Mild behavioral impairment (MBI) is a validated diagnostic entity, that describes the emergence of later life neuropsychiatric symptoms (NPS) in pre-dementia states. The aim of this study was to estimate the prevalence of MBI in people with subjective cognitive complains (SCCs) in primary care centers and observe the evolution in a longitudinal study.

Three hundred twenty-three participants belonging to the CompAS longitudinal study who attended primary care centers with SCCs and without previous diagnosis of dementia and other neurological or psychiatric disturbances underwent clinical, neurological, and neuropsychological examinations at baseline and at two follow-up times (around 24 and 60 moths). At each evaluation point participants were diagnosed as Cognitively Unimpaired (UC), Mild Cognitive Impairment (MCI) and SDC; at the follow-up assessments dementia was diagnosed as well. Diagnosis of MBI was made via a series of semistructured independent interviews with patients and relatives in accordance with the ISTAART-AA criteria and using the Spanish MBI-C cut-off point (Mallo et al, 2019). Frequencies of participants diagnosed in each category were obtained and evolution of the MBI along the follow-up evaluations was studied.

MBI diagnosis prevalence was 22.9% at baseline corresponding to 74 individuals of which at 24 months follow-up were MBI stable 31.1%, 14.9% evolved to MCI, 1.3% to dementia and 40% to CU, (attrition 12.2%). At 60 months follow-up, from the 23 individuals with MBI, 6 remained stable (26.1%), 6 (21.1%) evolved to MCI, 2 (8.7%) to dementia, 3 (13%) to CU, (attrition 26.1%) (Figure 1).

Results indicated that almost a quarter of individuals attending primary care centers with SCCs without previous diagnosis of dementia or psychiatric disorders are MBI. An important part of them evolve to UC or MCI, and only a minority progress to dementia. More studies are needed to analyze the cognitive, personal, and biological factors that determine this evolution.

Neuropsychiatric symptoms (NPS) are common in people with dementia and have a negative effect. Commonly used pharmacological and psychosocial interventions are not always effective and NPS can become refractory. Electroconvulsive therapy (ECT) may be effective for (severe) agitation and aggression and is well tolerated. Nevertheless, its application seems limited in the Netherlands. We explored the application of and attitudes of physicians towards ECT for (severe) NPS in older people with dementia in the Netherlands.

A survey study among geriatricians, elderly care physicians and old-age psychiatrists in the Netherlands in July 2020. An online invitation was included in the digital newsletter of the professional society or directly sent to the professional network of one of the authors (in case of old-age psychiatrists). The questionnaire included 20 closed- and open ended questions on demographic characteristics, experiences with (consideration of) referral for/application of ECT and attitudes towards ECT.

Sixty-one respondents completed the survey, eight had ever considered ECT. Two of these eight referred patient(s) for depressive behavior, sometimes combined with agitation. Lack of experience, ECT not being included in guidelines for this indication, unfamiliarity with possible (side) effects and risks, ethical and practical issues were the main reasons of the respondents for not considering ECT. Most respondents were open to referring patients with dementia for ECT to treat (severe) NPS, specifically in case of refractory symptoms.

Respondents are not negative about ECT, yet rarely consider it due to lack of awareness and knowledge and the ethical and practical issues related to its application. Although the response to our survey was low and the number of respondents is limited, we do feel that ECT may be an alternative for palliative sedation, which is used incidentally in cases of refractory NPS in the Netherlands. Further exploring the support base and possibilities for application of ECT-treatment for refractory NPS might therefore be worthwhile.

Diabetes Mellitus (DM) is one of the most prevalent chronic diseases, whose incidence has been increasing especially in the elderly, being estimated that over one-quarter of people over the age of 65 years have diabetes. Diabetes implications, whether due to acute or chronic complications, namely cognitive and functional impairments, can be devastating and usually determine the need for more supervision, implying a caregiver. For a better clinical characterization of DM, this study aimed to compare older adults, with and without DM, hospitalized in the Convalescence Units (CUs) of the Portuguese National Network of Integrated Continued Care (RNCCI).

This cross-sectional study included older adults (≥65 years old) admitted into three CUs in northern Portugal. The inability to communicate was considered an exclusion criterion. A comprehensive assessment protocol was used, which comprised the Mini Mental State Examination (cognitive function), the Katz Index, and the Lawton Index (basic and instrumental activities of daily living). A comparative analysis between patients’ groups (with and without DM) was performed using the Mann-Whitney and Chi-Square tests.

The final sample included 202 older adults (99 diabetics and 101 non- diabetics), with a mean age of 77 (±7) years, mostly (69.8%) women. Comparing the patients with and without DM, the first group had more dyslipidemia (97% vs. 62.1%, p<0.001) and osteoporosis (97% vs. 67%; p<0.001), as well as more comorbidities (6 vs. 5; p<0.001) and daily medication (9 vs. 7; p<0.001). Moreover, DM patients had more cognitive impairment (52.5% vs. 34.0%; p=0.008) and greater dependence on instrumental activities of daily living (57.6% vs. 37.6%; p=0.009). A tendency was found regarding the presence of a caregiver for those with diabetes (75.8% vs. 63.1%; p=0.051).

Patients with diabetes had more associated diseases and prescribed medicines, presented more cognitive impairment, greater dependence on instrumental activities of daily living, and were more likely to have a caregiver. This study will contribute to a better knowledge about the clinical and psychosocial characterization of older adults with DM in a specific context, allowing the development of future care plans and the adoption of better strategies for this group’s specificities.

Agitation in Alzheimer’s dementia (AAD) is prevalent, distressing, and burdensome. Medications for agitation are commonly prescribed off-label, although use is hindered by safety and tolerability concerns. This pooled analysis evaluates the safety and tolerability of brexpiprazole in patients with AAD.

Data were pooled from three Phase 3, 12-week, placebo-controlled trials (NCT01862640, NCT01922258, NCT03548584) (overall, and by brexpiprazole dose). The primary objective of each trial was to assess the efficacy of brexpiprazole on agitation. Safety was a secondary objective.

658 patients were randomized to brexpiprazole (0.5–3 mg/day, depending on the trial; n=655 treated), and 389 patients were randomized to placebo (n=388 treated). Mean baseline age was 73.5–74.2 years, and mean time since diagnosis of Alzheimer’s disease was 28.2–35.6 months. The pooled incidence of treatment-emergent adverse events (TEAEs) was 51.1% with brexpiprazole, with no notable differences between doses, and 45.9% with placebo. The incidence of serious TEAEs was 6.4% (brexpiprazole) versus 4.1% (placebo), and the incidence of TEAEs leading to discontinuation was 6.3% versus 3.4%, respectively. TEAEs that occurred in ≥2% of patients receiving brexpiprazole and more than in placebo-treated patients were insomnia (3.7% versus 2.8%), somnolence (3.4% versus 1.8%), nasopharyngitis (2.7% versus 2.6%), and urinary tract infection (2.6% versus 1.5%). Other TEAEs of interest included falls (1.7% versus 2.6%) and sedation (0.3% versus 0.0%). TEAE categories of interest included extrapyramidal symptom (EPS)-related TEAEs (5.3% versus 3.1%), cardiovascular TEAEs (3.7% versus 2.3%), and cerebrovascular TEAEs (0.5% versus 0.3%). The mean change from baseline to last visit in Mini–Mental State Examination score was 0.21 (brexpiprazole) and 0.14 (placebo). Six patients receiving brexpiprazole (0.9%) and one patient receiving placebo (0.3%) died; none of the deaths was considered related to brexpiprazole.

Based on pooled data, brexpiprazole was well tolerated in patients with AAD, and had a clinical safety profile consistent with that of brexpiprazole in other indications. Patients receiving brexpiprazole had a similar incidence of sedation, EPS events, falls, cardiovascular events, and cerebrovascular events compared with placebo, and no worsening of cognition. The incidence of death was low, and no deaths were considered related to study treatment.

Agitation and aggression (AA) occur frequently in patients with dementia (PwD), are challenging to manage, and are distressing for PwD, families, caregivers, and healthcare systems. Physiological parameters, such as Actigraphy, Heart Rate Variability, and Electrodermal Activity, measured via wearable sensors are correlated with AA in PwD. It is unclear whether these parameters could be compiled into an operational algorithm to create a pre-agitation biometric marker (i.e. parameters of Autonomous Nervous System’s arousal: elevated EDA, more frequent HR, lower heart rate variability (HRV), as well as higher motor activity) capable of predicting episodes of AA. This study will assess the feasibility and clinical utility of collecting physiological parameters via wearable multi-sensor Empatica E4 device in relation to clinically recorded episodes of AA in PwD.

This study is leveraging a clinical trial (ClinicalTrials.gov/NCT04516057) taking place at Ontario Shores Centre for Mental Health Sciences. Participants are inpatients, males and females, 55-years old or older, with clinically significant AA, and a diagnosis of a Major Neurocognitive Disorder due to Alzheimer’s disease or multiple aetiologies. Participants wear the E4 device for 48 to 72 hours on three occasions during the 8-week study period. Participant demographics, and clinical measures used to assess behavior are collected at specific time intervals during the study period.

The study is ongoing and currently to-date we have been able to acquire approximately 240 hours of recordings from patients. We will be presenting feasibility data (proportion of participants successfully completing a minimum 48-hours of recordings), correlation analysis between physiological measures and clinical measures to identify pre-agitation triggers. Further, we will use generalized linear models to test whether physiological measures can predict pre-agitation triggers. This study will allow estimation of sample size needed to detect a meaningful effect size, which will be determined from the prediction model. Deep learning using Python will be used to create a predictive algorithm using the physiological data to profile participants’ behaviors and detect pre-agitation triggers.

Early detection of AA in PwD will allow caregivers to offer timely, ndividualized, non-medical or medical interventions which will help avoid crises and critical incidents and improve quality of life of the PwD and their caregivers.

-Patients with a memory deficit, as well as patients with small deficits in various cognitive areas, with the requirement that there is no functional impairment in their domestic or work life, do not meet the criteria to be diagnosed with dementia, but they do meet the criteria for a diagnosis of mild cognitive impairment (MCI), which constitutes a transitional state between normal aging and mild dementia.

-Every year, 15% of patients with MCI with involvement only in the memory section, go on to be diagnosed with dementia.

In recent years, the use of a food for special medical purposes (FSMP), Souvenaid®, has been introduced into clinical practice, which, due to the composition of its active ingredient, Fortasyn connect (omega-3 fatty acids, uridine, choline, vitamins C, E, B6 and B12, selenium and folic acid) helps to:

• • Promote the development of neuronal synapses, demonstrating that it maintains the integrity of white and gray matter.

• • Reduce loss of functional connectivity.

• • Increase hippocampal cholinergic synapses and cholinergic neurotransmission.

• • Improve cognitive performance dependent on the hippocampus

A survey has been developed to explore the impact of a nutritional intervention, through the use of an FSMP in the areas related to cognition, functionality, and behavior, in a geriatric cohort with MCI older than 80 years. (Connect - Survey in the environment of mild cognitive impairment).

Survey: Each Geriatrics and Neurology professional had to select 5 cases that met the following characteristics: Presence of MCI, Age ≥ 80 years, and Receiving Souvenaid.

The professional sent CRO Alpha Bioresearch the list of caregivers with their contact details. The CRO contacted the subjects by telephone 3, 6, and 12 months after starting Souvenaid to carry out the survey.

The survey collects the perception of the patient and caregiver's cognition, functionality, and behavior, through a Likert scale with 5 possible response alternatives. The questionnaire is divided into two different parts:

1. – Data about the treatment (questions 1 to 5)

2. – Questions about the patient's health (questions 1 to 12);

The last one is divided into three parts: data on cognition 3 questions (questions 1 to 3), data on functional abilities with 5 questions (questions 4 to 8), and data on behavior 4 questions (questions 9 to 12).

Regarding the treatment at 12 months, there is a tolerance that reaches 76%, and 88% do not present problems with the administration of what is prescribed. The most common time of day for administration is breakfast and snacks. The most used flavor was vanilla and cappuccino. The most common way to acquire it was the direct route.

Regarding cognitive functions, the ability to remember is improved by 20%, orientation by 12%, and recognition by 8%, maintaining stability without changes by around 60-70%. Functional capacities improved between 8 and 16%, presenting no changes between 68-80%. Regarding the behavior, the improvement is between 12 to 28% in the evaluated items, presenting no changes between 60-84%.

There is stabilization at 3, 6, and 12 months both in cognition, functionality, and behavior. The positive impression of the perceived improvement in memory (around 20%) and apathy (exceeding 20% and reaching 28% per year) are striking.

The most recent treatment guidelines on delayed sleep phase disorder recommend the use of melatonin. However, these guidelines are in need of an update. Numerous systematic reviews and meta-analyses have since been conducted. This research aims to summarize all systematic reviews and meta-analyses investigating the efficacy of melatonin in delayed sleep phase disorder.

We performed a literature search using Pubmed, Embase, Cochrane Database of Systematic Reviews and Google. Characteristics and findings of all eligible systematic reviews and meta-analyses were summarised.

Five reviews, which included trials up to 2014, were obtained. The timing of melatonin administration and outcomes of interest varied considerably amongst the trials. All of the reviews found improvement in sleep-onset latency, while two reviews noted advancement in melatonin onset time.

There is a need for more updated evidence exploring the use of melatonin in delayed sleep phase disorder. Future studies should also specify if they are evaluating the hypnotic and/or chronobiotic effects of melatonin and consider these in their design.

Primary care clinics (PCCs) in Japan have acquired the capacity for screening and diagnosing dementia in its early stage. They face challenges in accommodating the complex care needs of people with early-stage dementia in collaboration with other healthcare providers in the community. The study aims were; 1) to classify team-based care models of PCCs for post-diagnostic care for people with early-stage dementia in Japan’s Community-based Integrative Care System and 2) to compare the scope of care in each model.

We conducted a cross-sectional postal survey to certified Dementia Support Doctors working in PCCs in Tokyo. To classify team-based care models, the questionnaire asked about the members, roles, and collaboration of the community-wide care team for early-stage dementia in which participants’ PCCs were involved. We gathered information on care provision across seven domains that PCCs offered for people with early-stage dementia. Three-step latent class analysis was performed to classify models and analyze differences in the proportions of care provision in each domain. The Tokyo Metropolitan Institute for Geriatrics and Gerontology institutional review board approved the study.

From the 188 responses, PCCs’ team practices were categorized into three classes, which we named “co-managed,” carved-out,” and “stand-alone” models. While the first two ran an extended care team through in-person communication across facilities in the community, the last applied a minimal team approach with limited and indirect external interaction. The “co-managed” and “carved-out” models were distinguished by how team members shared decision-making responsibilities for patient care. Maximum likelihood estimation grouped 46.6%, 32.8%, and 20.6% of the PCCs into each model in the above order. The three models significantly differed in the proportions of care provision in five of seven domains. The proportions in each domain were the highest for the “co-managed” model (60.7-100%), followed by the “carved-out” (46.2- 98.2%) and “stand-alone” (25.7-88.6%) models.

PCCs in Japan’s Community-based Integrative Care System formed three models of post- diagnostic support for people with early-stage dementia. Considering the application of the team approach and the breadth of care provision, either “co-managed” or “carved-out” models are recommended with available community resources in mind.

To describe the experience, challenges and solutions in implementing an outreach initiative to promote healthy ageing

Prevalence of mental health conditions in older adults is increasing rapidly in developing countries like India due to population ageing. UN Decade of Healthy Ageing (2021-2030) has been launched with focus on combatting ageism, promoting age friendly environment, integrated care and providing access to good quality long term care. Implementing interventions to promote healthy ageing in the Indian context has significant challenges in the background of limited availability dedicated elderly friendly health and social care systems.

Description of the outreach initiatives launched by the Geriatric Psychiatry Unit, Department of Psychiatry, National Institute of Mental Health and Neurosciences a tertiary care academic unit for old age psychiatry in India.

A systematic and comprehensive outreach initiative for healthy ageing has been implemented over 2 years. The main objectives for the initiative includes promoting awareness about ageing and mental health, promoting age friendly environment, training of caregivers, volunteers and other stakeholders, psychosocial intervention in old age homes, promoting integrative medicine for healthy ageing and providing geriatric tele-psychiatry services. The important strengths of this initiative has been collaboration with non-governmental organizations, promoting active participation from older adults and volunteers, mobilizing resources through corporate social responsibility funding and effective use of technology.

The experience of implementing this outreach initiative has contributed to important learnings for the team. The proposed solutions to address the challenges in sustaining this initiative and scaling up to reach a larger population will be discussed.

The present study aimed to compare the social function between mild cognitive impairment (MCI), mild Alzheimer’s disease (AD) dementia, and mild dementia with Lewy bodies (DLB) using the Japanese version of Social Functioning in Dementia scale (SF-DEM-J).

We interviewed 103 patients and family caregivers from June 2020 to March 2021: 54 patients with MCI, 34 with mild AD dementia, and 15 with mild DLB. We compared the caregiver-rated SF-DEM-J, Clinical Dementia Rating (CDR), MMSE, age, length of education, Geriatric Depression Scale (GDS), the University of California, Los Angeles Loneliness Scale (UCLA-LS), Neuropsychiatric Inventory (NPI), and informant version of the Apathy Evaluation Scale (AES) between MCI, mild AD dementia, and mild DLB groups using Kruskal-Wallis test with Dunn-Bonferroni correction for post-hoc analyses. We compared sex, living situation, and caregiver demographics between three groups using chi-square test. We performed correlation analysis between the score of each psychological test and the scores of SF-DEM-J within group using Spearman’s rank correlation coefficient.

For SF-DEM-J, the score of section 2 (communicating with others) was significantly worse in mild AD dementia than in mild DLB. The scores of section 1 (spending with others) and section 3 (sensitivity to others) and the total score did not significantly differ between three groups. The score of section 1 was significantly associated with MMSE in MCI, with anxiety and disinhibition of NPI, and AES in mild AD dementia, and with GDS in mild DLB. The score of section 2 was significantly associated with AES in MCI and mild AD dementia, with UCLA-LS in MCI, and with the length of education in mild DLB. The score of section 3 was significantly associated with agitation and irritability of NPI in MCI and mild AD dementia. The total score was associated with UCLA-LS and AES in MCI, and with AES in mild AD dementia.

Factors affecting social functioning differed between MCI, mild AD dementia, and mild DLB. Apathy, agitation and irritability affected social functioning in MCI and mild AD dementia while depressive mood affected social functioning in mild DLB.

The 8-item Informant Interview to Differentiate Aging and Dementia (AD8) was developed as a screening tool for dementia with a cutoff of 2 suggested by the initial study. However, various studies found different cutoff values, and many suggested a cutoff of 2 might result in a high false positive rate. A higher false positive rate in Taiwan was repeatedly shown when AD8 was self-administered in local government screening programs. We have developed a modified version of AD8 (m-AD8) with the purpose of enhancing its specificity. This study aimed to compare the performance of AD8 and m-AD8.

The m-AD8 consists of all items adapted from the original AD8. Modifications included: (1) limiting the evaluated period to the past year instead of the past several years, (2) reselecting examples to reflect the socio-cultural context in Taiwan, and (3) rearranging the order of questions according to their complexity. We recruited 118 participant-informant dyads from a university teaching hospital. For each informant, the AD8 was administered first and then the Clinical Dementia Rating (CDR) to minimize contamination effect. The m-AD8 was administered 7 days later. Two geriatric psychiatrists made the final consensus DSM-5 diagnosis for each subject after considering all clinical information, including history, Mini-Mental State Examination (MMSE), CDR, and, if available, other past neuropsychological tests and neuroimaging.

There were 59 subjects with normal cognition, 28 with mild neurocognitive disorder, and 31 with dementia (major neurocognitive disorder). When comparing dementia vs. non-dementia, the optimal cutoff value was 4 for both versions according to the Youden index. The AUC, sensitivity, and specificity were 0.893, 0.774, 0.862 for AD8, and 0.883, 0.741, 0.954 for m-AD8, respectively. The m-AD8 showed improved specificity, which was also true when the cutoff value was set as 2 or 3.

The optimal cutoff value for both versions was 4. The modification may change the performance of AD8 with improved specificity. These findings suggest that, depending on different situations, AD8 with a cutoff value higher than 2 may perform better in dementia screening.

Dementia is often associated with Neuropsychiatric Symptoms (NPS) such as agitation, hallucinations, anxiety, that can cause distress for the resident with dementia in long-term care settings and can impose emotional burden on the environment. NPS are often treated with psychotropic drugs, which, however, frequently cause side effects. Alternatively, non-pharmacological interventions can improve well-being and maintain an optimal quality of life (QoL) of those living with dementia. Music therapy is a non-pharmacological intervention that can reduce NPS and improve well-being of persons with dementia.

The main aim of this study is to assess the effects of individual music therapy on well-being controlled for providing individual attention in nursing home residents with dementia and NPS.

The research is conducted at eight facilities of one nursing home organization in the Netherlands. The participants in the intervention group receive 30 minutes of individual music therapy (MT) in their own room by a music therapist twice a week for 12 weeks. The participants in the control group receive 30 minutes of individual attention in their own room by a volunteer twice a week for 12 weeks. Assessments will be done at baseline, 6 weeks and 12 weeks. An independent observer, blinded for the intervention or control condition, assesses directly observed well-being (primary outcome) and pain before and after the sessions. Nurses assess other secondary outcomes unblinded, i.e., perceived quality of life and NPS assessed with validated scales. The sleepy duration is will be assessed by a wrist device called MotionWatch. Information about psychotropic drug use is derived from electronic medical chart review.

We will present baseline data and preliminary results.

The outcomes refer to both short-term and long-term effects consistent with therapeutic goals of care for a longer term. We hope to overcome limitations of previous study designs such as non- blinded designs and pragmatic designs in which music facilitators that were not only music therapists but occupational therapists and nurses. This study should lead to more focused recommendations for practice and further research into non-pharmacological interventions in dementia.

The trial is registered at the International Clinical Trials Registry Platform (ICTRP) search portal in the Netherlands Trial Registration number NL7708, registration date 04-05-2019.

Many previous studies have shown that the APOE e4 genotype affects cognition, brain volume, glucose metabolism and amyloid deposition. However, these studies were conducted separately, and few studies simultaneously investigated the effects of the APOE e4 genotype on cognition, brain volume, glucose metabolism and amyloid deposition in Alzheimer disease (AD). The purpose of this study is to simultaneously investigate the association of the APOE e4 genotype with cognition, brain volume, glucose metabolism and amyloid deposition in patients with AD.

This is a cross-sectional study of 69 subjects with Alzheimer’s disease (AD). All subjects were divided into carriers and noncarriers of the ε4 allele. Forty APOE ε4 carriers and 29 APOE ε4 non-carriers underwent neuropsychological, structural magnetic resonance imaging, 18F-fluorodeoxyglucose positron emission tomography scans (18F-FDG-PET) and 18F-Florbetaben amyloid positron emission tomography scans (amyloid PET). Analysis of covariance (ANCOVA) was conducted to compare the differences on cognition, brain volume, glucose metabolism and amyloid deposition between APOE ε4 carriers and non-carriers after controlling demographics.

APOE ε4 carriers had 50% lower scores of SVLT_delayed recall compared to non-carriers (0.88 ± 1.65 vs 1.76 ± 1.75). However, APOE ε4 carriers performed better on other cognitive tests than non- carriers (K-BNT (11.04 ± 2.55 vs 9.66 ± 2.82), RCFT (25.73 ± 8.56 vs 20.15 ± 10.82), and Stroop test_color response (48.28 ± 26.33 vs 31.56 ± 27.03)). APOE ε4 carriers had slightly smaller hippocampal volume than non-carriers (3.09 ± 0.38 vs 3.32 ± 0.38), but greater total brain cortical thickness (1.45 ± 1.55 vs 1.37 ± 1.24).

We found that APOE e4 genotype is associated with cognition, brain volume in AD, suggesting that APOE e4 genotype can play a very important role in the underlying pathogenesis of AD.

This systematic review and meta-analysis aimed to (1) assess the effectiveness of psychological therapies for depression in older people living in long-term care (LTC) settings, and (2) investigate differences in effectiveness between types of psychological treatments.

We included randomised controlled trials (RCTs) with participants aged 65 years and older. Participants were required to present with (a) major depressive disorder (MDD) or (b) symptoms of depression based on a score over a cut-point on a validated depression measure. The study setting was LTC facilities, including nursing homes, assisted-living facilities, and residential aged care facilities, where some level of day-to-day care was provided by staff employed in the facility. Treatments were grouped and classified as cognitive-behavioural therapy, behaviour therapy, or reminiscence therapy.

The literature review identified 19 studies for the qualitative synthesis: 18 were included in a meta-analysis. Results indicated a benefit for psychological treatments on depressive symptoms at end-of-intervention (standardized mean difference (SMD) -1.04, 95% CI -1.49 to -0.58; 18 trials, 644 participants), and at a medium-term follow-up (SMD -0.43, 95% CI -0.81 to -0.06; 8 RCTs, 355 participants), but not in the longer-term (SMD -0.16, 95% CI -0.58 to 0.27; 2 RCTs, 92 participants). There was no difference in outcomes between therapy types.

This systematic review demonstrated positive impacts of psychological therapies on symptoms of depression in older people living in LTC, both immediately after therapy and in the medium term, but longer-term impacts were not demonstrated.

Aphasia is a communication disorder associated with impairments in spoken language, understanding, reading and writing that impacts upon daily activities, participation in society and the quality of life (QoL), and it is common in elderly patients in the context of vascular diseases. We aimed to investigate participation in society and the environmental factors and health-related QoL of elderly people with aphasia.

People with aphasia whose age was above 65 were included in this study. QoL was assessed by the Japanese version of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) and Life stage Aphasia Quality Of Life scale-11 (LAQOL-11), and the participation in society and the environmental factors as barriers was assessed by the Japanese version of the Community Integration Questionnaire (CIQ) and the Japanese version 2 of the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. We explored predictors such as aphasia severity, communication impairment, cognitive functions, motor paralysis, activities of daily living (ADL).

We included 58 individuals (43 men; mean age 73.2 [SD 5.7] years) with aphasia after the mean 48 (SD 64.9) months of onset (of stroke, cerebral hemorrhage, subarachnoid hemorrhage, brain tumor, traumatic brain injury). The median of the total score of SAQOL-39 and LAQOL-11 was 3.91 (Quartile Deviation 0.47) out of 5 and 85.0 (QD 12.5) out of 110. The QoL was not associated with aphasia severity assessed by the Standard Language Test of Aphasia (SLTA) which is the most frequently used comprehensive aphasia rating scale in Japan, but poor QoL was significantly associated (Spearman correlations) with increased severity of communication impairment assessed by Communication ADL Test (P = 0.01). Moreover, increased QoL was significantly associated with increased participation in society (P = 0.03) and decreased environmental factors (P = 0.01).

Poor communication ADL may have a negative effect on QoL in elderly people with aphasia. Also, we show that QoL is associated with participation in society. For patients with aphasia after retirement, specific rehabilitation of communication ADL might be beneficial and should be explored in future studies.

Diabetes mellitus (DM) is known to be one of the risk factors for cognitive decline and dementia. Neuropsychiatric symptom (NPS) is present not only in dementia, but also mild cognitive impairment (MCI). In this study, we examined NPS of MCI with DM and compared MCI with DM and our MCI database to investigate the characteristics of MCI with DM.

The participants were subjects who were diagnosed as MCI from type 2 DM participants enrolled in Osaka University Hospital. To estimate NPS, we used Neuropsychiatric Inventory (NPI) score.

The number of MCI subjects with DM who were estimated NPS was 19. According to the NPI score, apathy is the most severe symptom in MCI (average score = 2.5±3.3). This result was the same as the score of our database. In the frequency of NPS, there was no difference between the results in NPI of MCI with DM and MCI of our data (n = 225) except for sleep disturbance and appetite/eating disturbance (chi-squared test, P < 0.05). The sleep disturbance was more frequent in MCI with DM than in MCI of our database. On the other hand, the appetite/eating disturbance was less frequent in in MCI with DM than in MCI of our database. Moreover, the appetite/eating disturbance was not observed in MCI with DM.

NPS of MCI with DM is almost the same as MCI of our database except for sleep disturbance and appetite/eating disturbance. This result might be influenced by the disorder of lifestyle habits that is often observed in patients with DM or cognitive impairment of DM.

The limitation of our study is the small number of cases, further investigation is needed.

To explore commonalities and differences in the sociodemographic, health, and neuropsychological characteristics of participants with SCD recruited in two culturally differentiated cohort studies, namely CIMA-Q (Canada; Bellevile et al., 2019) and CompAS (Spain; Juncos et al., 2012).

Older adults with subjective cognitive complaints of the CompAS (N=251; 68.92% women; Control: 30.3%; SCD: 25.9%; MCI: 28.7%) and the CIMA-Q (N=179; 71.5% women; Control:16.1%; SCD: 36.8%; MCI:28.6%) were recruited, respectively, from primary care centers and memory clinics, excluding patients with dementia and other neurological or psychiatric disturbances. Cognitive complaints were assessed considering coincident items of the QAM and MFE questionnaires. Cut-off points for the 5%ile were calculated independently in both samples and according to this, participants were classified as SCD or controls (CompAS: N= 141; CIMA-Q: N=161) considering complaints relevance at baseline (Pereiro et al., 2021). Participants underwent neuropsychological assessment. Participants diagnosed as Mild Cognitive Impairment (MCI) were excluded from the analysis. Between cohort-studies and inter-group (control, SCD) differences were tested in the sociodemographic, health and neuropsychological measures considered. The Holm-Bonferroni correction was applied to reduce the probability of type I error (p<.003).

Identical cut-off points for 5%ile were obtained in both samples though SCD prevalence was slightly higher in CIMA-Q. For both samples, equivalence between Control and SCD participants in sociodemographic, health, functionality, and neuropsychological measures was observed. Only complaints and depressive symptomatology was significantly higher in SCD participants than in controls in both CompAS and CIMA-Q studies.

Participants of the CIMA-Q, Controls and SCD, showed significantly higher age, cognitive reserve proxies, comorbidity, and better attentional performance than the CompAS participants (see Table 1). CompAS participants, Controls and SCD, showed more neuropsychiatric symptomatology than CIMA-Q participants (see Table 1).

Control and SCD participants showed equivalence on sociodemographic, health, functional, and neuropsychological measures in both studies. However, significant between-sample differences in the two groups, particularly in SCD participants, were observed in sociodemographic, health, cognitive reserve, behavioral and attentional measures. Identification of these factors are critical to analyze the transcultural validity of cognitive complaints in predicting progression to AD.

Table 1

Between group (control, SCD) and Between study (CIMA-Q, CompAS) differences in sociodemographic, health, and cognitive measures

Pleasant, meaningful, recreational or other activities are often used in depression treatment in nursing home (NH) residents. Residents may also undertake such activities alongside or without a treatment (informal activities). It is not clear if such informal activities can partially explain treatment effects. Our aim was to explore associations of depressive symptoms and resilience with informal activities in residents.

We calculated product scores of frequency and pleasantness for activities from 18 activity clusters in NH residents (AIM, Activities to Improve Mood inventory, Knippenberg et al., in prep). The Geriatric Depression Scale, 8 items (GDS-8, Jongenelis et al., 2007) and the Brief Resilience Scale (BRSnl, Dutch translation, Leontjevas et al., 2014) were administered when interviewing residents. Professional caregivers filled out the Nijmegen Observer Rated Depression scale (NORD, Leontjevas et al., 2011). Spearman’s rho’s of 0.20 to 0.39 and of 0.40 to 0.60 were regarded as weak and moderate, respectively.

277 Dutch speaking NH residents (male, N=104, 38%), from Flanders Belgium (male, N=137, 49.5%) and the Netherlands participated in the study. We found positive weak associations between the self-reported and observer-rated depression scales (GDS-8 and NORD), and between the AIM total score and resilience (BRSnl). Negative weak associations were found for both depression scales and resilience, and for the depression scales and AIM. Individual AIM clusters showed positive weak to moderate associations between resilience and activities stimulating cognition (e.g. reading, puzzling), activities related to nature (e.g. walking in a park, activities with animals), or doing something meaningful for others (e.g. helping with daily routines or volunteering). Regarding depression, next to the three mentioned clusters, negative weak to moderate associations were also found for craft activities, social activities, and showing a positive mindset (e.g. humour, giving compliments).

The results underscore the value of activities that residents may undertake on their own alongside or without a treatment. More research is needed to understand whether informal activities alongside or without a treatment may explain intervention effects (e.g. placebo effects) on depression or resilience, and how these activities may be used to improve treatment protocols.