal fluency). For this, a generalized estimating equation linear model was estimated for every cognitive test domain assessed.

Consistent results were revealed in all three regression models: A nonlinear association between alcohol consumption and cognitive decline was found—moderate alcohol intake was associated with overall better global cognitive function than low or elevated alcohol consumption or complete abstinence. Furthermore, female sex and higher educational obtainment were associated with better cognitive function, whereas higher age and depression were associated with a decline in cognitive functioning. No significant association was found for smoking.

Our data indicate that alcohol use is a relevant risk factor for cognitive decline in older adults. Furthermore, evidence-based therapeutic concepts to reduce alcohol consumption exist and should be of primary interest in prevention measures considering the aging European population.

Glycemic control for elderly diabetics is a challenge. Treatment satisfaction reflects this control.

To determine the factors associated with insulin treatment satisfaction among type 2 diabetic elderly.

A cross-sectional study on 86 type 2 diabetic insulin dependent elderly recruited from the outpatient endocrinology consultation during June and July 2021. We applied the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and geriatric assessment scores.

Three quarters of the patients were satisfied with the insulin therapy. Satisfied patients had significantly less history of hospitalization and more regular follow-up. Diabetic neuropathy medications were significantly less taken by satisfied patients. The number of daily insulin injections was significantly higher in the unsatisfied patients. Diabetic foot was significantly more frequent in unsatisfied patients. Satisfied patients were significantly less depressed, more independent in both basic and instrumental activities of daily living, without memory impairment, in better nutritional status and not falling. Higher DTSQ scores were associated with regular follow up (β 7.92, 95% CI 1.83 to 34.3). Lower DTSQ scores were associated with the history of hospitalization (β 0.12, 95% CI 0.02 to 0.58), the taking of medications for diabetic neuropathy (β 0.07, 95% CI 0.09 to 0.51), the high number of insulin injections (β 0.43, 95% CI 0.19 to 0.97) and the presence of diabetic foot (β 0.17, 95% CI 0.01 to 0.38).

Risk factors for patients’ insulin dissatisfaction should be detected early and managed appropriately to improve patients’satisfaction and consequently their well-being.

No significant relationships.

Although depression is one of the most common diseases among older people, it is still underdiagnosed due to frequent misleading symptoms.

The aims of our study were to assess depression in type 2 diabetic insulin-dependent older adults and to identify factors associated with depression among this population.

A cross-sectional study on 100 type 2 diabetic insulin-dependent elderly recruited from the outpatient endocrinology consultation during June and July 2021. We applied the geriatric assessment scores: the Geriatric Depression Scale 15-item, the KATS score, the Lawton scale. the five-word test, the Mini Nutritional Assessment and the Timed Up and Go test.

The mean age of the population was 70.8±5.8 years with sex ratio of 0.85. Depression was noted among 57% of the patients who were distributed as follow: around one fifth (21%) had mild depression while 36% had moderate to severe depression. Around one quarter of the patients (24%) were dependent in the basic activities of daily living. Depression was significantly associated with dependency (β = 5.27; 95% CI, 1.01 to 27.35), ophthalmologic diseases (β = 8.81; 95% CI, 2.18 to 35.63), high frequency of nocturia (β = 3.71; 95% CI, 1.24 to 11.05) and high frequency of bleeding at insulin injection site (β = 4.21; 95% CI, 1.49 to 11.84).

Our findings suggest that the prevalence of depression is high among type 2 diabetic insulin-dependent older adults. Early assessment of depression’s risk factors is a major pillar of the comprehensive care of our seniors.

No significant relationships.