Previous studies have shown that socioeconomically deprived groups exhibit higher lesion load of the white matter (WM) in aging. The aim of this study was to (i) investigate to what extent education and income may contribute to differences in white matter hyperintensities (WMHs) and (ii) identify risk profiles related to a higher prevalence of age-associated WMH.

Population-based adult study of the Leipzig Research Centre for Civilization Diseases (LIFE) in Leipzig, Germany.

Dementia-free sample aged 40–80 years (n = 1,185) derived from the population registry.

Information was obtained in standardized interviews. WMH (including the derived Fazekas scores) were assessed using automated segmentation of high-resolution T1-weighted anatomical and fluid-attenuated inversion recovery (FLAIR) MRI acquired at 3T.

Despite a significant association between income and WMH in univariate analyses, results from adjusted models (age, gender, arterial hypertension, heart disease, and APOE e4 allele) indicated no association between income and WMH. Education was associated with Fazekas scores, but not with WMH and not after Bonferroni correction. Prevalence of some health-related risk factors was significantly higher among low-income/education groups. After combining risk factors in a factor analysis, results from adjusted models indicated significant associations between higher distress and more WMH as well as between obesity and more deep WMH.

Previously observed differences in WMH between socioeconomically deprived groups might stem from differences in health-related risk factors. These risk factors should be targeted in prevention programs tailored to socioeconomically deprived individuals.

Cognitive decline is common in the old age, but some evidence suggests it may already occur during adulthood. Previous studies have linked age, gender, educational attainment, depression, physical activity, and social engagement to better cognitive performance over time. However, most studies have used global measures of cognition, which could mask subtle changes in specific cognitive domains. The aim of this study is to examine trajectories of recent and delayed memory recall from a variable-centered perspective, in order to elucidate the impact of age, gender, educational attainment, depression, physical activity, and social engagement on recent and delayed memory both at initial time and across a 10-year period.

The sample was formed by 56,616 adults and older adults that participated in waves 4 to 8 of the Survey of Health, Aging and Retirement in Europe (SHARE).

We used latent growth modeling to establish latent recent and delayed memory trajectories, and then tested the effects of the aforementioned covariates on the latent intercept and slopes.

Results showed that both recent and delayed recall display a quadratic trajectory of decline. All covariates significantly explained initial levels of immediate and delayed recall, but only a few had statistically significant effects on the slope terms.

We discuss differences between present results and those previously reported in studies using a person-centered approach. This study provides evidence of memory decline during adulthood and old adulthood. Further, results provide support for the neural compensation reserve theory.

Carer burden is common in younger-onset dementia (YOD), often due to the difficulty of navigating services often designed for older people with dementia. Compared to Alzheimer’s disease (AD), the burden is reported to be higher in behavioral variant frontotemporal dementia (bvFTD). However, there is little literature comparing carer burden specifically in YOD. This study hypothesized that carer burden in bvFTD would be higher than in AD.

Retrospective cross-sectional study.

Tertiary neuropsychiatry service in Victoria, Australia.

Patient-carer dyads with YOD.

We collected patient data, including behaviors using the Cambridge Behavioral Inventory-Revised (CBI-R). Carer burden was rated using the Zarit Burden Inventory-short version (ZBI-12). Descriptive statistics and Mann-Whitney U tests were used to analyze the data.

Carers reported high burden (ZBI-12 mean score = 17.2, SD = 10.5), with no significant difference in burden between younger-onset AD and bvFTD. CBI-R stereotypic and motor behaviors, CBI-R everyday skills, and total NUCOG scores differed between the two groups. There was no significant difference in the rest of the CBI-R subcategories, including the behavior-related domains.

Carers of YOD face high burden and are managing significant challenging behaviors. We found no difference in carer burden between younger-onset AD and bvFTD. This could be due to similarities in the two subtypes in terms of abnormal behavior, motivation, and self-care as measured on CBI-R, contrary to previous literature. Clinicians should screen for carer burden and associated factors including behavioral symptoms in YOD syndromes, as they may contribute to carer burden regardless of the type.

Increasingly diverse caregiver populations have prompted studies examining culture and caregiver outcomes. Still, little is known about the influence of sociocultural factors and how they interact with caregiving context variables to influence psychological health. We explored the role of caregiving and acculturation factors on psychological distress among a diverse sample of adults.

Secondary data analysis of the California Health Interview Survey (CHIS).

The 2009 CHIS surveyed 47,613 adults representative of the population of California. This study included Latino and Asian American Pacific Islander (AAPI) caregivers and non-caregivers (n = 13,161).

Multivariate weighted regression analyses examined caregiver status and acculturation variables (generational status, language of interview, and English language proficiency) and their associations with psychological distress (Kessler-6 scale). Covariates included caregiving context (e.g., support and neighborhood factors) and demographic variables.

First generation caregivers had more distress than first-generation non-caregivers (β=0.92, 95% CI: (0.18, 1.65)); the difference in distress between caregivers and non-caregivers was smaller in the third than first generation (β=-1.21, 95% CI: (-2.24, -0.17)). Among those who did not interview in English (β=1.17, 95% CI: (0.13, 2.22)) and with low English proficiency (β=2.60, 95% CI: (1.21, 3.98)), caregivers reported more distress than non-caregivers.

Non-caregivers exhibited the "healthy immigrant effect," where less acculturated individuals reported less distress. In contrast, caregivers who were less acculturated reported more distress.

To examine the relationship between childhood traumatic experiences and early and late-onset suicidal behavior among depressed older adults.

Cross-sectional study.

Inpatient and outpatient psychiatric services in Pennsylvania.

Our sample included 224 adults aged 50+ (M ± SD = 62.5 ± 7.4) recruited into three depressed groups: (1) 84 suicide attempters, (2) 44 suicide ideators, and (3) 58 non-suicidal comparisons, and a non-psychiatric healthy comparison group (N = 38).

The Childhood Trauma Questionnaire measured experiences of childhood trauma such as emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse.

Attempters were separated into early- and late-onset based on age of first attempt using a statistical algorithm that identified a cutoff age of 30 years old. Overall, we found group differences in emotional and physical abuse and neglect in both genders and sexual abuse in females, but not in males. Early-onset attempters experienced more childhood emotional abuse and neglect than late-onset attempters and were more likely to have experienced multiple forms of abuse. They also experienced more emotional abuse and neglect than all comparison groups. Consistently, early-onset attempters more often met criteria for current or lifetime PTSD relative to late-onset attempters and most comparison groups. Late-onset attempters had similar levels of childhood trauma as other depressed groups.

Our study reaffirms that there are distinct pathways to suicidal behavior in older adults based on their age of first suicide attempt and that trauma experienced in childhood has long-lasting emotional and behavioral consequences, even into late life.

We aimed to investigate the association between very late-onset schizophrenia-like psychosis (VLOSLP), a schizophrenia spectrum disorder with an onset of ≥60 years, and Alzheimer’s disease (AD) using biomarkers.

Retrospective cross-sectional study.

Neuropsychology clinic of Osaka University Hospital in Japan.

Thirty-three participants were classified into three groups: eight AD biomarker-negative VLOSLP (VLOSLP−AD), nine AD biomarker-positive VLOSLP (VLOSLP+AD), and sixteen amnestic mild cognitive impairment due to AD without psychosis (aMCI−P+AD) participants.

Phosphorylated tau levels in the cerebrospinal fluid and 18F-Florbetapir positron emission tomography results were used as AD biomarkers. Several scales (e.g. the Mini-Mental State Examination (MMSE), Wechsler Memory Scale-Revised (WMS-R) Logical Memory (LM) I and II, and Neuropsychiatric Inventory (NPI)-plus) were conducted to assess clinical characteristics.

Those in both VLOSLP−AD and +AD groups scored higher than those in aMCI−P+AD in WMS-R LM I. On the other hand, VLOSLP+AD participants scored in between the other two groups in the WMS-R LM II, with only VLOSLP−AD participants scoring significantly higher than aMCI−P+AD participants. There were no significant differences in sex distribution and MMSE scores among the three groups or in the subtype of psychotic symptoms between VLOSLP−AD and +AD participants. Four VLOSLP−AD and five VLOSLP+AD participants harbored partition delusions. Delusion of theft was shown in two VLOSLP−AD patients and five VLOSLP+AD patients.

Some VLOSLP patients had AD pathology. Clinical characteristics were different between AD biomarker-positive and AD biomarker-negative VLOSLP, which may be helpful for detecting AD pathology in VLOSLP patients.

We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI).

Prospective cohort study with assessments every 2 years (for up to 6 years).

Community, Sydney, Australia.

Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments (n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) (n = 157), and those who were cognitively normal at baseline and all reassessments (n = 232).

Cognitive and physical function measured over 2–6 years follow-up. Falls in the year following participants’ final assessment.

In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample.

Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.

To reduce sleep problems in people living with dementia using a multi-component intervention.

Cluster-randomized controlled study with two parallel groups and a follow-up of 16 weeks.

Using external concealed randomization, 24 nursing homes (NH) were allocated either to the intervention group (IG, 12 clusters, 126 participants) or the control group (12 clusters, 116 participants).

Participants were eligible if they had dementia or severe cognitive impairment, at least two sleep problems, and residence of at least two weeks in a NH.

The 16-week intervention consists of six components: (1) assessment of sleep-promoting activities and environmental factors in NHs, (2) implementation of two “sleep nurses,” (3) basic education, (4) advanced education for staff, (5) workshops to develop sleep-promoting concepts, and (6) written information and education materials. The control group (CG) received standard care.

Primary outcome was ≥ two sleep problems after 16 weeks assessed with the Sleep Disorders Inventory (SDI).

Twenty-two clusters (IG = 10, CG = 12) with 191 participants completed the study. At baseline, 90% of people living with dementia in the IG and 93% in the CG had at least two sleep problems. After 16 weeks, rates were 59.3% (IG) vs 83.8% (CG), respectively, a difference of −24.5% (95% CI, −46.3% – −2.7%; cluster-adjusted odds ratio 0.281; 95% CI 0.087–0.909). Secondary outcomes showed a significant difference only for SDI scores after eight and 16 weeks.

The MoNoPol-Sleep intervention reduced sleep problems of people living with dementia in NH compared to standard care.

We aimed to explore the reciprocal effects of social participation, loneliness, and physical inactivity over a period of 6 years in a representative sample of European adults over 50 years old.

A longitudinal study with a six-year follow-up period was conducted.

Four waves of the Survey of Health, Ageing and Retirement in Europe project were used.

This study includes 64,887 participants from Europe and Israel, who were aged 50 or older at the first time.

The relationship between participation in social activities, loneliness and physical inactivity was analyzed, controlling for age, gender, and disability. A series of cross-lagged panel models (CLPMs) were applied to analyze the relationships among these variables.

A CLPM with equal autoregressive cross-lagged effects across waves was the best fit to the data (χ2 = 7137.8, CFI = .972, RMSEA = .049, SRMR = .036). The autoregressive effects for the three variables showed high stability across waves, and all the cross-lagged effects in the model were statistically significant. Social activity and physical inactivity maintained a strong negative cross-lagged effect, while their cross-lagged effects on loneliness were comparatively smaller. Social activity had a positive cross-lagged effect on loneliness, while physical inactivity had a negative cross-lagged effect on loneliness.

These findings highlight the importance of promoting physical activity and social participation and addressing loneliness through targeted interventions in older adults.

Eating problems frequently occur in people with dementia with Lewy bodies (DLB), but few studies have investigated the clinical background of this phenomenon. This study examined the relationship between eating problems and various symptoms of DLB and the relation between the treatment needs for DLB people with eating problems and the understanding of their eating problems by caregivers and physicians.

This was a subanalysis of a cross-sectional, questionnaire-based survey study. Two hundred sixty-one subjects with DLB were divided into subjects with or without eating problems. Logistic or linear regression analysis was used to investigate the factors influencing eating problems. The treatment needs of DLB people for their eating problems and the understanding of these needs by caregivers and physicians were calculated as participant–caregiver and participant–physician kappa coefficient.

Of the 261 participants, 27% suffered from eating problems. The presence of eating problems in participants with DLB was related to depression (p = 0.01, OR : 2.19, 95% CI: 1.23–3.91) and apathy (p = 0.01, OR 2.15, 95% CI: 1.20–3.87), while the worsening of eating problems was related to dysphagia (β = 0.24, p = 0.03), apathy (β = 0.23, p = 0.05), and nighttime behavior (β = 0.24, p = 0.04). The participant–physician kappa coefficient for physician understanding of constipation, weight loss, dysphagia, weight gain, and increase in appetite was significantly lower than the corresponding participant–caregiver kappa coefficient (p-value of five symptoms < 0.01).

Physicians need to pay more attention to eating problems and their neuropsychiatric background in the long-term support and management of DLB subjects.

To examine the role of subjective cognitive difficulties (SCD), posttraumatic stress disorder (PTSD), and their interaction in predicting suicidal ideation and current suicidal intent in middle-aged and older United States (US) military veterans.

Population-based cross-sectional study.

Data were analyzed from the 2019 to 2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 3602 US veterans aged 50 years and older (mean age = 69.0).

Questionnaires including the Medical Outcomes Study Cognitive Functioning Scale (SCD), PTSD Checklist for DSM-5 (PTSD), Patient Health Questionnaire-9 (suicidal ideation in the previous two weeks), and the Suicide Behaviors Questionnaire-Revised (current suicidal intent).

A total of 154 (4.4%) veterans screened positive for current PTSD, 239 (6.7%) reported past two-week suicidal ideation, and 37 (1.0%) reported current suicidal intent. The probability of suicidal ideation among veterans with both SCD and PTSD was more than six times higher than that observed in the full sample (44.5% vs. 6.7%) and more than 2.5 times higher than that observed in veterans with SCD and no PTSD (44.5% vs. 17.5%). Veterans with both subjective memory and concentration difficulties were more likely to report suicidal intent, though the interaction between SCD and PTSD was not significantly associated with suicidal intent.

Middle-aged and older U.S. veterans with subjective cognitive impairment and PTSD report higher rates of suicidal ideation than those with SCD alone. Interventions targeting SCD and PTSD may mitigate suicide risk among middle-aged and older veterans.

Approximately 40% of global dementia cases in high-income countries are attributed to potentially modifiable risk factors, whereas in Latin America, this figure rises to 56%. This difference underscores the importance of initiating preventive trials in the region. LatAm- FINGERS is the first non-pharmacological multicenter randomized clinical trial in Latin America, involving 12 countries: Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Ecuador, Mexico, Puerto Rico, the Dominican Republic, and Uruguay. The trial aims to prevent cognitive impairment through a multidomain lifestyle intervention. It evaluates the feasibility and efficacy of these interventions in enhancing cognitive function among 1,200 participants over two years. The lifestyle intervention, modeled after the Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), encompasses nutrition, physical exercise, cardiovascular risk factor management, cognitive training, and socialization. Harmonization processes have ensured consistency with FINGER and the U.S. Study to Protect Brain Health through Lifestyle Intervention to Reduce Risk (U.S. POINTER) across Latin America. Since recruitment commenced in December 2021, 1,867 participants have been screened, with 1,186 enrolled. The cohort is predominantly female (73.8%), with an average age of 67.41 years, representing diverse ethnic backgrounds. LatAm-FINGERS has established the largest dataset on dementia risk in the region, evolving into a comprehensive database for cognitive, imaging, biomarker, and genetic research. It aims to promote collaborative efforts in dementia prevention across Latin America.

In this session, we will provide an overview of the trial’s Objectives and outcomes, the basis for the multidomain interventions, and describe the recruitment and adherence strategies implemented. We will conclude with results regarding the association of cardiovascular risk factors with social determinants of health.

LatAm-FINGERS: Establishing Eligibility and Outcomes for Effective Research Across Latin America

Objectives: LatAm-FINGERS is the first non-pharmacological, multicenter randomized clinical trial in Latin America, involving 12 countries and aiming to prevent cognitive impairment. The trial’s primary Objectives is to assess the feasibility and efficacy of a multidomain lifestyle intervention in improving cognitive function among 1,200 participants over two years. Additionally, this study aims to evaluate the validity properties of cognitive outcomes within the LatAm-FINGERS cohort.

Methods: To ensure consistency, the study employed harmonization processes with the original FINGER trial and the U.S. POINTER trial as part of the Worldwide FINGERS initiative. Eligibility criteria were standardized using normative z-scores. The Latin American Neuropsychological Battery (LatAm-NTB) was developed, including tests such as the Free and Cued Selective Reminding Test, Logical Memory, Digit Span, Stroop Test, Concept Shifting Test, Trail Making Test, Symbol Digit Modalities Test, and semantic and phonological fluency. A multivariate regression model was used to evaluate the validity of the LatAm-NTB.

Results: Since recruitment began in December 2021, 1,186 participants have been enrolled. The mean age is 67.41 years (SD = 4.65), with an average educational level of 12.9 years (SD = 3.7) and an average Mini-Mental State Examination (MMSE) score of 27.2 (SD = 2.17). Women comprise 73.8% of the cohort. A multivariate regression model, which included sociodemographic variables, non-modifiable risk factors, and cardiovascular risk, was constructed to explain cognitive performance. This model demonstrated better fit parameters (BIC: 734.649, AIC: 793.661) compared to the reduced model (BIC: 1041.591, AIC: 1051.426). Higher education (β = 0.04, SE = 0.003, p < .001), younger age (β = –0.01, SE = 0.002, p < .001), and a lower Framingham Risk Score (β = –0.01, SE = 0.003, p < .001) were associated with better cognitive performance. Being male was not significantly associated with cognitive outcomes (β = –0.01, SE = 0.02, p = 0.57).

Conclusions: Eligibility criteria were adequate to select the targeted population. The results suggest that the LatAm-NTB has promising validity indicators for assessing cognition in a follow- up clinical trial in Latin America.

Design and Harmonization of Interventions, barriers, and challenges

Background: The Objectives of this analysis is to show how an intervention in Latin American lifestyles to prevent cognitive deterioration was initiated, its design, and what harmonization strategies were used, taking into account the multiculturalism of this population, constituted by 12 countries throughout the continent. It is the first randomized, multicenter, non- pharmacological clinical trial conducted on this continent.

Methods: The design of the Interventions includes (1) physical activity, (2) nutrition, (3) cognitive stimulation, (4) control of cardiovascular factors, and (5) socialization. The feasibility of the intervention in Latin America and its effectiveness, especially in the cognitive variables, were considered. An external harmonization of them was carried out with those used in the Fingers study (Finland), and Pointers (USA). In turn, an internal harmonization between the 12 participating countries was made to ensure viability. The work was carried out in groups in each of the domains, composed of representatives from each of the 12 countries and members of the Scientific Committee, and was approved by the Steering Committee. The barriers and challenges are evaluated, affording different cultures and diverse eating habits. A barrier was the intensity of the physical intervention (that became a real challenge) and the different eating habits. In the last case, the LatAm-Mind diet was created after a multicultural work without moving away from the Mind and Mediterranean. In the accessibility to the technological devices to use the Brain H Q, which was the cognitive stimulation platform used, there were countries where access to a computer device or the Internet was normalized. In some countries, the exercises had to be applied in paper and pencil format. A high rate of metabolic syndrome was found (39%).

Conclusions: The study is feasible, comparable and agreed upon in the 12 countries, considering their ethnic diversity (56% are mestizo), geographical differences, eating habits, access to the internet, and digital technology. LatAm-FINGERS met the challenge to combine the diversity of the region into a multi-domain risk reduction intervention feasible across Latin America while retaining the original design of FINGERS.

Recruitment Strategies in the LatAm FINGERS Trial: a multicultural effort to prevent dementia across Latin America.

Background: LatAm-Fingers is the first non-pharmacological multicenter randomized clinical trial to prevent cognitive impairment in Latin America (LA). The trial congregates the efforts of 12 Countries, including Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Peru, Puerto Rico, and Uruguay. The main aim is to investigate the feasibility of a 24- month multi-domain lifestyle intervention and its efficacy on the cognition of 1200 participants.

Methods: Recruitment strategies differed across countries and regions because they were adapted to the idiosyncrasies of the local populations. Recruitment from medical center databases was found insufficient to provide a diverse cohort. Alternative strategies included social media posts with infographics and videos. A novel and successful strategy was in-person talks for older adults in local city halls and local nongovernmental organizations. The use of positive colloquial language was found to be much more effective in reaching underserved populations than scientific language (e.g., focusing on brain health vs. clinical trials). A significant recruitment source in Peru, Bolivia, and Ecuador low-income regions was the promotion within non-Catholic religious organizations. Appealing to the religious leaders’ endorsement was crucial for generating trust and

interest in different communities. In Mexico, one successful recruitment strategy involved performing physical exercises in local parks in low- income neighborhoods to demonstrate the intervention in-vivo, which attracted interested people from the area. Overall, in-person contact with participants and time dedicated to explaining the trial’s rationale in lay language was the most important strategy.

Results: We enrolled 1,186 participants in the study. The mean (SD) age is 67.41 (4.9) years, 73.8 % are female, 43.7% of participants have more than 16 years of schooling, and the MMSE score is 27.2 (2.2). To date, 51% of the population self-reports as mestizo (mixed race), and 31% as Caucasian. Other ethnicities represented include Native American (1.5%), Mulato (4%), Black (2%), and other (6%).

Conclusions: The LatAm-FINGERS trial recruited participants from a wide range of diverse populations. Our results support the decisive role of tailored and idiosyncratic strategies in reaching different communities and ensuring the representativeness of the study sample.

Cardiovascular health is associated with social determinants of health in the LatAm-FINGERS cohort

Background: Cardiovascular risk factors (CVRF) are among the main modifiable risk factors for dementia in Latin America (LA). Therefore, improving cardiovascular health (CVH) is one of the main Objectives of the LatAm- FINGERS trial, the largest non-pharmacological (lifestyle improvement) randomized trial in LA. But, to fully comprehend CVH it is necessary to explore its relation with the social determinants of health (SDH), that are closely associated with lifestyle.

Methods: LatAm-FINGERS is an initiative to develop a joint regional intervention protocol to prevent cognitive deterioration in 12 LA countries. Participants (between 60-77 years old) should have high dementia risk (CAIDE > 6), were evaluated clinically and cognitively at baseline and every 6 months for 2 years. At baseline, we measured the CVRF according to the Framingham risk score and the CVH with the “Life’s Essential 8 cardiovascular health index” (CVHI), a composed score that includes lifestyle’s (diet, physical activity, nicotine exposure, sleep health) and metabolic variables (body mass index (BMI), blood lipids, blood glucose, and blood pressure). Each score ranges from 0 to 100, with higher values meaning a healthier profile. SDH was measured by years of education, race, and occupation. Occupation categorical data was transformed into an ordinal scale using the Hollingshead score. For an exploratory analysis we did partial correlations (controlled by age and sex) between CVHI and SDH measures.

Results: Preliminary data from 1,024 participants were analyzed, age = 67 ± 5 years, education = 13 ± 4 years, 72% women, 87% had high CVRF. The CVHI (60 ± 16) was obtained with 7 of the 8 variables, excluding sleep health. Diet (39 ± 13) and physical activity (37 ± 39) were the unhealthiest scores, while blood glucose (75 ± 26) was the healthiest one. There were significant correlations between CVHI with years of education (r = 0.179, p < 0.001) and occupation score (r = 0.169, p < 0.001). Moreover, CVH individual components correlated with SDH, except for blood lipids.

Conclusions: In the LatAm-FINGERS cohort, better socioeconomic position is associated with a healthier cardiovascular index at baseline, being important to explore the role of SDH in CVH modification across the trial.

Young-onset dementia (YOD) has a profound impact on spouses. However, little is known on how the quality of the relationship changes over time in YOD. This study aims to determine how the quality of the relationship changes over time and identify predictors of this change.

This study used data from the NEEDs in Young onset Dementia (NeedYD) study. The primary outcome measure was the quality of the relationship perceived by spouses measured throughout 24 months. Baseline characteristics of persons with YOD and spouses were also measured to assess their predictive value.

Totally, 178 dyads were included. The perceived quality of the relationship deteriorated over time. A longer symptom duration, a diagnosis of frontotemporal dementia, lower levels of awareness of deficits, lower levels of initiative toward daily living activities, and higher levels of apathy, hyperactivity, depression, and anxiety in the person with YOD were associated with a lower perceived quality of the relationship by spouses. A coping style characterized by palliative and passive reacting patterns and higher levels of neuroticism in spouses was also associated with a lower quality of the relationship.

The quality of the relationship as perceived by spouses deteriorated over time and was influenced by characteristics of the person with YOD as well as their spouse. Helping spouses to come to terms with factors that threaten their sense of couplehood might help them to develop a more positive attitude toward their spousal relationship and improve the quality of the relationship and care.

Gender norms embedded in communities may restrict opportunities and harm the mental health of older adults, yet this phenomenon has received little attention. This study investigates the connection between older adults’ perceptions of community gender norms and mental health and suicide-related outcomes.

Cross-sectional.

This study analyzed data from the 2019 wave of the Japan Gerontological Evaluation Study.

In total, 25,937 participants aged 65 years or older in 61 municipalities.

Perceptions of community gender norms were assessed by the respondents’ perceptions of the gender-differentiating language used by those around them such as “You should/should not do XXX, because you are a man/woman.”

The prevalence of all mental health outcomes was higher among both men and women who perceived community gender norms as restrictive. These associations remained in fully adjusted multivariable analyses. Prevalence ratios for men were 1.36 [95% confidence interval: 1.13, 1.65] for psychological resistance to obtaining help, 1.85 [1.54, 2.23] for depressive symptoms, 1.99 [1.34, 2.96] for suicidal ideation, and 2.15 [1.21, 3.80] for suicide attempts. The corresponding figures for women were 1.39 [1.17, 1.65], 1.80 [1.55, 2.10], 2.13 [1.65, 2.74], 2.62 [1.78, 3.87]. There was a more pronounced association between perceiving community gender norms as restrictive and depressive symptoms and suicidal behaviors among those with nonconventional gender role attitudes compared to those with conventional attitudes.

Considering the effects of community gender norms, in addition to individual gender role attitudes, may be critical in designing effective public health interventions for improving mental health.

We explored the influence of study partner (SP) characteristics on SP-reported neuropsychiatric symptoms (NPS) presence across the neurocognitive spectrum and on the prognostic utility of mild behavioral impairment (MBI).

We performed cross-sectional (n = 26,748) and longitudinal (n = 12,794) analyses using participant-SP dyad data from the National Alzheimer’s Coordinating Center. Participants were cognitively normal (CN; n = 11,951) or had mild cognitive impairment (MCI; n = 5686) or dementia (n = 9111).

SPs rated NPS using the Neuropsychiatric Inventory Questionnaire. We used multivariable logistic regression to model the association between SP characteristics (age, sex, and relationship to participant [spouse, child, and other]) and NPS status (outcome). Cox regressions assessed SP characteristics as moderators of MBI associations with incident dementia or as predictors of incident dementia in MBI + participants only.

Among CN persons, younger, female, and spouse SPs reported NPS more frequently. In MCI, younger SPs and those who were spouses or children of participants reported higher NPS odds. For dementia participants, NPS odds were higher in female and spouse SPs. MBI associations with incident dementia were slightly weaker when SPs were older but did not depend on SP sex or relationship to participant. Among MBI + participants with spouse or child SPs, hazard for dementia was higher when compared to MBI + participants with other SPs.

SP age, sex, and relationship to participant influence NPS reporting across the neurocognitive spectrum, with potential implications for MBI prognosis. Considering SP characteristics may enhance the accuracy of NPS assessments, which may facilitate therapy planning and prognosis.