Addressing Cyberscams and Acquired Brain Injury ("I Desperately Need to Know What to Do"): Qualitative Exploration of Clinicians' and Service Providers' Perspectives.

BACKGROUND: People with acquired brain injury (ABI) may be more susceptible to scams owing to postinjury cognitive and psychosocial consequences. Cyberscams result in financial loss and debilitating psychological impacts such as shame and mistrust, interference with neurorehabilitation, and reduced independence. Despite these significant consequences, there are no psychological treatments to support cyberscam survivors. There is limited evidence regarding how the current workforce is addressing post-ABI cyberscams. OBJECTIVE: This study aims to understand the perspectives and needs of clinicians and service providers in addressing post-ABI cyberscams. METHODS: Overall, 20 multidisciplinary clinicians and service providers were recruited through purposive sampling across Australia. Semistructured interviews explored post-ABI scam experiences and vulnerabilities, treatments and their efficacy, and recommendations for future cybersafety recovery interventions. Reflexive thematic analysis was used. RESULTS: In total, 8 themes encompassing a biopsychosocial understanding of scam vulnerabilities and impacts were identified: "genuine lack of awareness: cognitive-executive difficulties"; "not coping with the loss of it all"; "needing trust and connection"; "strong reactions of trusted others"; "nothing structured to do"; "financial stress and independence"; "cyberability"; and "scammer persuasion." Each theme informed clinical recommendations including the need to provide psychological and cognitive support, enhance financial and cybersafety skills, promote meaningful social engagement, and foster collaboration between families and clinical support teams. CONCLUSIONS: The multifaceted range of scam vulnerabilities and impacts highlighted the need for individualized, comprehensive, and targeted treatments using a biopsychosocial approach to enable cyberscam recovery among people with ABI. These findings will guide the development of a co-designed intervention.

Validation of the Informant Quick Dementia Rating System (QDRS) among Older Adults in Singapore.

BACKGROUND: The Quick Dementia Rating System (QDRS) is a brief and rapid tool that can be administered by an informant without the need for a trained assessor. OBJECTIVE: Our objective was to examine the validity, reliability, and cost-effectiveness of the informant QDRS in a Singapore memory clinic sample. METHODS: We assessed a total of 177 older adults, among whom, 32 had no cognitive impairment (NCI), 61 had mild cognitive impairment (MCI), and 84 had dementia. Elderly underwent 1) the informant QDRS, 2) the Clinical Dementia Rating (CDR) as the gold standard diagnosis, 3) the Mini-Mental State Examination (MMSE), and 4) the Ascertain Dementia 8 (AD8) as comparisons to the QDRS. The extent to which the QDRS may reduce the recruitment cost (time) of clinical trials was also calculated. RESULTS: The QDRS had excellent internal consistency (Cronbach alpha = 0.939). It correlated highly with the CDR-global (R = 0.897), CDR Sum-of-Boxes (R = 0.915), MMSE (R = -0.848), and the AD8 (R = 0.747), showing good concurrent validity. With an optimal cut-off of 1.5 for MCI (sensitivity 85.2%, specificity 96.3%) and 6 for dementia (sensitivity 90.1%, specificity 89.2%), the QDRS achieved a higher overall accuracy of 85.0%, as compared to MMSE (71.2%) and AD8 (73.4%). A simulated clinical trial recruitment scenario demonstrated that pre-screening with the QDRS followed by a confirmatory CDR would reduce the time needed to identify NCI subjects by 23.3% and MCI subjects by 75.3%. CONCLUSION: The QDRS is a reliable cognitive impairment screening tool which is suitable for informant-administration, especially for identification of MCI.

Cerebrovascular disease in suspected non-Alzheimer's pathophysiology and cognitive decline over time.

BACKGROUND: The underlying cause of cognitive decline in individuals who are positive for biomarkers of neurodegeneration (N) but negative for biomarkers of amyloid-beta (A), designated as Suspected non-Alzheimer's pathophysiology (SNAP), remains unclear. We evaluate whether cerebrovascular disease (CeVD) is more prevalent in those with SNAP compared to A-N- and A+N+ individuals and whether CeVD is associated with cognitive decline over time in SNAP patients. METHODS: A total of 216 individuals from a prospective memory clinic cohort (mean [SD] age, 72.7 [7.3] years, 100 women [56.5%]) were included and were diagnosed as no cognitive impairment (NCI), cognitive impairment no dementia (CIND), Alzheimer's dementia (AD) or vascular dementia (VaD). All individuals underwent clinical evaluation and neuropsychological assessment annually for up to 5 years. Carbon 11-labeled Pittsburgh Compound B ([11 C]-PiB) or [18 F]-flutafuranol-positron emission spectrometry imaging was performed to ascertain amyloid-beta status. Magnetic resonance imaging was performed to assess neurodegeneration as measured by medial temporal atrophy ≥2, as well as significant CeVD (sCeVD) burden, defined by cortical infarct count ≥1, Fazekas score ≥2, lacune count ≥2 or cerebral microbleed count ≥2. RESULTS: Of the 216 individuals, 50 (23.1%) A-N+ were (SNAP), 93 (43.1%) A-N-, 36 (16.7%) A+N- and 37 (17.1%) A+N+. A+N+ individuals were significantly older, while A+N+ and SNAP individuals were more likely to have dementia. The SNAP group had a higher prevalence of sCeVD (90.0%) compared to A-N-. Moreover, SNAP individuals with sCeVD had significantly steeper decline in global cognition compared to A-N- over 5 years (p = 0.042). CONCLUSIONS: These findings suggest that CeVD is a contributing factor to cognitive decline in SNAP. Therefore, SNAP individuals should be carefully assessed and treated for CeVD.

SINgapore GERiatric intervention study to reduce physical frailty and cognitive decline (SINGER)-pilot: A feasibility study.

INTRODUCTION: The SINGER pilot randomized controlled trial aims to examine the feasibility and acceptability of the Finnish Geriatric Intervention Study (FINGER) multi-domain lifestyle interventions compared to Singaporean adaptations. METHODS: Seventy elderly participants were recruited and randomized into FINGER (n = 36) or SINGER (n = 34) interventions; involving physical exercise, cognitive training, diet, and vascular risk factors management, for 6 months. RESULTS: Both intervention groups were equally feasible and acceptable with participants completing at least 80% of the interventions. Body strength improved in both groups (Pupper body = .04, P lower body = .06, P core = .05). More participants in the SINGER group attained good blood pressure control at month-6 compared to FINGER (41% vs 19%; P = .06). DISCUSSION: This study is the first to compare the feasibility of multi-domain interventions adapted to local culture with the FINGER interventions. The findings will be utilized for a larger study to provide evidence for the efficacy of multi-domain lifestyle interventions in preventing cognitive decline.

Demographic and social correlates and indicators for behavioural compliance with personal protection among Chinese community-dwellers during COVID-19: a cross-sectional study.

OBJECTIVES: Examine compliance with personal protective measures in communities for the prevention and control of local transmission of the COVID-19, and explore indicators for such behavioural compliance. DESIGN: Cross-sectional design with a self-selecting sample. Data collected in February 2020. SETTING: Community dwellers in China. PARTICIPANTS: 2956 participants aged 16 and above completed the study and were included in the analysis. OUTCOME MEASURES: Nationwide COVID-19 survey. Demographics and self-reported compliance with four personal protective measures-home quarantine, mask-wearing, temperature-taking and hand-sanitising were collected. Outbreak severity and timeliness of personal protection order were obtained from the China Center for Disease Control and Prevention website. Logistic regression models were employed to examine the association between demographic and social indicators and behavioural compliance. RESULTS: Compliance with home quarantine was only associated with gender (men, OR=0.61 (0.51-0.73), inverse association) but no other indicators. In contrast, men had higher compliance with mask-wearing (OR=1.79 (1.49-2.16)) and temperature-taking (OR=1.27 (1.05-1.53)). Compared with younger adults (≤20 years), the middle-age groups (31-40 and 41-50 years of age) were more compliant with all protective behaviours, except for home quarantine (OR=0.71 (0.54-0.93) and 0.67 (0.46-0.97), respectively). CONCLUSION: Male gender was associated with lower compliance with home quarantine yet higher compliance with mask-wearing and temperature-taking. The middle-age participants (31-50 years) had lower compliance with home quarantine but higher with other measures. These findings may be supported by the economic considerations and the long-inherited Confucian values among Chinese. In light of the ongoing COVID-19 pandemic, public health authorities should tailor policy implementation to disparities in psychosocial indicators.