Kelly J. Atkins

INTRODUCTION: Advancements in disease‐modifying therapies and collaborative dementia care programs have created opportunities to transform care for people with Alzheimer's disease. METHODS: We modeled people aged 71 across three scenarios: 18 months of lecanemab, collaborative care, and combined interventions. Outcomes included quality‐adjusted life years (QALYs), 2024 costs, and incremental cost‐effectiveness ratios (ICERs) as appropriate. RESULTS: Per person, collaborative care (vs usual care) increased QALYs by 0.26 with savings of $48,000 (dominant); adding lecanemab to collaborative care yielded an additional 0.16 QALYs at a total cost per QALY of $218,000 (societal perspective) and $248,000 (healthcare perspective). When scaled to the US population, lecanemab yielded 180,000 QALYs at a cost of $39.5 billion; collaborative care yielded 1.5 million QALYs and saved $300 billion. Findings were robust to uncertainties. DISCUSSION: Collaborative dementia care offers health and economic benefits and should be prioritized for widespread implementation.

Summary: Introduction: Peri‐operative neurocognitive disorders are common among older adults presenting for surgery and anaesthesia. Cognitive screening is recommended to identify patients at risk for adverse neurocognitive outcomes, though the most appropriate peri‐operative tool remains debated. Remote assessment methods may be advantageous, but they need robust validation. We aimed to examine the feasibility and validity of the Modified Telephone Interview for Cognitive Status (TICS‐M) among older adults and provide recommended TICS‐M scores to identify those most at risk of poor postoperative cognitive outcomes. Methods: As part of a prospective longitudinal study with 215 older adults living in the community or scheduled for elective surgery, we conducted the modified, 22‐item, 50‐point version of the TICS remotely, followed by in‐person assessments using two common cognitive screening tools: the Mini‐Mental State Examination (MMSE); Alzheimer's Disease Assessment Scale Cognition Subscale (ADAS‐Cog); and a comprehensive neuropsychological and functional assessment. Results: The TICS‐M was feasible and acceptable, with a completion rate of 86%. TICS‐M scores correlated with scores on the MMSE (r = 0.61, p < 0.001) and ADAS‐Cog (r = ‐0.55, p < 0.001) at baseline, and associations remained consistent at 12‐ and 24‐month follow‐up. After controlling for age, sex and education, baseline performance on the TICS‐M was independently associated with subsequent cognitive impairment at 12 months (OR 0.84, 95% CI 0.77–0.92, p < 0.001) and 24 months (OR 0.84, 95% CI 0.76–0.94, p = 0.001). A TICS‐M score of 32.5 was the optimal threshold to identify people with cognitive impairment (0.76, 95% CI 0.70–0.82, p < 0.001). Discussion: The TICS‐M is a feasible, valid and reliable remotely administered tool that shows utility in the peri‐operative environment. We recommend its implementation into routine clinical practice for remote pre‐operative assessment in patients aged ≥ 65 y scheduled for surgery and anaesthesia.

Summary: Background: Peri‐operative neurocognitive disorders are one of the most common complications affecting older adults after anaesthesia and surgery. It is not clear how exposure to surgery and anaesthesia contributes to the prevalence of long‐term neurocognitive disorders. This study aimed to report the prevalence of neurocognitive disorders, and explore pre‐operative factors associated with neurocognitive disorders 5 years after elective orthopaedic surgery. Methods: A prospective, 5‐year longitudinal, cohort study was performed recruiting patients (aged ≥ 60 y) undergoing elective orthopaedic surgery and a contemporaneous non‐surgical control group. Neurocognitive disorder was evaluated and classified at baseline and 5‐year review incorporating: self‐ and informant‐reported cognition; functional participation; and performance on neuropsychological tests. Results: Recruitment at 5‐year follow‐up included 195 patients and 21 control participants. In the patient cohort the prevalence of neurocognitive disorder was 38.1% (n = 75), with 61 (30.1%) meeting the criteria for mild neurocognitive disorder and 14 (7.1%) for major neurocognitive disorder. At 5‐year follow‐up, 121 (61.4%) patients were classified with a neurocognitive disorder, with 88 (44.7%) characterised with mild neurocognitive disorder and 33 (16.8%) with major neurocognitive disorder. Age (odds ratio (95%CI) 1.07 (1.02–1.13); p = 0.01) and baseline cognitive impairment (odds ratio (95%CI) 2.1 (1.06–4.15); p = 0.03) were significant predictors of neurocognitive disorder 5 years after surgery. Conclusion: More than half of older adult patients had some form of neurocognitive disorder 5 years after elective orthopaedic surgery. Surgery and anaesthesia may be associated with the trajectory of cognitive decline in at‐risk older adults, including those with pre‐operative cognitive impairment. Cognitive screening should be factored into pre‐operative assessments of older adults to inform subsequent care.

Aim: In Huntington's disease (HD) and Parkinson's disease (PD), apathy is a frequently cited barrier to participation in physical activity. Current diagnostic criteria emphasize dissociable variant...

Individuals with body dysmorphic disorder (BDDDD) and clinically concerning body-image concern (BICIC) appear to possess abnormalities in the way they perceive visual information in the form of a bias towards local visual processing. As inversion interrupts normal global processing, forcing individuals to process locally, an upright-inverted stimulus discrimination task was used to investigate this phenomenon. We examined whether individuals with nonclinical, yet high levels of BIC would show signs of this bias, in the form of reduced inversion effects (i.e., increased local processing). Furthermore, we assessed whether this bias appeared for general visual stimuli or specifically for appearance-related stimuli, such as faces and bodies. Participants with high-BIC (n = 25) and low-BIC (n = 30) performed a stimulus discrimination task with upright and inverted faces, scenes, objects, and bodies. Unexpectedly, the high-BIC group showed an increased inversion effect compared to the low-BICIC group, indicating perceptual abnormalities may not be present as local processing biases, as originally thought. There was no significant difference in performance across stimulus types, signifying that any visual processing abnormalities may be general rather than appearance-based. This has important implications for whether visual processing abnormalities are predisposing factors for BDD or develop throughout the disorder.

The body image concern (BIC) continuum ranges from a healthy and positive body image, to clinical diagnoses of abnormal body image, like body dysmorphic disorder (BDD). BDD and non-clinical, yet high-BIC participants have demonstrated a local visual processing bias, characterised by reduced inversion effects. To examine whether this bias is a potential marker of BDD, the visual processing of individuals across the entire BIC continuum was examined. Dysmorphic Concern Questionnaire (DCQ; quantified BIC) scores were expected to correlate with higher discrimination accuracy and faster reaction times of inverted stimuli, indicating reduced inversion effects (occurring due to increased local visual processing). Additionally, an induced global or local processing bias via Navon stimulus presentation was expected to alter these associations. Seventy-four participants completed the DCQ and upright-inverted face and body stimulus discrimination task. Moderate positive associations were revealed between DCQ scores and accuracy rates for inverted face and body stimuli, indicating a graded local bias accompanying increases in BIC. This relationship supports a local processing bias as a marker for BDD, which has significant assessment implications. Furthermore, a moderate negative relationship was found between DCQ score and inverted face accuracy after inducing global processing, indicating the processing bias can temporarily be reversed in high BIC individuals. Navon stimuli were successfully able to alter the visual processing of individuals across the BIC continuum, which has important implications for treating BDD.