Objectives: Older people with care needs are often supported by their older care-partners (50+). Over time, the increased demand in care needs can result in the care partner placing their own health needs aside. This study was aimed at establishing and piloting a novel co-designed Carer Health and Wellbeing Service (CHWS) that offers multidisciplinary (social work, psychology, occupational therapy, and physiotherapy) one-to-one support to care partners.

Methods: We conducted a pre-post 6-month study design including qualitative and quantitative Methods. Consenting individuals attending the CHWS completed five measures pre- and post- their interaction with the CHWS: Carer Support Needs Assessment Tool (CSNAT); Preparedness for Caregiving Scale (PCS); Family Appraisal of Caregiving Questionnaire (FACQ); EuroQoL Five Dimension Five Level Scale (EQ-5D-5L); and Health Economics Survey.

Results: Service operation commenced 1 day/week in March 2024 with 16 participants to date. Preliminary pre- service use indicates care partners feel underprepared for the carer role (particularly emotionally and psychologically), experience high levels of guilt when addressing their own care needs and are unsure about how to advocate or navigate the existing support system. Care partners have been coached to identify, prioritize, and address their current health and wellbeing needs. Additional findings regarding the implementation of the CHWS will be reported in this presentation.

Conclusions: The preliminary sample presents several emotional and psychological needs that need addressing. These will inform the type of support services to be provided as part of the CHWS, which will also be presented at the conference.

Objectives: Cancer’s impact on physical and mental health varies by sex. This study explores physical and neurocognitive characteristics among elderly cancer survivors and investigates sex- specific differences in cortical thickness related to a history of cancer.

Methods: This study is part of the Arakawa geriatric cohort study for people aged 65 years or older, consisting of 1,098 individuals. Participants provided a self-reported history of cancer and underwent face-to-face diagnostic interviews, Mini-Mental State Examination (MMSE), Geriatric depression scale 15 (GDS-15), Pittsburgh Sleep Quality Index (PSQI), and three- dimensional T1-weighted magnetic resonance imaging. Cortical thickness was measured using FreeSurfer software. We explored the associations between cortical thickness, cancer history, and clinical-demographic data using univariate and multivariable regression analyses. Each analysis was conducted for the entire sample and then stratified by sex.

Results: Of 1,098 participants, 189 (17.2%) reported a history of cancer. These individuals were generally older, with a higher proportion being men. Among men, those with cancer history had lower BMI, a higher prevalence of sleep disorders (PSQI ≥ 6), lower MMSE registration scores, and more MMSE comprehension impairments. Women with a cancer history showed no significant differences in sleep or cognitive functions. After adjusting for age, imaging acquisition site, education, estimated total intracranial volume, and dementia diagnosis, cortical thicknesses of cancer survivors was found to be reduced in the left posterior cingulate in men (B [95%CI)] = 0.31 [0.12–0.78]) and in the left paracentral lobule in women (B [95%CI] = 0.22 [0.02–0.54)]).

Conclusions: Cancer history in elderly adults is associated with sex-specific differences in physical, psychological, and brain structural characteristics. In men, links were observed with underweight, sleep disturbances, and specific cognitive dysfunctions alongside reduced cortical thickness in the left 2024 International Psychogeriatric Association International Congress, IPA posterior cingulate cortex. In women, no neuropsychological changes were noted, although reduction in left paracentral cortical thickness were identified. Future research should employ longitudinal Methods to deepen understanding of cancer’s long-term psychophysical effects, with an emphasis on sex-based differences.

Knuuttila and Morgan (2019) challenge the widespread understanding that deidealization is no more than a simple process of relaxing assumptions to build increasingly more realistic models. They submit that, in practice, processes of model deidealization are diverse and complex and thus warrant more explicit scrutiny. Drawing on a case from economics, my analysis extends their proposal by showing how narratives, as additional representational forms, can assume a crucial role in deidealizing mathematical models. I thereby propose to consider that processes of model deidealization are not necessarily exhausted by processes in which one theoretical mathematical model is replaced with another one.

Summary: The aging of the population poses significant challenges in healthcare, necessitating innovative approaches. Advancements in brain imaging and artificial intelligence now allow for characterizing an individual’s state through their brain age,’’ derived from observable brain features. Exploring an individual’s biological age’’ rather than chronological age is becoming crucial to identify relevant clinical indicators and refine risk models for age-related diseases. However, traditional brain age measurement has limitations, focusing solely on brain structure assessment while neglecting functional efficiency.

Our study focuses on developing neurocognitive ages’’ specific to cognitive systems to enhance the precision of decline estimation. Leveraging international (NKI2, ADNI) and Canadian (CIMA- Q, COMPASS-ND) databases with neuroimaging and neuropsychological data from older adults [control subjects with no cognitive impairment (CON): n = 1811; people living with mild cognitive impairment (MCI): n = 1341; with Alzheimer’s disease (AD): n= 513], we predicted individual brain ages within groups. These estimations were enriched with neuropsychological data to generate specific neurocognitive ages. We used longitudinal statistical models to map evolutionary trajectories. Comparing the accuracy of neurocognitive ages to traditional brain ages involved statistical learning techniques and precision measures.

The results demonstrated that neurocognitive age enhances the prediction of individual brain and cognition change trajectories related to aging and dementia. This promising approach could strengthen diagnostic reliability, facilitate early detection of at-risk profiles, and contribute to the emergence of precision gerontology/geriatrics.

We employ direct numerical simulations to investigate the heat transfer and flow structures in turbulent Rayleigh–Bénard convection in both cylindrical cells and laterally periodic domains, spanning an unprecedentedly wide range of aspect ratios $0.075 \leqslant \varGamma \leqslant 32$. We focus on Prandtl number ${Pr}=1$ and Rayleigh numbers ${{Ra}}=2\times 10^7$ and ${{Ra}}=10^8$. In both cases, with increasing aspect ratio, the heat transfer first increases, then reaches a maximum (which is more pronounced for the cylindrical case due to confinement effects), and then slightly goes down again before it finally saturates at the large aspect ratio limit, which is achieved already at $\varGamma \approx 4$. Already for $\varGamma \gtrsim 0.75$, the heat transfers in both cylindrical and laterally periodic domains become identical. The large-$\varGamma$ limit for the volume-integrated Reynolds number and the boundary layer thicknesses are also reached at $\varGamma \approx 4$. However, while the integral flow properties converge at $\varGamma \approx 4$, the confinement of a cylindrical domain impacts the temperature and velocity variance distributions up to $\varGamma \approx 16$, as thermal superstructures cannot form close to the sidewall.

In this study, we examine how local government debt responds to environmental policies in China. We show that when an environmental policy impacts the economy, local governments are likely to increase debt issuance, with this effect becoming stronger when local officials have greater career incentives within the Chinese bureaucratic system. Over-accumulation of local government debt, which leads to social welfare losses, is closely tied to the urgency local officials feel to secure promotions. Our analysis offers valuable insights for better coordination between fiscal and environmental policies.

Objectives: Activities that require active thinking, like occupations, may influence cognitive function and its change over time. Associations between retirement and dementia risk have been reported, however the role of retirement age in these associations is unclear. We assessed associations of occupation and retirement age with cognitive decline in the US community-based Atherosclerosis Risk in Communities (ARIC)cohort.

Methods: We included 14,090 ARIC participants, followed for changes in cognition during up to 21 years. Information on current or most recent occupation was collected at ARIC baseline (1987–1989; participants aged 45–64 years) and categorized according to the 1980 US Census protocols and the Nam-Powers-Boyd occupational status score. Follow-up data on retirement was collected during 1999–2007 and classified as retired versus not retired at age 70. Trajectories of global cognitive factor scores from ARIC visit 2 (1990–1992) to visit 5 (2011–2013) were presented, and associations with occupation and age at retirement were studied using generalized estimating equation models, stratified by race and sex, and adjusted for demographics andcomorbidities.

Results: Mean age (SD) at first cognitive assessment was 57.0 (5.72) years. Higher occupational status and white- collar occupations were significantly associated with higher cognitive function at baseline. Occupation was associated with cognitive decline over 21 years only in women, and the direction of the effect on cognitive function differed between black and white women: in white women, the decline in cognitive function was greater in homemakers and low status occupations, whereas in black women, less decline was found in homemakers and low (compared to high) occupational status. Interestingly, retirement on or before age 70 was associated with less 21-year cognitive decline in all race-sex strata, except for blackwomen.

Conclusions: Associations between occupation, retirement age and cognitive function substantially differed by race and sex. Further research should explore reasons for the observed associations and race-sex differences.

Objectives: This systematic review aims to analyze the safety of mirtazapine in patients aged 60 years or older, as well as its side effects in this population.

Methods: A systematic literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. Searches were conducted in the Embase, LILACS, PsycINFO, PubMed, Scopus, and Web of Science for articles published in any language using the terms Mirtazapine AND (pharmacovigilance OR ‘side effect*’ OR ‘adverse reaction*’ OR ‘adverse event*’ OR safety). This review was registered in PROSPERO: CRD42023492249.

Results: Seventy-two papers met the inclusion criteria. A total of 12.983.837 patients aged 60 or over included the studies selected for this systematic review. Most of the reported indications (54.1%) were for depression. The most reported adverse events were drowsiness (5–30%), dry mouth (1–37.5%), constipation (3.9–23.2%), urinary infection (8.8–24%), fractures (0.3–18.6%) and risk of death (0.28–1.7%). From the included randomized controlled trials, comparing mirtazapine with placebo, mirtazapine resulted in higher rates of dry mouth. Compared with amitriptyline, mirtazapine had lower risk of dry mouth and drowsiness, and a higher risk of constipation. Compared with fluoxetine, mirtazapine had higher rates of drowsiness and dry mouth.

Conclusions: This work provides full characterization of mirtazapine safety in older people, which may help healthcare providers better anticipate, prevent and manage adverse events in this population.

The dominant mode instability in hypersonic boundary-layer transition is the so-called second-mode instability, which has a peculiar nature strongly coupled with thermoacoustic phenomena. In linear stability theory, the unstable wave is associated with one of the two eigenvalues that originate from the acoustic branches, referred to as slow and fast modes. Interestingly, the unstable mode (slow or fast) reaches its maximum amplification as the other mode (fast or slow) attains a minimum. The phase velocity of the two modes is then very close, and this phenomenon is called synchronization. The aim of the present study is to unravel the physical mechanism that explains the second-mode growth. To that aim, second-order nonlinear equations are written for the disturbances given by linear stability. In this framework, entropy, kinetic energy and temperature energy budgets are obtained up to second order. The budgets are scrutinized for various Mach numbers and for adiabatic and cold-wall thermal conditions. Perturbation entropy budgets clearly show the process is a reversible one. An energy exchange between kinetic energy and temperature energy of the weakly nonlinear modes is driven by pressure–dilatation terms. As underlined in previous studies, the unstable mode experiences an alternate heating and cooling near the wall, which is shown to be a rather nonlinear process. The change in fluctuating thermal energy in the form of a dilatational wave is sustained by pumping disturbance kinetic energy through the pressure–dilatation term, the direction of the conversion being driven by the relative phase between pressure and dilatation. This process is similar for the slow and fast modes, the unstable mode being amplified and the other being damped. No change in the process has been noted at the location of the synchronization, suggesting that the modes have the same nature but evolve independently.

Background: Within nursing home care, the role of professional caregivers is paramount. While certain caregiver behaviors, such as personal attention, can positively affect residents’ mood, limited attention has been given to the automatic cognitive processes guiding these behaviors. Automatic cognitive processes refer to mental operations that occur rapidly and effortlessly, often beyond conscious awareness. These processes can impact habits and preferences, thereby influencing behavior.

Objective: This study aimed to develop and evaluate two pictorial Implicit Association Tasks(IATs) to measure nursing home caregivers’ implicit associations with mood-improving behaviors for residents, focusing on implicit valence (liking) and motivation (wanting) regarding these behaviors.

Methods: Study 1 (N = 41) involved developing the Valence towards Behaviors to improve residents’ Mood IAT (VBM-IAT) and the Motivation for Behaviors to improve residents’ Mood IAT (MBM-IAT), and evaluating the content validity of target stimuli representing mood-improving behaviors. Study 2 (N = 230) examined stimulus classification ease (accuracy and speed) for both target and attribute stimuli (representing positive or negative valence, and motivation or demotivation). Additionally, the IATs’ internal consistency was examined. A sub- sample (N = 111) examined test-retest reliability, convergent validity (with self-reported attitude towards depression, altruism, and mood-improving behaviors), and divergent validity (against social desirability).

Results: Content validity was satisfactory (CVI: ≥ .85). Error rates were acceptable for attribute stimuli (4.0%), but above the accepted limit of 10% for target stimuli (12.4%). All stimuli exhibited prolonged response times exceeding the desirable 800 ms threshold. The VBM-IAT and MBM-IAT demonstrated good internal consistency (rsb: .81; .85, respectively) but poor test-retest reliability (ICC: .29; .25). Mixed model analysis showed that both IATs correlated with altruism (estimated effect: .28, 95% CI [.11, .45]; .24 [.07, .42]). The VBM-IAT related to self- reported mood-improving behaviors (.20 [.03,.36]), while the MBM-IAT associated with the behavioral subscale of attitude towards depression (.21 [.03, .39]). The IATs did not significantly correlate with other scales.

Conclusions: The IATs show potential in measuring caregivers’ implicit valence and motivation regarding behaviors to improve residents’ mood, offering an innovative pathway for investigating automatic cognitive processes in caregiving. However, some limitations in psychometric properties were identified, aligning with challenges in similar IATs.

Objective: Higher intimacy is associated with less behavioral and psychological symptoms of dementia (BPSD) in people with dementia, however, the processes underlying this association remain unclear. This study investigates the role of expressed emotion (EE) and relationship closeness between caregivers and patients with dementia in the manifestation of BPSD.

Methods: We recruited 56 families with dementia and collected 3-month longitudinal data including demographic details of current family caregivers providing care, caregiving relationship closeness (RCS), and BPSD measured using the Neuropsychiatric Questionnaire (NPI-Q). We assessed EE using the validated Family Attitudes Scale (FAS), where higher scores indicate greater intensity of expressed emotion. Correlational and mediation analyses were conducted using baseline and three-month follow-up data to explore the relationships between RCS, EE, and BPSD. Mediation analysis was performed using the SPSS PROCESS Version 4.1 macro. The study received approval from the Institutional Review Board of Osaka University.

Results: Correlation analysis showed that there was significance between RCS and BPSD at baseline and third month (r = –0.301, p < 0.05), and between EE and BPSD (r = 0.378, p < 0.001). Furthermore, mediation analysis demonstrated that caregivers’ EE significantly mediated the association between RCS and BPSD in dementia patients. The indirect effect of RCS on BPSD through caregivers’ EE was found to be significant, with a 95% confidence interval (CI) of (–0.6097, –0.1790), where the CI excludes zero. This indicates that the mediation effect of caregivers’ EE on the relationship between RCS and BPSD is statisticallysignificant.

Conclusions: It suggests that interventions aimed at improving caregiver-patient relationships and managing caregivers’ EE could be crucial in mitigating BPSD, providing a direction for future research and intervention development to support both patients and their families in the dementia care.

Background: Dementia is rapidly increasing in Asia.

Aim: There has been an Asian forum to ascertain country-specific patterns of management of dementia and to investigate country-specific characteristics.

Methods: In 2009, 11 dementia experts on Alzheimer’s from Korea, Japan, mainland China, Hong Kong China, Taiwan, Singapore, Philippines, Malaysia, Indonesia, Thailand, and India were invited to participate in the survey. The 33-item questionnaire were answered; awareness of dementia, characteristics of patients with memory problems, referral, diagnosis of MCI and dementia, diagnostic tools including the high-technology device, pharmacological treatment of MCI and dementia, current issues on AD, barriers and challenges in the management of dementia. Since then, 3 surveys have been completed in 2009, 2012, and 2024.

Results: New revised research diagnostic criteria for AD needing spinal tapping and brain imaging might not be adopted for clinical practice in memory clinics in Asia. Brain imaging studies like CT, MRI, SPECT, or PET are applied for more than 75% of patients as a usual part of the diagnostic workup in Korea, Japan, mainland China, Taiwan, Singapore, Indonesia, and Thailand, while 51 ∼ 75% in Philippines and 25 ∼ 50% in Hong Kong, Malaysia, and India. Proportion of patients who continue pharmacological treatment after the initial diagnosis of dementia varies country by country varies. Most countries endorsed all approved anti- dementia drugs, but some others approved a few of them (i.e., only donepezil present in Japan, galantamine absent in China, memantine absent in Indonesia, rivastigmine absent in Thailand. Cholinesterase inhibitors are prescribed in more than 90% of patients in 6 countries (i.e. Korea, Japan, Taiwan, Singapore, Philippines, Malaysia). In other 5 countries, medications like memantine, huperzine, ginkgo biloba, vitamin E, herb medicine or others are being more frequently prescribed than in above 6 countries.

Conclusions: Well-organized and planned governmental policies about dementia, in collaboration with dementia experts and their organizations, will effectively reduce burden of dementia in Asia, where an epidemic tide of dementia is approaching.

Objectives: To describe and analyze the knowledge and resources of Community Health Workers (CHWs) in delivering an evidence-based mental health community intervention for older adults with depression (VIDACTIVA’’) in an urban low-income setting in Lima, Peru. CHWs delivered a multi-component intervention that includes problem-solving, behavioral activation, and psychoeducation over eight sessions. We analyze data integrating CHWs perspectives to assess the feasibility and acceptability of the intervention.

Methods: We conducted a qualitative study with 16 CHWs aged 45 to 73 who delivered VIDACTIVA’’ program to 32 older adults. Over an 18-month period, we collected data through in-depth interviews with CHWs, field notes from weekly meetings with them to assess the progress of older adults, and an exploratory-artistic workshop that produced collages with poetic narratives and short testimonial videos. These data collection Methods aimed to elicit both individual and collective assessments of CHWs’ experiences delivering theprogram.

Beyond traditional data collection, we provided a reflective space for CHWs to consider the meaning of their work and identify lessons learned throughout the intervention.

Results: We identified three key learnings and resources employed by CHWs: 1) Trust and rapport: Good listening and establishing trustworthy interpersonal bonds were crucial in building rapport and respect when working with vulnerable older adults in insecure peri-urban areas of Lima. 2) Adapting session settings: CHWs adapted the conditions of the sessions to ensure viability, such as moving sessions from the older adults’ home to a public area where older adults felt safer discussing family issues. Additionally, CHWs sometimes refrained from wearing uniforms and ID cards that identified them as mental health agents to avoid the stigma associated with mental health illnesses. 3) Addressing urgent needs: CHWs took concrete actions to meet the urgent needs of the most vulnerable older adults, such as arranging medical appointments or accompanying them to the hospital.

Conclusions: CHWs primarily focused on strategies that build strong and intimate interpersonal bonds, which made the sessions viable, accepted, and appreciated by older adult participants. We highlight the importance of leveraging CHWs’ experience and knowledge as a critical factor for enhancing acceptability and feasibility in conducting community-based interventions.

Phoneme discrimination is believed to be less accurate in non-native languages compared to native ones. What remains unclear is whether differences in pre-attentive phonological processing emerge between the first foreign language (L2) and additional ones (L3/Ln), and whether they might be influenced by the acquisition setting (formal vs. naturalistic). We conducted an event-related brain potential oddball study with native Polish learners of English (L2) and Norwegian (L3/Ln). The results revealed a graded amplitude of the mismatch negativity (MMN) effect, which was largest in L1, smaller in L2, and smallest in L3/Ln. Considering the previously obtained results for naturalistic/mixed learners with the same language combination, we believe that the acquisition setting is an important factor influencing the perception of phonemic contrasts. In the naturalistic group, no difference was observed between L1 and L2, while the instructed group exhibited more fine-grained distinctions between all tested languages.

Objectives: Highlight the presentation of behavioral symptoms in addition to the classic clinical trial in idiopathic normal pressure hydrocephalus in the elderly. Identify apathy as the most prevalent behavioral symptom in normal pressure hydrocephalus (NPH) in the elderly.

Methods: A bibliographic review of apathy as a behavioral symptom of NPH is carried out. Likewise, in addition to highlighting apathy as a possible diagnostic marker, the evidence of it as a prognostic marker of therapeutic response is discussed. For this, a review of publications in English and Spanish from the last 10 years was carried out in databases including Cochrane Library, EMBASE, MEDLINE/PubMed, SCOPUS. The MESH terms apathy, Hakims-Adams, idiopathic normal pressure hydrocephalus, chronic hydrocephalus, neuropsychiatric symptoms were used for the search.

Results: Sixteen articles were selected that verified the heterogeneity of the diagnostic criteria for apathy for its detection in patients with NPH. Likewise, it is identified that apathy is the most prevalent behavioral alteration with a prevalence of 60% of patients in this condition. Regarding its predictive value as a prognostic marker for shunt surgical treatment, the evidence is not conclusive either to confirm or to rule out the usefulness of apathy. Conclusions: Apathy should be considered as another diagnostic key in NPH. Thus, the classic description of this condition as a motor-cognitive-urinary syndrome must be reconceptualized as a motor-cognitive-behavioral- urinary syndrome.

We introduce a continuum framework for the energetics of particle-size segregation in bidisperse granular flows. Building on continuum segregation equations and a recent segregation flux model, the proposed framework offers general analytical expressions to study the physics of granular flows from a mechanical energy perspective. We demonstrate the framework's applicability by examining the energetics of shear-driven granular flows. Numerical experiments with varying frictional coefficients and particle-size ratios reveal two distinct phases in the energetics, marked by the separate onset of particle segregation and diffusive remixing. Furthermore, our numerical simulations alongside previous experimental results show that the bulk Richardson number $Ri$, defined as the potential energy to kinetic energy ratio at steady state, follows the scaling relationship $Ri\equiv \hat {E}^{(s)}_{gp} / \hat {E}^{(s)}_{k} \propto Pe^{-1/2}_{sr}$ for $0.1 \leq Ri\leq ~10^{3}$ and $10^{-4} \leq Pe_{sr} \leq ~300$, the segregation–rheology Péclet number. Finally, we present a Péclet-number-dependent theoretical expression for the degree of mixing (or segregation), validated by the compiled numerical and experimental dataset. Our findings hint that the bulk segregation–mixing state can be predicted and controlled using the segregation Péclet number $Pe$ and $Pe_{sr}$, both determined from known system parameters, providing an instrumental tool for engineering and geophysical applications.

Objectives: The study aims to: (i) develop a clinical post-fall assessment tool for older adults in long-term care (LTC) settings; (ii) validate the tool’s effectiveness and usability; and (iii) assess the practical application and impact of the tool within LTC units.

Methods: The three-phase study employed a sequential exploratory mixed-Methods framework. Phase I: Tool development comprised a comprehensive literature review and a qualitative study of semi-structured interviews with nine healthcare professionals. Phase II: Validation adopted an embedded design, where qualitative perceptions from 18 professionals through two focus groups informed iterative improvements and a quantitative questionnaire (a Likert scale and open-ended questions) assessed the tool’s effectiveness and user experience. Phase III: Implementation encompassed a retrospective and prospective longitudinal study, focusing on fall incidence, communication efficacy, and usability, to gauge the tool’s real-world impact.

Results: From Phase I, a mnemonic checklist was developed and structured into five sections: patient characteristics, fall description, primary and secondary assessments, and post-fall management—selected for clinical practicality. In Phase II, focus group insights prompted refinements to the tool, while follow-up questionnaires indicated the tool’s substantial utility in enhancing practice (65%), communication (69%), usability (71%), and satisfaction (76%). Responses highlighted key challenges such as resistance to change and workload, contrasting with facilitators like availability and uniformity. The need for training and a period of adaptation were viewed as factors that could compromise use. In Phase III, the tool showed greater utility for identifying fall-related complications and managing falls, with a notable preference among all nurses, regardless of experience level, particularly those with less than 5 years of experience.

Moreover, a comparison of falls over two three-month periods—one without the tool and one with it—revealed that the tool enhanced communication between doctors and nurses. This improvement led to quicker notification of doctors and more efficient transfers of patients to the emergency room when necessary.

Conclusions: Our tool aims to improve comprehensive post-fall assessments for older adults in LTC settings, facilitating improved communication and decision-making among healthcare professionals. With its usability and practical design, this mnemonic checklist shows great potential for wide adoption in enhancing patient care practices.

Objectives: To highlight the importance of differential diagnosis in the psychogeriatric context, with an emphasis on Lewy Body Dementia (LBD).

Case Report: A 68-year-old woman with 6 years of education presented with symptoms of hypobulia, social withdrawal, sadness, and anhedonia 10 years ago. Concurrently, she experienced delusions and visual hallucinations, believing that armed neighbors were entering her house to kill her. She began psychiatric treatment at the Geriatric Psychiatry department at UNIFESP, where she was diagnosed with depressive disorder with psychotic symptoms and panic disorder. She was started on sertraline, and due to QT interval prolongation with risperidone and quetiapine, clozapine 100mg was introduced, without extrapyramidal signs and symptoms She experienced remission of visual hallucinations but developed apathy but started to exhibit periods of mental confusion. During follow-up, cognitive impairment was noted, and a diagnosis of dementia was made. She began forgetting to turn off the stove, leaving doors open, and getting lost in unfamiliar places. MRI of the brain (2017) showed diffuse bilateral atrophy, and SPECT (2018) showed diffuse (non-localized) hypoperfusion, as per medical records. The attending team referred her for joint evaluation, suspecting frontotemporal dementia and behavioral variant Alzheimer’s disease due to observed apathy and behavioral changes. She was referred for follow-up at the Behavioral Neurology Clinic at UNIFESP. The patient was evaluated by behavioral, sleep, and extrapyramidal neurology clinics. All concurred on the most probable diagnosis of Lewy body dementia (LBD), characterized initially by well- defined visual hallucinations of deceased relatives interacting with her, significant movement during sleep with vocalization and dream enactment, rigidity, gait instability that worsened with antipsychotic treatment, episodes of inattention, and marked apathy. Cognitive fluctuation was noted by her husband and confirmed by the application of the MMSE in different consultations. Galantamine 24mg was prescribed, leading to initial improvement in cognitive complaints at the start of treatment.

Discussion: Lewy Body Dementia is the second most common neurodegenerative disease causing dementia. It is believed to be vastly underdiagnosed, with a significant disparity between the number of clinically diagnosed cases and those diagnosed via neuropathology at postmortem autopsy. According to a study conducted by Auning E et al., which differentiated the presenting complaints of DLB and AD, the most common complaint reported by DLB patients was memory dysfunction, with a prevalence of 57%, followed by visual hallucinations (44%), depression (34%), problem-solving difficulties (33%), gait disturbances (28%), and tremor and stiffness (25%), all features presented by the patient in this case report.

Conclusions: Specificity and diagnostic accuracy in the clinical setting remain challenges in the diagnosis of DLB. In the clinical setting, DLB is often misdiagnosed.