We aimed to psychometrically evaluate and validate a Japanese version of the Social Functioning in Dementia scale (SF-DEM-J) and investigate changes in social function in people with dementia during the coronavirus disease-19 (COVID-19) pandemic.

We interviewed people with mild cognitive impairment (MCI) and mild dementia and their caregivers during June 2020–March 2021 to validate patient- and caregiver-rated SF-DEM-J and compared their scores at baseline (April 2020 to May 2020) and at 6–8 months (January 2021 to March 2021) during a time of tighter COVID-19 restrictions.

The neuropsychology clinic in the Department of Psychiatry at Osaka University Hospital and outpatient clinic in the Department of Psychiatry and Neurology at Daini Osaka Police Hospital, Japan.

103 dyads of patients and caregivers.

SF-DEM-J, Mini-Mental State Examination, Neuropsychiatric Inventory, UCLA Loneliness Scale, and Apathy Evaluation Scale.

The scale’s interrater reliability was excellent and test–retest reliability was substantial. Content validity was confirmed for the caregiver-rated SF-DEM-J, and convergent validity was moderate. Caregiver-rated SF-DEM-J was associated with apathy, irritability, loneliness, and cognitive impairment. The total score of caregiver-rated SF-DEM-J and the score of Section 2, “communication with others,” significantly improved at 6–8 months of follow-up.

The SF-DEM-J is acceptable as a measure of social function in MCI and mild dementia. Our results show that the social functioning of people with dementia, especially communicating with others, improved during the COVID-19 pandemic, probably as a result of adaptation to the restrictive life.

Patients with hoarding disorder (HD) show difficulty discarding items due to the perceived need to save the items and to distress about discarding them, which causes domestic squalor (DS), especially in young people. In older people, dementia also causes DS. In this case series, we report five cases of older people with DS and compare DS due to HD with DS due to dementia.

Case 1 was an 82-year-old female who showed hoarding symptoms in her 60s. She was diagnosed with late-onset HD. Case 2 was a 73-year-old female who showed hoarding symptoms in her 10s. She was diagnosed with early-onset HD. Cases 1 and 2 showed difficulty discarding. Case 1 went to the dump site to collect items that had been discarded by her family. Case 2 strongly refused to throw away items that were considered unnecessary by her family. However, cases 1 and 2 could continue to live at home with nonpharmacological treatment, such as limiting shopping items and getting items from friends and discarding items with their family step by step. Case 3 was a 56-year-old male who showed hoarding symptoms in his 50s. Case 4 was a 72-year-old female who showed hoarding symptoms in her 60s. Cases 3 and 4 were diagnosed with behavioral variant frontotemporal dementia. Case 5 was a 67-year-old female who showed hoarding symptoms in her 60s. She was diagnosed with dementia with Lewy bodies. Case 3-5 did not feel distressed that their family discard their items in their absence. However, despite adjustments to their living environment, they could not continue to live at home and were admitted to a nursing home.

In this case series, although cases with DS due to HD showed difficulty discarding items, they could continue to live at home. However, in cases with DS due to dementia, although their house was easily cleaned, they cloud not continue to live at home due to impairment of their daily activities. Therefore, it is important not to miss HD in older people, and DS due to dementia may be a sign they have difficulty living at home.

Although the previous studies indicated that impaired cerebrospinal fluid (CSF) dynamics might contribute to the pathophysiology of Alzheimer’s disease (AD), the longitudinal changes of CSF volumes in AD has been still unclear. In this study, using the methodology of quantitative assessment of CSF volumes in idiopathic normal pressure hydrocephalus (iNPH), we assessed longitudinal changes in CSF volumes in AD patients.

The subjects were the patients with mild cognitive impairment and dementia due to AD who visited Osaka University Hospital from November 2009 to October 2018. We excluded the patients with gait disturbances and MRI findings such as Disproportionately enlarged subarachnoid-space hydrocephalus (DESH), which was the suggestive finding of iNPH. For each subject, MRI was performed in the first visit and 1 year later. We quantitatively measured CSF volumes in DESH-related regions, such as ventricle systems (VS), Sylvian fissures (SF), and sulci at high convexity and the midline (SHM)., using an automatic brain volumetric software program (AVSIS) (Ishii et al. 2006, 2013). The ratio of each regional volume to the intracranial volume was calculated and we compared these parameters between two visits.

We enrolled 98 patients with AD (mean (SD) age = 76.0 (5.7)). Wilcoxon signed rank test revealed that, while the ratios of CSF volumes in VS and SF significantly increased during the one-year observation (VS: 4.01 (1.05) % vs 4.14 (1.09) %, p<0.001 ;SF: 1.40 (0.21) % vs 1.42 (0.22) %, p=0.007), those in SHM significantly decreased (4.30 (0.70) % vs 4.23 (0.69) %, p<0.001). The change ratio of relative volumes in VS was correlated with those in SF and SHM (r=0.451, p<0.001; r=-0.350, p<0.001).

In patients with AD, the CSF volumes in VS and SF increased while CSF volumes in SHM decreased. This trend of the longitudinal change was similar to the change in the patients with iNPH. The finding of this study indicates that, in the patients with AD, CSF dynamics may be impaired like the patients with iNPH.

The present study aimed to compare the social function between mild cognitive impairment (MCI), mild Alzheimer’s disease (AD) dementia, and mild dementia with Lewy bodies (DLB) using the Japanese version of Social Functioning in Dementia scale (SF-DEM-J).

We interviewed 103 patients and family caregivers from June 2020 to March 2021: 54 patients with MCI, 34 with mild AD dementia, and 15 with mild DLB. We compared the caregiver-rated SF-DEM-J, Clinical Dementia Rating (CDR), MMSE, age, length of education, Geriatric Depression Scale (GDS), the University of California, Los Angeles Loneliness Scale (UCLA-LS), Neuropsychiatric Inventory (NPI), and informant version of the Apathy Evaluation Scale (AES) between MCI, mild AD dementia, and mild DLB groups using Kruskal-Wallis test with Dunn-Bonferroni correction for post-hoc analyses. We compared sex, living situation, and caregiver demographics between three groups using chi-square test. We performed correlation analysis between the score of each psychological test and the scores of SF-DEM-J within group using Spearman’s rank correlation coefficient.

For SF-DEM-J, the score of section 2 (communicating with others) was significantly worse in mild AD dementia than in mild DLB. The scores of section 1 (spending with others) and section 3 (sensitivity to others) and the total score did not significantly differ between three groups. The score of section 1 was significantly associated with MMSE in MCI, with anxiety and disinhibition of NPI, and AES in mild AD dementia, and with GDS in mild DLB. The score of section 2 was significantly associated with AES in MCI and mild AD dementia, with UCLA-LS in MCI, and with the length of education in mild DLB. The score of section 3 was significantly associated with agitation and irritability of NPI in MCI and mild AD dementia. The total score was associated with UCLA-LS and AES in MCI, and with AES in mild AD dementia.

Factors affecting social functioning differed between MCI, mild AD dementia, and mild DLB. Apathy, agitation and irritability affected social functioning in MCI and mild AD dementia while depressive mood affected social functioning in mild DLB.

We aimed to investigate the association between very late-onset schizophrenia-like psychosis (VLOSLP), a schizophrenia spectrum disorder with an onset of ≥60 years, and Alzheimer’s disease (AD) using biomarkers.

Retrospective cross-sectional study.

Neuropsychology clinic of Osaka University Hospital in Japan.

Thirty-three participants were classified into three groups: eight AD biomarker-negative VLOSLP (VLOSLP−AD), nine AD biomarker-positive VLOSLP (VLOSLP+AD), and sixteen amnestic mild cognitive impairment due to AD without psychosis (aMCI−P+AD) participants.

Phosphorylated tau levels in the cerebrospinal fluid and 18F-Florbetapir positron emission tomography results were used as AD biomarkers. Several scales (e.g. the Mini-Mental State Examination (MMSE), Wechsler Memory Scale-Revised (WMS-R) Logical Memory (LM) I and II, and Neuropsychiatric Inventory (NPI)-plus) were conducted to assess clinical characteristics.

Those in both VLOSLP−AD and +AD groups scored higher than those in aMCI−P+AD in WMS-R LM I. On the other hand, VLOSLP+AD participants scored in between the other two groups in the WMS-R LM II, with only VLOSLP−AD participants scoring significantly higher than aMCI−P+AD participants. There were no significant differences in sex distribution and MMSE scores among the three groups or in the subtype of psychotic symptoms between VLOSLP−AD and +AD participants. Four VLOSLP−AD and five VLOSLP+AD participants harbored partition delusions. Delusion of theft was shown in two VLOSLP−AD patients and five VLOSLP+AD patients.

Some VLOSLP patients had AD pathology. Clinical characteristics were different between AD biomarker-positive and AD biomarker-negative VLOSLP, which may be helpful for detecting AD pathology in VLOSLP patients.

To examine the relationship between cerebrospinal fluid (CSF) biomarkers of Alzheimer’s disease (AD) and tap test response to elucidate the effects of comorbidity of AD in idiopathic normal-pressure hydrocephalus (iNPH).

Case–control study.

Osaka University Hospital.

Patients with possible iNPH underwent a CSF tap test.

Concentrations of amyloid beta (Aβ) 1–40, 1–42, and total tau in CSF were measured. The response of tap test was judged using Timed Up and Go test (TUG), 10-m reciprocation walking test (10MWT), Mini-Mental State Examination (MMSE), and iNPH grading scale. The ratio of Aβ1–42 to Aβ1–40 (Aβ42/40 ratio) and total tau concentration was compared between tap test-negative (iNPH-nTT) and -positive (iNPH-pTT) patients.

We identified 27 patients as iNPH-nTT and 81 as iNPH-pTT. Aβ42/40 ratio was significantly lower (mean [SD] = 0.063 [0.026] vs. 0.083 [0.036], p = 0.008), and total tau in CSF was significantly higher (mean [SD] = 385.6 [237.2] vs. 293.6 [165.0], p = 0.028) in iNPH-nTT than in iNPH-pTT. Stepwise logistic regression analysis revealed that low Aβ42/40 ratio was significantly associated with the negativity of the tap test. The response of cognition was significantly related to Aβ42/40 ratio. The association between Aβ42/40 ratio and tap test response, especially in cognition, remained after adjusting for disease duration and severity at baseline.

A low CSF Aβ42/40 ratio is associated with a poorer cognitive response, but not gait and urinary response, to a tap test in iNPH. Even if CSF biomarkers suggest AD comorbidity, treatment with iNPH may be effective for gait and urinary dysfunction.