Remote testing in Abbiategrasso (RTA): results from a counterbalanced cross-over study on direct-to-home neuropsychology with older adults.

BACKGROUND: The SARS-CoV-2 pandemic forced to rethink teleneuropsychology, since neuropsychological assessments started to be performed by phone or videoconference, with personal devices and without direct assistance from the clinician, a practice called "Direct-To-Home NeuroPsychology" (DTH-NP). AIMS: The present study, employing a counterbalanced cross-over design, was aimed at evaluating (1) the feasibility and (2) the acceptability of DTH-NP in Italian older adults without previously diagnosed neurocognitive disorder, (3) the comparability between remote and face-to-face administration of selected neuropsychological tests. METHODS: Fifty-eight community-dwelling older adults (65-85 years) were randomly assigned to one of two groups performing a complete neuropsychological assessment remotely (via phone call and videoconference) and face-to-face, in a counterbalance order, 8 weeks apart. The study recruitment rate was calculated, and the number of uncompleted tests and acceptability questionnaire responses were compared between the two administration modalities. Comparability was defined as good reliability of DTH-NP (intraclass correlation coefficient) and agreement between remote and face-to-face scores (Bland-Altman plots). RESULTS: Recruitment rate was 81%, with a preference for telephonic contact (79%). The acceptability analysis did not reveal any issues related to the DTH-NP assessment, even if most participants would rather repeat it face-to-face. Tests assessing short-term memory, language, and reasoning showed good comparability. DISCUSSION AND CONCLUSION: Our results point out to a good recruitment rate in a DTH-NP study in an Italian population of older adults (mean age = 80), satisfying acceptability of DTH-NP and remote-face-to-face comparability of certain verbally mediated tests. Further studies including larger samples in videoconference modality, and outpatients, could better clarify its strengths and limits.

Life during COVID-19 lockdown in Italy: the influence of cognitive state on psychosocial, behavioral and lifestyle profiles of older adults.

OBJECTIVE: Few studies have examined lockdown effects on the way of living and well-being of older adults stratified by cognitive state. Since cognitive deficits are common in this population, we investigated how cognition influenced their understanding of the pandemic, socio-behavioral responses and lifestyle adaptations during lockdown, and how these factors affected their mood or memory. METHOD: Telephone-based survey involving 204 older adults ≥65 y/o (median: 82) with previous assessments of cognitive state: 164 normal-old (NOLD), 24 mild-neurocognitive disorder (mild-NCD), 18 mild-moderate dementia. A structured questionnaire was developed to assess psychological and socio-behavioral variables. Logistic regression was used to ascertain their effects on mood and memory. RESULTS: With increasing cognitive deficits, understanding of the pandemic and the ability to follow lockdown policies, adapt to lifestyle changes, and maintain remote interactions decreased. Participants with dementia were more depressed; NOLDs remained physically and mentally active but were more bored and anxious. Sleeping and health problems independently increased the likelihood of depression (OR: 2.29; CI: 1.06-4.93; p = 0.034 and OR: 2.45; CI: 1.16-5.16; p = 0.018, respectively); Regular exercise was protective (OR: 0.30; CI: 0.12-0.72; p = 0.007). Worsening subjective memory complaints were associated with dementia (p = 0.006) and depression (p = 0.004); New-onset sleeping problems raised their odds (OR: 10.26; CI: 1.13-93.41; p = 0.039). Finally, >40% with health problems avoided healthcare mainly due to fear of contagion. DISCUSSION: NOLD and mild-NCD groups showed similar mood-behavioral profiles suggesting better tolerance of lockdown. Those with dementia were unable to adapt and suffered from depression and cognitive complaints. To counteract lockdown effects, physical and mental activities and digital literacy should be encouraged.

Effect of a Social Networking Site Training on Cognitive Performance in Healthy Older People and Role of Personality Traits. Results from the Randomized Controlled Trial Ageing in a Networked Society-Social Experiment (ANS-SE) Study.

OBJECTIVES: The study aimed to evaluate the short-term efficacy of social network sites (SNSs) training on cognitive performance in cognitively healthy older individuals, and to explore the influence of personality traits on cognitive benefits of SNSs training. METHODS: The Aging in a Networked Society-Social Experiment study was a randomized controlled trial with three arms: intervention group (course on SNSs use), active control group (lifestyle education) and waiting list. Among the 180 eligible participants, 144 participated, 115 completed the study. The assessment comprised: Stroop Color and Word Test, Wechsler tests (Digit span, Symbol search, Coding), and Eysenck Personality Questionnaire- Revised- Short Form. RESULTS: There was no significant cognitive improvement for treatment group versus the control groups. Time interference significantly worsened in lifestyle education group compared to the waiting list, after controlling for baseline test scores and personality traits. CONCLUSION: The present study does not support the usefulness of SNSs training with healthy older adults. The educational content of lifestyle education is not an inert condition among individuals with high levels of neuroticism and socially desirable responding. There is a need to design experimental conditions in the control groups which do not influence participant's outcomes.

Estimating the potential for dementia prevention through modifiable risk factors elimination in the real-world setting: a population-based study.

BACKGROUND: Preventing dementia onset is one of the global public health priorities: around 35% of dementia cases could be attributable to modifiable risk factors. These estimates relied on secondary data and did not consider the concurrent effect of non-modifiable factors and death. Here, we aimed to estimate the potential reduction of dementia incidence due to modifiable risk factors elimination, controlling for non-modifiable risk factors and for the competing risk of death. METHODS: Participants from the InveCe.Ab population-based prospective cohort (Abbiategrasso, Italy) without a baseline dementia diagnosis and attending at least one follow-up visit were included (N = 1100). Participants underwent multidimensional assessment at baseline and after 2, 4, and 8 years, from November 2009 to January 2019. Modifiable risk factors were low education, obesity, hypertension, diabetes, depression, smoking, physical inactivity, hearing loss, loneliness, heart disease, stroke, head injury, and delirium. Non-modifiable risk factors were age, sex, and APOE ε4 genotype. The primary endpoint was dementia diagnosis within the follow-up period (DSM-IV criteria). We performed competing risk regression models to obtain sub-hazard ratio (SHR) for each exposure, with death as competing risk. The exposures associated with dementia were included in a multivariable model to estimate their independent influence on dementia and the corresponding population attributable fraction (PAF). RESULTS: Within the study period (mean follow-up, 82.3 months), 111 participants developed dementia (10.1%). In the multivariable model, APOE ε4 (SHR = 1.89, 95% CI 1.22-2.92, p = 0.005), diabetes (SHR = 1.56, 95% CI 1.00-2.39, p = 0.043), heart disease (SHR = 1.56, 95% CI 1.03-2.36, p = 0.037), stroke (SHR = 2.31, 95% CI 1.35-3.95, p = 0.002), and delirium (SHR = 8.70, 95% CI 3.26-23.24, p <  0.001) were independently associated with increased dementia risk. In the present cohort, around 40% of dementia cases could be attributable to preventable comorbid diseases. CONCLUSIONS: APOE ε4, diabetes, heart disease, stroke, and delirium independently increased the risk of late-life dementia, controlling for the competing risk of death. Preventive intervention addressed to these clinical populations could be an effective approach to reduce dementia incidence. Further studies on different population-based cohort are needed to obtain more generalizable findings of the potential of dementia prevention in the real-world setting. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01345110 .

Loneliness and Social Engagement in Older Adults Based in Lombardy during the COVID-19 Lockdown: The Long-Term Effects of a Course on Social Networking Sites Use.

Older adults are less familiar with communication technology, which became essential to maintain social contacts during the COVID-19 lockdown. The present study aimed at exploring how older adults, previously trained for Social Networking Sites (SNSs) use, experienced the lockdown period. In the first two weeks of May 2020, telephone surveys were conducted with individuals aged 81-85 years and resident in Abbiategrasso (Milan), who previously participated in a study aimed at evaluating the impact of SNSs use on loneliness in old age (ClinicalTrials.gov, NCT04242628). We collected information on SNSs use, self-perceived loneliness, and social engagement with family and friends. Interviewed participants were stratified as trained (N = 60) and untrained (N = 70) for SNSs use, based on their attendance to group courses held the previous year as part of the main experimental study. The groups were comparable for sociodemographics and clinical features. Participants trained for SNSs use reported significantly higher usage of SNSs and reduced feeling of being left out. Compared to pre-lockdown levels, individuals trained for SNSs use showed a lighter reduction in social contacts. These findings support the utility of training older adults for SNSs use in order to improve their social inclusion, even in extreme conditions of self-isolation and perceived vulnerability.

Assessing the impact of Social Networking Site use on older people's loneliness and social isolation. A randomized controlled trial: The Aging in a Networked Society-Social Experiment Study (ANS-SE).

INTRODUCTION: An ageing society poses unprecedented challenges to societies. Information and Communication Technologies (ICTs), including Social Networking Sites (SNSs), may contribute to contrast loneliness and social isolation in old age. Despite of the potentialities of SNSs, there is only a handful of studies assessing the causal relationship of SNS use and older people's well-being. This paper aims to provide further evidence on the design of randomised controlled trials exploring the causal impact of SNS use on loneliness and social isolation in old age. METHODS AND ANALYSIS: The Aging in a Networked Society-Social Experiment Study (ANS-SE) is a randomised controlled trial conducted on people aged 75 and over residing in a town located in the Milan area (Italy) aiming to assess the impact of SNS use on loneliness and social isolation (i.e. the primary outcomes of this study). The study is constituted of two stages, i.e. the baseline and the follow up. The experiment is structured into one treatment group and two control groups; the interventions are the attendance to a course on SNS use (T1) and lifestyle education and brain functioning (C1). The inactive control group (C) is constituted of a waiting list. We will perform bivariate and regression analysis. ETHICS AND DISSEMINATION: The study has been approved by the Ethic Committee of the University of Milano Bicocca (prot. 431/2019) and was registered at Clinical Trials.gov (NCT04242628). Written consent was obtained from all respondents. Results from the study will be discussed with the local community and stakeholders, presented in national and international conferences and published in leading peer-review journals. The consent forms, the anonymised dataset, and the relevant statistical codes will be deposited with the Italian Unidata archive, also in charge of releasing the data to the public, upon a short embargo period.