Correlates of Functional Impairment in Patients with the Behavioral Variant of Frontotemporal Dementia: A PRISMA-Compliant Systematic Review.

The behavioral variant of frontotemporal dementia (bvFTD) has a devastating effect on multiple domains of daily living. The purpose of this PRISMA-compliant systematic review is to summarize the most important factors associated with functional impairment in this clinical group by critically analyzing the existing literature spanning the period from 2000 to 2023. To be included in the review, a study had to investigate any kind of correlates of functional status in bvFTD patients, using a previously validated instrument of functional assessment. Out of 40 articles assessed for eligibility, 18 met the inclusion criteria. The anatomical pattern of cerebral atrophy at baseline appeared to be the strongest predictor of the rate of functional decline over time, with the frontal-dominant anatomical subtype being associated with a faster rate of functional impairment. Additionally, executive dysfunction as well as apathy appeared to contribute significantly to functional disability in bvFTD patients. A comparative examination of bvFTD in relation to other clinical subtypes of FTD and other types of dementia in general suggests that it is the predominant atrophy of the frontal lobes along with the subsequent unique combination of cognitive and neuropsychiatric manifestations that account for the pronounced functional limitations observed in these individuals, even from the early stages of the disease.

Alzheimer's Disease as Type 3 Diabetes: Common Pathophysiological Mechanisms between Alzheimer's Disease and Type 2 Diabetes.

Globally, the incidence of type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) epidemics is increasing rapidly and has huge financial and emotional costs. The purpose of the current review article is to discuss the shared pathophysiological connections between AD and T2DM. Research findings are presented to underline the vital role that insulin plays in the brain's neurotransmitters, homeostasis of energy, as well as memory capacity. The findings of this review indicate the existence of a mechanistic interplay between AD pathogenesis with T2DM and, especially, disrupted insulin signaling. AD and T2DM are interlinked with insulin resistance, neuroinflammation, oxidative stress, advanced glycosylation end products (AGEs), mitochondrial dysfunction and metabolic syndrome. Beta-amyloid, tau protein and amylin can accumulate in T2DM and AD brains. Given that the T2DM patients are not routinely evaluated in terms of their cognitive status, they are rarely treated for cognitive impairment. Similarly, AD patients are not routinely evaluated for high levels of insulin or for T2DM. Studies suggesting AD as a metabolic disease caused by insulin resistance in the brain also offer strong support for the hypothesis that AD is a type 3 diabetes.

Antidiabetic Drugs in the Treatment of Alzheimer's Disease.

The public health burden of type 2 diabetes mellitus and Alzheimer's disease is steadily increasing worldwide, especially in the population of older adults. Epidemiological and clinical studies suggest a possible shared pathophysiology between the two diseases and an increased risk of AD in patients with type 2 diabetes mellitus. Therefore, in recent years, there has been a substantial interest in identifying the mechanisms of action of antidiabetic drugs and their potential use in Alzheimer's disease. Human studies in patients with mild cognitive impairment and Alzheimer's disease have shown that administration of some antidiabetic medications, such as intranasal insulin, metformin, incretins, and thiazolidinediones, can improve cognition and memory. This review aims to examine the latest evidence on antidiabetic medications as a potential candidate for the treatment of Alzheimer's disease.

Normative Data for the Montreal Cognitive Assessment in Greek Older Adults With Subjective Cognitive Decline, Mild Cognitive Impairment and Dementia.

OBJECTIVE: The aim of the study was to provide normative data for the MoCA in a Greek cohort of people older than 60 years who meet criteria for subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia in order to optimize cutoff scores for each diagnostic group. METHOD: Seven hundred forty-six community-dwelling older adults, visitors of the Day Center of Alzheimer Hellas were randomly chosen. Three hundred seventy-nine of them met the criteria for dementia, 245 for MCI and 122 for SCD. RESULTS: Initial statistical analyses showed that the total MoCA score is not affected by gender (P = .164), or age (P = .144) but is affected by educational level (P < .001). A cutoff score of 23 for low educational level (≤6 years) can distinguish people with SCD from MCI (sensitivity 71.4%, specificity 84.2%), while 26 is the cutoff score for middle educational level (7-12 years; sensitivity 73.2%, specificity 67.0%) and high educational level (≥13 years; sensitivity 77.6%, specificity 74.7%). Montreal Cognitive Assessment can discriminate older adults with SCD from dementia, with a cutoff score of 20 for low educational level (sensitivity 100%, specificity 92.3%) and a cutoff score 23 for middle educational level (sensitivity 97.6%, specificity 92.7%) and high educational level (sensitivity 98.5%, specificity 100%). CONCLUSION: Montreal Cognitive Assessment is not affected by age or gender but is affected by the educational level. The discriminant potential of MoCA between SCD and MCI is good, while the discrimination of SCD from dementia is excellent.

Expectations of nursing personnel and physicians on dementia training : A descriptive survey in general hospitals in Germany and Greece.

BACKGROUND: The number of dementia training programs in hospital settings is steadily increasing. The way training sessions are designed influences the way the learning content is implemented in practice. To develop a successful training it is important to meet the needs of the target group; however, not much is known about staff preferences and expectations relevant to future dementia training programs in hospitals in Germany and Greece. OBJECTIVE: The aim of this survey was to explore staff training needs relevant to the topic of dementia, in general hospitals in Germany and Greece. This study analyzed the interests of staff members, preferences and expectations with respect to dementia training. MATERIAL AND METHODS: This was a descriptive survey based on a 54-item questionnaire conducted with 61 nursing staff, head nurses and physicians (Germany: n = 25, Greece: n = 36) recruited from 5 hospitals (Germany: n = 3, Greece: n = 2). Parts of the questionnaire explored participants' previous education regarding dementia and their expectations towards future dementia programs. RESULTS: Although staff attendance in educative programs was high in the last 5 years for both countries, participation in dementia training programs was low (Germany 24%, Greece 5.5%). Additionally, the great majority of participants were willing to be trained in future dementia training programs (Germany 96%, Greece 100%). Employees from both countries expect increased clinical skills as a result of participation in such training programs. In Greece, staff members hope for better handling of people with dementia, while in Germany, concrete practical advice is preferred. CONCLUSION: There seems to be a strong willingness to participate in further dementia training programs where not only theoretical knowledge is provided but also practical advice.

Retrogenetic models of working memory: Preliminary multi-group analysis.

AIM: The aim of the present study was the qualitative comparison of working memory capacity of young children and older adults through the investigation of the latent structure stability or change in Working Memory capacity (WM) in childhood and aging, using Multiple Group Confirmatory Factor Analysis (MGCFA). METHOD: The sample consisted of 62 kindergarten and 56 elementary school students (age range: 4-8 years) and 52 young-old adults and 54 old-old adults (age range: 60-94 years). Adults were asked to complete the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale-15 (GDS-15) as screening tests. The children were examined via the Raven Colored Progressive Matrix (CMP) test for the same reason. WM was examined via four measures of Working Memory Test Battery for Children (WMTB-C). RESULTS: MGCFA applied to the data of the kindergarten students' subsample, elementary school students' subsample, young-old and old-old adults' subsamples as well as of older adults with low (0-9 years of education) educational level. Initially, through MGCFA, four "models" were confirmed, one for each age-related subsample, and they were different from each other. However, when the same method was applied exclusively to young-old and old-old adults with low educational level, the models that emerged were similar to the kindergarten students' model. CONCLUSION: When we "keep" the educational level equal (low) for all, the hypothesis of retrogenesis is confirmed. Cognitive reserve appears to be protective, keeping differentiated WM's components in every age group other than that of kindergarten students. The results support the "retrogenetic" hypothesis, mainly due to the finding of a delay in WM components' development in the group of kindergarten students, and their dedifferentiation in the low-educated young-old and old-old adults.

The association between Alzheimer's disease and cancer: Systematic review - Meta-analysis.

The objective of the present study was the quantitative assessment of the previously documented inverse relationship between Alzheimer's Disease (AD) and cancer (CA) by conducting a meta-analysis and evaluating systematic differentiations of the aforementioned relationship based on cancer localization. For the purpose of the study all available empirical data of the last decade, which met specific criteria, were included in the analysis by querying PubMed, Web of Science and Cochrane Library databases. Seven studies were included in the analysis, with a total sample of 18,887 (10,859 AD patients, 8,028 non-demented controls) participants to calculate cancer risk among AD patients, and 11 studies, with a total of 5,607,076 (1,853,318 cancer patients, 3,753,758 healthy controls) participants, were assessed to evaluate AD risk among cancer patients. The analysis revealed that AD patients appear to have a reduced risk of cancer, by 40% (RR 0.60, 95% CI 0.45 - 0.79), while cancer history was associated with a reduced risk of AD, by 15% (RR 0.85, 95% CI 0.77-0.92). Systematic differences were also identified based on site-specific cancer. Indications of heterogeneity and publication bias were present in the analysis. Our meta-analysis is only the fourth conducted on this subject, with newer evidence suggesting a mitigation of the inverse relationship. We emphasize the need for new studies to assess the inverse comorbidity hypothesis, especially in AD patients.

Self-report instruments of cognitive failures as screening tools for Subjective Cognitive Impairment in older adults.

BACKGROUND: The term "Subjective Cognitive Impairment (SCI)" is the most widely accepted term for cognitive complaints of otherwise apparently healthy older adults. It is presently clear that SCI might be a risk factor for the development of Mild Cognitive Impairment and dementia. As regards SCI measurement and potential diagnosis, several studies showed that SCI is a condition in which people score in the normal range on common tests but believe they experience cognitive decline. Hence, to assess the characteristic of the SCI subtle cognitive decline, self-report measures were developed to estimate "self-experience" of minimal decline in cognition seem the most appropriate tools. In this vein, the present study aimed at examining the capacity of the Greek version of two self-report instruments of the aforementioned type to detect SCI in community dwelling older adults. MATERIAL AND METHODS: The study sample consisted of 295 participants, who were allocated into four age-groups: young adults, middle-aged adults, older adults and older-old adults. The first three groups were gender and education-matched. The participants were examined via two objective tests of the Delis-Kaplan Executive Function System (D-KEFS) which is a neuropsychological battery designed to measure executive functions. In specific, they were tested via the D-KEFS Tower Test (TT) which mainly measures "planning" function, and the D-KEFS Color-Word Interference Test (C-WIT) which primarily measures "inhibition" and "switching" functions. Both tests consist of four conditions. The participants were also asked to answer to: (a) the Cognitive Failures Questionnaire (CFQ), and (b) the Prospective and Retrospective Memory Questionnaire (PRMQ), which were designed to assess subjective estimations of everyday slips of actions and cognitive failures, and episodic memory slips in everyday life, respectively. As concerns the psychometric qualities of the two questionnaires, a single-factor structure of the Greek versions of the CFQ and the PRMQ was verified in a previous study via the application of Confirmatory Factor Analysis. RESULTS: No age-group effects on CFQ score were found. Receiver Operating Characteristic (ROC) curve analyses were subsequently performed, using objective tests' scores as test variables and CFQ classification based on the 75th percentile score, as state variable. ROC curves analyses using "C-WIT conditions' 1, 2 time of completion" as test variables and CFQ classification, in older adult age-group, as state variable, showed that a CFQ score ≥47 is indicative of an early stage of objective cognitive impairment in older age. Cronbach's α values, for the Prospective and Retrospective Memory Questionnaire ranged from .89 (young adults) to .93 (older adults). No age-group effects on PRMQ score were observed. ROC curves analyses were performed, using objective measures' scores as well as CFQ score as test variables and PRMQ classification based on the 75th percentile score, as state variable. These analyses using "C-WIT conditions' 3, 4 time of completion" as well as CFQ score as test variables and PRMQ classification, in older adult age-group, as state variable, showed that a PRMQ score ≥43 is indicative of an early stage of objective cognitive impairment as well as of subjective estimations of general cognitive decline in older age. CONCLUSION: Self-report questionnaires of "everyday" cognitive and memory failures seem to be associated with specific objective tests of cognition in aging. Hence, they are useful tools for detecting early cognitive impairment at least in older adults. Their administration together with objective cognitive tasks of high difficulty could substantially help for SCI screening. Given that there is also evidence that the experience of subtle impairment in cognition is related to increased likelihood of biomarker abnormalities indicative of AD pathology, the assessment of subjective estimations is revealed as a useful primary indicator of early AD effects on cognitive functioning.

Social cognition in adults: the role of cognitive control.

AIM: This study aimed at examining the direct and indirect, via cognitive control and emotion recognition, effects of advancing age on adults' social cognition, and especially, on complex forms of it such as indirect speech, faux pas, and social mental verb understanding. METHOD: The sample comprised a total of 70 adults, aged from 18 to 83 years. Participants were almost equally distributed in each one of three age-groups (young, middle-aged, and older adults), according to their gender and educational level. Three tasks measuring the ability to interpret indirect speech, the ability to understand faux pas, and social mental verb understanding, respectively, were administered as measures of social cognition. Cognitive control, as inhibitory control, task switching, updating-monitoring, and planning, as well as basic emotion decoding from visual cues, were measured by four and one task respectively. RESULTS: After the confirmation of the factor structure of each one of the dimensions of social cognition, and the examination of the direct effects of age on them, the all-inclusive path model finally confirmed showed that age has a significant negative indirect effect, via cognitive control, on social cognition as ability to interpret indirect speech and faux pas. CONCLUSION: The decreased performance that cognitively healthy older adults exhibit, as regards specific complex dimensions of social cognition, could be attributed to negative effects of age on cognitive control. However, it is likely that some other complex dimensions of social cognition are not affected by frontal aging.

Comparing the latent structure of Raven's educational coloured progressive matrices among young children and older adults: A preliminary study.

OBJECTIVE: The aim of the present study was the comparison of the general cognitive ability (g) between young children and older adults through the investigation of the latent structure qualitative changes in [R] Educational Coloured Progressive Matrices (CPM) from age to age, using Confirmatory Factor Analyses (CFA) and testing a conventional unidimensional model. METHOD: The sample consisted of 42 kindergarten and 56 elementary school students (age range: 5-8 years) and 118 new-old adults and 27 old-old adults (age range: 61-88 years). The participants' cognitive abilities were examined in: (a) the Raven's Educational CPM test, and (b) the Mini-Mental State Examination (MMSE). RESULTS: CFA applied to data of the total sample, elementary school students subsample and new-old adults subsample, indicating that individual variability across [R] CPM measured variables (total scores for each of the three sets) can be modeled by one latent variable (a single underlying factor). The same pattern of [R] CPM latent structure was not verified for the subsamples of kindergarten students and old-old adults, since the variance of a single underlying factor was not found to be statistically significant. CONCLUSION: The results support the existence of a different factor structure in [R] Educational CPM between first- to second- grade elementary school students and new-old adults, on the one hand, and kindergarten students and old-old adults, on the other. This difference could possibly reflect the underdevelopment of inductive reasoning and executive functioning in the group of kindergarten students and the disorganization of them in the group of old-old adults.

An Examination of the Motives for Attributing and Interpreting Deception in People with Amnestic Mild Cognitive Impairment.

The aim of the present study was to examine how a person with amnestic mild cognitive impairment perceives the phenomenon of deception. Amnestic mild cognitive impairment (aMCI) usually represents the prodromal phase of Alzheimer's disease (AD), with patients showing memory impairment but with normal activities of daily living. It was expected that aMCI patients would face difficulties in the attribution and interpretation of deceptive behavior due to deficits regarding their diagnosis. The main sample of the study consisted of 76 older adults who were patients of a daycare center diagnosed with aMCI. A sample of 55 highly educated young adults was also examined in the same experiment to qualitatively compare their performance with that of aMCI patients. Participants were assigned a scenario where a hypothetical partner (either a friend or a stranger) was engaged in a task in which the partner could lie to boost their earnings at the expense of the participant. The results showed that aMCI patients, even if they understood that something was going wrong, did not invest in interpretations of potential deception and tended to avoid searching for confirmative information related to the hypothetical lie of their partner compared to highly educated young adults. It seems that aMCI patients become somehow "innocent", and this is discussed in terms of cognitive impairment and/or socioemotional selectivity.

Subjective Cognitive Impairment Can Be Detected from the Decline of Complex Cognition: Findings from the Examination of Remedes 4 Alzheimer's (R4Alz) Structural Validity.

R4Alz is utilized for the early detection of minor neurocognitive disorders. It was designed to assess three main dimensions of cognitive-control abilities: working-memory capacity, attentional control, and executive functioning. OBJECTIVES: To reveal the cognitive-control dimensions that can differentiate between adults and older adults with healthy cognition, people with subjective cognitive impairment, and people diagnosed with mild cognitive impairment by examining the factorial structure of the R4Alz tool. METHODS: The study comprised 404 participants: (a) healthy adults (n = 192), (b) healthy older adults (n = 29), (c) people with SCI (n = 74), and (d) people diagnosed with MCI (n = 109). The R4Alz battery was administered to all participants, including tests that assess short-term memory storage, information processing, information updating in working memory, and selective, sustained and divided attention), task/rule-switching, inhibitory control, and cognitive flexibility. RESULTS: A two-factorial structural model was confirmed for R4Alz, with the first factor representing "fluid intelligence (FI)" and the second factor reflecting "executive functions (EF)". Both FI and EFs discriminate among all groups. CONCLUSIONS: The R4Alz battery presents sound construct validity, evaluating abilities in FI and EF. Both abilities can differentiate very early cognitive impairment (SCI) from healthy cognitive aging and MCI.

Attitudes of Family Members and Caregivers Regarding Alzheimer's Disease Pre-Symptomatic Screening.

Background: In recent years, studies have examined the acceptability and attitudes that influence the intention to early screen for Alzheimer's disease (AD) in the general population, older people, carers, and asymptomatic individuals who report a family history of AD. However, it remains unclear what specific factors promote or reduce the acceptability of pre-symptomatic screening. Objective: The aim of this study is to explore the attitudes of family and non-family members as well as caregivers and non-caregivers toward the pre-symptomatic screening of AD. Methods: A total of 213 participants completed the Perceptions regarding pRE-symptomatic Alzheimer's Disease Screening (PRE-ADS) Questionnaire. Group comparisons using t-test and one-way ANOVA were used to examine differences in attitudes toward pre-symptomatic screening regarding age, family history, knowing someone with AD, influence of depression, and feelings of anxiety. The subscale "Acceptability of Screening" was developed to investigate the willingness to undergo pre-symptomatic screening. Results: Participants with a family history showed greater acceptance of pre-symptomatic screening while both caregivers and non-caregivers had similar attitudes. People with a family history as well as those with personal connections to dementia indicate a greater need for knowledge. The findings suggest that younger adults appear to perceive less harm from testing, whereas those who experience higher levels of anxiety and depression seem to perceive more testing harms. Conclusions: Comparing the attitudes of people with and without a family history as well as caregivers and non-caregivers toward pre-symptomatic screening of AD is critical to understand the differences between these groups and develop comprehensive screening programs.

The Mixed Role of Sleep and Time of Day in Working Memory Performance of Older Adults with Mild Cognitive Impairment.

The importance of night sleep for maintaining good physical and cognitive health is well documented as well as its negative changes during aging. Since Mild Cognitive Impairment (MCI) patients bear additional disturbances in their sleep, this study aimed at examining whether there are potential mixed effects of sleep and afternoon time of day (ToD) on the storage, processing, and updating components of working memory (WM) capacity in older adults with MCI. In particular, the study compared patients' performance in the three working memory components, in two-time conditions: "early in the morning and after night sleep", and "in the afternoon and after many hours since night sleep". The Working Memory Capacity & Updating Task from the R4Alz battery was administered twice to 50 older adults diagnosed with MCI. The repeated measures analysis showed statistically significant higher performance in the morning condition for the working memory updating component (p < 0.001). Based on the findings, it seems that the afternoon ToD condition negatively affects tasks with high cognitive demands such as the WM updating task in MCI patients. These findings could determine the optimal timing for cognitive rehabilitation programs for MCI patients and the necessary sleep duration when they are engaged in cognitively demanding daily activities.

The Efficacy of a Metacognitive Training Program in Amnestic Mild Cognitive Impairment: A 6-Month Follow-Up Clinical Study.

This study was conducted in response to the increasing prevalence of Alzheimer's disease (AD) dementia and the significant risk faced by individuals with amnestic mild cognitive impairment with multiple-domain deficits (aMCI-md). Given the promising effects of MTPs, the primary aim of this study was to further explore their impact by assessing the maintenance of their benefits. Thus, 45 participants were randomly allocated in two groups: the Experimental group (n = 22), which received the metacognitive training program (MTP), and the Control group (n = 23) that received the cognitive exercises program (CEP). The training programs-the MTP and the CEP-included 10 individual sessions of a one-hour duration and took place once per week. To test the efficacy of the MTP, cognitive and metacognitive outcomes were compared between two groups-Experimental (EG) and Control (CG)-at four distinct time points: before-after-3 months-6 months after intervention. Based on this study's findings, the positive effects of the MTP were evident over a six-month period. Specifically, already three months post-training, the CG began to show a decline in training-related gains. In contrast, the EG's performance consistently improved, highlighting the superior efficacy of the MTP. Gains attributed to the MTP were detected in cognitive measures: cognitive flexibility and immediate visual recall, as well as in metacognitive measures: metacognitive control, improved metacognitive beliefs of attention, and an increased use of cognitive strategies. In conclusion, the results demonstrated the sustained effects of the MTP in cognitive and metacognitive measures over a period of six months, providing novel insight into the application and efficacy of the MTP in individuals with MCI.

Metacognitive beliefs of efficacy about daily life situations and use of cognitive strategies in amnestic mild cognitive impairment: a cross-sectional study.

Metacognition, the ability to monitor and regulate cognitive processes, is essential for individuals with Mild Cognitive Impairment (MCI) to accurately identify their deficits and effectively manage them. However, previous studies primarily focused on memory awareness in MCI, neglecting other domains affected in daily life. This study aimed to investigate how individuals with MCI perceive their abilities to handle various cognitively challenging situations representing real-life scenarios and their use of compensatory strategies. Thus 100 participants were recruited, including 50 with amnestic MCI with multiple deficits (aMCI) and 50 cognitively healthy controls (HC) matched in age and education. Participants completed three metacognitive scales assessing self-perceived efficacy in everyday life scenarios and one scale evaluating use of cognitive strategies. Results indicated that aMCI participants reported significantly lower self-efficacy in memory and divided-shifted attention scenarios compared to HC. Surprisingly, no significant group differences were found in the self-reports about the use of cognitive strategies. This suggests a potential gap in understanding or applying effective strategies for compensating cognitive deficits. These findings emphasize the importance of cognitive training programs targeting metacognitive knowledge enhancement and practical use of cognitive strategies that could enhance the quality of life for individuals with MCI.

The Relationships of Specific Cognitive Control Abilities with Objective and Subjective Sleep Parameters in Mild Cognitive Impairment: Revealing the Association between Cognitive Planning and Sleep Duration.

This study aimed to examine the associations between specific sleep parameters and specific aspects of cognitive functioning in individuals diagnosed with mild cognitive impairment (MCI), compared with healthy controls (HCs) by using cognitive, subjective, and objective sleep measures. A total of 179 participants were enrolled, all aged ≥ 65 years (mean age = 70.23; SD = 4.74) and with a minimum of six years of education (mean = 12.35; SD = 3.22). The sample included 46 HCs (36 females), 75 individuals with amnestic MCI (aMCI) (51 females), and 58 individuals with non-amnestic MCI (naMCI) (39 females). Inhibition, cognitive flexibility as a combined application of inhibitory control and set shifting or task/rule switching, and planning were examined. The following D-KEFS subtests were administered for their evaluation: Verbal Fluency Test, Color-Word Interference Test, and Tower Test. Self-reported sleep questionnaires (Athens Insomnia Scale, Stop-Bang questionnaire, and Pittsburg Sleep Quality Index) were used for subjective sleep assessments. Actigraphy was used for objective sleep measurements. Mixed-measures ANOVA, MANOVA, and one-way ANOVA, as well as the Scheffe post hoc test, were applied to the data. The results showed that the three groups exhibited statistically significant differences in the Tower Test (total achievement score, total number of administered problems, and total rule violations). As regards objective sleep measurements, the total sleep time (TST) was measured using actigraphy, and indicated that there are significant differences, with the HC group having a significantly higher mean TST compared to the naMCI group. The relationships evaluated in the TST Tower Test were found to be statistically significant. The findings are discussed in the context of potential parameters that can support the connection between sleep duration, measured as TST, and cognitive planning, as measured using the Tower Test.

Metacognitive Awareness of Older Adult Drivers with Mild Cognitive Impairment: Relationships with Demographics, Subjective Evaluation of Cognition, and Driving Self-Efficacy.

(1) Self-regulation of driving is a means of maintaining one's driving identity. The purpose of this study was to investigate the extent to which older drivers with Mild Cognitive Impairment (MCI) are metacognitively aware of the requirements of specific demanding driving conditions and whether this awareness is linked to subjective assessments of cognition. (2) One hundred seventeen (117) older MCI drivers participated in a telephone survey in which they reported their metacognitive experiences in nine driving conditions, listed as an aim of self-regulation. The analyses included the participants' subjective cognitive assessments, both in terms of their cognitive state and their perceived driving self-efficacy. (3) The analyses pointed out a direct and negative effect of age on the formation of the metacognitive feeling of certainty. Furthermore, an indirect effect of sex through driving self-efficacy was established. This effect was negative in the case of the metacognitive feeling of difficulty and the estimation of effort and positive in the case of the metacognitive feeling of certainty. (4) This position points out the need to establish appropriate levels of the perceived self-efficacy of older drivers with MCI, and it raises issues when it moves to fictitious levels.

Discriminant Potential of the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) in Greek Older Adults with Subjective Cognitive Decline and Mild Cognitive Impairment.

Background: Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) is a widely used screening tool for detecting older adults with Alzheimer's disease among their cognitively healthy peers. A previous study in Greek population showed that ADAS-Cog-Greek (G) is a valid tool and can identify people with Alzheimer's disease from older adult control group; however, there is no current data about whether ADAS-Cog can differentiate older adults with mild cognitive impairment (MCI) from those who have subjective cognitive decline (SCD). Objective: The current study aimed to examine the discriminant potential of ADAS-Cog-G in Greek older adults who meet the criteria for SCD or MCI. Methods: Four hundred eighty-two community-dwelling older adults, visitors of the Greek Alzheimer Association and Related Disorders, were enrolled in the current study. One hundred seventy-six of them met the criteria for SCD and three hundred six had MCI. Results: Path analysis applied to the data showed that age, as well as educational level affected ADAS-Cog-G performance. Results showed that the cut-off scores, which better discriminate people with SCD from MCI as well as their sensitivity and specificity values, were extracted in participants with high educational level (13 educational years<) and mainly under the age of 75 years. Conclusions: The current study provided evidence concerning the discriminant potential of ADAS-Cog-G to differentiate older adults with SCD from those with MCI in the Greek population, and therefore contributes to the relevant literature on the field.