Can cerebrospinal fluid biomarkers tell us something about financial capacity in Alzheimer's disease patients? A preliminary study.

BACKGROUND: Although diagnostic markers in cerebrospinal fluid (CSF) have become a rapidly growing research field, they have not as yet been investigated in relation to capacities that are of interest to geriatric psychiatry and neuropsychology, such as financial capacity. The aim of this study was to assess whether CSF biomarkers can predict financial capacity in patients with a diagnosis of major neurocognitive disorder due to Alzheimer's disease (AD). METHODS: Participants were examined with a number of neuropsychological tests, with an emphasis on the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) and CSF tests. RESULTS: Amyloid ß peptide 1-42 (Aß42), total tau, and phosphorylated tau were not found to predict financial capacity performance in AD, but MMSE shows a strong positive correlation with LCPLTAS. CONCLUSIONS: These preliminary findings indicate that complex cognitive functions, such as financial capacity, may not be directly linked to CSF concentrations of the abovementioned biomarkers. Further studies with larger numbers of patients will be required to assess the reproducibility of these findings and to determine whether this approach can assist not only in diagnosis but also in neuropsychological assessment.

Language Markers of Dementia and Their Role in Early Diagnosis of Alzheimer's Disease: Exploring Grammatical and Syntactic Competence via Sentence Repetition.

Background: Earlier research focuses primarily on the cognitive changes due to Alzheimer's disease (AD); however, little is known with regard to changes in language competence across the lifespan. Objective: The present study aims to investigate the decline of language skills at the grammatical and syntactic levels due to changes in cognitive function. Methods: We administered the Litmus Sentence Repetition Task (SRT) to 150 native speakers of Greek who fall into five groups: 1) young healthy speakers, 2) cognitively intact elder healthy speakers, 3) speakers with subjective cognitive impairment (SCI), 4) speakers with mild cognitive impairment (MCI); and 5) speakers with AD dementia at the mild/moderate stages. All participants underwent a physical and neurological examination and cognitive screening with a standardized neuropsychological battery to assess cognitive status comprehensively and evaluate aspects like working memory, executive function, attention and memory to appropriately classify them. Results: The data analysis revealed that the SRT had high discriminatory value in the development of AD; specifically, both accuracy and grammaticality indices were related to cognitive decline. Additionally, syntax significantly affected the performance of speakers with structures such as clitics being particularly challenging and in most structures the performance of speakers with MCI drops significantly compared to speakers with SCI. Conclusions: Linguistic indices revealed subtle early signs of cognitive decline that can be helpful in the early detection of AD, thus facilitating the clinical process offering support to language-based assessment tools such as sentence repetition, a non-invasive type of assessment to evaluate symptoms of AD.

Assessing the Linguistic Capacity Across Alzheimer's Disease and Its Preclinical Stages: Evidence from Narrative Macrostructure in Elderly Speakers of Greek.

Background: The assessment of language deficits can be valuable in the early clinical diagnosis of neurodegenerative disorders, including Alzheimer's disease (AD). Objective: The present study aims to explore whether language markers at the macrostructural level could assist with the placement of an individual across the dementia continuum employing production data from structured narratives. Methods: We administered a Picture Sequence Narrative Discourse Task to 170 speakers of Greek: young healthy controls (yHC), cognitively intact healthy elders (eHC), elder participants with subjective cognitive impairment (SCI), with mild cognitive impairment (MCI), and with AD dementia at the mild/moderate stages. Structural MRIs, medical history, neurological examination, and neuropsychological/cognitive screening determined the status of each speaker to appropriately groupthem. Results: The data analysis revealed that the Macrostructure Index, Irrelevant Info, and Narration Density markers can track cognitive decline and AD (p < 0.001; Macrostructural Index: eHC versus AD Sensitivity 93.8%, Specificity 74.4%, MCI versus AD Sensitivity 93.8%, Specificity 66.7%; Narration Density: eHC versus AD Sensitivity 90.6%, Specificity 71.8%, MCI versus AD Sensitivity 93.8%, Specificity 66.7%). Moreover, Narrative Complexity was significantly affected for subjects with AD, Irrelevant Info increased in the narrations of speakers with MCI and AD, while Narration Length did not appear to indubitably differentiate between the cognitively intact groups and the clinical ones. Conclusions: Narrative Macrostructure Indices provide valuable information on the language profile of speakers with(out) intact cognition revealing subtle early signs of cognitive decline and AD suggesting that the inclusion of language-based assessment tools would facilitate the clinical process.

Blood DNA methylomic signatures associated with CSF biomarkers of Alzheimer's disease in the EMIF-AD study.

INTRODUCTION: We investigated blood DNA methylation patterns associated with 15 well-established cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) pathophysiology, neuroinflammation, and neurodegeneration. METHODS: We assessed DNA methylation in 885 blood samples from the European Medical Information Framework for Alzheimer's Disease (EMIF-AD) study using the EPIC array. RESULTS: We identified Bonferroni-significant differential methylation associated with CSF YKL-40 (five loci) and neurofilament light chain (NfL; seven loci) levels, with two of the loci associated with CSF YKL-40 levels correlating with plasma YKL-40 levels. A co-localization analysis showed shared genetic variants underlying YKL-40 DNA methylation and CSF protein levels, with evidence that DNA methylation mediates the association between genotype and protein levels. Weighted gene correlation network analysis identified two modules of co-methylated loci correlated with several amyloid measures and enriched in pathways associated with lipoproteins and development. DISCUSSION: We conducted the most comprehensive epigenome-wide association study (EWAS) of AD-relevant CSF biomarkers to date. Future work should explore the relationship between YKL-40 genotype, DNA methylation, and protein levels in the brain. HIGHLIGHTS: Blood DNA methylation was assessed in the EMIF-AD MBD study. Epigenome-wide association studies (EWASs) were performed for 15 Alzheimer's disease (AD)-relevant cerebrospinal fluid (CSF) biomarker measures. Five Bonferroni-significant loci were associated with YKL-40 levels and seven with neurofilament light chain (NfL). DNA methylation in YKL-40 co-localized with previously reported genetic variation. DNA methylation potentially mediates the effect of single-nucleotide polymorphisms (SNPs) in YKL-40 on CSF protein levels.

Blood-based multivariate methylation risk score for cognitive impairment and dementia.

INTRODUCTION: The established link between DNA methylation and pathophysiology of dementia, along with its potential role as a molecular mediator of lifestyle and environmental influences, positions blood-derived DNA methylation as a promising tool for early dementia risk detection. METHODS: In conjunction with an extensive array of machine learning techniques, we employed whole blood genome-wide DNA methylation data as a surrogate for 14 modifiable and non-modifiable factors in the assessment of dementia risk in independent dementia cohorts. RESULTS: We established a multivariate methylation risk score (MMRS) for identifying mild cognitive impairment cross-sectionally, independent of age and sex (P = 2.0 × 10-3). This score significantly predicted the prospective development of cognitive impairments in independent studies of Alzheimer's disease (hazard ratio for Rey's Auditory Verbal Learning Test (RAVLT)-Learning = 2.47) and Parkinson's disease (hazard ratio for MCI/dementia = 2.59). DISCUSSION: Our work shows the potential of employing blood-derived DNA methylation data in the assessment of dementia risk. HIGHLIGHTS: We used whole blood DNA methylation as a surrogate for 14 dementia risk factors. Created a multivariate methylation risk score for predicting cognitive impairment. Emphasized the role of machine learning and omics data in predicting dementia. The score predicts cognitive impairment development at the population level.

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 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.

Synaptic protein CSF levels relate to memory scores in individuals without dementia.

INTRODUCTION: We investigated how cerebrospinal fluid levels of synaptic proteins associate with memory function in normal cognition (CN) and mild cognitive impairment (MCI), and investigated the effect of amyloid positivity on these associations. METHODS: We included 242 CN (105(43%) abnormal amyloid), and 278 MCI individuals (183(66%) abnormal amyloid) from EMIF-AD MBD and ADNI. For 181 (EMIF-AD MBD) and 36 (ADNI) proteins with a synaptic annotation in SynGO, associations with word learning recall were analysed with linear models. RESULTS: Subsets of synaptic proteins showed lower levels with worse recall in preclinical AD (EMIF-AD MBD: 7, ADNI: 5 proteins, none overlapping), prodromal AD (EMIF-AD MBD only, 27 proteins) and non-AD MCI (EMIF-AD MBD: 1, ADNI: 7 proteins). The majority of these associations were specific to these groups. DISCUSSION: Synaptic disturbance-related memory impairment occurred very early in AD, indicating it may be relevant to develop therapies targeting the synapse early in the disease.

CSF proteomic profiles of neurodegeneration biomarkers in Alzheimer's disease.

INTRODUCTION: We aimed to unravel the underlying pathophysiology of the neurodegeneration (N) markers neurogranin (Ng), neurofilament light (NfL), and hippocampal volume (HCV), in Alzheimer's disease (AD) using cerebrospinal fluid (CSF) proteomics. METHODS: Individuals without dementia were classified as A+ (CSF amyloid beta [Aß]42), T+ (CSF phosphorylated tau181), and N+ or N- based on Ng, NfL, or HCV separately. CSF proteomics were generated and compared between groups using analysis of covariance. RESULTS: Only a few individuals were A+T+Ng-. A+T+Ng+ and A+T+NfL+ showed different proteomic profiles compared to A+T+Ng- and A+T+NfL-, respectively. Both Ng+ and NfL+ were associated with neuroplasticity, though in opposite directions. Compared to A+T+HCV-, A+T+HCV+ showed few proteomic changes, associated with oxidative stress. DISCUSSION: Different N markers are associated with distinct neurodegenerative processes and should not be equated. N markers may differentially complement disease staging beyond amyloid and tau. Our findings suggest that Ng may not be an optimal N marker, given its low incongruency with tau pathophysiology. HIGHLIGHTS: In Alzheimer's disease, neurogranin (Ng)+, neurofilament light (NfL)+, and hippocampal volume (HCV)+ showed differential protein expression in cerebrospinal fluid. Ng+ and NfL+ were associated with neuroplasticity, although in opposite directions. HCV+ showed few proteomic changes, related to oxidative stress. Neurodegeneration (N) markers may differentially refine disease staging beyond amyloid and tau. Ng might not be an optimal N marker, as it relates more closely to tau.

Peer Support Workers as an Innovative Force in Advocacy in Dementia Care: A Transnational Project Delivered in Norway, Greece, Italy, and Romania.

Aim: Peer Support Workers (PSW) as an Innovative Force in Advocacy in Dementia Care (PIA) project aimed to create sustainable and competency-enhancing services for people with dementia by finding new ways to involve former as well as current caregivers in dementia services and, therefore, provide their valuable perspective in dementia care and daily practice. Participants and Methods: In order to achieve the aforementioned goals, the first step consisted in mapping the situation existing in the partners' countries, respectively, Norway, Greece, Italy, and Romania. Subsequently, specific and well-structured training material was created with the purpose of recruiting and engaging PSW, in order to contribute to dementia services. The training material was then transferred to a digital platform addressed to PSW, people living with dementia (PwD), caregivers, and health professionals. Results: The PIA project proposed the introduction of PSW in dementia care, establishing a close collaboration across the contributing countries, and trained a total of fifty potential PSW. Each country identified a specific role and function of PSW in dementia practice, according to their national particulars. The training seminars and videos proposed by the PIA project are presented in the current study and therefore helped to the distribution of significant information about the contribution of (potential) PSW in dementia care. All the results were uploaded on the platform designed to increase communication and collaboration across health professionals as well as caregivers. Conclusion: The PIA project developed and designed training materials and methodologies for establishing PSW in dementia care in Norway, Greece, Italy, and Romania. PIA aims at introducing PSW in the healthcare system of the aforementioned countries, whereas future studies will elaborate on novel ways to measure the efficacy of being a PSW, as well as the benefits to stakeholders.

Involvement of the choroid plexus in Alzheimer's disease pathophysiology: findings from mouse and human proteomic studies.

BACKGROUND: Structural and functional changes of the choroid plexus (ChP) have been reported in Alzheimer's disease (AD). Nonetheless, the role of the ChP in the pathogenesis of AD remains largely unknown. We aim to unravel the relation between ChP functioning and core AD pathogenesis using a unique proteomic approach in mice and humans. METHODS: We used an APP knock-in mouse model, APPNL-G-F, exhibiting amyloid pathology, to study the association between AD brain pathology and protein changes in mouse ChP tissue and CSF using liquid chromatography mass spectrometry. Mouse proteomes were investigated at the age of 7 weeks (n = 5) and 40 weeks (n = 5). Results were compared with previously published human AD CSF proteomic data (n = 496) to identify key proteins and pathways associated with ChP changes in AD. RESULTS: ChP tissue proteome was dysregulated in APPNL-G-F mice relative to wild-type mice at both 7 and 40 weeks. At both ages, ChP tissue proteomic changes were associated with epithelial cells, mitochondria, protein modification, extracellular matrix and lipids. Nonetheless, some ChP tissue proteomic changes were different across the disease trajectory; pathways related to lysosomal function, endocytosis, protein formation, actin and complement were uniquely dysregulated at 7 weeks, while pathways associated with nervous system, immune system, protein degradation and vascular system were uniquely dysregulated at 40 weeks. CSF proteomics in both mice and humans showed similar ChP-related dysregulated pathways. CONCLUSIONS: Together, our findings support the hypothesis of ChP dysfunction in AD. These ChP changes were related to amyloid pathology. Therefore, the ChP could become a novel promising therapeutic target for AD.

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.

Assessing the cognitive decline of people in the spectrum of AD by monitoring their activities of daily living in an IoT-enabled smart home environment: a cross-sectional pilot study.

Introduction: Assessing functional decline related to activities of daily living (ADLs) is deemed significant for the early diagnosis of dementia. As current assessment methods for ADLs often lack the ability to capture subtle changes, technology-based approaches are perceived as advantageous. Specifically, digital biomarkers are emerging, offering a promising avenue for research, as they allow unobtrusive and objective monitoring. Methods: A study was conducted with the involvement of 36 participants assigned to three known groups (Healthy Controls, participants with Subjective Cognitive Decline and participants with Mild Cognitive Impairment). Participants visited the CERTH-IT Smart Home, an environment that simulates a fully functional residence, and were asked to follow a protocol describing different ADL Tasks (namely Task 1 - Meal, Task 2 - Beverage and Task 3 - Snack Preparation). By utilizing data from fixed in-home sensors installed in the Smart Home, the identification of the performed Tasks and their derived features was explored through the developed CARL platform. Furthermore, differences between groups were investigated. Finally, overall feasibility and study satisfaction were evaluated. Results: The composition of the ADLs was attainable, and differentiation among the HC group compared to the SCD and the MCI groups considering the feature "Activity Duration" in Task 1 - Meal Preparation was possible, while no difference could be noted between the SCD and the MCI groups. Discussion: This ecologically valid study was determined as feasible, with participants expressing positive feedback. The findings additionally reinforce the interest and need to include people in preclinical stages of dementia in research to further evolve and develop clinically relevant digital biomarkers.

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.

Predictors of Nursing Home Placement in a Cohort of European People with Alzheimer's Disease and Other Dementia Cases Enrolled in SCU-B or Non SCU-B Centers: The RECage Study.

Background: Nursing home placement (NHP) can be the final step of patients with Alzheimer's disease. Objective: We aimed to identify NHP predictors among 508 people with dementia with a 3-year follow-up. Methods: We analyzed data from the international observational RECage study, involving 508 people with especially Alzheimer's disease and comparing a cohort enrolled by five centers with a Special Care Unit for BPSD (behavioral and psychological symptoms of dementia) and another one enrolled by six centers lacking this facility. The tertiary objective of the study was to assess the possible role of the SCU-B in delaying NHP. We assessed the relationship of the baseline characteristics with NHP by means of univariate analysis followed by Cox's multivariate model. Results: Patients' mean age was 78.1 years, 54.9% were women. Diagnosis mean age was 75.4 (±8.32) years; the main diagnosis was Alzheimer's disease (296; 58.4%). During follow-up, 96 (18.9%) patients died and 153 (30.1%) were institutionalized without a statistically significant difference between the two cohorts (p = 0.9626). The mean NHP time was 902 (95% CI: 870-934). The multivariable analysis without death as a competing risk retained four independent predictors of NHP: age increase (hazard ratio (HR) = 1.023, 95% CI: 1.000-1.046), patient education level increase (HR = 1.062, 95% CI: 1.024-1.101), Neuropsychiatric Inventory total increase (HR = 1.018; 95% CI: 1.011-1.026), and total Mini-Mental State Examination as a favorable factor (HR = 0.948, 95% CI: 0.925-0.971). Gender (females versus males: HR = 1.265, 95% CI: 0.899-1.781) was included in the final Cox's model for adjusting the estimates for. Conclusions: Our data partially agree with the predictors of NHP in literature including the effect of high education level. No caregivers' factors were statistically significant. Clinical trial registration: NCT03507504.

The Effects of Pomegranate Seed Oil on Mild Cognitive Impairment.

Background: In recent years, there has been a growing interest, supported by many experimental and clinical studies, about the benefits of pomegranate in preventing various pathologic conditions, including brain neurodegeneration. The pomegranate seed oil (PSO) contains high levels of fatty acids that have antioxidant and anti-inflammatory properties. Objective: Due to the lack of clinical trials, the aim of the present study was to investigate the effects of PSO on cognition of people with mild cognitive impairment (MCI). Methods: Eighty people with the diagnosis of MCI were randomized forty to take 5 drops of PSO and follow the Mediterranean Diet (MeDi) and forty just followed MeDi. All were examined with an extensive neuropsychological assessment before and after one year of treatment. Results: The results showed that the participants who took the PSO had statistically significantly better global cognition (p = 0.004), verbal episodic memory (p = 0.009), and processing and executive functions (p < 0.001) in contrast with the participants who did not take it. Conclusions: In conclusion, the PSO can be beneficial for people with MCI as it is helpful for some important cognitive domains. As PSO is a natural product that does not burden the human body, it can be used by people with MCI and be a significant and promising part of holistic approaches for the prevention of dementia.

A Semantic Framework to Detect Problems in Activities of Daily Living Monitored through Smart Home Sensors.

Activities of daily living (ADLs) are fundamental routine tasks that the majority of physically and mentally healthy people can independently execute. In this paper, we present a semantic framework for detecting problems in ADLs execution, monitored through smart home sensors. In the context of this work, we conducted a pilot study, gathering raw data from various sensors and devices installed in a smart home environment. The proposed framework combines multiple Semantic Web technologies (i.e., ontology, RDF, triplestore) to handle and transform these raw data into meaningful representations, forming a knowledge graph. Subsequently, SPARQL queries are used to define and construct explicit rules to detect problematic behaviors in ADL execution, a procedure that leads to generating new implicit knowledge. Finally, all available results are visualized in a clinician dashboard. The proposed framework can monitor the deterioration of ADLs performance for people across the dementia spectrum by offering a comprehensive way for clinicians to describe problematic behaviors in the everyday life of an individual.

What goes wrong with the perceptions of elder financial abuse? Data from older adults, healthcare professionals and students from Greece.

This study examines what healthcare professionals, students and older adults believe about elder financial abuse in Greece. Participants responded to two vignettes by choosing which characteristics indicate elder financial abuse. Greeks are less likely to perceive financial exploitation when the perpetrator is a close family member, but are more likely to recognize it when perpetrated by paid caregivers or more distant (male) relatives. Signing over the victim's property to another is less likely to be perceived as elder abuse than is the taking of money from bank accounts, even though the property is often worth more than what is taken from the account. Although there are some differences in perception between healthcare professionals and others in Greek society, these (and other anomalies) make it difficult to accurately report and prevent elder financial abuse in Greece.

A Protocol for the Development and Assessment of a Non-Pharmacological Intervention Designed to Improve Cognitive Skills of Adults with Intellectual Disabilities: A Mixed Method Design.

Aim: This paper describes the steps of a protocol for developing and assessing a non-pharmacological intervention, specifically a Serious Game, with the goal of improving eight cognitive skills in adults with Intellectual Disabilities. Serious games that focus on one deficit and/or are restricted to one disorder have been developed to improve the cognitive skills of people with Intellectual Disabilities. There is a lack of a single tool that targets various cognitive skills as well as a broader spectrum of disorders. Purpose: The presentation of the protocol which describes the steps of developing a new Serious Game that will be evaluated in a randomised control trial intervention. Participants and Methods: The protocol is divided into three stages: identification of cognitive deficits and development of the Serious Game, randomised control trial intervention- follow up assessment, and evaluation of the Serious Game by trainers and caregivers. The participants of the intervention are adults with Intellectual Disabilities. Results: The protocol's results are expected to cover the development of a new Serious Game for specific cognitive functions of a mixed group of adults with Intellectual Disabilities, evaluating the structure and content of the game through neuropsychological assessments for participants and specific questionnaires for trainers and caregivers, evaluating the improvement of specific cognitive abilities in participants in the intervention; and measuring the possible improvement of the quality of life and social interaction of people with Intellectual Disabilities. Conclusion: This is the first study to develop a protocol and implement and assess this new Serious Game. This Serious Game is expected to assist people with Intellectual Disabilities in cognitive and social aspects.