Neelum T. Aggarwal

Background: Medication adherence is a critical challenge for people living with dementia and their caregivers. Standard care relies on appropriate medication management, yet there are few effective options beyond manual pill-counting and caregiver-administered dosing. These methods are prone to errors and impose a significant burden. Technologically enhanced adherence tools include smart caps, reminder apps, and electronic dispensers, which improve tracking but still depend on manual interaction, lack clinical integration, and are often unsuitable for cognitive impairment. The HiDO HomeCare System (HCS) is an artificial intelligence–enabled self-medication device, advancing the field by removing manual pill counting, automating the chain-of-custody, verifying consumption, and logging medication adherence through neuroscience-based logic and real-time monitoring. Objective: This study evaluated the feasibility, usability, and performance of the HCS for at-home medication management in dyads of people living with dementia and their caregivers. We examined setup, dispensing accuracy, task efficiency, and user satisfaction. Methods: A pooled analysis usability study was conducted with 35 caregiver-patient dyads at Rush University Medical Center, combining 2 sequential in-clinic cohorts run at different time points with the same protocol. Participants were recruited from the Rush Memory Clinic and Rush Alzheimer’s Disease Center data repository. Participant dyads completed device setup, medication dispensing, and simulated medication use with the system’s automated logging and dual-camera verification. Dyads repeated dispensing and simulated medication use following automated reminders sent to their mobile device. Dyads were encouraged to repeat dispensing tasks multiple times. Quantitative measures included setup time, time to dispense, success rates, reliability, and System Usability Scale scores. Qualitative measures also captured caregiver perceptions of usability, acceptability, and burden. Results: All 35 dyads successfully completed at least one dispensing task using the HCS. The average time for the first dispense attempt was 1:41 (SD 1:13) minutes (n=35). The second attempt averaged 1:35 (SD 1:10) minutes (n=21). Attempt 3 averaged 2:03 (SD 1:34) minutes (n=6). The system maintained accuracy across all users, with some variability in timing across age groups. The HCS received an overall mean System Usability Scale score of 70.2 (SD 18.2; n=34), reflecting above-average usability of the device. Caregivers reported that access to a system like HCS could reduce stress associated with medication administration and recommended improvements to specific design elements. Conclusions: The HCS demonstrated early feasibility, accuracy, and usability as a self-medication device tailored to people living with dementia. By automating the medication safety chain from delivery through consumption, HCS reduces caregiver workload and enhances patient safety and medication management. These findings support HCS as a viable medication adherence solution, addressing limitations of prior devices and enabling better dementia care. Larger-scale, longitudinal studies are planned to examine clinical outcomes, caregiver burden, and cost-effectiveness within real-world home and community settings.

Intracranial atherosclerosis disease (ICAD) accounts for 30% of ischemic strokes, has the highest stroke recurrence rate, and is associated with accelerated cognitive decline. This study investigates associations between diet patterns and the risk of ICAD. Participants in a longitudinal clinical neuropathologic cohort study, with complete dietary, medical history, and neuropathology data, were included. Diet scores were computed (median interval to death = 5.9 [3.0-8.7] years). History of hypertension (HTN) and myocardial infarction (MI) were self-reported. Large vessel ICAD was evaluated at the circle of Willis, and severity of ICAD was assessed based on number of atherosclerotic plaques, extent of vessel involvement, and degree of vessel occlusion to create a 4-level grading system (0-3). All regression models were adjusted for age, sex, education, caloric intake, and APOE4. Of the 676 participants (mean age at death = 91.1 years, SD = 6.1, 71% women), 361 (53%) had mild, 142 (21%) had moderate, and 28 (4%) had severe ICAD. There was no direct relationship between diet and ICAD. The association between ICAD and MI (OR 1.38, 95% CI 0.95-2.00) was not significant. HTN (OR 1.598, 95% CI 1.15-2.18) was positively associated with ICAD. The association of diet with ICAD differed by history of MI (Mediterranean-DASH intervention for neurodegenerative delay [MIND] [p = 0.007], MedDiet [p = 0.006]). The association between ICAD and the MIND diet also differed by whether HTN was reported (β = -0.212, SE = 0.111, p = 0.055) as did the relationship between ICAD and the MedDiet (β = -0.077, SE = 0.035, p = 0.029). In stratified analysis, among individuals with preexisting MI (N = 130), those with a better diet had lower odds of ICAD (MedDiet: OR 0.88, 95% CI 0.81-0.96; MIND: OR 0.69, 95% CI 0.53-0.90). A direct relationship between diet and ICAD was not seen. Stratified analysis suggested that healthy diet may be of value for individuals with HTN or MI: In these high-risk individuals, a healthy dietary pattern is associated with lower odds of severe large vessel ICAD. In vivo studies of dietary habits and brain health, specifically in those at high vascular risk, are needed.

BACKGROUND Medication adherence is a critical challenge for people living with dementia and their caregivers. Standard care relies on appropriate medication management, yet there are few effective options beyond manual pill-counting and caregiver-administered dosing. These methods are prone to errors and impose a significant burden. Technologically enhanced adherence tools include smart caps, reminder apps, and electronic dispensers, which improve tracking but still depend on manual interaction, lack clinical integration, and are often unsuitable for cognitive impairment. The HiDO HomeCare System (HCS) is an artificial intelligence–enabled self-medication device, advancing the field by removing manual pill counting, automating the chain-of-custody, verifying consumption, and logging medication adherence through neuroscience-based logic and real-time monitoring. OBJECTIVE This study evaluated the feasibility, usability, and performance of the HCS for at-home medication management in dyads of people living with dementia and their caregivers. We examined setup, dispensing accuracy, task efficiency, and user satisfaction. METHODS A pooled analysis usability study was conducted with 35 caregiver-patient dyads at Rush University Medical Center, combining 2 sequential in-clinic cohorts run at different time points with the same protocol. Participants were recruited from the Rush Memory Clinic and Rush Alzheimer’s Disease Center data repository. Participant dyads completed device setup, medication dispensing, and simulated medication use with the system’s automated logging and dual-camera verification. Dyads repeated dispensing and simulated medication use following automated reminders sent to their mobile device. Dyads were encouraged to repeat dispensing tasks multiple times. Quantitative measures included setup time, time to dispense, success rates, reliability, and System Usability Scale scores. Qualitative measures also captured caregiver perceptions of usability, acceptability, and burden. RESULTS All 35 dyads successfully completed at least one dispensing task using the HCS. The average time for the first dispense attempt was 1:41 (SD 1:13) minutes (n=35). The second attempt averaged 1:35 (SD 1:10) minutes (n=21). Attempt 3 averaged 2:03 (SD 1:34) minutes (n=6). The system maintained accuracy across all users, with some variability in timing across age groups. The HCS received an overall mean System Usability Scale score of 70.2 (SD 18.2; n=34), reflecting above-average usability of the device. Caregivers reported that access to a system like HCS could reduce stress associated with medication administration and recommended improvements to specific design elements. CONCLUSIONS The HCS demonstrated early feasibility, accuracy, and usability as a self-medication device tailored to people living with dementia. By automating the medication safety chain from delivery through consumption, HCS reduces caregiver workload and enhances patient safety and medication management. These findings support HCS as a viable medication adherence solution, addressing limitations of prior devices and enabling better dementia care. Larger-scale, longitudinal studies are planned to examine clinical outcomes, caregiver burden, and cost-effectiveness within real-world home and community settings.

BACKGROUND Medication mismanagement is one of the most prevalent and concerning risk factors for persons living with dementia (PlwD) living at home, contributing to preventable hospitalizations, adverse drug events, and an increased caregiver burden. Each year, over 3 million older U.S. adults are admitted to nursing homes due to medication-related adherence problems. PlwD often manage complex regimens involving multiple medications where errors and challenges in medication consumption are significantly prone. Medication adherence is a critical yet often unmet need in dementia care, with traditional systems like pill bottles and manual tracking proving insufficient. HiDO is an automated, artificial intelligence (AI)-driven, medication dispensing and direct observation platform designed to optimize adherence. The innovative device integrates medication delivery, dose timing, medication synchronization, and a pair of front-facing video cameras to validate the right medications, right route, right time, right dosage to the right patient (5R’s). OBJECTIVE The study objective was to obtain pilot end-user validation through usability testing with the goal of creating an automated, secure, AI-driven medication delivery and observation platform to maximize therapy compliance and health outcomes for PlwDs. METHODS PlwDs with mild cognitive impairment or early-stage dementia (Montreal Cognitive Assessment (MoCA) score of 18 to 24, inclusive) and their caregivers were recruited for in-person usability testing in the Midwest region of the US. After written informed consent was obtained, dyads learned about the HiDO device and watched a demonstration of its set-up and typical usage. Dyads were then asked to complete a series of tasks using the device and to evaluate its ease of use. Subjective feedback was elicited using a semi-structured interview process. It was expected that device setup would take less than 5 minutes, at least 75% of all tasks would be successfully completed, and no more than one non-critical error would occur per dyad. Following usability testing, dyads also completed the System Usability Scale (SUS). RESULTS Fifteen dyads were recruited in the Midwest region of the US. The mean SUS score was 80, suggesting high usability and typically placing the system in the top 10-15% of products evaluated with the scale. Two critical and 13 non-critical errors were experienced. Minor device adjustments could enhance usability further. Themes in qualitative comments regarding usability included: a) Positive Perceptions of Innovation; b) Perceived Usefulness for Polypharmacy; c) Size and Placement Constraints; d) Accessibility and Display Preferences; and e) Need for Setup Guidance and Support Features for Care givers. CONCLUSIONS This usability study provides an understanding of how PlwDs perceived the HiDO device, its utility, and its usability. Most participants found the device usable; those who had minor usability issues suggested corrective design actions. The results are limited by the set of 15 dyads. Further utility, technology effectiveness, and usability testing in a larger cohort and an in-field trial are necessary. CLINICALTRIAL NCT06691256

Background: The Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet is a hybrid of the Mediterranean and DASH diets, with added foods designed to target brain health. Observational studies demonstrate inverse relations with cognitive decline but clinical trial evidence is lacking.Method: We assigned at random 604 older adults without cognitive impairment, a family history of dementia, BMI>25, and a MIND diet score ≤8 on a 14‐item screener, to the MIND diet or placebo (usual diet) for three years (January 2017 ‐ June 2021); all participants received diet counseling for weight loss, monthly cooking sessions, and other support over 3 years. Cognition was assessed with a 12‐test battery from which a measure of global cognition was derived. The trial was interrupted due to the COVID‐19 global pandemic and analyses were conducted to account for the interruption. Using random effects analyses we assessed rate of cognitive decline from baseline to trial close in each group, both pre‐ and post‐COVID.Result: Overall, 564 participants (93%) completed the trial. In an intent‐to‐treat analysis, those assigned to MIND diet maintained better global cognition compared to placebo control (difference in standard units = 0.015 per year, 95% CI: ‐0.005, 0.034); findings were borderline significant. To help interpret findings, the effect estimate was equivalent to being 4.3 years younger in age for this sample population. Pre‐pandemic, we observed a significant, positive effect of MIND on change in cognition over two years compared to placebo/usual diet (beta = 0.026, 95% CI: 0.001, 0.052).Conclusion: Over three years, the MIND diet was beneficial for cognition compared to usual diet, although results were not formally statistically significant. However, there was evidence of a statistically significant effect of the MIND diet before the start of the COVID‐19 pandemic, which impeded the intervention protocol and outcome ascertainment.

Background: The COVID pandemic has brought death and dying to the forefront, contributing to the already high levels of physician burnout. Furthermore, there is a negative correlation between physician burnout and empathy. Due to time constraints of clinical rotations in traditional medical education, there are often shortcomings in students’ understanding of how to best manage and communicate with chronically or terminally ill patients. This study implements a distributive model of a virtual reality (VR)‐based curriculum, utilizing vignettes that portray a Latinx woman, Beatriz, with Alzheimer’s disease, and a veteran, Clay, with cancer transitioning to hospice from a first‐person perspective.Method: Medical and premedical students in Chicago were recruited (N = 12, 75% female, 58% White, 58% M2) and engaged in a self‐directed VR‐based curriculum, including Embodied Labs modules and corresponding lectures from expert physicians. Lecture content time was 2 hours 40 minutes and VR module time was 35 minutes, which students completed at their own pace prior to a Zoom group discussion. Participants completed a series of pre‐ and post‐surveys.Result: Preliminary qualitative analysis reveals participant‐perceived increased competencies in the following themes: medical knowledge and preparedness (100%), compassion and empathy (67%), communication and patience (50%), emotional connection and advocacy (50%), and family values and comfort (42%) after program completion. Moreover, 11/12 participant reflections either directly stated the value of this experience for their professional development or explicitly highlighted its utility within medical school curricula. Additional qualitative content analyses and quantitative statistics on the changes in pre‐ and post‐survey measures are forthcoming.Conclusion: Burnout and reduced patient‐centered‐care have been identified as barriers to empathic delivery of care in the COVID era. Utilizing VR to develop a medical curriculum fosters increased compassion and empathy in the context of dementia and end‐of‐life care. This multi‐dimensional curriculum can be scaled and implemented virtually to mitigate the impact of burnout on empathy in trainees caring for patients during the pandemic. Future aims include formally integrating this model into a medical curriculum, targeting students early in their career before they are overwhelmed with burnout, and broadening content to include trainees from diverse medical professional programs and institutions.

Background: To investigate the effect of pre‐existing neurological symptoms and disease in coronavirus disease 2019 (COVID‐19) health outcomes in a large Illinois‐based cohort.Method: A multicenter retrospective study analyzed differences in a cohort of COVID‐19 positive patients with and without baseline neurological symptoms or disease admitted to RUSH University Systems for Health from March to November 2020. We measured sex and health outcome differences in hospitalization rates, symptoms during initial admission, complications, readmissions, and mortality of the two groups.Result: Of the total of 1708 hospitalized COVID‐19 positive patients (mean age: 58.04, 930 males) — 31% [527] patients had a history of neurological symptoms and/or disease, 9% [140] with dementia. Nonspecific symptoms during hospitalization including myalgia (19%), headache (11%), epilepsy (0.8%), tremors (3%), and abdominal pain (11%) were reported more frequently in patients with a neurologic history. Female patients with pre‐existing neurological conditions were hospitalized more than their male counterparts (40% versus 24%). Compared to those with no neurological conditions, patients with neurological conditions had higher rates of complications, such as acute myocardial infarction (13% vs. 8%; p = 0.002) and deep vein thrombosis/pulmonary embolism (14% vs. 10%; p = 0.02). Multivariate analysis showed that history of stroke and migraines are independently associated with readmission to a hospital floor (generalized linear model, z = 2.092, z = 3.320, p = 0.036, p < 0.001, respectively); of those readmitted, 13% had a history of dementia. Of the patients that died in hospital, 6% had a history of dementia.Conclusion: Neurologic manifestations are common in hospitalized COVID‐19 positive patients and are associated with higher rates of complications during hospitalization. The increasing evidence for SARS CoV‐2’s impact on the central nervous system raises important questions on the long‐term consequences of this virus to patients with pre‐existing brain injury.

Objective: Diet may reduce Alzheimer’s dementia risk and slow cognitive decline, but the understanding of the relevant neuropathologic mechanisms remains limited. The association of dietary patterns with Alzheimer’s disease (AD) pathology has been suggested using neuroimaging biomarkers. This study examined the association of MIND and Mediterranean dietary patterns with beta-amyloid load, phosphorylated tau tangles, and global AD pathology in postmortem brain tissue of older adults. Methods: Autopsied participants of the Rush Memory and Aging Project) with complete dietary information (collected through a validated food frequency questionnaire) and AD pathology data (beta-amyloid load, phosphorylated tau tangles, and global AD pathology [summarized neurofibrillary tangles, neuritic and diffuse plaques]) were included in this study. Linear regression models controlled for age at death, sex, education, APO-ε4 status, and total calories were used to investigate the dietary patterns (MIND and Mediterranean diet) and dietary components associated with AD pathology. Further effect modification was tested for APO-ε4 status and sex. Results: Among our study participants (N=581, age at death: 91.0 ± 6.3 years; mean age at first dietary assessment: 84.2 ±5.8; 73% female; 6.8 ± 3.9 years of follow-up) dietary patterns were associated with lower global AD pathology (MIND: β= -0.022, p=0.034, standardized β=-2.0; Mediterranean: β=-0.007, p=0.039, standardized β=-2.3) and specifically less beta-amyloid load (MIND: β=-0.068, p=0.050, standardized β=-2.0; Mediterranean: β=-0.040, p=0.004, standardized β=-2.9). The findings persisted when further adjusted for physical activity, smoking, and vascular disease burden. The associations were also retained when participants with mild cognitive impairment or dementia at the baseline dietary assessment were excluded. Those in the highest tertile of green leafy vegetables intake had less global AD pathology when compared to those in the lowest tertile (Tertile-3 vs. Tertile-1: β= -0.115, p=0.0038). Conclusion: The MIND and Mediterranean diets are associated with less postmortem AD pathology, primarily beta-amyloid load. Among dietary components, green leafy vegetables inversely correlate with AD pathology.

Background and Objectives Recent studies suggest the utility of blood biomarkers in detecting changes in neurodegenerative disorders. The objective of our research was to test the hypothesis that the longitudinal changes in total tau (t-tau), neurofilament light chain (Nf-L), and glial fibrillary acidic protein (GFAP) are associated with structural MRI and the development of clinical Alzheimer disease (AD) and cognitive decline. Methods Data came from a population-based sample with serum concentrations of t-tau, Nf-L, and GFAP and cognitive characteristics measured over 17 years. The inclusion criteria for this investigation were based on participants with blood samples, cognitive function testing, and clinical diagnosis for AD. The longitudinal changes in the serum biomarkers were examined using linear mixed models for log10-transformed concentrations. Results In 1,327 participants (60% Black participants and 60% women, the concentration of t-tau increased annually by 4.8% (95% CI = 4.0–5.6) and Nf-L by 5.9% (95% CI = 5.4–6.4). The longitudinal change in GFAP was higher among Black participants than among White participants (4.4% vs 3.5% per year, p = 0.028). Baseline MRI characteristics were associated with the longitudinal changes in serum biomarkers of clinical AD. Specifically, a higher baseline third ventricular volume was associated with a higher rate of increase in the concentration of t-tau, and white matter hyperintensities predicted a higher rate of increase in Nf-L. The rate of change in concentrations of t-tau, Nf-L, and GFAP was significantly higher among those who developed clinical AD than in those with no cognitive impairment. For each standard deviation unit decline in global cognition, longitudinal change in t-tau increased by 81% (95% CI = 76–86), Nf-L by 113% (95% CI = 105–120), and GFAP by 66% (95% CI = 62–70). Discussion Blood biomarkers showed significant longitudinal changes corresponding to cognitive decline, clinical AD, and structural MRI characteristics. Our findings show that longitudinal changes in serum biomarkers were associated with several cognitive endophenotypes. Classification of Evidence The study found Class II evidence that longitudinal changes in serum t-tau, Nf-L, and GFAP were associated with cognitive decline and the development of clinical AD in people older than 65 years.