Claire V. Burley

Background: Osteoarthritis (OA) is highly prevalent in older adults and is associated with increased dementia risk. The primary aims of this pilot randomised controlled trial (RCT) were to assess the feasibility and acceptability of a 12-week multidisciplinary Healthy Body & Mind Program for individuals with OA and dementia or cognitive concerns. Health outcomes were assessed as a secondary, exploratory aim. Method: Feasibility was assessed via recruitment, retention, and adherence. Acceptability was assessed using post-program interview and focus group data and analysed using the Theoretical Framework of Acceptability. Exploratory analyses were completed of health outcomes (quality of life, pain, cognition, and psychological and physical health) using repeated measures ANOVAs (group × time interaction; intervention versus control) for outcomes with complete control-group data. Results: Of 27 people screened, 18 (67%; mean age = 72 ± 6 years, 16 [89%] female; mean MoCA = 19 ± 2) were randomised to the program or a wait-list control group over a six-month recruitment period. Eligibility criteria and recruitment terminology were modified during this period to support enrolment. Six participants (two intervention, four control) withdrew after randomisation but before commencement, and nine of 18 (50%) completed the program. Among completers, session attendance was 92%. Qualitative data found strong positive affective attitude toward the program, low burden, good intervention coherence, favourable opportunity costs, and improved exercise self-efficacy. Eight of nine completers said they would continue attending if the program were offered as an ongoing service. Delivery considerations for scale-up included the effect of group attrition on remaining participants and cost of expert-delivered sessions. Conclusion: The program was acceptable to participants and, once commenced, delivered with good adherence, but the trial was not feasible as designed, chiefly due to challenging recruitment and pre-commencement attrition. Future trials should expand recruitment channels and pre-specify feasibility progression criteria. More flexible delivery should be tested against a standard protocol arm to avoid compromising methodological rigor. Clinical trial registration number: NCT06070818; 25/09/2023 (ClinicalTrials.gov).

Inorganic nitrate, reduced in vivo to nitric oxide via the nitrate-nitrite pathway, has been proposed to influence brain health through vasoactive and neurovascular mechanisms. A 2019 meta-analysis found no effect of nitrate supplementation on cognition or cerebral blood flow, but evidence was then limited to small, short trials in healthy adults. We updated this systematic review, searching MEDLINE, Embase and PsycINFO to June 2026, and extended it to observational studies of habitual dietary nitrate intake. Two reviewers independently screened studies, extracted data and assessed risk of bias (RoB 2; ROBINS-E). Standardised mean differences from 22 randomised trials were pooled in random-effects models; supplementation did not improve cognition (14 trials, 383 participants; SMD 0.100, 95% CI -0.023 to 0.224), resting cerebral blood flow (9 trials; SMD 0.102, 95% CI -0.161 to 0.364) or stimulated cerebral blood flow (6 trials; SMD 0.226, 95% CI -0.064 to 0.516). Seven observational studies could not be pooled, but all five prospective cohorts reported associations favouring higher habitual nitrate intake for brain health outcomes. These findings confirm the earlier null trial result; small, short, underpowered trials and heterogeneous but promising cohort evidence leave open whether dietary nitrate benefits brain health.

Dementia prevalence in the Middle East and North Africa (MENA) is projected to rise exponentially, with estimates suggesting increases of 367% by 2050. This region faces distinctive challenges, including rapid demographic transition, high rates of modifiable risk factors, and fragmented health systems. This paper examines region-specific risk factors and pooled prevalence rates of dementia across the MENA region. We conducted a narrative review of dementia risk factors in the MENA region, including analysis of population-attributable risk (PAR) estimates and pooled estimates of dementia prevalence among adults aged 50 years and older. Dementia prevalence was estimated at 1.84% among individuals aged 50 years and older, increasing to 3.81% among those aged 60 years and older, with substantial variability across countries. Smoking (>30%), physical inactivity ( ~ 50%), and high burdens of diabetes, hypertension, and obesity were consistently associated with increased dementia risk. Additional region-specific drivers include nutritional transitions, gut dysbiosis, consanguinity, and environmental risk factors such as air pollution and climate-related heat stress. Critical barriers to prevention and care include limited research infrastructure, low health literacy, stigma, and inequitable health care access. Dementia prevalence in MENA is rising rapidly, driven by demographic change and high exposure to modifiable risk factors that are relatively region-specific in terms of their contribution. Strengthening prevention, early detection, and equitable access to care should be regional health priorities.

Informal dementia care is all-encompassing, yet carers' psychosocial needs are frequently overlooked. We conducted a systematic review to synthesize evidence examining subjective carer burden and pre-death grief of adult informal family carers of people living with dementia. A pre-registered review (PROSPERO registration: CRD420251052503) was conducted in accordance with PRISMA guidelines. Four databases (MEDLINE, CINAHL, PubMed, and PsycINFO) were searched in June 2025 to identify peer-reviewed studies reporting original data, yielding 5,084 records. Thirty-five studies met inclusion criteria (N = 2210 carers, 69% female). Methodological quality was assessed and findings were synthesized into 7 themes: Relational Reconfiguration, Living with Uncertainty and Loss, Absorption and Enmeshment, Emotional Distress, Managing Behavioral Challenges, Coping and Identity Preservation, and Transition to Formal Care. Evidence is limited by exploratory studies and an over-reliance on Western samples. Findings suggest a need for psychosocial interventions that reflect the complexity of the caring journey.

People living with osteoporosis can experience worse mental health and quality of life (QoL), including pain and psychological distress than those without. Psychological stress and poor mental health are associated with an increased risk of osteoporosis (OP). We conducted a systematic review and meta-analysis of randomised controlled trials investigating the effect of exercise on mental health, QoL and pain in people living with OP. A systematic review and meta-analysis was conducted following PRISMA guidelines (PROSPERO: CRD42023440020). Inclusion criteria were randomised controlled trials investigating exercise in people diagnosed with OP, including QoL, mental health, and/or pain outcomes. Exclusion criteria were non-human studies or studies not translatable into English. An electronic search of the literature was performed from inception to December 2025 in PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science. Bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The Consensus on Exercise Reporting Template was used to assess reporting quality. Three authors independently extracted data into Microsoft Excel. Data were analysed using Cochrane Review Manager Web (version 9.4.1), including mean differences (MD) and standardised mean differences (SMD) using a random-effects inverse variance model. Moderator analyses assessed modality, intensity, duration, frequency, setting, participant age, the presence of fracture (%), the nature of fracture and the osteoporosis diagnosis (postmenopausal or other). Certainty and quality of evidence were assessed using the GRADE approach. Twenty-three trials (n = 2120, mean age 67.1 ± 5.98yrs, 95.1% female) were included: five resistance training, six balance training, six combined resistance and balance training, three multi-modality, two Clinical Pilates, one aquatic, one combined aerobic, strength and Yi Jin Jing. A total of 1135 participants underwent exercise (low-high intensity, 2-7 times weekly) for 19 ± 12 weeks targeting upper, lower and full body, with seventeen studies reporting progression. Exercise improved mental health (SMD 0.53 [0.25, 0.81], p = 0.0002, moderate certainty evidence), QoL (SMD 0.62 [0.29, 0.95], p = 0.0003, moderate certainty evidence) pain (SMD 0.36 [0.17, 0.55], p = 0.0002, low certainty evidence), and pain at rest MD - 1.69 [- 2.38, - 0.99], p < 0.00001, moderate certainty evidence). Clinical Pilates was most effective for mental health (p = 0.006), QoL (p < 0.00001) and pain (p = 0.01). For mental health, the largest effect was seen with interventions performed three times per week for 4-11 weeks. Reporting quality varied (CERT, mean 11.1 ± 3.4, range 5-18), as did bias, with concerns regarding evidence certainty, internal validity and statistical conclusion validity bias. Exercise improves mental health, QoL, and pain. Pilates appeared most effective for all outcomes; however, resistance training was also effective for both QoL and pain. Further high-quality research following standardised reporting guidelines is needed for people living with osteoporosis. KEY POINTS: • Exercise improves mental health, quality of life and pain for people living with osteoporosis. Pilates was most effective, while resistance training also showed an effect for quality of life and pain outcomes. Further high-quality research is needed for people living with osteoporosis and poor mental health.

Background: Osteoarthritis (OA) has been reported in approximately1‐in‐2 older adults and is associated with a 1.5‐fold increase in dementia risk. Half of overall disease burden is due to modifiable factors such as physical activity and lifestyle. Currently no programs exist for people living with OA and thinking concerns/dementia. The aims of this pilot randomised controlled trial (RCT) are to determine whether a 12‐week multidisciplinary Healthy Body & Mind Program improves health outcomes in people living with OA and thinking concerns/dementia. Method: Eighteen consenting participants with OA and thinking concerns/dementia (mean age=71.5±5.7years; mean telephone Montreal Cognitive Assessment [MoCA]=18.9±2.1) were randomly allocated to the 12‐week program or usual medical care (wait‐list control). Outcome measures included quality of life (QoL) [SF‐36], pain (Western Ontario and McMaster Universities Arthritis Index [WOMAC]), cognition (MoCA and Cambridge Cognition multitasking test [MTT], spatial working memory [SWM] and paired associated learning [PAL]) and psychological health (Depression, Anxiety and Stress Scale [DASS‐21]). Data were analysed using ANOVAs (intervention/control) and paired t‐tests (baseline/follow‐up). Cognition data were available for baseline/follow‐up only. Results: Repeated measures ANOVAs revealed significant time by group interactions for overall pain ( p = .034;η ² =0.348) and QoL scores ( p = .025; η ² =0.380), where outcomes improved for the intervention group ( N = 9) and worsened for the control group ( N = 4). Significant interactions were also observed for the QoL subscales emotional ( p = .036; η ² =0.342), social ( p < .001; η ² =0.645), and general health ( p = .046; η ² =0.046). No significant differences were observed for psychological health measures. A clinically meaningful improvement was observed in overall cognition (mean MoCA increased by 1.2 points). T‐tests revealed significant improvements in the MTT (including number of incongruent errors ( p = .03;d=0.84), mean reaction latency on congruent trials ( p = 0.008;d=17.07) and incongruent trials ( p = .01;d=5.14), mean multitasking cost ( p = 0.009;d=1.80), total correct responses ( p = .01;d=3.39) and total errors ( p Healthy Body & Mind Program improved pain, QoL, and cognition in people living with OA and thinking concerns or dementia. Future research should scale‐up and deliver this program to larger populations to identify if such programs have the potential to improve public health and reduce dementia risk at a national level.

Background: The Western Pacific Region (WPR) currently has the third‐highest prevalence of dementia globally and is projected to have the highest prevalence by 2050, with >76 million cases. The 2024 Lancet Commission on Dementia suggests that tackling 14 modifiable risk factors could prevent 45% of cases globally ¹ . However, the WPR is socioeconomically and culturally diverse, requiring region‐specific strategies to address dementia effectively. Method: The population attributable risk (PAR) for nine (out of 14) Lancet Commission factors was calculated for 19 WPR countries using relative risk values from the Lancet Commission and published risk factor prevalence data. The nine factors comprised low education, hearing loss, depression, physical inactivity, diabetes, smoking, hypertension, obesity, and alcohol misuse. Mean PAR values were also calculated for high‐income, upper‐middle income, and low‐middle income WPR countries. Results: PAR values varied across WPR countries (Table 1). The greatest differences were observed for education (18.5%) and obesity (12.0%) and smallest for depression (3.3%) and alcohol (2.1%). In low‐middle income countries, the highest mean PAR value was for education (9.75%) (Figure 1). By contrast, the highest values in middle‐high and high‐income countries were for diabetes (9.21%) and inactivity (6.42%). Smoking had the second highest mean PAR value in all three groups (range: 5.9‐9.2). Hearing loss and obesity also ranked highly across all groups. Conclusion: Country‐specific population‐level strategies are urgently needed to effectively reduce dementia risk. Low‐middle income countries will benefit most from interventions and policies that improve access to education; middle‐high income countries from targeting diabetes, and high‐income countries from targeting physical inactivity. Targeting smoking and hearing loss will benefit the entire WPR region. Strategic partnerships between academics, policy makers and industry will ensure appropriate resources are directed to where they will have the most impact. References Livingston G et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, Volume 404, Issue 10452, 572‐628. Clarke AJ et al. (2024). Risk factors for the neurodegenerative dementias in the Western Pacific region. The Lancet Regional Health – Western Pacific, Volume 50,101051

Background: Globally, approximately 55 million people are living with dementia. Osteoarthritis occurs in half of all older adults and is associated with pain, depression, and increased dementia risk. Currently, no program exists for people with osteoarthritis and cognitive decline that addresses modifiable risk factors, such as physical inactivity and lifestyle behaviors. Objective: This study aims to examine the feasibility, acceptability, and health outcomes following the 12-week Healthy Body and Mind Program, designed for people with osteoarthritis who are experiencing cognitive decline. The findings will inform the designs of larger trials. Methods: In total, 20 consenting participants aged 45 years or older with osteoarthritis and cognitive decline will be randomly allocated to the 12-week program or a waitlist control group. Feasibility and acceptability will be assessed based on retention and adherence rates to the program, the number of people who provide consent to take part in the study, and evaluation questions following completion of the program. Health outcomes will include quality of life, cognition (global, attention, learning, and memory), pain, psychological health (stress, anxiety, and depression), and physical health. Results: This study has been reviewed and approved by the University of New South Wales Human Research Ethics Committee (HC230506). This project will be carried out according to the National Statement on Ethical Conduct in Human Research (2007). As of October 2025, we have enrolled 18 participants and completed their data collection. Results are expected to be published in peer-reviewed journals during the first quarter of 2026. Participant confidentiality will be maintained in line with ethical considerations. Conclusions: This protocol reports methods to determine feasibility, acceptability, and preliminary health outcome data of the Healthy Body and Mind Program informed by individuals with lived experience of dementia and osteoarthritis. Trial Registration: ClinicalTrials.gov NCT06070818; clinicaltrials.gov/study/NCT06070818 International Registered Report Identifier (IRRID): DERR1-10.2196/75816