This is a report of a workshop for local residents organized by university researchers in various fields with the aim to develop a dementia prevention method. The five academic fields involved in the project are Health & Sports, Psychology, Food Nutrition, Music, and Nursing.

Dementia Prevention Workshop took place once a week between October 2021 and July 2022 except for some intervals due to surges in Covid-19 infection cases. Dual task exercises were conducted at each session, followed by groupworks by researchers of Psychology, Nutrition, Music, and Nursing Science taking turns. Psychologists facilitated the understanding of assertion, nutritionists held lectures on food life designed for dementia prevention, musicians played instruments, and nurses intervened through the Group Reminiscence Method. The Nursing Science experts conducted evaluations at the beginning and the end of each session using SF-36 and CES-D and checked the participants’ mood before and after the reminiscence session with Japanese UWIST mood adjective checklist (JUMACL).

16 participants took the measurement after the workshop, and their average age (SD) was 72.9 (5.5). In the overall evaluation, the participants’ motor ability improved(p<.05), and they retained cognitive functions. In SF-36, no statistically significant differences were observed before and after the classroom. Compared to the data from 2017, the scores in the social aspect were lower. In CES-D, the scores significantly worsened after the workshop, with some participants’ scores exceeding 16 points, which is the depression cutoff point. In JUMACL, the Tense Arousal (TA) related to the arousal state and the Energetic Arousal (EA), which is supposedly related to intellectual activities, both improved after the session.

In a single evaluation before and after a group reminiscence session, the state of relaxed concentration with a suggested connection with intellectual activities, but the overall evaluation result throughout the workshop project suggested the need to reinforce the approach to the mental aspect because of some participants observed with decreased scores in the mental aspects with depressive tendency. We will establish an intervention plan by also incorporating the impact of Covid-19-related depression.

Apathy is the most common neuropsychiatric symptom in Alzheimer’s disease (AD), however there are no approved treatments. In the recent Apathy in Dementia Methylphenidate Trial 2 (ADMET 2), methylphenidate treatment resulted in a significant reduction in apathy with a small to medium effect size. We assessed response in ADMET 2 to identify individuals likely to benefit from methylphenidate.

In ADMET 2, AD patients with clinically significant apathy were randomized to methylphenidate or placebo. Twenty-three potential predictors of treatment outcome chosen a priori for evaluation were divided into levels (e.g. anxiety present/absent). For each predictor, change in Neuropsychiatric Inventory apathy (NPI-A) due to methylphenidate for each level was estimated. Predictors with larger differences in effect (>= 2pt NPI-A) between levels were selected. Participants were then grouped into 10 subgroups by their index scores, constructed based on model-based prediction of response (NPI-A >=4).

In total 177 participants (66% male, mean (SD) age 75.7 (8.0), Mini-Mental State Examination 18.9 (4.8)) had 3 month follow-up data. Six potential predictors met criteria for multivariate modelling. The median Index score was -1.33 (range: -8.35 to 6.83). Methylphenidate was more efficacious in participants with no NPI anxiety (change in NPI-A - 2.21, Standard Error (SE):0.60, p=0.0004) or agitation (-2.63, SE: 0.68, p=0.0002), and who were on cholinesterase inhibitors (ChEI) (-2.44, SE:0.62, p=0.0001), between 52-72 years of age (- 2.93, SE:1.05, p=0.007), had normal diastolic blood pressure (-2.43, SE: 1.03, p=0.02), and more functional impairment (-2.56, SE: 1.16, p=0.03) as measured by the Alzheimer’s Disease Cooperative Study Activities of Daily Living scale. After 3 months of methylphenidate, 79% of participants with a higher index score (>median) responded (>= 4pt NPI-A) and 49% of those with a lower index score responded.

Individuals who were less anxious or agitated, younger, on a ChEI, had normal diastolic blood pressure, and with more impaired function were more likely to benefit from methylphenidate when compared to placebo. Consistent with its potential activating effects, methylphenidate may be particularly beneficial for apathetic AD participants with lower baseline anxiety and agitation.

Caregiving of a relative with dementia is considered a chronic stressful situation that generates physical and psychological strain and that may have negative effects on caregivers’ health. Many caregivers make the decision to enter their relatives in a nursing-home, however, there are few studies that analyze psychosocial (e.g., guilt) and biomarkers of cardiovascular risk (C-reactive protein, CRP) variables that are related to this decision during the caregiving process stress. The aim of this study was to analyze caregivers’ differences between caregivers who finish the role of caring of their relatives with dementia and those who continue their caregiving role throughout the process of caring in a 3-year period.

The sample consisted of 294 family caregivers of people with dementia and was divided in two groups; a) caregivers who institutionalized their relatives during a 3-year period (12.7%); and caregivers who maintained their role as caregivers (87.3%).

Preliminary results show that caregivers who institutionalized their relatives with dementia in some time point of the caregiving process presented at baseline more frequency of behavioral problems (t = -2.95; p < .01), more feelings of guilt (t = -3.52; p < .01) and compassion (t = -3.79; p < .01), reported less frequency of dysfunctional thoughts about caregiving (t = 1.99; p < .05) and presented higher levels of CRP (t = 2.72; p < .01), compared to caregivers who maintained their role as caregivers. In addition, caregivers who institutionalized their relative were younger (t= 2.13; p < .05) and reported more weekly hours (t= -3.46; p < .01) and more days (t= -3.01; p < .01) of home help compared to those caregivers who maintained their role. No significant effects were found for caregivers’ gender (p = .38), daily hours caring (t= 1.54; p = .13) nor time caring (t=-1.1; p = .27).

The results of this study present several clinical implications. Knowing variables that are related to the decision of institutionalization could prevent it as well as it can be useful to accompany caregivers by providing support throughout the entire process.

The 8-item Informant Interview to Differentiate Aging and Dementia (AD8) was developed as a screening tool for dementia with a cutoff of 2 suggested by the initial study. However, various studies found different cutoff values, and many suggested a cutoff of 2 might result in a high false positive rate. A higher false positive rate in Taiwan was repeatedly shown when AD8 was self-administered in local government screening programs. We have developed a modified version of AD8 (m-AD8) with the purpose of enhancing its specificity. This study aimed to compare the performance of AD8 and m-AD8.

The m-AD8 consists of all items adapted from the original AD8. Modifications included: (1) limiting the evaluated period to the past year instead of the past several years, (2) reselecting examples to reflect the socio-cultural context in Taiwan, and (3) rearranging the order of questions according to their complexity. We recruited 118 participant-informant dyads from a university teaching hospital. For each informant, the AD8 was administered first and then the Clinical Dementia Rating (CDR) to minimize contamination effect. The m-AD8 was administered 7 days later. Two geriatric psychiatrists made the final consensus DSM-5 diagnosis for each subject after considering all clinical information, including history, Mini-Mental State Examination (MMSE), CDR, and, if available, other past neuropsychological tests and neuroimaging.

There were 59 subjects with normal cognition, 28 with mild neurocognitive disorder, and 31 with dementia (major neurocognitive disorder). When comparing dementia vs. non-dementia, the optimal cutoff value was 4 for both versions according to the Youden index. The AUC, sensitivity, and specificity were 0.893, 0.774, 0.862 for AD8, and 0.883, 0.741, 0.954 for m-AD8, respectively. The m-AD8 showed improved specificity, which was also true when the cutoff value was set as 2 or 3.

The optimal cutoff value for both versions was 4. The modification may change the performance of AD8 with improved specificity. These findings suggest that, depending on different situations, AD8 with a cutoff value higher than 2 may perform better in dementia screening.

Treatment-resistant depression (TRD) is not uncommon in older people. Brain stimulation, such as 4-6 weeks of repetitive transcranial magnetic stimulation (rTMS) or theta burst stimulation (TBS) targeting the left dorsolateral prefrontal cortex, has been evidenced as an essential intervention for adult TRD and also documented in the current international treatment guideline. In 2018, Taiwan Food and Drug Administration cleared the rTMS as a treatment option for TRD and now rTMS is still a treatment at their own expense in Taiwan. Additionally, prolonged intermittent TBS (piTBS) protocol has been proven its similar antidepressant efficacy as standard 4-6 weeks rTMS/iTBS in adult TRD, but in a shorter treatment course of 2 weeks. For older adults with depression, 4-6 weeks of treatment course may burden their caregiver due to their limited ambulation and transportation ability. However, hitherto there was no study to investigate the antidepressant efficacy of left-sided prefrontal piTBS in treating older TRD.

A chart review was performed at a single Taiwan hospital from 2018 to 2020. 17-items Hamilton Depression Rating Scale (HDRS-17) was measured before and after the piTBS intervention. Maudsley Staging Method was used for the depression treatment refractoriness.

We identified 23 old adults with TRD (mean [SD] age, 66.0[5.2]; 78% female) who underwent 10-20 sessions of daily piTBS (1800 pulses/session; 10sessions, n=18, 15sessions,n=4, 20session,n=1). On continuous outcomes, mean(SD) HDRS-17 total scores improved from 20.5(6.62) to 11.8(7.7) after receiving piTBS intervention. The mean percent improvement of HDRS-17 was 46.0%±29.4%. Dichotomous outcomes showed response rate of 43.5% and remission rate of 34.8%. No seizures or other serious adverse events were noted, and no premature discontinuation was noted.

This study is the largest study demonstrating the piTBS protocol provides a comparable reduction in depression symptoms in older adults with TRD, similar to the effectiveness in adult TRD and the efficacy of standard sequential bilateral rTMS/iTBS in older TRD in the FOUR-D trial. Regarding desirable efficiency and effectiveness, piTBS may be an optimal form of rTMS in treating older adults with TRD. Further large comparative effectiveness trials with standard iTBS or high-frequency rTMS in this population are warranted.

Repetitive transcranial magnetic stimulation (rTMS) is an effective, safe, and well-tolerated option for treatment-resistant depression (TRD). The minimal medical and cognitive side effects are advantages of rTMS for all patients. However, the majority of rTMS studies in older adults are notable for underdosing rTMS relative to the corresponding FDA-protocol, as noted by recent international meta-analyses. This study utilizes the standardized rTMS FDA protocol and compares the response rates between older adult and non-older adult patients in a TRD clinic in Atlanta, Georgia with depressive symptoms as the primary outcome and anxiety symptoms as the secondary outcome.

This retrospective chart review of patients who received rTMS between March 2017 to June 2022 used descriptive statistics to compare treatment parameters and dropout rates between older adult and non-older adult patients. A 2 x 3 repeated-measures analysis of variance (ANOVA) analyzed changes in self-reported depression and anxiety symptom severity throughout treatment course (baseline, treatment midpoint, and final treatment) between the two groups.

Eighty-nine patients were included for analysis: Group 1: >55 years old (n= 42; M= 66.48, sd= 6.16; 71% female), and Group 2: <55 years old (n = 47; M= 37.40, sd= 9.13; 60% female). All patients received at least 3000 pulses per session, with 85.71% of patients completing the FDA protocol in Group 1 and 85.11% of patients completing in Group 2. A >50% improvement in depression scores at the end of treatment were seen in 38.1% of patients in Group 1 and 31.9% of patients in Group 2. Both groups demonstrated significant within-group reductions of depression throughout treatment (ps < .001). A smaller subset of patients completed an anxiety questionnaire. Forty percent in Group 1 (n=24) and 33.3% in Group 2 (n=25) showed a >50% improvement in anxiety scores by end of treatment. Both groups demonstrated significant within-group reductions of anxiety throughout treatment (ps < .001). The between groups’ difference for change in depression and anxiety scores was not statistically significant.

With FDA protocol dosing, older and non-older patients have consistent response and tolerability. While overall response rates were slightly lower than reported standardized clinical trials, our real-world sample highlights the effectiveness of rTMS for patients, including adults over 55, treated in an unselected, naturalistic outpatient sample.

Due to a lack of validated assessment instruments, this study aimed to pilot test the newly developed Health and Social Care Professionals’ Knowledge & Attitudes Towards Later Life Sexuality (HSCP-KALLS) instrument. The HSCP-KALLS instrument is designed to assess health and social care professionals’ knowledge (46 items) and attitudes (40 items) towards later life sexuality including components related to dementia, sex worker services and Lesbian, Gay, Bisexual, Transgender, Intersex or Queer/Questioning (LGBTIQ+).

A group of health and social care professionals (n = 22) and Healthcare-related educator (n = 2) were invited to complete the HSCP-KALLS instrument. Feedback on items phrasing and the experience of completing the instrument was sought.

Written feedback regarding either phrase of items or use of the instrument was not specifically addressed by participants. A high level of internal consistency was revealed for both the knowledge and attitude items (α = 0.84 & 0.88, respectively). A decent level of knowledge (M=39.75, SD=4.90) and positive attitudes (M=161.04, SD=13.50) towards later life sexuality were demonstrated by participants. Participants had greater knowledge on items related to ageing, intimacy, and sexuality (95%), with a lower level of knowledge on items related to sexuality diversity (e.g., LGBTIQ+). Providing more trainings about later life sexuality was frequently addressed in the knowledge written feedback. Participants generally demonstrated positive attitudes towards later life sexuality. However, a high proportion of ambivalent responses were noted on some attitude items (e.g., A9 & A18) that participants indicated in written feedback that their responses would depend on circumstances.

Preliminary reliability and feasibility of using the HSCP-KALLS instrument has been encouraging, with further testing in large samples now, required to robustly establish psychometric properties. Supporting later life sexuality is essential and the use of HSCP-KALLS instrument can inform and identify professional development needs of health and social care professionals to improve care provision for older people by supporting their expression of sexuality in healthcare settings.

People with dementia commonly have impaired social functioning and may not recognise this. This lack of insight may result in worse outcomes for the person and their family carers. We aimed to characterise insight into social functioning in dementia, and describe its association with dementia severity.

Observational cross-sectional study of people aged >65 years with clinically diagnosed dementia and their family informants recruited from three sites in Germany, Japan and the United Kingdom. We used the Social Functioning in Dementia scale (SF-DEM), which assesses three domains: “spending time with other people” (domain 1), “communicating with other people” (domain 2), and “sensitivity to other people” (domain 3). We calculated lack of insight into social functioning as the discrepancy between the ratings of the participants with dementia and their informant. We described this discrepancy and the proportion of people with dementia whose rating was overestimated, congruent or underestimated compared to their family informant. We calculated the association between SF-DEM discrepancy score and total mini-mental status examination (MMSE) score and recall and attention/concentration subdomains.

In 108 participants with dementia (50.9% women), mean age = 78.9 (standard deviation, SD 6.5) years, and mean MMSE score = 22.7 (SD 3.7). Ratings of patients and informants for domain 1 did not differ, but patient-rating was higher than carer-rating for domain 2 (patient-rated score 11.2 (2.5), carer-rated score 10.1 (3.4); p = 0.003) and domain 3 (patient-rated score 9.7 (2.4), carer-rated score 8.1 (2.8); p < 0.001). Sixty (55.6%) people with dementia overestimated their overall social functioning, 30 (27.8%) underestimated, and 18 (16.7%) gave ratings congruent with their family informant. Performance on the MMSE, and its sub-domains was not associated with SF-DEM discrepancy score.

We found that insight varies according to subdomains of social functioning, with people with dementia rating their communication and sensitivity differently, and usually higher than their carers. Researchers and clinicians should consider insight into social functioning in dementia as a multidimensional, rather than a unified, concept. Clinicians should help family members understand and adapt by explaining their relative with dementia’s lack of insight about aspects of their social functioning.

Older adults are vulnerable to postoperative delirium after surgery and anesthesia, which may affect their cognitive function and increase depressive symptoms. Anesthesia nurses are dominant in the number of anesthesia medical teams. This study aimed to examine the differences between anesthesia nurses' self- perceived roles and competencies and their recognition of the roles and competencies of anesthesia specialty nurses.

A cross-sectional study was conducted. A structured questionnaire based on a guideline of the International Council of Nurses was designed.

The participated anesthesia nurses’ (N=200) scale scores and mean scores for each question on the self-perceived role and competency scales were lower than the scores on their recognition of the roles and competencies of anesthesia specialty nurse scales. Regarding the self-perceived roles, the scholar domain received the lowest score (Mean= 2.99, SD= 1.00), while the self-perceived competencies, the management domain received the lowest score (Mean = 3.81, SD = 0.67). Similarly, the scholar domain received the lowest score (mean = 3.34, SD = 1.068) in recognition of the roles of an anesthetic specialist nurse, while the management domain received the lowest score (mean = 4.18, SD = 0.58) in the recognition of the competencies of an anesthesia specialist nurse. Anesthesia nurses' self-perceived roles were affected by their nursing ladder and the hospital level at which anesthesia nurses work. Their self-perceived competencies were affected by their nursing ladder and salary. In addition, their recognition of the roles as anesthesia specialist nurses was affected by the hospital level at which anesthesia nurses work. The nursing ladder affected their recognition of the competencies of an anesthesia specialist nurse.

This study has demonstrated that anesthesia nurses must improve their self-perceptions of their roles and competencies to satisfy the expectations of their roles and competencies as anesthesia specialty nurses. The findings of this study could be used to develop future anesthesia nurse education and training programs to provide better care to elderly patients.

As the world’s population ages, the number of people with dementia is expected to increase. In addition to progressive cognitive and functional deterioration, dementia comprises neuropsychiatric symptoms (NPS). NPS present significant management challenges based on their high frequency and disruptive nature. Against the prevailing guidelines, their treatment is often over-reliant on psychotropic drugs and other restrictive care approaches, frequently without a thorough assessment of underlying and potentially modifiable causes, such as over- and under-stimulating environments, untreated medical illnesses, drug interactions, or unidentified unmet needs. Consistent with the latter, the unmet needs model proposes that these neuropsychiatric phenomena are needs-driven and constitute indicators of identifiable unmet physical, psychological, emotional, or social needs. Despite this backdrop, few studies have investigated this association using standardized and replicable measures. In this context, the present study aims to put the unmet needs model into a practical context in order to disentangle the contribution of the unmet needs, assessed with the Camberwell Assessment of Need for the Elderly (CANE), to the presence of NPS.

A cross-sectional study was conducted. Participants were assessed with validated, accessible, and replicable measures, including the CANE interview and the Neuropsychiatric Inventory (NPI). Other variables collected included residents’ demographic characteristics, cognitive and functional impairment, and daily medication. Multivariate models were used to explore potential risk factors for NPS.

Residents from four nursing homes entered the study. Results found that those with unmet needs assessed using CANE and those taking hypnotic/sedative medications had a higher risk of presenting at least one NPS, even after adjusting for other demographic and clinical-functional covariates.

Built on the main finding that unmet needs assessed with CANE can independently contribute to explaining the presence of NPS, a working model is proposed to find solutions for these symptoms based on uncovering unmet needs. The CANE, as a practical, low-cost, yet clinically relevant assessment of met and unmet needs may be used to signal need areas that can be useful for formulation and intervention purposes and may offer the first step towards individually-tailored non- pharmacological interventions for NPS.

To explore the benefits and barriers of using an interactive robotic seal (PARO, Figure 1) based on the experiences of nursing home residents living with dementia and chronic pain, their family members, and formal caregivers.

Semi-structured interviews were conducted alongside a feasibility randomized controlled trial at one nursing home in Brisbane, Australia between July 2021 and January 2022 (Trial registration: ACTRN 12621000837820). Residents with dementia and chronic pain interacted with PARO individually for 15 min once or twice daily, five days per week for three consecutive weeks. After which, individual interviews were conducted with residents who were capable of communicating (n=13), family members (n=3), registered nurses (n=4), care assistants (n=11), a physical therapist (n=1), a diversional therapist (n=1) and the facility manager (n=1) who experienced or observed the residents’ interactions with PARO. The interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Almost all participants reported that interacting with PARO benefited residents with dementia and their caregivers. These benefits included (1) reducing pain by providing distraction and stimulation; (2) reducing behavioral and psychological symptoms of dementia; (3) promoting positive emotions by recalling memories; and (4) reducing anxiety and care burden for family and formal caregivers. Neutral attitudes toward PARO were reported by three residents with mild cognitive impairment as they reported it did not make any difference. Barriers to using PARO included limited staff training and the implementation of person‐ centered care due to limited resources.

Overall, multiple stakeholders were positive about using PARO to reduce pain and behavioral symptoms of nursing home residents living with dementia and chronic pain. PARO may also reduce the care burden of family and formal caregivers. PARO might be incorporated into daily practice to support nursing home residents living with dementia. Improving staff training and understanding individual preferences of residents may enhance the implementation of PARO in this population.

Figure 1

A resident living with dementia and her family after interacting with PARO (Distribution of this photo has been approved by the resident and her family)

Being diagnosed with dementia can be a hectic and critical period. While severe dementia may act as a shield when it comes to suicidal risk, mild and early dementia stages may still preserve cognitive functions to elaborate a suicidal plan. Having insight may lead to feelings of despair and sadness that patients find unbearable to deal with. The aim of this article is to review the current literature regarding suicidal risk after a dementia diagnosis.

Review of the most recent literature regarding the risk of suicide among patients with a recent dementia diagnosis. The research was carried out through the PubMed and UptoDate databases, using the terms “dementia”, “diagnosis” and “suicidal risk”.

Previous research showed inconclusive findings, with some authors suggesting a higher risk of an early suicide attempt in patients recently diagnosed with dementia, and others suggesting otherwise. Nowadays, the literature mainly reports that older adults with recent dementia diagnoses are at increased risk of endeavoring suicide. There is an important requirement to offer appropriate support to patients and their families, at the time, or as soon as possible, when a dementia diagnosis is made, to diminish the risk of suicide attempts in these patients.

Patients with recent diagnosis of dementia, or diagnosed at an earlier age, seem to have higher suicidal risk. The period immediately after diagnosis is when individuals need greater support, so these results demand for better assistance for those experiencing such intellectual decline.

Most people living with dementia do so at home, comprising approximately 30 million people globally. Despite extensive research on psychotropic medication use in long-term care settings, there has been little comparative research looking at psychotropic use in people living with dementia at home.

The study aim was to systematically review the literature to identify factors associated with psychotropic medication use in people living with dementia at home.

The PROSPERO-registered review was conducted using PRISMA guidelines. A comprehensive search of four databases (2010 to 2020) was undertaken for the systematic review to identify empirical studies. A combination of MESH search terms for dementia, community-dwelling, and psychotropic medications were used. Suitable data were subject to meta-analysis using Comprehensive Meta-Analysis to calculate raw data to event rates and pooled, adjusted event rates for different modifier sub-analyses. Thematic analysis was utilised to synthesise emergent factors and a meta-analysis undertaken on suitable data.

The search identified 619 articles of which 39 met inclusion/exclusion criteria. Use of psychotropics ranged from 18.7% for anxiolytic/hypnotics, to 26.9% for antipsychotics and 33.1% for antidepressants. Thematic analysis suggested that psychotropic prescribing was associated with a range of patient and environmental factors, including, but not limited to: (i) age (<75yr; >90yr); (ii) gender (being male); (iii) more advanced functional decline; and (iv) living alone. There was a conspicuous absence of data pertaining to carer and prescriber factors. Significant associations were identified in the meta-analysis between psychotropic use and respite in full-time care or hospitalisation as well as co-morbid psychiatric illness.

The reasons for psychotropic prescribing in this population remain poorly understood. Significant associations and knowledge gaps identified here generate opportunities for further research and development of targeted interventions to improve care and meeting the needs of this population group. This includes cautionary trigger questions for prescribers including: What am I treating? Who am I treating? How will I measure response? How can I ensure that psychotropics initiated in respite/hospital are used short-term only?

We aimed to study the relationship between glutathione (GSH), a key molecule of the anti-oxidant defense system in the blood, and glutathione reductase (GR), which reduces oxidized GSSG to GSH and maintains redox balance, with the prevalence of Alzheimer’s dementia and cognitive decline.

20 with normal cognition and 20 with Alzheimer's dementia who completed the 3rd f/u clinical evaluation over 6 years were selected by matching age and gender. Plasma glutathione (GSH) and glutathione reductase (GR) concentrations were independent variables. Clinical diagnosis and neurocognitive test scores were used as dependent variables indicating cognitive status.

The higher the GR, the greater the possibility of normal cognition rather than Alzheimer's dementia. Also, the higher the GR, the higher the neurocognitive score. However, this association was not significant in GSH in any way. After 6 years, the conversion rate from normal cognition to cognitive impairment was significantly higher in the lower 50th percentile of the GR group than in the upper 50th percentile.

According to the result of this study, the higher the GR, the lower the prevalence of Alzheimer's dementia and incidence of cognitive impairment, and the higher the cognitive outcome. Therefore, GR can be regarded as a protective biomarker for Alzheimer’s dementia and cognitive decline.

There is an urgent need for clinical blood biomarkers which can rule in/out neurological disorders early in those with psychiatric symptoms, personality or behavioural changes and/or functional decline together with cognitive symptoms. The neuronal axonal protein neurofilament light (NfL) is released from damaged neuronal axons and can be measured in in blood and cerebrospinal fluid (CSF). We have undertaken a series of studies aimed at examining the clinical utility of blood and CSF NfL in assisting with the distinction between psychiatric and neurodegenerative / neurological disorders.

Since 2016 we have measured blood and CSF NfL levels across multiple psychiatric and neurological populations recruited through Neuropsychiatry, Royal Melbourne Hospital and our collaborators (national and international). We have described our findings in a series of published studies. Data from our ongoing work, in larger cohorts and diagnostic groups, will be presented. The diagnostic groups include people with psychiatric disorders (schizophrenia, bipolar disorder, depression, functional neurological disorders), neurodegenerative disorders (Alzheimer’s disease, frontotemporal dementia, Huntington’s disease, Niemann-Pick Type C) and neurological disorders (e.g., epilepsy).

Our initial pilot study (n=129) found that CSF NfL was a promising biomarker in differentiating psychiatric from neurological disorders. In our larger follow up larger study (n=498) which included more diagnostic groups CSF NfL levels exhibited high accuracy (91%), sensitivity (92%), and specificity (87%) in differentiating psychiatric from neurological disorders, and distinguished behavioural variant frontotemporal dementia from frontal lobe syndrome phenocopies/mimics, with high accuracy. We have found that NfL is not elevated in people with treatment resistant schizophrenia compared to controls and is elevated in people with Niemann-Pick Type C compared to people with psychiatric disorders and controls. Further (unpublished) data has shown that these findings are replicated with plasma NfL levels across 400 further psychiatric, neurological and control participants.

NfL is a highly promising biomarker which differentiates psychiatric from neurological disorders with high sensitivity and specificity. The translation of NfL levels into standard clinical practice could substantially improve the clinical diagnostic process in people with complex neuropsychiatric and cognitive disorders.

Ageing and dementia affect many aspects of life, including intimate relationships, sex and sexual expression. Older people, including those living with dementia, can have sexual relationships and form new ones. Their sexual and physical health, quality of life, and psychological well-being can be improved by respecting their intimacy and sexuality expression preferences. However, due to ageism and stigma, healthcare professionals often ignore the sexual feelings and needs of those with dementia living in long-term care. Discussions with stakeholders and literature show limited attention paid to understanding the sexual preferences of people living with dementia in health and social care. In 2020, the Intimacy and Sexuality Expression Preference (ISEP) tool was developed for use in long-term care to gather information on intimate and sexual expression preferences of older people, including those living with dementia, to assist in care provision. The ISEP tool was trialled in a Queensland, Australia, nursing home with 14 older residents. This presentation will share insight into the use of the ISEP tool and how it informs the development of ‘ISEP: A Practical User Guide’. This guide provides information on how to (a) use the ISEP tool for assessment; (b) interpret and integrate findings into care (i.e., identify a potential course of action); and (c) evaluate outcomes. Illustrative examples will be included. It will inform how preferences for the expression of sexuality can be practically addressed to improve care practices and care outcomes (i.e., satisfaction and quality of life) for people with dementia.