Stephanie Wong

Objectives: As the world’s population ages, it is imperative to develop community initiatives that address the well‐being needs of older adults. This study aimed to identify older adults’ needs and preferences for a bespoke well‐being program in local councils in Southern Adelaide, South Australia. Methods: Six local older adults (between 65 and 87 years of age) participated in six co‐design focus groups. In the focus groups, older adults reviewed and discussed previous Council‐led well‐being programs and developed a new well‐being program for older adults. Reflexive thematic analysis was intentionally conducted on focus group dialog, after program development, to represent the perspectives and preferences of the older adults for a future well‐being program. Results: Three themes on preferred program content and delivery methods were identified. Theme (1) get the balance right, with two subthemes (a) volume of information versus activities, discussion, and self‐reflection and (b) facilitation matters, which highlight the value older adults placed on facilitation activities, discussion, and self‐reflection to facilitate behavior change. Theme (2) we value the science, with two subthemes (a) some topics warrant more practical strategies than scientific information and (b) information should be tailored, relatable and provide choice. Theme (3) continue to challenge aging stereotypes, including two subthemes (a) language must be accessible and (b) respect the diversity of the aging experience. Conclusions: To ensure maximum value for older adult participants at the community‐level in Australia, well‐being programs for older adults should include evidence‐based tailored content, time for discussion and group interaction, while also respecting the diversity of older adults in terms of abilities and preferences. Recommendations for policy makers and practitioners are outlined at the conclusion of the paper.

Background: Appropriately balancing potential risks versus rewards is important for affective decision-making in everyday life. Impaired affective decision-making on risk-taking tasks has been reported in individuals with dementia, but the neural correlates of such deficits, and whether they relate to neuropsychiatric symptoms, such as disinhibition and apathy, have not been directly examined. Methods: Forty-one behavioural-variant frontotemporal dementia (bvFTD), 28 Alzheimer’s disease (AD) patients and 42 healthy controls completed the Balloon Analogue Risk Task (BART), which assessed their ability to weigh risks versus rewards to maximise monetary earnings. Informant-reported measures of disinhibition and apathy were completed. All participants underwent structural magnetic resonance imaging brain scans. Results: While bvFTD and AD patients showed some impairments on the BART relative to controls, a high degree of variability was observed within patient groups. Poorer BART performance was associated with bilateral medial prefrontal and orbitofrontal cortex atrophy. A hierarchical cluster analysis revealed four groups of patients, with distinct patterns of BART performance, varying levels of disinhibition and apathy, and divergent patterns of brain atrophy. The group that showed the worst performance on the BART (i.e., collected the least money and popped the most balloons) showed the greatest disinhibition and orbitofrontal cortex atrophy. Conclusions: Our findings highlight the heterogeneous nature of affective decision-making deficits in dementia and uncover important links between BART performance, symptoms of disinhibition and apathy, and orbitofrontal cortex atrophy. Greater understanding of these symptom profiles and underlying neurocognitive mechanisms may help to inform potential management strategies for impaired affective decision-making in dementia.

Objective: The social cognitive abilities of emotion perception, cognitive theory of mind (ToM), affective ToM, and emotional empathy change across adulthood. Few existing studies have examined the performance of a single social cognitive domain in later life, with no known studies having examined all four abilities together. Although it is well understood how non-social cognitive performance changes with age, and this has helped inform diagnostic methods for age-related disorders, relatively little is known about typical age-related social cognitive performance in later life. The current study aimed to investigate the association between age and social cognitive performance within a sample of healthy midlife to older adults. Method: This cross-sectional study examined emotion perception using the Mini-SEA Facial Emotion Recognition Test, cognitive and affective ToM using The Shortened Awareness of Social Inference Test—Short Form, and emotional empathy using the Interpersonal Reactivity Index in 236 healthy adults aged 43–80 years (M = 60.30, SD = 6.88, 76% female). Results: Multiple linear regression analyses revealed that age only had a significant, medium, negative association with cognitive (B = −.08, p < .001) and affective (B = −.05, p < .001) ToM and was not significantly associated with emotion perception or emotional empathy. Conclusions: These findings enhance our understanding of normal social cognitive aging in later life, which can inform decisions around adding social cognitive measures into existing neuropsychological diagnostic tools for psychiatric, neurological, and developmental disorders.

Objective: Older adults are identified to have reduced social cognitive performance compared to younger adults. However, few studies have examined age-associations throughout later life to determine whether these reductions continue with advancing age.Method: This study assesses cross-sectional associations of emotion perception, cognitive and affective theory of mind (ToM), and emotional empathy in a healthy sample of 157 adults aged 50–89 years (M = 65.31, SD = 9.00, 68% female sex). Emotion perception, cognitive ToM, and affective ToM were measured using The Awareness of Social Inference Test Short Form (TASIT-S), while affective ToM was also measured using Reading the Mind in the Eyes Revised (RME-R). Emotional empathy was measured using the Empathy Quotient.Results: Multiple regression analyses, adjusting for multiple comparisons, revealed a moderate negative association between age and emotion perception for all emotions combined, as well as for sad and revolted expressions, but not happy, neutral, anxious, or angry expressions. Age had a negative, moderate association with first-order cognitive, second-order cognitive, and affective ToM measured using TASIT-S, but not RME-R. Age was not significantly associated with emotional empathy.Conclusions: This study contributes to the limited understanding of age-related associations of social cognitive performance throughout later life. This knowledge can inform future research examining the clinical utility of including social cognitive measures in neuropsychological screening and diagnostic tools for later-life neurological disorders.

Emotional empathy is a congruent emotional response stemming from another's emotional state and has mixed evidence for its association with age. We sought to synthesize existing data to investigate cross-sectional changes in emotional empathy across adulthood using random-effects meta-analyses. Embase, APA PsycInfo, Medline, and Scopus databases were systematically searched until October 2022. Thirty-three studies assessed age categorically by comparing older (M = 68.42, SD = 4.95) with younger (M = 27.55, SD = 6.82) adults and demonstrated higher emotional empathy in older adults (g = 0.10, p = .039). Seven studies examined age continuously (18-100 years), resulting in a positive correlation with age (z_r = .08, p = .033). Subgroup analyses identified age effects differed based on the emotional empathy measure but not on measure type (state vs. trait) or gender ratio (73% women and 27% men). Cross-sectional results indicate emotional empathy may increase across adulthood. These results clarify the previously mixed reports of typical emotional empathy functioning in later life. Age effects varying due to the emotional empathy measure examined indicate that these measures' convergent validity should be reexamined. Further research should employ older, population-based, non-western, educated, industrialized, rich, and democratic samples and longitudinal designs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: The capacity to handle money and personal finances is crucial for living independently. Cognitive decline can lead to financial mismanagement (e.g., forgetting to pay bills, overspending) and exploitation (e.g., falling for financial scams). While greater susceptibility to financial mismanagement and exploitation is commonly reported by carers of people with dementia, objective neuropsychological measures of these financial skills are scarce. It is also unclear whether profiles of change in financial skills vary across different stages and subtypes of dementia.Method: A normative sample of 112 healthy controls and individuals with mild cognitive impairment (MCI; n = 16), Alzheimer’s disease (AD; n = 7) or behavioural‐variant frontotemporal dementia (bvFTD; n = 18) completed a novel neuropsychological Test of Financial Skills (TOFS), which assessed performance across three key areas: everyday financial tasks, susceptibility to financial scams and financial goal planning. For all patients and controls, measures of dementia severity (Clinical Dementia Rating Scale) and general cognition (Addenbrooke’s Cognitive Examination, 3^rd Ed.) were also collected.Result: Relative to controls, AD and bvFTD patients showed lower overall performance on the TOFS, whereas MCI patients did not differ significantly from controls. While AD and bvFTD patients showed similar levels of impairment on everyday financial tasks and financial goal planning, bvFTD patients performed significantly worse on the financial scams subtest. Across all participants, lower TOFS performance was associated with greater dementia severity and cognitive impairment.Conclusion: Our results are consistent with previous studies of carer‐reported changes in financial mismanagement and exploitation in people with dementia. Notably, we found important differences in the areas of financial skills impacted by different stages and subtypes of dementia. These findings provide novel insights into the different factors that contribute to deficits in financial skills in people with dementia, highlight the importance of objective neuropsychological assessments in this area, and open avenues for targeted financial support strategies.

Theory of mind (ToM) has been argued to be a multidimensional construct, with ToM inferences depending on distinct processes across affective and cognitive ToM tasks and across first-order cognitive and second-order cognitive ToM tasks. Behavioural evidence for a multidimensional account has primarily depended on dissociations identified via analysis of variance, a statistical approach insufficient for assessing dimensionality. Instead, state-trace analysis (STA) is a more appropriate statistical technique to uncover dimensionality. The current study first applied STA to two summary datasets that had previously identified key dissociations between cognitive and affective ToM; these reanalyses did not support a multidimensional account of ToM. Next, STA was applied to a more detailed dataset to reveal whether ToM is based on multiple processes in a sample of 115 older adults aged 60–85 years (M = 68.5, SD = 5.92, 61.7% female) with higher or lower emotion perception ability. Participants made ToM judgements about different social exchanges (e.g., sarcasm or lying). STA results supported a multidimensional account of ToM across first-order cognitive, second-order cognitive, and affective ToM subdomains. These results lay a more rigorous foundation for subsequent studies to further examine the dimensionality of ToM and to apply formal modelling, progressing the field’s understanding and measurement of the cognitive processes driving ToM judgements.

The current clinical diagnostic criteria for Alzheimer’s disease (AD) recognize an atypical, non-amnestic presentation of AD, characterized by prominent executive dysfunction. Increasing evidence, however, indicates that the clinical phenotype of this so-called “frontal-variant” of AD (fv-AD) includes behavioral symptoms and deficits in social cognition, together with disproportionate frontal lobe atrophy. As these features resemble those characteristic of behavioral-variant frontotemporal dementia (bvFTD), differential diagnosis can be challenging. Here, we report a case of fv-AD who met clinical diagnostic criteria bvFTD, but had in vivo amyloid neuroimaging evidence of AD pathology. We compare this case against two individuals who were clinically diagnosed with bvFTD and early-onset AD, with in vivo amyloid neuroimaging confirmation of pathology. We highlight the challenges in differential diagnosis by contrasting their behavioral, cognitive and structural neuroimaging findings.