A general obligation to make aggregate research results available to participants has been widely supported in the bioethics literature. However, dementia research presents several challenges to this perspective, particularly because of the fear associated with developing dementia. The authors argue that considerations of respect for persons, beneficence, and justice fail to justify an obligation to make aggregate research results available to participants in dementia research. Nevertheless, there are positive reasons in favor of making aggregate research results available; when the decision is made to do so, it is critical that a clear strategy for communicating results is developed, including what support will be provided to participants receiving aggregate research results.

Age-related hearing loss (ARHL) is common and a known risk factor for social disengagement in later life. This study explored social functioning following a diagnosis of ARHL. Using a constructivist grounded theory approach we developed an interview schedule to advance a grounded theory from data collected from six older adults who used either hearing aids or cochlear implants. Interview questions concerned social functioning as well as focusing on their perspective of the impact of ARHL on cognitive functioning. We describe a grounded theory conceived as ‘Reconnecting to Others’. This theory posits that participants faced social challenges in relation to their ARHL, and resolved these challenges partly through the use of hearing aids and cochlear implantation. The theory also emphasises the importance of help from other hearing aid users for new users, and corroborates prior findings about strategies older adults with ARHL use to cope with their hearing impairment in various social situations. Once hearing aids and cochlear implants are used and adapted to with the help of peers, participants completed their journey by helping others who had received diagnoses of ARHL. Additionally, participants spoke of the pleasure of hearing again. Interestingly, no participant felt that their ARHL had impacted their cognitive functioning. Our theory provides a basis for explaining existing quantitative findings as well as creating new hypotheses for future testing.

Globally, an estimated 46 million people are currently living with dementia and this figure is projected to increase 3-fold by 2050, highlighting this major public health concern and its substantial associated healthcare costs. With pharmacological treatment yet to reach fruition, the emphasis on evidence-based preventative lifestyle strategies is becoming increasingly important and several modifiable lifestyle factors have been identified that may preserve cognitive health. These include good cardiovascular health, physical activity, low alcohol intake, smoking and a healthy diet, with growing interest in vitamin D. The aim of the present paper is to review the evidence supporting the potential roles of vitamin D in ageing and cognitive health in community-dwelling older adults. Furthermore, to describe the utility and challenges of cognitive assessments and outcomes when investigating vitamin D in this context. Evidence indicates that serum 25-hydroxyvitamin D (25(OH)D) may impact brain health. There is a biological plausibility from animal models that vitamin D may influence neurodegenerative disorders, through several mechanisms. Epidemiological evidence supports associations between low serum 25(OH)D concentrations and poorer cognitive performance in community-dwelling older populations, although an optimal 25(OH)D level for cognitive health could not be determined. The effect of raising 25(OH)D concentrations on cognitive function remains unclear, as there is a paucity of interventional evidence. At a minimum, it seems prudent to aim to prevent vitamin D deficiency in older adults, with other known common protective lifestyle factors, as a viable component of brain health strategies.

Mealtime interventions typically focus on institutionalised older adults, but we wanted to investigate whether they may also be effective among those living independently. Using a randomised controlled trial design, we assessed the effects of a novel mealtime intervention on self-efficacy, food enjoyment and energy intake. A total of 100 adults living alone aged over 60 years were randomised to the treatment or control conditions: all received a guidebook on nutrition and culinary skills. Treatment group participants received a weekly visit from a trained volunteer who prepared and shared a meal with them. Participants in the treatment group showed improvements relative to those in the control group at borderline significance (P=0·054) for self-efficacy and at significance for food enjoyment. Significant improvements were observed in female participants in the treatment but not in the control group in energy intake (although following corrections for multiple comparisons, only the effect on food enjoyment remained significant). These findings will inform the design of future complex interventions. For this type of intervention to be successful, more focus has to be placed on making interventions more personalised, potentially according to sex. Findings are important for nutritional sciences as they indicate that, in order to improve energy intake and food enjoyment among older adults, multimodal nutritional interventions including social components may be successful.

Objectives: It is widely believed that phonemic fluency is more difficult than naming exemplars from a semantic category. Normative data in this regard are scarce, and there is considerable disagreement in the literature regarding the pattern in normal ageing and neurodegenerative conditions. Our objective was to provide normative data for semantic phonemic discrepancy scores from a large sample of older adults. Methods: A total of 5780 community-dwelling older adults were included in this prospective, longitudinal study. Discrepancy scores were calculated by subtracting phonemic fluency score from semantic fluency score for each participant. Quantile regression was used to estimate normative values stratified for age. Results: Subjects did better on testing of semantic fluency. The average discrepancy score was 9.18±6.89 words, (range, −20 to 37; n=5780). At the fiftieth percentile, those in their fifth decade produced 10 more “animals” than “letter F” words. Subjects scored one word less per decade, with an average of seven more “animal” words produced by those in their eighth decade. Conclusions: Our study is the first to provide normative data and confirms that, for animal versus letter F fluency, the semantic advantage persists into later life in a population-based sample of community-dwelling older adults. Given that a majority of clinical samples have confirmed a reverse of this pattern in Alzheimer’s dementia (i.e., loss of semantic advantage in Alzheimer’s disease, yielding a phonemic advantage), our findings support the clinical utility of brief fluency tests and encourage further research into their use in diagnosis and prediction of progression to dementia. (JINS, 2016, 22, 1–7)

Background: Anxiety and depression are common in older people but are often missed; to improve detection we must focus on those elderly people at risk. Frailty is a geriatric syndrome inferring increased risk of poor outcomes. Our objective was to explore the relationship between frailty and clinically significant anxiety and depression in later life.

Methods: This study had a cross-sectional design and involved the assessment of 567 community-dwelling people aged ≥60 years recruited from the Technology Research for Independent Living (TRIL) Clinic, Dublin. Frailty was measured using the Fried biological syndrome model; depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale; and anxiety symptoms measured using the Hospital Anxiety and Depression Scale.

Results: Higher depression and anxiety scores were identified in both pre-frail and frail groups compared to robust elders (three-way factorial ANOVA, p ≤0.0001). In a logistic regression model the odds ratio for frailty showed a significantly higher likelihood of clinically meaningful depressive and anxiety symptoms even controlling for age, gender and a history of depression or anxiety requiring pharmacotherapy (OR = 4.3; 95% CI 1.5, 11.9; p = 0.005; OR = 4.36; 95% CI 1.4, 13.8; p = 0.013 respectively).

Conclusions: Our findings suggest that even at the earliest stage of pre-frailty, there is an association with increased symptoms of emotional distress; once frailty develops there is a higher likelihood of clinically significant depression and anxiety. Frailty may be relevant in identifying older people at risk of deteriorating mental health.

Objectives: The hypothesis that burnout is predictive of performance deficits on a number of neuropsychological tests was examined among a group of psychiatric nurses. A possible relationship between burnout and state and trait anxiety levels was also investigated.

Methods: A sample of psychiatric nurses (n=45) completed the Maslach Burnout Inventory (MBI) and the State-Trait Anxiety Inventory (STAI). Their performance on a number of neurocognitive tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) was examined. The neurocognitive tests measured visual memory, verbal memory and attention.

Results: Multiple regression analyses were conducted between the burnout subscales and the results of the neuropsychological tests, and also between the burnout subscales and both state and trait anxiety levels. No overall significant relationship was found between neurocognitive performance and burnout. However, trait anxiety was significantly predictive of each of the burnout subscales of emotional exhaustion, depersonalisation and also of decreased personal accomplishment.

Conclusions: The levels of burnout were in the moderate range for all three subscales and so the population was suffering from burnout. The fact that the trait anxiety variable was predictive of all three of the burnout subscales suggests that predisposition towards anxiety may be a vulnerability factor among people who suffer from burnout.

Background: Life satisfaction is a subjective expression of well-being and successful aging. Subjective well-being is a major determinant of health outcomes in older people. The aim of this study was to determine which factors predicted well-being in older people living in the community as measured by their satisfaction with life.

Methods: The relationship between life satisfaction, as measured by the Life Satisfaction Index (LSI-A) and physical, cognitive and demographic variables was examined in 466 older people living in the community using a stepwise regression model

Results: Depression, loneliness, neuroticism, extraversion, recent participation in physical activity, age and self-reported exhaustion, were the independent predictors of life satisfaction in our elderly cohort.

Conclusion: Subjective well-being, as measured by the Life Satisfaction Scale, is predicted by depression, loneliness, personality traits, recent participation in physical activity and self-reported exhaustion. The mental and emotional status of older individuals, as well as their engagement in physical activity, are as important as physical functionality when it comes to life satisfaction as a measure of well-being and successful aging. These areas represent key targets for intervention.

We describe an unusual cause of autobiographical memory loss in a 55 year old man who presented with prominent memory loss for significant events in his life over a period of five years with evidence of patchy memory loss for events prior to this. It was associated with emotional lability and was complicated by a number of tragic events in his life in the previous four years. In addition there were a number of brief episodes (< 30 mins) where he would transiently lose his memory for events including for hours, days or months prior to the event. Neuropsychological assessment confirmed prominent autobiographical memory loss with minimal deficits in other domains. An electroencephalogram (EEG) revealed a simple partial seizure arising from the right temporal lobe, pointing to a diagnosis of Transient Epileptic Amnesia. He was commenced on anti-epileptic medication and responded both subjectively and objectively. There are approximately 94 cases of TEA described in the literature and the diagnostic criteria and postulated aetiology of this illness is discussed here. Clinicians need to have high index of suspicion of epilepsy when assessing a patient with prominent autobiographical memory impairments.

Autonoetic consciousness refers to the ability to mentally transport oneself back in subjective time to relive elements of, or all, of a past event, and is compromised in the early stages of Alzheimer’s disease (AD). Here, we investigate autobiographical memory (ABM) and the recollective experience in amnestic mild cognitive impairment (aMCI). aMCI participants exhibited significant deficits compared with healthy elderly controls for both personal semantic and event detail components of ABM. These decrements were evident across all life epochs for episodic recall. Recall of an event that occurred 1 week previously, was tested in the same spatiotemporal context, and provided the greatest group dissociation, with elderly controls benefitting from a context-dependent memory effect. This reinstantiation of context did not ameliorate the anterograde deficits in the aMCI cohort, nor did it facilitate the mental reliving of these memories for either participant group. Whereas reliving judgments were comparable in both groups, aMCI participants exhibited a compromised capacity to generate vivid, self-referential visual imagery and to re-experience the original emotion of events. These contextual and experiential deficits extended beyond recently encountered events into remote epochs, and suggest a greater level of ABM impairment in aMCI than previously assumed. (JINS, 2010, 16, 546–555.)

We investigated the relative discriminatory efficacy of an event-based prospective memory (PM) task, in which specificity of the instructions and perceptual salience of the PM cue were manipulated, compared with two widely used retrospective memory (RM) tests (Rivermead Paragraph Recall Test and CERAD-Word List Test), when detecting mild cognitive impairment of suspected Alzheimer’s disease etiology (MCI-AD) (N = 19) from normal controls (NC) (N = 21). Statistical analyses showed high discriminatory capacity of the PM task for detecting MCI-AD. The Non-Specific-Non-Salient condition proved particularly useful in detecting MCI-AD, possibly reflecting the difficulty of the task, requiring more strategic attentional resources to monitor for the PM cue. With a cutoff score of <4/10, the Non-Specific-Non-Salient condition achieved a sensitivity = 84%, and a specificity = 95%, superior to the most discriminative RM test used (CERAD-Total Learning: sensitivity = 83%; specificity = 76%). Results suggest that PM is an early sign of memory failure in MCI-AD and may be a more pronounced deficit than retrospective failure, probably reflecting the greater self-initiated retrieval demands involved in the PM task used. Limitations include the relatively small sample size, and the use of a convenience sample (i.e. memory clinic attenders and healthy active volunteers), reducing the generalizability of the results, which should be regarded as preliminary. (JINS, 2009, 15, 154–159.)

Background and objectives: Cognitive screening is a “first step” in detecting dementia and other neuropsychiatric syndromes and hence represents an important public health and clinical initiative. A plethora of cognitive screening instruments has been advocated in recent years, but the extent to which these instruments are used or their effectiveness is not well known. An International Psychogeriatric Association (IPA) survey was designed to determine which cognitive screening instruments were used most frequently by clinicians with special expertise in the neuropsychiatric aspects of old age and also to determine the ones considered most useful by these specialists.

Method: Under the auspices of the IPA, the survey was mailed in the fall of 2004 to all IPA members as well as members of the American and Canadian Associations of Geriatric Psychiatry. The survey inquired about demographic information, the frequency of use of cognitive screening instruments, and the value attributed to the cognitive screening instruments. Participants also had an opportunity to provide written commentary.

Results: A total of 334 completed surveys were processed. The majority of respondents were geriatric psychiatrists (58%). Of the 20 different instruments that were listed on the survey, only six were selected as “routinely” or “often used” by the survey respondents. These instruments in declining order were: (1) the Folstein Mini-mental State Examination; (2) the Clock Drawing Test; (3) Delayed Word Recall; (4) the Verbal Fluency Test; (5) Similarities; and (6) the Trail Making Test. “Effectiveness” and “ease of administration” were the test characteristics most highly predictive of frequency of use. Open-ended comments highlighted patient factors that continue to provide challenges, including ethnicity/culture, language, education/literacy, and sensory impairment. Respondents concluded that “no single test is adequate.”

Conclusions: Psychogeriatricians worldwide routinely use a relatively small number of brief cognitive screening instruments. Further evaluation is necessary as the need increases for cognitive screening guidelines that inform public health initiatives related to dementia and neuropsychiatric syndromes.

Despite a growing list of potential new risk factors for Alzheimer's disease (AD), one of the oldest remains controversial. Is female gender a risk factor for AD? It is likely that the greatest influence on the gender differential in crude prevalence rates is the increasing incidence of dementia with age (Paykel et al., 1994) combined with the greater longevity women (Moritz & Ostfeld, 1990). This must be distinguished from the hypothesis that there may also be a gender difference in the age-specific prevalence rates some dementias such as AD. In turn, this could be due to either a higher incidence dementia in women, or to longer survival times in women following diagnosis. What is the evidence for these hypotheses?