The worldwide costs of dementia in 2019.

INTRODUCTION: Dementia is a leading cause of death and disability globally. Estimating total societal costs demonstrates the wide impact of dementia and its main direct and indirect economic components. METHODS: We constructed a global cost model for dementia, presenting costs as cumulated global and regional costs. RESULTS: In 2019, the annual global societal costs of dementia were estimated at US $1313.4 billion for 55.2 million people with dementia, corresponding to US $23,796 per person with dementia. Of the total, US $213.2 billion (16%) were direct medical costs, US $448.7 billion (34%) direct social sector costs (including long-term care), and US $651.4 billion (50%) costs of informal care. DISCUSSION: The huge costs of dementia worldwide place enormous strains on care systems and families alike. Although most people with dementia live in low- and middle-income countries, highest total and per-person costs are seen in high-income countries. HIGHLIGHTS: Global economic costs of dementia were estimated to reach US $1313.4 in 2019. Sixty-one percent of people with dementia live in low-and middle-income countries, whereas 74% of the costs occur in high-income countries. The impact of informal care accounts for about 50% of the global costs. The development of a long-term care infrastructure is a great challenge for low-and middle-income countries. There is a great need for more cost studies, particularly in low- and middle-income countries. Discussions of a framework for global cost comparisons are needed.

Brain health as a global priority.

Brain health is an evolving concept that has become increasingly popular within clinical and academic centers, journalism and the general public. It can be defined as the state of brain functioning across cognitive, sensory, social-emotional, behavioural and motor domains, allowing a person to realize their full potential over the life course. Multiple, interconnected determinants play a role in shaping brain health from pre-conception through the end of life. Brain health can be optimized by addressing the following determinants: physical health, healthy environments, safety and security, learning and social connection, and access to quality services. Optimizing brain health improves brain structure and functioning across all domains and benefits health by lowering rates of neurological disorders, mental health conditions, and substance use; improving quality of life for people with lived experience of these conditions; and improving physical health (particularly through improved endocrine and immunological functioning and lower rates of stress-related physical health conditions). Additionally, optimizing brain health can lead to social and economic benefits including increased school retention and academic achievement, lower rates of teenage pregnancies, lower rates of incarceration, lower health care costs and rates of disability, higher productivity, and greater wealth. Optimizing brain health for all is paramount to ensuring human health and well-being globally. It is central to achieving global commitments outlined in the Intersectoral global action plan on epilepsy and other neurological disorders 2022-2031, WHO's Triple Billion targets, the UN SDGs and the 2021 Geneva Charter for Well-being. Efforts to optimize brain health require multi-stakeholder collaborations and must be integrated across all sectors of society: health and social care; education; legislature and governance; finance and economy; employment; infrastructure, urban planning and housing; and ecology, nature and climate. In return, robust investments in actions that optimize brain health across the life course promise to improve multiple health outcomes and lift development and well-being globally. Multisectoral engagement and collaboration are urgently needed in order to move the brain health agenda forward for all people.

Harmonizing neuropsychological assessment for mild neurocognitive disorders in Europe.

INTRODUCTION: Harmonized neuropsychological assessment for neurocognitive disorders, an international priority for valid and reliable diagnostic procedures, has been achieved only in specific countries or research contexts. METHODS: To harmonize the assessment of mild cognitive impairment in Europe, a workshop (Geneva, May 2018) convened stakeholders, methodologists, academic, and non-academic clinicians and experts from European, US, and Australian harmonization initiatives. RESULTS: With formal presentations and thematic working-groups we defined a standard battery consistent with the U.S. Uniform DataSet, version 3, and homogeneous methodology to obtain consistent normative data across tests and languages. Adaptations consist of including two tests specific to typical Alzheimer's disease and behavioral variant frontotemporal dementia. The methodology for harmonized normative data includes consensus definition of cognitively normal controls, classification of confounding factors (age, sex, and education), and calculation of minimum sample sizes. DISCUSSION: This expert consensus allows harmonizing the diagnosis of neurocognitive disorders across European countries and possibly beyond.

Dementia and caregiver burden: A three-year longitudinal study.

OBJECTIVES: Dementia, with its progressive cognitive and functional decline and associated neuropsychiatric symptoms, places a large burden on caregivers. While frequently studied, longitudinal findings about the overall trajectory of burden are mixed. The study sought to characterize caregiver burden over a 3-year period and identify predictors of this burden. METHODS: Seven-hundred-and-eighty-one patients with dementia were recruited from nine memory clinics around Australia. Measures of caregiver burden, cognition, function, and neuropsychiatric symptoms were completed with patients and their caregivers at regular intervals over a 3-year period. Patients' level of services and medication use were also recorded. RESULTS: Of the 720 patients with measures of caregiver burden at baseline, 47.4% of caregivers had clinically significant levels of burden. This proportion increased over time, with 56.8% affected at 3 years. Overall levels of burden increased for caregivers of patients without services, though did not change for caregivers of patients receiving services or residential care after controlling for other variables. Patient characteristics-including greater neuropsychiatric symptoms, lower functional ability, fewer medications, lack of driving ability-and female sex of caregivers were associated with greater burden. CONCLUSIONS: High levels of caregiver burden are present in a large proportion of caregivers of people with dementia and this increases over time for those without services. Clinical characteristics of patients (including neuropsychiatric symptoms, function, overall health, driving status), level of services, and caregiver sex appear to be the best predictors of this burden. These characteristics may help identify caregivers at greater risk of burden to target for intervention.

Mild Cognitive Impairment and Caregiver Burden: A 3-Year-Longitudinal Study.

OBJECTIVES: Mild cognitive impairment (MCI) is common, affecting 10%-35% of people over 65, and poses unique challenges for patients and their caregivers. Comparatively little research has examined caregiver burden in this population, with longitudinal research, in particular, lacking. We examined caregiver burden in a sample of people with MCI over 3 years. DESIGN: Three-year observational study. SETTING: Nine memory clinics in Australia. PARTICIPANTS: One-hundred-and-eighty-five people with MCI and their caregivers. MEASUREMENTS: Measures of caregiver burden, cognition, function, neuropsychiatric symptoms, driving status, and medication use were completed with patients and their caregivers at regular intervals over a 3-year period. RESULTS: Between 21.1% and 29.5% of caregivers reported a clinically significant level of burden over the study. Patients' higher levels of neuropsychiatric symptoms, lower functional ability, and lack of driving ability, and caregivers' employment were associated with greater caregiver burden over time. Caregiver burden did not increase over time when controlling for patient and caregiver characteristics. CONCLUSIONS: High levels of caregiver burden are present in a significant proportion of caregivers of people with MCI. Clinical characteristics of patients - including severity of neuropsychiatric symptoms and functional impairment - and the employment status of caregivers predict burden. Such characteristics may help identify caregivers at greater risk of burden to target for intervention.

Validity and reliability of the Persian version of general practitioner assessment of cognition (P-GPCOG).

Objectives: The study aimed to examine the validity, reliability, and practicality of the Persian version of the General Practitioner Assessment of Cognition (P-GPCOG) as a brief, efficient cognitive assessment instrument in Iranian older adults. Method: The sample comprised 151 community-dwelling older adults and 79 nursing home residents (aged ≥60 years). The English GPCOG was translated, back-translated, and revised to prepare the final P-GPCOG. The Abbreviated Mental Test score (AMTs) and the Depression in Old Age Scale (DIA-S) were administered to the two different samples to establish the convergent and discriminant validity of the P-GPCOG. Results: The mean age of the sample was 70.67 (SD = 9.51); 57.4% were male. The mean P-GPCOG scores for the total, cognitive and informant subscales were 7.67 (SD = 4.59), 4.18 (SD = 2.73), and 3.49 (SD = 2.24), respectively. Cognitive (P < 0.001), informant (P < 0.001) and total scores (P < 0.001) differed significantly between community-dwelling participants and nursing home residents. Worse cognitive performance on the P-GPCOG correlated significantly with worse scores on the AMTs (r = 0.61, P < 0.001) and less so with depressive symptoms as measured with the DIA-S (r = -0.20, P < 0.05). Cronbach's alpha for the P-GPCOG cognitive and informant subscales were 0.90 and 0.83 respectively, indicating a high degree of internal consistency and homogeneity between items. The test-retest correlation for the total P-GPCOG score was 0.82 in 30 participants after 19 days. P-GPCOG cognitive scores correlated significantly with education. Conclusion: The P-GPCOG displayed strong psychometric properties, offering healthcare professionals a quick and efficient cognitive instrument for older Persian speakers. As with other cognitive assessment tools, the P-GPCOG cognitive score is affected by a person's level of education.

Management of Nursing Home Residents Following Acute Hospitalization: Efficacy of the "Regular Early Assessment Post-Discharge (REAP)" Intervention.

OBJECTIVES: Rehospitalization of nursing home (NH) residents is frequent, costly, potentially avoidable and associated with diminished quality of life and poor survival. This study aims to evaluate the impact and cost-effectiveness of the Regular Early Assessment Post-Discharge (REAP) protocol of coordinated specialist geriatrician and nurse practitioner visits on rates of rehospitalization, hospital length of stay, and emergency department presentations for NH residents recently discharged from hospital. DESIGN: Prospective randomized controlled study of recently hospitalized NH residents. SETTING: Twenty-one of 24 eligible NHs within the geographical catchment area of St George Hospital, a 650-bed university hospital in Sydney, Australia. PARTICIPANTS: NH residents from eligible facilities admitted to St George Hospital's geriatric service were enrolled prior to hospital discharge. INTERVENTION: REAP intervention of monthly coordinated specialist geriatrician and nurse practitioner assessments within participants' NHs for 6 months following hospital discharge. MEASUREMENTS: Impact of the REAP intervention on hospital readmissions, hospital inpatient days, emergency department utilization, general practitioner visits, investigations and associated costs during the study intervention period. RESULTS: Forty-three NH residents were randomly allocated to REAP intervention (n = 22) or control (n = 21) groups. The REAP intervention group had almost two-thirds fewer hospital readmissions (P = .03; Cohen's d = 0.73) and half as many emergency department visits than controls. Total costs were 50% lower in the REAP intervention group, with lower total hospital inpatient (P = .04; Cohen's d = 0.63) and total emergency department (P = .04; Cohen's d = 0.65) costs. CONCLUSION: Cost-effective reductions in the utilization of hospital-related services were demonstrated following implementation of the REAP intervention for NH residents recently discharged from hospital.

A Comprehensive Review of the Quality and Feasibility of Dementia Assessment Measures: The Dementia Outcomes Measurement Suite.

The diagnosis of dementia and the management of its associated symptoms are aided by high-quality assessment tools. However, there is disagreement on the optimal tools among abundant alternatives and lack of consistent quality standards across the different domains of dementia-related change (ie, cognition, severity, function, behavioral and psychological symptoms, delirium, quality of life). Standardization is difficult because the relevance of a measurement tool for health professionals may depend on the clinical setting and on the dementia type and severity. To address this need, we conducted a comprehensive and clinically relevant evidence-based review of dementia-related tools and present a set of recommended tools, the Dementia Outcomes Measurement Suite. The review revealed that considerable development has occurred in terms of assessment of persons with mild cognitive impairment, executive dysfunction, cognitively mediated functional change, and apathy. More research is needed to develop and validate tools to assess health-related quality of life and specific symptoms of dementia including anxiety, wandering, and repetitive vocalizations. This extensive overview of the quality of different measures may serve as a guide for health professionals clinically and for researchers developing new or improved dementia assessment tools.

Validation of the General Practitioner Assessment of Cognition - Chinese version (GPCOG-C) in China.

BACKGROUND: To assess the reliability, validity, and diagnostic utility of the Chinese version of General Practitioner Assessment of Cognition (GPCOG-C). The GPCOG, which is specifically designed for use in primary care to screen for cognitive impairment, consists of a patient section testing cognition, and an informant section asking about decline in cognitive and functional abilities. METHODS: The English version of GPCOG was translated, back-translated, and subsequently revised to determine the final GPCOG-C. Our sample comprised 253 community-dwelling volunteers with memory concerns aged 50 years and over and 103 outpatients of a psychogeriatric clinic with memory complaints. Participants were assessed by one of the four general practitioners or six psychogeriatricians. The Mini-Mental State Examination (MMSE), the Hasegawa's Dementia Scale (HDS), and the GPCOG-C were compared against the DSM-IV-defined dementia diagnosis. RESULTS: The internal consistency (Cronbach's α) was 0.68 for the GPCOG patient section. The test-retest was 0.98 for the GPCOG-C total. The sequential administration of both components of GPCOG-C had a sensitivity of 97% and a specificity of 89%, with a positive predictive value of 72% and a negative predictive value of 99%. Both the GPCOG-C total and sequential two-stage scoring methods performed at least well as the MMSE and HDS in detecting dementia. The administration time for the two-stage approach was 4.3 ± 2.4 min. CONCLUSIONS: The GPCOG-C is a valid, time efficient instrument for dementia screening in China.

Predictors and outcomes for caregivers of people with mild cognitive impairment: a systematic literature review.

BACKGROUND: Dementia caregiving is strongly linked to depression, anxiety, and burden in caregivers. Little is known about whether the same holds for people supporting an older person with mild cognitive impairment (MCI). We aim to systematically review the current evidence for negative caregiver outcomes in MCI using Pearlin and colleagues' stress process model as a theoretical framework. METHODS: Widely used scientific literature databases were searched using MCI- and caregiver-related terms with "AND" relations. Results were limited to quantitative English language articles published in peer-reviewed journals between 1980 and November 2010. RESULTS: Of the 266 identified articles, six reported relevant depression data on 988 MCI caregivers (73% spouses). The pooled Center for Epidemiologic Studies Depression scale (CES-D) mean score was 12.95 (standard deviation = 6.16). The pooled depression prevalence (i.e., CES-D score ≥ 16 or equivalent) was 23%. Two studies compared depression in MCI and dementia caregivers, indicating higher levels in dementia caregivers. Other outcomes, such as burden, stress, or anxiety, were only investigated by individual studies precluding pooling of data. Similarly, pooling of the data on the predictors of caregiver outcomes was impossible because of data heterogeneity. However, descriptive analysis of predictors revealed that Pearlin and colleagues' caregiver stress process model at least partially applies to the MCI context. CONCLUSIONS: The studies reviewed were all cross sectional in design, involving clinical samples, thus limiting generalizability. Depression and psychological comorbidity, although not as pronounced as in dementia caregivers, are common complications in MCI caregivers. The long-term course of outcomes in MCI caregivers requires further investigation.