This study investigates the relationship between insomnia and cognitive dysfunctions including, subjective memory impairment (SMI), mild cognitive impairment (MCI), and dementia, by considering depression in a community sample of elderly individuals.

Data for 1,740 elderly individuals aged 65 years and over were obtained from a nationwide dementia epidemiological study conducted in South Korea. Cognitive functional status was assessed by the Mini-Mental State Examination and the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet Clinical Assessment Battery. Insomnia was defined as the presence of at least one of the four sleep complaints (difficulty in initiating sleep, difficulty in maintaining sleep, early morning awakening, and non-restorative sleep), accompanied by moderate to severe daytime consequences. Depression was evaluated using the Geriatric Depression Scale.

The prevalence of insomnia in the patients with SMI, MCI, and dementia was found to be 23.2%, 19.6%, and 31.0%, respectively. The patients with SMI, MCI, and dementia were significantly more likely to have insomnia and the four sleep complaints than the normal comparison patients. After adjusting for sociodemographic factors, the significant relationships between cognitive dysfunctional status and insomnia remained. However, after adjusting for sociodemographic factors and depression, no significant relationships with any of the sleep complaints or insomnia remained.

Insomnia is a very common complaint in the elderly with SMI, MCI, and dementia. Depression might play an important factor in the relationship between insomnia and cognitive dysfunctional status in the elderly.

Depression is a common comorbid disorder of dementia. This study explores the prevalence of and factors associated with depressive symptomatology, and antidepressant prescription rates in severe dementia across eight European countries.

In total, 414 people with severe dementia completed measures of cognition and quality of life (QoL), whilst carers completed proxy measures of activities of daily living (ADLs), depression, neuropsychiatric symptoms, QoL and comorbidity.

Findings indicated that 30% of the sample had depression, whilst the highest and lowest prevalence of depression was reported in Germany and Finland, respectively. Lower QoL, the presence of pain and more frequent neuropsychiatric symptoms were associated with depressive symptomatology, whilst no significant relationship between impairment of ADLs, comorbidity, and depression emerged. Spain and Estonia had the highest and lowest rates of antidepressant prescribing, respectively, whilst Germany had the highest discrepancy between depressive symptomatology and prescription.

The study highlights variations across countries in the prevalence of depressive symptomatology in severe dementia and prescription of antidepressants. Information about factors associated with depressive symptomatology may help to better identify and manage depression.

The Longitudinal Aging Study in India (LASI) was initiated to capture data to be comparable to the Health and Retirement Survey (HRS) and hence used study instruments from the HRS. However, a rigorous psychometric evaluation before adaptation of cognitive tests may have indicated bias due to diversities across Indian states such as education, ethnicity, and urbanicity. In the present analysis, we evaluated if items show differential item functioning (DIF) by literacy, urbanicity, and education status.

We calculated proportions for each item and weighted descriptive statistics of demographic characteristics in LASI. Next, we evaluated item-level measurement differences by testing for DIF using the alignment approach implemented using Mplus software.

We found that cognitive items in the LASI interview demonstrate bias by education and literacy, but not urbanicity. Items relating to animal (word) fluency show DIF. The model rates correct identification of the prime minister as the most difficult binary response item whereas the day of the week and numeracy items are rated comparatively easier.

Our study would facilitate comparison across education, literacy and urbancity to support analyses of differences in cognitive status. This would help future instrument development efforts by recognizing potentially problematic items in certain subgroups.

Impaired olfaction may be a biomarker for early Lewy body disease, but its value in mild cognitive impairment with Lewy bodies (MCI-LB) is unknown. We compared olfaction in MCI-LB with MCI due to Alzheimer’s disease (MCI-AD) and healthy older adults. We hypothesized that olfactory function would be worse in probable MCI-LB than in both MCI-AD and healthy comparison subjects (HC).

Cross-sectional study assessing olfaction using Sniffin’ Sticks 16 (SS-16) in MCI-LB, MCI-AD, and HC with longitudinal follow-up. Differences were adjusted for age, and receiver operating characteristic (ROC) curves were used for discriminating MCI-LB from MCI-AD and HC.

Participants were recruited from Memory Services in the North East of England.

Thirty-eight probable MCI-LB, 33 MCI-AD, 19 possible MCI-LB, and 32HC.

Olfaction was assessed using SS-16 and a questionnaire.

Participants with probable MCI-LB had worse olfaction than both MCI-AD (age-adjusted mean difference (B) = 2.05, 95% CI: 0.62–3.49, p = 0.005) and HC (B = 3.96, 95% CI: 2.51–5.40, p < 0.001). The previously identified cutoff score for the SS-16 of ≤ 10 had 84% sensitivity for probable MCI-LB (95% CI: 69–94%), but 30% specificity versus MCI-AD. ROC analysis found a lower cutoff of ≤ 7 was better (63% sensitivity for MCI-LB, with 73% specificity vs MCI-AD and 97% vs HC). Asking about olfactory impairments was not useful in identifying them.

MCI-LB had worse olfaction than MCI-AD and normal aging. A lower cutoff score of ≤ 7 is required when using SS-16 in such patients. Olfactory testing may have value in identifying early LB disease in memory services.

This study examined the relationships between social capital, perceived neighborhood environment, and depressive symptoms among older adults living in rural China, and the moderating effect of self-rated health (SRH) in these relationships.

A quota sampling method was applied to recruit 447 participants aged 60 years and older in rural communities in Jilin province, China in 2019.

Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. Structural equation modeling was used to build latent constructs of social capital and test the proposed model. Multiple group analysis was used to test the moderation effects.

Cognitive social capital and structural social capital were both associated with depressive symptoms controlling for participants’ demographics, socioeconomic status, and health status. After adding perceived environment variables in the model, the relationship between cognitive social capital and depressive symptoms became nonsignificant, while structural social capital remained became a significant factor (β = −.168, p < .01). Satisfaction with health care was significantly associated with depressive symptoms among those with poor SRH (β = −.272, p < .01), whereas satisfaction with security and transportation were strongly associated with depressive symptoms among those with good SRH (security: β = −.148, p < .01; transportation: β = −.174, p < .01).

Study findings highlighted the importance of social capital and neighborhood environment as potential protective factors of depressive symptoms in later life. Policy and intervention implications were also discussed.

One common finding in analyses of health systems with respect to dementia is that there is a “diagnosis gap” in dementia with less than a half of those with dementia ever attracting a diagnosis of dementia. The service response to this has been to develop memory clinics and other services to enable good quality diagnosis of the syndrome of dementia and its sub-types.

This narrative review considers who memory assessment services are for and what they should aim to achieve. We will consider the evidence base and discuss “what good looks like.”

The sparsity of the evidence base for the provision of memory services is striking. There is a lack of studies that have evaluated the absolute and relative impact of different models of diagnostic services or the impact of diagnosis and stage of illness at diagnosis.

There remains genuine uncertainly about: the positive and negative impacts of receiving the diagnosis of dementia; the effects of receiving the diagnosis of dementia at an earlier or later stage; and how best to provide memory assessment services in terms of clinical and cost-effectiveness. We need applied health research designed to fill these important evidence gaps, resolving uncertainty, and allowing the development and delivery of efficient and effective services and policy to enable people to live well with dementia. The methodology that will be needed will be a challenge since, due to ethical and practical considerations, it is likely to have to be observational rather than experimental.

Depressive symptoms are a leading cause of disability and emotional suffering, particularly in old age. However, evidence on depression and old age in developing countries remains largely ignored. The aim of this study was to examine the relation between health behavior and social conditions with depression among dependent community-dwelling older persons in the Republic of Chile.

This is a cross-sectional and inferential study, using nationally representative secondary data. Two models used logistic regression on 640 dependent community-dwelling older persons from all over Chile, who personally answered a depression assessment, excluding those taking antidepressants. The geriatric depression scale (GDS-15) was used as outcome. The first model aims at any kind of depression (GDS 5>). The second aims at severe depression (GDS 10>). As exposure, we used the health behavior and social conditions of the older persons. Socio-demographic and physical conditions were used as adjustment.

44.5% of the older persons presented depressive symptoms. Among them, 11% had severe depression. Logistic regression showed that significant detrimental factors for being depressed in both models were visiting the doctor five times or over because of acute diseases, feeling uncomfortable with their living arrangement, and feeling discriminated. On the other hand, every additional day of physical exercise and living alone had a beneficial and detrimental effect only in model one.

Analyses on ways to support older persons living alone and the promotion of physical exercise to avoid depression are needed, along with a deeper understanding of the comfort with their living arrangement. Finally, ways to address the discrimination among older persons should be further explored.

Literature indicates that people's experiences of receiving a diagnosis of dementia can have a lasting impact on well-being. Psychiatrists frequently lead in communicating a diagnosis but little is known about the factors that could contribute to potential disparities between actual and best practice with regard to diagnostic disclosure. A clearer understanding of psychiatrists’ subjective experiences of disclosure is therefore needed to improve adherence to best practice guidelines and ensure that diagnostic disclosure facilitates living well with dementia.

This study utilized qualitative methodology. Semi-structured interviews conducted with 11 psychiatrists were analyzed using Interpretive Phenomenological Analysis (IPA).

Three superordinate and nine subordinate themes emerged from the data analysis. These included the following: (i) “The levels of well-being” (Continuing with life, Keeping a sense of who they are, Acceptance of the self), (ii) “Living well is a process” (Disclosure can set the scene for well-being, Positive but realistic messages, Whose role it is to support well-being?), and (iii) Ideal care versus real care (Supporting well-being is not prioritized, There isn't time, The fragmentation of care).

Findings indicate that psychiatrists frame well-being in dementia as a multi-faceted biopsychosocial construct but that certain nihilistic attitudes may affect how well-being is integrated into diagnostic communication. Such attitudes were linked with the perceived threat of dementia and limitations of post-diagnostic care. Behaviors used to manage the negative affect associated with ethical and clinical tensions triggered by attempts to facilitate well-being at the point of diagnosis, and their impact on adherence to best practice disclosure, are discussed.