Yen Ying Lim

INTRODUCTION: Obstructive sleep apnea (OSA) is a potential risk factor for cognitive impairment and dementia; however, its contribution in midlife and interactions with APOE ε4 remain unclear. METHODS: Participants were 2795 cognitively unimpaired, middle‐aged adults enrolled in the Healthy Brain Project. OSA status was determined by self‐report. Cognition was assessed using the Cogstate Brief Battery, and dementia risk using the Cardiovascular Risk Factors, Ageing, and Incidence of Dementia (CAIDE) score. RESULTS: Participants with OSA demonstrated poorer memory than those without OSA, although this association was attenuated after adjusting for vascular risk. Individuals with OSA (with or without APOE ε4) had significantly higher CAIDE scores than those with neither risk factor. APOE ε4 did not moderate OSA‐cognition associations. DISCUSSION: OSA may be associated with poorer memory and greater dementia risk, irrespective of APOE ε4 carriage. These findings highlight the need for early OSA screening to identify individuals at elevated dementia risk.

Background: In Australia, access to Alzheimer's disease (AD) therapeutics requires apolipoprotein E ( APOE ) genotype testing and disclosure, yet the feasibility, acceptability and tolerability of APOE disclosure in an Australian context remains unknown. Objective: This pilot study evaluated a researcher-delivered, videoconferencing-based APOE disclosure protocol in cognitively unimpaired (CU) Australian adults with dementia family history. Methods: The DISCLOSE- APOE protocol, informed by prior expert approaches and Australian consumer preferences, was piloted in fifteen CU adults aged 40–70 (8 ε4 carriers, 7 non-carriers). The protocol comprised 7 online sessions, including mood/suicide risk assessment, education, and psychological readiness evaluation. APOE genotype was disclosed 1:1 via videoconferencing using a standardized interaction procedure. Existing data and online questionnaires assessed participant characteristics and outcomes pre- and post-disclosure. Paired-samples t-tests examined within-group mood changes, and independent-samples t-tests compared post-disclosure test-/event-related distress between carriers and non-carriers. Results: All participants (M age = 60.8 (±6.4), 60% female) completed the pilot, and no adverse events occurred. Baseline mood was equivalent across groups. Anxiety decreased post-disclosure in both ε4 carriers and non-carriers. Depressive symptoms increased slightly but not significantly in ε4 carriers and remained sub-threshold. Test-related distress was moderately higher in ε4 carriers post-disclosure. Conclusions: Researcher-delivered and remote APOE disclosure via videoconferencing resulted in no attrition nor clinically-significant short-term psychological distress, with pilot data providing preliminary evidence of feasibility, acceptability and tolerability in this cohort. Findings will inform the development and implementation of culturally-appropriate and scalable APOE disclosure protocols in research and clinical settings to facilitate delivery of anti-Aβ therapies in Australia.

BACKGROUND The increasing prevalence of dementia, alongside limitations in clinical workforce capacity, highlights the need for more accessible and scalable approaches to cognitive assessment. Internet-based cognitive assessment, including digital cognitive tests (DCTs) and cognitive assessment via telehealth (CATH), provides a potential solution. However, successful implementation depends on consumer acceptability, which remains poorly understood within the context of Alzheimer’s disease (AD) diagnosis. OBJECTIVE This study aimed to examine consumer perspectives regarding cognitive assessment and the use of internet-based cognitive assessment for AD diagnosis, including (1) experiences undergoing cognitive assessment and (2) attitudes toward testing for AD using digital methods, including perceived barriers and enablers to engagement. METHODS A cross-sectional mixed-methods design was used, comprising an online survey and semi-structured interviews on a sample of middle-to-older aged Australian adults. Quantitative data were analysed using descriptive statistics and non-parametric tests to examine subgroup differences. Open-ended survey responses were analysed using content analysis. Interview data were analysed using applied thematic analysis, with findings mapped to the COM-B framework (capability, opportunity, motivation). RESULTS A total of 842 survey responses were analysed, with 54% reporting prior cognitive assessment experience. Satisfaction with cognitive assessment was generally high, but significantly higher among older adults (P=.001) and for assessments conducted in-person (P<.001). Content analysis indicated that experiences were shaped by emotional responses, clinician qualities, test design features, and outcomes following assessment. Willingness to undergo AD testing was high overall but varied by modality, with blood-based testing preferred over remote and in-person cognitive assessment methods (P<.001). DCT willingness was comparable to in-person cognitive assessment, whereas CATH willingness, while high, was significantly lower than all other modalities (P<.001). Willingness to engage in internet-based cognitive assessment was associated with age, education, and prior experience with digital or telehealth modalities. Interviews (N=26) identified seven themes mapped to COM-B, including digital competency, convenience, test design, social support, emotional responses, as well as a strong preference for maintaining choice between in-person and digital assessment options. CONCLUSIONS Consumers are generally receptive to cognitive assessment and internet-based approaches for AD diagnosis. However, experiences and preferences vary across modalities and are shaped by individual capability, familiarity, and support. While consumers recognise internet-based cognitive assessment offers advantages in accessibility and efficiency, it does not fully replace the perceived value of in-person interactions. These findings underscore the importance of flexible, consumer-centred implementation strategies that preserve

Alzheimer's disease (AD) causes alterations in speech and language across multiple domains, including semantic content, pragmatics, prosody, morphosyntax, phonology and timing/fluency, with some of these changes detectable early in the disease course. Definitive biomarker assessments of AD are often invasive or resource-intensive; there is a need for scalable measures in screening and monitoring AD. Advances in natural language processing and automated transcription can quantify speech and language features from structured tasks and natural conversations. This review summarizes domain-specific changes across the AD continuum, evaluates evidence linking these features to biomarkers of AD pathology (amyloid and tau), and discusses opportunities and limitations for future work. We conclude by identifying priorities for the field, namely, domain-aware task design, demographic and language-sensitive norms and standardized, biomarker-validated datasets.

BACKGROUND The continuing rise in dementia diagnoses, combined with limited growth in the clinical workforce, necessitates more efficient and accessible methods of cognitive assessment. While technological developments have allowed clinicians to deliver assessment services via telehealth, current uses, barriers, and enablers to telehealth assessment in Australia are not well understood. OBJECTIVE This study aimed to explore clinician experiences and opinions, including barriers and enablers, of conducting cognitive assessment via telehealth with middle-to-older aged adults in Australia. METHODS An online quantitative survey was distributed to clinicians with prior experience of providing cognitive assessments with middle-to-older aged adults. A subsample of survey respondents also participated in an online semi-structured interview. Respondent characteristics and quantitative data were analysed using descriptive statistics. Qualitative interview data were analysed using applied thematic analysis and results mapped to the domains of the COM-B framework (capability, opportunity and motivation). RESULTS Survey responses (n=88) were received from psychologists (56%), specialist doctors (20%), primary health clinicians (16%) and other allied health professionals (8%). A majority (88%) had some telehealth experience, with almost half (44%) using it weekly or more. Most common reasons for using telehealth included patient preferences, reduced travel and infection risk, and increased work flexibility and economic savings. The main barriers included the need for a patient support person, as well as technological issues. Most respondents (63%) had also administered a cognitive assessment via telehealth. Clinician confidence in the results obtained via a telehealth assessment were generally high; in particular, confidence was significantly higher for psychologists and those with previous cognitive assessment via telehealth experience (P<.001). Qualitative analysis resulted (n=20) in three themes mapped to the COM-B framework: 1. clinician telehealth skills and patient digital competency (capability); 2. suitability of cognitive tests, patient’s testing environment, technology and social support (opportunity); and 3. clinician opinions and approach to practice (motivation). Specific enablers and barriers within each theme were explored in greater detail. CONCLUSIONS Despite current barriers, clinicians across health disciplines described several factors that can support more frequent and effective use of telehealth-based assessment. Practical recommendations are provided as a scaffold to increase clinician and patient capacity, as well as cognitive test validation, intending to facilitate effective and appropriate utilisation of cognitive assessment via telehealth. Addressing these factors can help ensure cognitive assessments for middle-to-older aged adults are more accessible while meeting clinical standards in the assessment and diagnosis of dementia. CLINICALTRIAL NA

Communities of practice offer an opportunity to break down siloes for those with personal and professional experience of dementia. We aimed to design the Dementia Learning and Research Community in Australia, a virtual space to bring people with an interest or experience of dementia together to learn from each other, and provide opportunities for education and networking. A three-phase co-design process was conducted, consisting of six co-design workshops (or two workshops per phase) with people with personal or professional experience of dementia. The workshops addressed the three elements of a community of practice-the community, domain and practice. Participants discussed their preferences for these elements through facilitated group discussions and were provided with summaries of key points after each workshop. A total of 16 participants attended the workshops, including people living with dementia, carers, healthcare workers and researchers. They identified the need for a comfortable, respectful space that covers a range of research and care-based topics. Participants suggested webinars, discussion forums, panel sessions and resource banks within a members' only online platform. They highlighted the need for platform accessibility for people living with dementia and those in rural areas. A public facing website and members' only platform have now been created. This co-design process successfully brought together a range of participants with personal and professional experience of dementia to identify preferences for a community of practice on dementia across Australia. Future evaluations of the members' only platform will allow it to continue to evolve and identify areas for improvement. A Public Advisory Committee (comprising one person living with dementia and three former carers of people living with dementia) were involved during the grant writing stage, reviewed research documents (including participant information sheets) and provided guidance on the co-design workshop content. Two of the members of the committee who are former carers also reviewed this manuscript and are co-authors.

Background: Communities of practice offer an opportunity to break down siloes for those with personal and professional experience of dementia. We aimed to design the Dementia Learning and Research Community in Australia, a virtual space to bring people with an interest or experience of dementia together to learn from each other, and provide opportunities for education and networking. Methods: A three‐phase co‐design process was conducted, consisting of six co‐design workshops (or two workshops per phase) with people with personal or professional experience of dementia. The workshops addressed the three elements of a community of practice—the community, domain and practice. Participants discussed their preferences for these elements through facilitated group discussions and were provided with summaries of key points after each workshop. Results: A total of 16 participants attended the workshops, including people living with dementia, carers, healthcare workers and researchers. They identified the need for a comfortable, respectful space that covers a range of research and care‐based topics. Participants suggested webinars, discussion forums, panel sessions and resource banks within a members' only online platform. They highlighted the need for platform accessibility for people living with dementia and those in rural areas. A public facing website and members' only platform have now been created. Conclusions: This co‐design process successfully brought together a range of participants with personal and professional experience of dementia to identify preferences for a community of practice on dementia across Australia. Future evaluations of the members' only platform will allow it to continue to evolve and identify areas for improvement. Patient and Public Contribution: A Public Advisory Committee (comprising one person living with dementia and three former carers of people living with dementia) were involved during the grant writing stage, reviewed research documents (including participant information sheets) and provided guidance on the co‐design workshop content. Two of the members of the committee who are former carers also reviewed this manuscript and are co‐authors.

Background: Apolipoprotein E ( APOE ) ɛ4 carriage is the strongest genetic risk factor for sporadic Alzheimer's disease dementia. Clinical guidelines discourage APOE disclosure, but therapeutic advances are changing this. Limited work has assessed knowledge and interest in APOE disclosure in Australian adults, and it remains unclear which characteristics are associated with interest within this sample. Objective: This study examines knowledge and interest in APOE disclosure among Australian adults. Based on previous estimates, it was hypothesized that ≥50% would be interested in APOE disclosure. Methods: Cognitively unimpaired middle- and older-aged adults (N = 1421) completed the Knowledge, Interest and Preferences for APOE Testing and Disclosure survey, measuring APOE knowledge, interest in APOE disclosure, and perceived benefits/concerns. Participants completed online assessments measuring demographic, mood, subjective cognitive, Alzheimer's disease literacy, and perceived risk characteristics. Participants were categorized into four groups based on their interest: 1) want to know, 2) interested but need more information to decide, 3) unsure, 4) do not want to know). Results: Almost half of participants (44.2%) indicated that they had heard of APOE previously. Most participants (82%) were interested in knowing their APOE genotype or wanting more information. Compared to individuals who did not want to know their APOE genotype (114, 7.9%), individuals who wanted to know were younger, female, more likely to report dementia family history, and had greater perceived cognitive and Alzheimer's disease risk. Conclusions: Interest in APOE disclosure is high among Australian adults, consistent with international estimates. Findings will inform APOE disclosure protocols for Australian adults at-risk of dementia.