BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: AN OVERVIEW OF THEORETICAL FRAMEWORKS AND ASSOCIATED NONPHARMACOLOGICAL TREATMENTS FOR BPSD

Behavioural and Psychological Symptoms of Dementia (BPSD) such as agitation and aggression are core symptoms of dementia and affect almost everyone with the condition. Such symptoms cause distress to the person with dementia and their caregivers and have also been found to predict early institutionalisation as well as death. Historically, BPSD have been managed with medication, typically using anti-psychotic drugs. However, recent data show that anti-psychotic medications increase mortality and the risk of stroke in people with dementia. On the other hand, non-pharmacological interventions such as sensory manipulation, psychological therapies and providing training and psychoeducation for caregivers, present more encouraging results. Consequently, there is a need to explore the potential impact of non-pharmacological interventions on BPSD

Use of Online Dietary Recalls among Older UK Adults:A Feasibility Study of an Online Dietary Assessment Tool

This study examined the feasibility of including myfood24, an online 24-hour dietary recall tool, in a cohort studies of older adults. Participants (n = 319) were recruited during follow-up visits for the CHARIOT-Pro Sub-study, a prospective study of cognitively healthy adults aged 60–85 years at baseline. Email invitations were sent over three consecutive months, with weekly reminders. Multivariable regression models were applied to examine the number of recalls completed in relation to technology readiness (TR) scores and demographic characteristics. Ninety-four percent of people agreed to participate. Among participants, 67% completed at least one recall, and 48% completed two or more. Participants who completed multiple recalls reported higher self-confidence with technology and received a higher TR score than those who did not complete any recalls. A one-point higher TR score was associated with higher odds of completing three recalls compared to zero recalls (OR 1.70, 95% CI 0.96–3.01); this association was further attenuated after adjustment for demographic and other TR-related covariates (OR 1.35, 95% CI 0.63–2.88). This study demonstrates reasonable participation rates for a single myfood24 recall among older adults participating in a cohort study but suggests that further support may be required to obtain multiple recalls in this population

Health, Lifestyle, and Psycho-Social Determinants of Poor Sleep Quality During the Early Phase of the COVID-19 Pandemic: A Focus on UK Older Adults Deemed Clinically Extremely Vulnerable

Background: Several studies have assessed the impact of COVID-19-relatedlockdownson sleep quality across global populations. However, no study to date has specifically assessed at-riskpopulations, particularly those at highest risk of complications from coronavirus infection deemed “clinically-extremely-vulnerable-(COVID-19CEV)” [as defined by Public Health England, 2020].Methods: In this cross-sectional study, we surveyed 5,558 adults aged ≥50 years (of whom 523 met criteria for COVID-19CEV) during the first pandemic wave that resulted in a nationwide-lockdown (April-June 2020) with assessments of sleep quality (an adapted sleep scale that captured multiple sleep indices before and during the lockdown), health/medical, lifestyle, psychosocial and socio demographic factors. We examined associations between these variablesand sleep quality;and explored interactions of COVID-19CEV status with significant predictors of poor sleep,to identify potential moderating factors. Results: 37% of participants reported poor sleep quality which was associated with younger age, female sex and multimorbidity. Significant associations with poor sleep included health/medical factors: COVID-19 CEV status, higher BMI, arthritis, pulmonary disease, and mental health disorders; and the following lifestyle and psychosocial factors: living alone, higher alcohol consumption, an unhealthy diet and higher depressive and anxiety symptoms. Moderators of the negative relationship between COVID-19 CEV status and good sleep quality were marital status, loneliness, anxiety and diet. Within this subgroup, less anxious and less lonely males, as well as females with healthier diets, reported better sleep. Conclusions: Sleep quality in older adults was compromised during the sudden unprecedented nation-wide lockdown due to distinct modifiable factors. An important contribution of our study is the assessment of a “clinically-extremely-vulnerable” population and the sex differences identified within this group. Male and female older adults deemed COVID-19 CEV may benefit from targeted mental health and dietary interventions, respectively. This work extends the available evidence on the notable impact of lack of social interactions during the COVID-19 pandemic on sleep, and provides recommendations towards areas for future work, including research into vulnerability factors impacting sleep disruption and COVID-19-related complications. Study results may inform tailored interventions targeted at modifiable risk factors to promote optimal sleep; additionally, providing empirical data to support health policy development in this area

Protocol of the Cognitive Health in Ageing Register: Investigational, Observational and Trial Studies in Dementia Research (CHARIOT): Prospective Readiness cOhort (PRO) SubStudy

The Cognitive Health in Ageing Register: Investigational, Observational and Trial Studies in Dementia Research (CHARIOT): Prospective Readiness cOhort (PRO) SubStudy (CPSS), sponsored by Janssen Pharmaceutical Research & Development LLC, is an Alzheimer's disease (AD) biomarker enriched observational study that began 3 July 2015 CPSS aims to identify and validate determinants of AD, alongside cognitive, functional and biological changes in older adults with or without detectable evidence of AD pathology at baseline. CPSS is a dual-site longitudinal cohort (3.5 years) assessed quarterly. Cognitively normal participants (60-85 years) were recruited across Greater London and Edinburgh. Participants are classified as high, medium (amnestic or non-amnestic) or low risk for developing mild cognitive impairment-Alzheimer's disease based on their Repeatable Battery for the Assessment of Neuropsychological Status performance at screening. Additional AD-related assessments include: a novel cognitive composite, the Global Preclinical Alzheimer's Cognitive Composite, brain MRI and positron emission tomography and cerebrospinal fluid analysis. Lifestyle, other cognitive and functional data, as well as biosamples (blood, urine, and saliva) are collected. Primarily, study analyses will evaluate longitudinal change in cognitive and functional outcomes. Annual interim analyses for descriptive data occur throughout the course of the study, although inferential statistics are conducted as required. CPSS received ethical approvals from the London-Central Research Ethics Committee (15/LO/0711) and the Administration of Radioactive Substances Advisory Committee (RPC 630/3764/33110) The study is at the forefront of global AD prevention efforts, with frequent and robust sampling of the well-characterised cohort, allowing for detection of incipient pathophysiological, cognitive and functional changes that could inform therapeutic strategies to prevent and/or delay cognitive impairment and dementia. Dissemination of results will target the scientific community, research participants, volunteer community, public, industry, regulatory authorities and policymakers. On study completion, and following a predetermined embargo period, CPSS data are planned to be made accessible for analysis to facilitate further research into the determinants of AD pathology, onset of symptomatology and progression. The CHARIOT:PRO SubStudy is registered with clinicaltrials.gov (NCT02114372). Notices of protocol modifications will be made available through this trial registry. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

HEALTH AND DISEASE IN THE KANTO REGION DURING THE EDO PERIOD (17th-19th CENTURIES), JAPAN

　The current dissertation is an attempt to reconstruct patterns ofhealth and disease during the Edo period (1603-1867 AD) in urban andrural populations in Japan and observe the effects of urbanization inthem from a more comparative approach, utilizing a wide range ofskeletal indicators, including infectious diseases, trauma, dietaryindicators and non specific stress indicators. This study tried to testthe hypotheses that: 1) urbanization in the Edo period, despite theimprovement of the living conditions, led to a negative effect on theoverall health of the populations, 2) that the effects of urbanizationhad a significant impact on the lifestyle of the urban individuals,changing the gender roles in their society and therefore theirsusceptibility to disease and 3) that despite the temporary residentialcharacter of the people in the urban centers, the duration of their staywas long enough to affect their health status. 　For the purposes of the current research two urban and four ruralpopulations from the Kanto region, Japan, dated in the Edo period (1603-1867 AD) were utilized. Non specific stress indicators (porotichyperostosis, cribra orbitalia, enamel hypoplasia, periostitis), specificinfections (Tuberculosis, Syphilis), dental pathological conditions (caries,antemortem tooth loss, periapical lesions), trauma and degenerative jointdiseases were all studied and compared in terms of prevalence and severityin regards to sex, age and geographic distribution. 　The results indicated that nutritional stress, epidemics and overcrowdingconditions were some of the key factors that increased the health risks ofthe Edo period people in the urban centers. Urbanization and the rapidincrease of productivity during this period appeared to have had a profoundeffect on the health of urban adults associated to a change in gender roles.Urban males followed a more intense lifestyle, where infectious diseases,hard labor and accidents, due to activity or interpersonal violence, weremore prevalent. In addition urban females, although equally exposed to theeffects of urbanization as males, however, they appear to have experienceda change in activity patterns compared to rural females, while they wereaffected by nutritional deficiencies early in life, owing possibly todifferential nutrition, an early age of marriage, increased birth rate andprolonged breast feeding in the urban Edo setting. In addition, despite ofthe continuous migration from and to urban centers, the length of residencewas long enough to affect and change health patterns. Finally, rural adultsappeared more uniform reflecting a lack of considerable gender differencesin regards to daily lifestyle and division of labor, maintaining a harsh andpathogenic living environment for both sexes

The impacts of social restrictions during the COVID-19 pandemic on the physical activity levels of over 50-year olds: The CHARIOT COVID-19 Rapid Response (CCRR) cohort study.

ObjectivesTo quantify the associations between shielding status and loneliness at the start of the COVID-19 pandemic, and physical activity (PA) levels throughout the pandemic.MethodsDemographic, health and lifestyle characteristics of 7748 cognitively healthy adults aged >50, and living in London, were surveyed from April 2020 to March 2021. The International Physical Activity Questionnaire (IPAQ) short-form assessed PA before COVID-19 restrictions, and up to 6 times over 11 months. Linear mixed models investigated associations between shielding status and loneliness at the onset of the pandemic, with PA over time.ResultsParticipants who felt 'often lonely' at the outset of the pandemic completed an average of 522 and 547 fewer Metabolic Equivalent of Task (MET) minutes/week during the pandemic (95% CI: -809, -236, pConclusionsThose shielding or lonely at pandemic onset were likely to have completed low levels of PA during the pandemic. These associations are influenced by co-morbidities and health status

Practice Effect of Repeated Cognitive Tests Among Older Adults: Associations With Brain Amyloid Pathology and Other Influencing Factors

Background: Practice effects (PE), after repeated cognitive measurements, may mask cognitive decline and represent a challenge in clinical and research settings. However, an attenuated practice effect may indicate the presence of brain pathologies. This study aimed to evaluate practice effects on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) scale, and their associations with brain amyloid status and other factors in a cohort of cognitively unimpaired older adults enrolled in the CHARIOT-PRO SubStudy. Materials and Methods: 502 cognitively unimpaired participants aged 60-85 years were assessed with RBANS in both screening and baseline clinic visits using alternate versions (median time gap of 3.5 months). We tested PE based on differences between test and retest scores in total scale and domain-specific indices. Multiple linear regressions were used to examine factors influencing PE, after adjusting for age, sex, education level, APOE-ε4 carriage and initial RBANS score. The latter and PE were also evaluated as predictors for amyloid positivity status based on defined thresholds, using logistic regression. Results: Participants’ total scale, immediate memory and delayed memory indices were significantly higher in the second test than in the initial test (Cohen’s dz = 0.48, 0.70 and 0.35, P < 0.001). On the immediate memory index, the PE was significantly lower in the amyloid positive group than the amyloid negative group (P = 0.022). Older participants (≥70 years), women, non-APOE-ε4 carriers, and those with worse initial RBANS test performance had larger PE. No associations were found between brain MRI parameters and PE. In addition, attenuated practice effects in immediate or delayed memory index were independent predictors for amyloid positivity (P < 0.05). Conclusion: Significant practice effects on RBANS total scale and memory indices were identified in cognitively unimpaired older adults. The association with amyloid status suggests that practice effects are not simply a source of measurement error but may be informative with regard to underlying neuropathology

Coefficients of study variables.

ObjectivesTo quantify the associations between shielding status and loneliness at the start of the COVID-19 pandemic, and physical activity (PA) levels throughout the pandemic.MethodsDemographic, health and lifestyle characteristics of 7748 cognitively healthy adults aged >50, and living in London, were surveyed from April 2020 to March 2021. The International Physical Activity Questionnaire (IPAQ) short-form assessed PA before COVID-19 restrictions, and up to 6 times over 11 months. Linear mixed models investigated associations between shielding status and loneliness at the onset of the pandemic, with PA over time.ResultsParticipants who felt ‘often lonely’ at the outset of the pandemic completed an average of 522 and 547 fewer Metabolic Equivalent of Task (MET) minutes/week during the pandemic (95% CI: -809, -236, pParticipants who were shielding at the outset of the pandemic completed an average of 352 fewer MET minutes/week during the pandemic than those who were not (95% CI: -432, -273; pConclusionsThose shielding or lonely at pandemic onset were likely to have completed low levels of PA during the pandemic. These associations are influenced by co-morbidities and health status.</div

Variables extracted from survey.

ObjectivesTo quantify the associations between shielding status and loneliness at the start of the COVID-19 pandemic, and physical activity (PA) levels throughout the pandemic.MethodsDemographic, health and lifestyle characteristics of 7748 cognitively healthy adults aged >50, and living in London, were surveyed from April 2020 to March 2021. The International Physical Activity Questionnaire (IPAQ) short-form assessed PA before COVID-19 restrictions, and up to 6 times over 11 months. Linear mixed models investigated associations between shielding status and loneliness at the onset of the pandemic, with PA over time.ResultsParticipants who felt ‘often lonely’ at the outset of the pandemic completed an average of 522 and 547 fewer Metabolic Equivalent of Task (MET) minutes/week during the pandemic (95% CI: -809, -236, pParticipants who were shielding at the outset of the pandemic completed an average of 352 fewer MET minutes/week during the pandemic than those who were not (95% CI: -432, -273; pConclusionsThose shielding or lonely at pandemic onset were likely to have completed low levels of PA during the pandemic. These associations are influenced by co-morbidities and health status.</div