Objectives: As life expectancy continues to rise globally, the prevalence of dementia is also increasing. However, there is a lack of studies in Latin American countries that describe the sociodemographic and clinical characteristics of dementia patients and their caregivers, potentially overlooking important differences that could impact diagnosis in a diverse population. This study aims to elucidate the sociodemographic characteristics of patients with Behavioral Variant Frontotemporal Dementia (bvFTD) and Early-Onset Alzheimer’s Disease (AD), as well as their primary caregivers in Colombia, while also examining the clinical presentation ofdementia.

Methods: A total of 83 Colombian participants were included in the study, consisting of 40 healthy controls and 43 individuals previously diagnosed with bvFTD (n = 20) and early-onset AD (n = 23). Diagnoses were established based on the current diagnostic criteria for both conditions. Participants underwent sociodemographic assessments, and a clinical evaluation was conducted. Additionally, caregivers were characterized sociodemographically.

Results: Most participants were female (67%) with a mean age of 63 years. Educational levels were comparable between the dementia group (12.4 years) and the control group (12.9 years). A higher proportion of dementia cases were observed in lower socioeconomic status categories (1 to 3). Past medical history of hypertension, type 2 diabetes, and traumatic brain injury was more prevalent in the bvFTD group, whereas coronary disease was more common in the AD group. Initial psychiatric misdiagnosis occurred more frequently in bvFTD (50%) compared to AD (26%), with depression being the most common misdiagnosis in both groups (37.5%), followed by bipolar disorder (25%) and anxiety (25%). Most caregivers were female (70%) with a mean age of 50 years. The most common caregiver-patient relationships were daughter (25.6%) and husband (25.6%), followed by wife (23.3%). The mean educational level of bvFTD caregivers (13.95) was higher than that of AD caregivers (12.87).

Conclusions: These findings provide valuable insights into the sociodemographic characteristics of dementia patients and their caregivers in Latin America, a population that is often underrepresented in research. Further exploration of diagnostic variations may be warranted, given the high prevalence of misdiagnosis in this region.

Background: The sporadic nature of AD suggest that aside from biological determinants, environmental factors such as stress may play a role in the development, progression and outcome of disease. Recent data implicated stress as a potential risk factor in development of AD. This study aims to analyze the possible relationship between recent stressful life events and AD.

Methods: We studied 132 patients with diagnosis of probable AD, according validated criteria, in mild to moderate stages. Medium age was 72.4 years. Meantime elapsed from the initial symptoms was 2.4 years. A control group of 89 healthy individuals paired for age, sex and education was studied. A questionnaire looking for stressful life events in the 3 years before diagnosis of AD was performed to patients, caregivers and controls.

Results: In the AD group, 97 patients (73.5%) presented a history of significant stressful life events, 2.3 years (SD .4 years) before the onset of symptoms. The most common findings in the AD group were: couple death (28 cases), son’s death (17 cases), history of assault or violent theft (25 cases), and history of car accident without severe injuries (13 cases). Other stressful situations were marked financial problems, bereavement, retirement, adaptive changes due to migrations and diagnosis of severe somatic disease in the family. In the control group, only 24 individuals (27%) recognized similar previous stress factors in the previous 3 years

Conclusions: We observed an association between stressful life events preceding the onset of dementia in a high percentage of our patients. Stress could trigger the degenerative process in AD and growing evidences suggest a dysfunction in neuroendocrine and immune system. According our results, we can establish a relationship between several stressful life events and the onset of dementia. It is an observational finding and does not imply direct causality. Future studies are required to examine this association in more detail in order to explain the possible mechanisms of this relationship.

Objectives: To clarify that correlation in plasma soluble TREM2 (sTREM2) and cognitive function between mild cognitive impairment (MCI) and normal cognitive function in a Chinese community population, and further to explore whether plasma sTREM2 can be used as a blood biomarker to predict and identify MCI.

Methods: This study included 216 community elderly people in Shijiazhuang and Xingtai City, Hebei Province, including 106 MCI and 110 normal cognitive function (NC) subjects. The Montreal cognitive assessment (MoCA) was used, mini mental state examination (MMSE), Boston naming test (BNT), digit span test (DST) to evaluate the cognitive functions of all subjects. Fasting venous blood was collected at the same time, and ELISA was used to detect Aβ42, Aβ40, P-Tau217, P-Tau231, TREM2, sTREM2 concentration. Use software based on SPSS26.0 to analyze the data.

Results: 1. The level of sTREM2 in the MCI group was higher than that in NC group, and the difference was statistically significant (H = 4312.0, P = 0.001). There was no statistical significance in the difference of the other index between two groups (P > 0.05). 2.Correlation analysis showed that sTREM2 was negatively correlated with P- tau217, education level, MMSE, MoCA, BNT, and DST (P < 0.05). TREM2 was positively correlated with P-tau217 and Aβ42 (P < 0.05). 3. Incorporate whether it was MCI as the dependent variable, gender, age, education level, living style, and the above blood indicators as independent variables in binary logistic regression analysis. The results showed that sTREM2 was a risk factor for MCI (OR = 1.009, 95%CI = 1.002– 1.016, P = 0.015), junior high school education or above was a protective factor for MCI (OR = 6.133, 95 % CI = 2.651–14.189, P < 0.001). 4.The area under the ROC curve of sTREM2 was 0.630 (sensitivity 0.472, specificity 0.782), and the area under the ROC curve of sTREM2 combined with MMSE was 0.849 (sensitivity 0.679, specificity 0.873).

Conclusions: sTREM2 is a risk factor for cognitive function decline in MCI. Plasma sTREM2 levels combined with the cognitive function assessment scale have good clinical value in identifying mild cognitive impairment.

Background: Clinical outcome is one of the indicators for treatment effect in specific populations such as the elderly. Depression is manifested as the result of biological, psychological, and social factors which are interrelated in the symptoms of low mood, energy, and motivation. In specific population of elderly, depression is related to the issue of loneliness and may impact the quality of life, as well as the progression of other medical comorbidities. Therefore, it is important to monitor the progress of treatment among theelderly.

Objectives: The Objectives of this study is to observe clinical improvement of depressive symptoms through the Montgomery-Åsberg Depression Rating Scale (MADRS).

Methods: This is an observational cohort study conducted in the outpatient clinic setting. The data was collected after one month of follow-up. Each patient was assessed using the MADRS questionnaire in every clinical encounter. The MADRS scores were analysed statistically using descriptive and dependent variableanalysis.

Results: We collected 304 data of patients using MADRS as part of the clinical measurement. The average age is 69.98±6.6 years old. From gender distribution, 57.6% are female and 42.4% are male. From one-month follow-up, 37.8% of patients showed improvement of MADRS score and 39.1% remains the same from the previous visit.

Statistical analysis showed significant change of MADRS score after follow-up, indicating the importance of routine visit and monitoring for elderly showing symptoms of depression.

Conclusions: Psychometric evaluation is an essential component for observing the clinical improvement for elderly with symptoms of depression.

Introduction: Frailty is a common condition among older individuals and is associated with increased vulnerability to adverse health outcomes. The COVID-19 pandemic has further highlighted the impact of viral infections on frail individuals.

Objectives: This study assessed the functional and clinical analysis changes in frail patients before and after SARS- CoV-2. This study evaluated the functional and clinical changes in frailty patients before and after SARS-CoV-2 infection in a cohort of 20 frailty patients of a long-stay facility.

Methods: Demographic, clinical, and functional data, including the Barthel index, Katz index, and Mini-Mental Examination, were collected. Clinical analyses were also conducted, including a complete blood count and biochemical profile. The functional and clinical analyses were compared before and after SARS-CoV-2 infection using t-tests. Pearson’s correlation was used to analyze the relationship between functionality, frailty, and clinical biomarkers.

Results: The cohort had a mean age of 84 ± 2.42 years, with 80% female. The most common comorbidities were Arterial Hypertension, Diabetes Mellitus type II, and Alzheimer’s disease. The functional assessment showed a significant increase in functional dependence on basic activities of daily living after the SARS-CoV-2 infection. Significant differences were also observed in grooming, bowel, and bladder control. Clinicals biomarkers, such as albumin, showed substantial changes post-infection.

Conclusions: The findings indicate worsening functional dependence and changes in clinical biomarkers after an illness. These results emphasize the need for targeted interventions and support for frail individuals during viral outbreaks. Further research is warranted to explore the long-term consequences of COVID-19 on frailty and develop strategies to mitigate its impact.

Introduction: Cognitive function has traditionally been associated with mental abilities, but there are reports that it may be associated with performance in physical function and even in ADLs. This relationship between the mental and the physical raises important questions about comprehensive health across the life course.

Methods: A cross-sectional descriptive observational study was carried out with correlation analysis between the main variables under study. The purpose of the research was to establish the functional relationship between muscle strength, gait speed, and cognitive functions in elderly people with or without cognitive impairments at 55 years of age. Cognitive function (MOCA), ABVD (Barthel index), IADL (Lawton and Brody questionnaire), and anthropometric and physical function variables were studied. A descriptive and inferential analysis of the data obtained was performed together with a correlation analysis to establish the functional relationship between the groups of variables. Ethical safeguards were taken in all cases, and informed consent approved by the Ethics Committee of the Catholic University of Temuco, Chile, was applied.

Results: The primary findings of this study show that, in older individuals with or without cognitive impairment, muscle strength, gait speed, and cognitive function have a functional relationship. There is also a strong correlation between these variables’ performance in the physical domain. In addition, sex-associated differences were detected that are relevant to study and investigate in further studies. The effect of aging was differentiated in the case of women (younger than 75 years and older than 75 years) without detecting significant differences, but there was a tendency to increase deterioration with increasing cognitive and physicalage.

Conclusions: Cognitive function is related to physical performance variables, and these may be predictors of aging as attenuators or aggravators. Therefore, it is of utmost importance to consider the interrelationship of these variables when addressing the health and well-being of this population. It is necessary to investigate aspects that generate preventive actions aimed at healthy and active aging, especially in the performance of cognitive function related to activities of daily living (basic and instrumental).

Introduction: Early functional changes in women compromise elements such as muscle mass and strength, physical function, and gait speed, leading to a physiological decline that may contribute to frailty in old age.

Objectives: This study aimed to relate strength and physical performance to premature functional decline in women aged 40 years and older.

Methods: A cross-sectional descriptive observational study was conducted, and two groups of women were contrasted (40 to 60 years old and 60 and over), completing a sample of 31 women. Functional decline, lower limb muscle power, prehensile strength, physical performance, gait speed, phenotype of frailty status, level of physical activity, and other sociodemographic factors were contrasted. The UCT internal ethicscommittee.

Results: Preliminary results showed that, among the demographic variables, women over 60 had a lower level of schooling, with 29% having incomplete basic education. Both groups reported a similar number of children: 93% in those under 60 and 100% in those over 60, with an average of 2.3 and 3.06 children, respectively. Statistically significant differences were detected in physical performance, lower limb strength, and gait speed, which were higher in women under 60.

Conclusions: The present report detected that lower limb strength, a determinant of great relevance in the aging population, affects gait speed. Likewise, muscle strength leads to a more rapid decline in older people. In both groups, physical performance played a crucial role in characterizing aging and frailty, particularly at ages over 60, when a decline in performance was evident. Notably, there were no variations in grip strength or physical activity levels, possibly because both groups performed poorly, raising the possibility of functional decline in women who have not yet reached old age.

Introduction: Motor impairment remains underexplored in Alzheimer’s disease. We previously described the functional impairment of gait and exploratory activity of male 3xTg-AD mice at different stages of Alzheimer’s disease progression. We describe movement limitations and muscle weakness as indicators of severity.

Methods: In the present report, a cross-sectional study was carried out that analyzed the muscular structure of the quadriceps and triceps surae muscles of transgenic (3xTg-AD) and non-transgenic males in the early (6 months), intermediate (12 months), and advanced (16 months) stages of Alzheimer’s disease. Longitudinal sections of the quadriceps and triceps surae stained with hematoxylin and eosin (H&E) were evaluated. Using conventional histological techniques, they were then rinsed with PBS, pH 7.4. For the F-actine immunohistochemistry, the sections were blocked by incubating them in IgG-free 2% bovine serum albumin (BSA, Sigma) for 60 min. Then specimens were incubated for 10 minutes with 0.2% Triton X-100 in PBS at room temperature. The slides were incubated overnight at 4 °C with F-actin (Santa Cruz Biotechnology Inc., CA, USA). Slides were counterstained with VectaShield using 4, 60-diamino-2-phenylindole dihydrochloride (DAPI) (Vector Labs., CA, USA) for nuclei staining and visualized in the blue channel.

Results: Lower fluorescence labeling was detected in 3xTg-AD mice at all ages, with a greater decline at older ages. Signs of sarcopenia are also present in an advanced stage of AD, with differences in fiber distribution, the number of cell nuclei, and the presence of adipose tissue.

Conclusions: The previously reported gait alterations in Alzheimer’s disease could be the result of structural deficiencies due to sarcopenia and poor muscle contraction, which leads to the limitations of movement in locomotion reported in 3xTg-AD mice.

Objectives: Subjective memory concerns are associated with increased risk for Alzheimer’s disease (AD). Self- perception of frequency of memory slips, in particular, correlates with neuroimaging markers of AD including cerebral amyloid deposition and functional connectivity of the hippocampus and posterior default mode network. The hippocampal complex includes functionally and structurally distinct subfields (cornu ammonis (CA), dentate gyrus, and subiculum) which show selective atrophy in aging and in AD, as well as psychiatric conditions such as major depressive disorder. In the current study, we measured hippocampal subfield volumes in cognitively unimpaired older adults and examined their association with frequency of forgetting and verbal memory.

Methods: Participants were 51 older adults (23M, age 71.0 SD = 6.3) with normal neuropsychological test performance who completed the Memory Functioning Questionnaire (MFQ) and a high-resolution T2-weighted scan of the medial temporal lobe at 3T. The Automatic Segmentation of Hippocampal Subfields (ASHS) processing pipeline was used to extract CA1, CA2, CA3, dentate gyrus, and subiculum volumes. Partial correlations were performed within the total sample to examine the association between subfield volumes and MFQ Frequency of Forgetting (“How often do you….?”) subscale scores, which has been linked to AD neuroimaging markers,19 –21 as well as long delayed recall scores on the California Verbal Learning Test (CVLT-LDR). Covariates were age, sex, and total intracranial volume.

Results: Frequency of Forgetting was significantly correlated with left CA2 [r = .42, P = .003] and right subicular volume [r = .45, P = .001] In contrast, CVLT-LDR was not correlated with any hippocampal subfield volume. No other hippocampal subfield volumes were correlated with Frequency of Forgetting.

Conclusions: The associations between subicular volume, a region implicated in AD, and subjective, but not Objectives memory, suggests that self-perception of frequency of memory lapses in daily life may be sensitive to subtle, early AD-related volumetric changes within the hippocampus. The similar dissociation found for CA2, a region linked to social memory in animal models, is noteworthy. These findings suggest potential neuroanatomical mechanisms for the association between subjective memory concerns and AD risk.

Objectives: Compare the psychometric characteristics of three brief screening instruments - Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and its basic version (MoCA basic), for early detecting mild and major neurocognitive disorder (NCD), discriminating from normal elders and provide MoCA and MoCA basic norms and accuracy data for seniors with a lower education level, including illiterates.

Methods: Cross-sectional study, with 60 years or older community dwelling individuals, submitted to diagnostic interviews (according to DSM-5) and screening tests. Of a total of 271 elderly interviewed, 59 had mild and 32 had major NCD. A sum of 266 MMSE; 104 MoCA and 81 MoCA basic were applied. Area under the ROC curve (AUC) was determined for all three tests, and sensitivity (S), specificity (E) and cutoff score (CS) for the last two were determined.

Results: The total scores varied significantly according to age and education (p < 0.01). MMSE had a high discriminative validity – AUC for normal vs major NCD = 0,915 (p < 0.001; 95% CI 0,868– 0,963) and regular for normal vs mild NCD = 0,706 (p < 0.001; 95% CI 0,631–0,781). MoCA demonstrated excellent discriminative validity – AUC for normal vs major NCD = 0.932 (p < 0.001; 95% CI 0.842–1.000) and regular for mild NCD – AUC = 0.753 (p < 0.001; 95% CI: 0.654– 0.853). CS was 9 (S = 83% E = 95%) and 16 (S = 83% E = 68%). MoCA basic showed excellent discriminative validity for major NCD vs normal AUC = 0.910 (p < 0.001; 95% CI 0.818–1.002) and good for mild NCD vs normal AUC = 0.834 (p < 0.001; 95% CI: 0.742 –0.927). CS was 21 for both conditions (S = 100% E = 72%; S = 89% E = 72%).

Conclusions: The MoCA and MoCA basic are valid screening instruments for cognitive assessment of low-schooled elderly people from the community, but we found different cut-off from the original and other studies. The MMSE still remains a good and useful tool. These results provide information about psychometric characteristics of the instruments for elderly with low schooling in Brazil.

Background: Hospital-related negative outcomes such as reduced functional ability and mortality are significantly more frequent in people with dementia compared to other groups. Although these can result from preventable adverse events (AE) related to care standards (e.g., in-hospital falls or infection), researchers usually link such outcomes with the dementia itself. To date, it is unclear whether and the extent to which negative outcomes in hospitalised people with dementia are partly or fully due to the occurrence of AE.

Aim: To explore the AE endured by people with dementia in hospital settings and to determine whether and the extent to which these are associated with negative outcomes.

Methods: A scoping review was undertaken in line with Arksey and O’Malley’s framework in PUBMED, Web of Science, CINAHL, and Scopus in October 2023. Primary studies in English, Spanish, or Portuguese published in peer-reviewed journals were eligible.

Results: Of the 1,976 retrieved documents, 16 were included. Considering all studies and AE together, people with dementia had between 2.8 to 5.2 times higher risk of having an AE compared to people without dementia. In non- surgical settings, the most frequently reported AE were falls, delirium, and infections, while in surgical settings, these included postoperative delirium, infections, and other complications. Longer hospital stay, increased healthcare costs, higher risk of discharge to residential care (vs. home), and increased mortality were significantly more frequent in people with dementia. The link between the AE and negative outcomes was explored in three studies: longer hospital stay was linked to having endured a fall, delirium, or pneumonia as AE; higher risk of 90- day readmission was linked to having had delirium, and higher mortality was found in those with a hip fracture due to an in-hospital fall.

Conclusions: AE are more common in people with dementia compared to other hospitalised groups and may be largely responsible for the negative outcomes found in this population. However, current evidence is limited and does not allow for this relationship to be confidently established. Future research should further explore such associations with the goal to improve care and safety for people with dementia in hospital settings.

Introduction: The progression of dementia may be followed by decreased sexual activity for People with Alzheimer’s Disease (PwAD) and their spouse-carers. The aim of this study was to investigate the perception of change in sexual activity and sexual satisfaction among couples whose spouses were diagnosed with Alzheimer’s Disease (AD).

Methods: Using a cross-sectional design, we compared 74 dyads of people with Alzheimer´s disease (PwAD) and their spouse-carers, and 21 elderly dyads control. We assessed sexual satisfaction with Questionnaire on Sexual Experience and Satisfaction (QSES), cognition using a Mini-Mental State Examination (MMSE), disease severity using a Clinical Dementia Rating scale (CDR), awareness of disease with Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), functionality with Pfeffer Functional Activities Questionnaire (FAQ), depressive symptoms with Cornell Scale for Depression in Dementia (CSDD), quality of life using a Quality of Life in Alzheimer’s Disease Scale (QoL-AD), and burden using a Zarit Burden Interview (ZBI). Univariate and multivariate regression analyses were conducted to identify the factors that influenced couples’ sexual satisfaction.

Results: We found a significant difference between the perception and no perception of change in sexual activity of PwAD (p < 0.001), spouse-carers (p < 0.01), and controls (p < 0.05). Moderate to severe sexual dissatisfaction was observed in 36.5% of PwAD, 65% of spouse- carers, and 31% of controls. The linear regression indicated that PwAD sexual satisfaction was related to cognitive impairment (p < 0.05). Spouse-caregivers sexual satisfaction was related to gender of spouse-caregivers (p < 0.05) and the presence of sexual activity (p < 0.001).

Conclusions: The perception of change and consequent interruption of sexual activity, with higher sexual dissatisfaction, were higher in PwAD and their spouse-carers, in comparison with control group. We also found that spouse-carers experienced lower levels of sexual satisfaction than PwAD and healthy elderly couples. Moreover, PwAD sexual satisfaction was related to the level of cognitive impairment and spouse-carers’ sexual satisfaction was related to gender and the presence of sexual activity.

Background and Aims: The growth of the elderly population poses challenges and opportunities in society. As we age, normal changes occur that can affect functionality and independence. Aging is associated with brain changes that result in cognitive decline. The most common cause of cognitive decline among the elderly is Alzheimer’s disease (AD). It is characterized by a progressive spectrum of memory problems that affect the functional capacity of the elderly and their ability to perform activities of daily living, increasing the level of dependence and the social, emotional, and economic burden on caregivers. Alzheimer’s disease is the 6th leading cause of death in the United States and the 4th leading cause of death in Puerto Rico. These challenges can only be addressed through clinical research for managing conditions, non-pharmacological treatments and therapies, and educational initiatives covering basic aspects of geriatrics aimed at healthcare professionals, direct service providers, and caregivers. These efforts will provide effective management alternatives when intervening with the elderly population and the public. The aims are: to discuss the educational initiative with Dominican caregivers, to review advances in Alzheimer’s disease research, to present the translation and cultural validation of Cognitive Stimulation Therapy as a non-pharmacological intervention for patients in the early stages of MCI and Alzheimer’s, and to raise awareness about the importance of physical literacy through the eight (8) Movement Patterns of Brain Dance for older adults.

Background and Aim: Puerto Rico is experiencing a rapidly aging society. In old age, it is common to experience one or more chronic diseases that require special attention. If not properly addressed, these health conditions can reduce functionality in daily activities. Some risk factors that can affect health and functionality include sedentary lifestyle, social isolation, and unhealthy lifestyles. To reduce these risk factors, it is necessary to implement health promotion measures aimed at improving the well-being of older adults. Brain Dance has a positive impact on the health of older adults. Its benefits include increasing circulation, reorganizing the neurological system, reducing stress, maintaining joint flexibility, and being aware of the communication between body and mind. The aim was to promote the health of older adults through the 8 Movement Patterns of Brain Dance at CAMPEA, Santa Monica, Bayamón, during the months of March to May 2023.

Methods: A collaboration agreement was established between the Geriatric Research and Education Center and CAMPEA to train older adults and service providers on the benefits of Brain Dance, and educational materials were provided to complement the activities.

Results: The program was implemented as designed. A total of 12 older adults, 60+ practiced Brain Dance and 6 direct services providers were trained on the benefits of Brain Dance in older adults. An infographic with the Eight Movements Patterns was designed and distributed to older adults and services providers.

Conclusions: Older adults reported that engaging in Brain Dance helped them to increase their confidence, bring back memories from the past, strengthen their group interactions, gain new knowledge, develop new skills, self- discover, pay greater attention to the connection between their mind and body, and achieve a state of joy.

Objectives: Shared decision-making (SDM) is a promising approach to promote patient and person-centeredness in psychiatric clinical practice. Despite being an ethical requirement, implementing SDM might be challenging, particularly for patients with severe mental illnesses who may not always be recognized as having decision-making capacity, leading to physicians often taking control.

Methods: Case Report.

Results: Mrs. D, an 84-year-old Caucasian woman with a history of multiple depressive episodes since age 24 and hypertension, was brought to the Emergency Department by her daughters due to weight loss, depressed mood, hopelessness, anhedonia. She repeated that she had no heart and expressed fears of being hospitalized, believing doctors would remove her organs, which were no longer working, and described her arms as crumbling like sand. She was initially assessed for food refusal and delusional nihilistic thoughts, which started four months prior to presenting to the hospital after discontinuation of lithium carbonate due to intoxication and got progressively worse.

The patient met the criteria for MDD with Cotard Syndrome. Recommended treatments included ECT and pharmacotherapy. During her first ECT session, she presented a 10-second post-seizure asystole. After reevaluating her treatment, her daughters asked about alternatives. Although there were no contraindications to ECT treatment, the team, in collaboration with family members, explored options. A therapeutic strategy with venlafaxine, mirtazapine, olanzapine, aripiprazole, lithium carbonate, subcutaneous dextrocetamine was implemented.

Two months later, following 15 dextrocetamine infusions, she showed partial resolution of symptoms and was discharged with no delusional content in speech. She continued outpatient dextrocetamine infusions and achieved complete symptom remission within six months, regaining her autonomy and returning to gardening. After remission, the patient expressed a desire to avoid ECT if possible, should it be indicated in the future.

Conclusions: This report highlights the potential of SDM to explore and discuss scenarios during the informed consent process and gather information on the patient’s preferences in the event of a temporary decrease in capacity. SDM with elderly can be supported by advance care planning and directives, decision aids, training clinical staff, encouraging patient questions. Key steps include creating decision aids, training staff, and familiarizing older adults with SDM.

Objectives: Evaluate the chronobiological rhythm of elderly people with type I bipolar disorder (BD), stable and without dementia, compared to controls.

Methods: A cross-sectional study was performed with 20 patients diagnosed with type I bipolar disorder, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and 20 controls. Actigraphic records were gathered from all participants over 7 days, besides clinical and demographic information. Non-parametric chronobiological measurements were calculated to evaluate the activity-rest cycle. Comparisons between groups were evaluated using Student’s t-test or Mann-Whitney test, for data with normal and non- normal distribution, respectively. All procedures were conducted following the principles outlined in the Declaration of Helsinki.

Results: Compared to controls, patients with type I BD exhibited lower M10 values, which represent the average activity during the 10 hours of peak movement within 24 hours. Additionally, they showed increased daytime and nighttime inactivity, decreased exposure to nighttime light, and higher sleep fragmentation, as evaluated by the Hurst exponent. No differences were observed between the groups about L5 values, a parameter that indicates the average activity time in the 5 hours of least activity within 24 hours, exposure to daylight, and autocorrelation, a measure that assesses sleep synchronization.

Conclusions: Differences in chronobiological patterns were observed between elderly patients with type I BD and controls. In general, patients exhibited reduced activity levels, both during the daytime and nighttime. These findings may be related to the progression of the disease, as well as prolonged exposure to medications to treat BD, such as mood stabilizers and antipsychotics. The increased sleep fragmentation observed in patients may also be associated with these factors. To date, there is a lack of data assessing the chronobiological rhythm and sleep patterns in elderly individuals with TB, underscoring the need for further studies involving thispopulation.

Objectives: Insomnia, defined by sleep initiation or maintenance difficulties, is linked to fatigue, depression, and chronic diseases. Though non-pharmacological treatment approaches are preferred, drugs like benzodiazepines and Z drugs are commonly prescribed, despite significant risks. Hypnotics, used by 9% of the general population and 11.9% of older women, can lead to severe side effects, especially among the elderly, including falls and increased mortality. This study aims to assess sleep quality, hypnotic use, and their impact on mortality among Brazilian older adults.

Methods: Using data from 8,004 cases from the Brazilian Longitudinal Study of Aging and sleep measures were collected from the first wave (2015–2016), and mortality data from the second wave (2019–2021). A cox hazard model was performed to analyze self-reported sleep quality (Likert scale from very poor to very good, and one yes/no question evaluating whether the individual had restful sleep for the most part of the past week) and sleeping pill use (past month frequency) in relation to mortality risk. Covariates included age, sex, marital status, education, income, comorbidities, smoking, alcohol consumption, and physical activity level.

Results: We found no association between self-reported sleep quality or experiencing restful and mortality risk after 4-6 years. On the other hand, when compared to individuals who did not take sleeping pills during the past month, hazard ratios (HR) for death were, respectively, 1.79 (1.11–2.88, p = 0.016) and 1.31 (1.03–1.65, p = 0.026) for those who took medication 1–2 times a week and those who took medication 3 or more times a week. Taking sleeping pills less than once a week had no association with mortality. While the top 3 mortality causes for individuals who did not use sleeping pills were stroke, myocardial infarction and diabetes, the top 3 causes for heavy users were myocardial infarction, lung cancer and chronic obstructive pulmonarydisease.

Conclusions: Insomnia must be adequately treated, but awareness of medication risks is vital. This study highlights higher mortality risk with frequent sedative-hypnotic use in older adults. Warranting non-drug treatments and careful hypnotic use could enhance health outcomes.

Summary: Age-related neurocognitive decline is often an irreversible health issue from onset. The concomitant costs could be exponential if left unchecked. There is a need to be able to delay the onset of age-related neurocognitive decline or possibly avoid it altogether. Previous studies have shown that there is a strong positive relationship between the fitness of neurocognitive function and cognitive training. Our laboratory conducted two pilot trials (Lee et al., 2013 & 2015) and one larger scale randomised controlled trial (RCT) (Yeo et al., 2018) investigating the usability and efficacy of a brain-computer interface (BCI) based attention and memory cognitive training system on older adults between ages 60 to 80. The participants across all three trials found the different iterations of our attention-memory training system to be usable and acceptable, with adherence rates surpassing 90%.

Interestingly, a growing number of studies suggest combined cognitive training and physical activity may result in a better neurocognitive outcome as compared to only cognitive training. Combining the insights from those studies and our previous trials, we developed a novel personalized multimodal BCI-based cognitive and physical training system, NeeuroCycle, for neurocognitive protection and enhancement in older adults. NeeuroCycle comprises of a stationary recumbent bicycle and a gamified cognitive training system paired with real-time frontal electroencephalogram (EEG) neurofeedback. The cognitive training program consists of six different tasks that target attention, immediate/working and delayed memory, decision- making, and visuospatial abilities. Certain parts of the gameplay are directly impacted by the partcipant’s own real-time EEG signals. NeeuroCycle has also been designed to include locally relevant stimuli and designs for our Singaporean older adult participants. Evaluation of NeeuroCycle’s efficacy is ongoing. The current study employs a three-arm RCT approach (physical- and-cognitive training [mBCI], cognitive training only [nBCI], and active control [AC] groups). We hypothesise that mBCI par1cipants will perform significantly better on cognitive assessments compared to nBCI and AC participants. Findings of the study will be presented at the IPA Congress. If tested to be effective, we expect NeeuroCycle to be an accessible, safe, and cost-effective way for older adults to maintain or improve cognitive health, which is beneficial for ageing societies.

Objectives: Primary age-related tauopathy (PART) is associated with cognitive impairment, characterized by the presence of neurofibrillary tangles composed of tau protein, independent of amyloid plaque deposition. In this study, we examined the differences in neuropsychological assessments between PART and Alzheimer’s disease (AD) over a three-year follow-up period in patients with amnestic mild cognitive impairment (amnestic MCI).

Methods: Ten patients (mean age = 75.9; SD = 7.0; Global Clinical Dementia Rating Scale = 0 or 0.5) were recruited from Memory Clinic at Keio University Hospital. They were classified into two groups of five patients with amnestic MCI or subjective cognitive impairment due to either PART (amyloid-/tau+) or AD (amyloid+/tau+) based on the results of [18 F]PM-PBB3 and [18F]Florbetaben Positron Emission Tomography imaging scanning. A battery of neuropsychological tests: Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale (ADAS), Logical memory test of Wechsler Memory Scale–Revised, Word fluency, Trail Making Test (TMT), was administered at baseline (the first visit) and after three years.

Results: All patients remained as MCI (Global CDR = 0.5) at three-year follow-up. Although ADAS score was deteriorated more in AD than PART group at three-year follow-up (p < 0.05), PART and AD groups did not differ in overall cognitive abilities including memory. However, in PART group, the TMT A & B completion time tended to be prolonged compared to AD group (p = 0.98). On the other hand, TMT B/A indicated as executive function was indifferent in both groups.

Conclusions: Patterns of cognitive decline trajectory differed between PART and AD in amnestic MCI, suggesting a difference in the neuropathological course leading to progression to AD. PART may show greater decline in visuospatial attention compared to AD. It implies that PART has distinct neuropathological and clinical features compared to AD.

Background: Psychosis represents a major unmet medical need in patients with Alzheimer’s disease (AD) dementia. With no approved medications for AD dementia psychosis (ADP), current treatment relies on off-label uses of antipsychotics with limited efficacy and significant safety concerns. Xanomeline is an M1/M4 preferring

muscarinic receptor agonist that has previously been shown to have antipsychotic effects in subjects with AD (Bodick et al., 1997). While xanomeline had promising efficacy for potentially treating psychosis in AD, cholinergic adverse events limited further clinical development of xanomeline. Xanomeline and trospium is an investigational treatment that combines xanomeline with trospium, an FDA-approved non- specific muscarinic receptor antagonist. Unlike xanomeline, trospium does not measurably cross the blood-brain barrier, providing a mechanism to mitigate peripheral cholinergic effects of xanomeline while maintaining its muscarinic receptor agonist activities in the brain.

Methods: ADEPT-2 trial is a phase 3, randomized, double-blind, placebo-controlled, parallel group study to evaluate the safety and efficacy of xanomeline and trospium for the treatment of ADP. Subjects aged 55-90 years with moderate to severe psychosis associated with mild to severe AD dementia will be enrolled into the study. Eligible subjects will be randomized to receive either xanomeline and trospium or placebo in a double-blinded manner for 12 weeks and subjects who complete the study will be eligible to participate in a one-year, open-label safety extension study.

Results: The primary efficacy endpoint of the study is change from baseline to end of Week 12 in the Neuropsychiatric Inventory-Clinical (NPI-C): Hallucinations and Delusions (H+D) score and the key secondary efficacy endpoint is change from baseline to end of Week 12 in the Cohen- Mansfield Agitation Inventory (CMAI). The safety endpoints include the evaluation of safety and tolerability of xanomeline and trospium compared with placebo in subjects with ADP. The study started in 2023 and will enroll approximately 360 subjects with psychosis associated with AD dementia.

Conclusions: ADEPT-2 is designed to assess the safety and efficacy of xanomeline and trospium for the treatment of psychosis in patients with AD dementia. If ADEPT-2 is successful, xanomeline and trospium have the potential to be the first in a new class of pharmacologic treatment for AD psychosis based on muscarinic receptor agonism.