搜索结果：International journal of geriatric psychiatry

High-quality dementia care is underpinned by interprofessional collaborative practise, and healthcare training is a critical opportunity to develop these skills. This review aims to examine the evidence for whether interprofessional dementia education for undergraduate healthcare students positively impacts outcomes related to collaborative practise. Inclusion criteria consisted of papers investigating dementia interprofessional education interventions delivered within undergraduate education and that assessed outcomes relating to interprofessional collaboration. Searches were limited to papers published after 2014 and were conducted in eight databases: PubMed/MEDLINE, EMBASE, Web of Science, ERIC, The Cochrane Library, PsycINFO, CINAHL, Applied Social Sciences Index and Abstracts (ASSIA), British Education Index (BEI). A narrative synthesis was conducted and data quality was assessed. 11 papers, evaluating 11 different interventions, were included in the narrative synthesis. Four studies demonstrated positive changes in student attitudes or perceptions of interprofessional education or collaboration. Seven studies had evidence that students' knowledge or perceived skills about interprofessional collaboration increased. No evidence was presented for change in student behaviour, or impact on patients or organisational practise. Three studies presented findings on outcomes specifically relating to interprofessional dementia care. The findings suggest that dementia interprofessional education may contribute to interprofessional competencies. Therefore, interprofessional education could provide added value to dementia education, both of which are high priorities in the undergraduate curriculum. However, the strength of the evidence was weak as the methodological quality of the papers was low. Additionally, interventions were varied and therefore, optimal components of dementia interprofessional education were not identified. More rigorous investigation is needed on the impact of dementia interprofessional education with a focus on the longer-term impact on student practise and service delivery.

Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.

Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1·3 billion (95% uncertainty interval [UI] 1·2 to 1·4) individuals were estimated to be living with MASLD (ie, 16·1% of the global population), with an age-standardised prevalence rate of 14 429·3 (95% UI 13 268·3 to 15 990·6) per 100 000 population, representing a percentage increase of 142·7% (95% UI 139·2 to 146·7) in crude numbers from 1990 (0·5 billion [0·5 to 0·6]) and of 28·6% (27·8 to 29·5) in the rate (11 217·2 [10 276·8 to 12 467·0] per 100 000 in 1990). An estimated 3·6 million (2·8 to 4·5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39·6 (31·2 to 49·9) per 100 000 population. Despite a 116·3% (93·3 to 139·4) increase in crude DALYs (from 1·7 million [1·3 to 2·1] in 1990), its age-standardised estimate remained consistent (1·8% [-8·6 to 12·8]) from 1990 (38·9 [30·1 to 49·8] per 100 000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29 246·1 [26 848·3 to 32 048·7] per 100 000) and Andean Latin America showed the highest DALY rate (152·3 [114·1 to 194·7] per 100 000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653·5 [7923·7 to 9592·8] per 100 000) and east Asia had the lowest DALY rate (16·3 [13·5 to 19·9] per 100 000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15 616·4 [14 349·2 to 17 263·3] per 100 000 people in 2023) than in females (13 245·2 [12 132·0 to 14 692·6] per 100 000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2·2 [95% UI 1·6 to 3·1] per 100 000 people), followed by high BMI (1·4 [0·6 to 2·4] per 100 000 people) and smoking (1·0 [0·3 to 1·8] per 100 000 people). Our forecasting model estimates that 1·8 billion (95% UI 1·6 to 2·0) individuals are likely to have MASLD by 2050, representing a 42·0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15 774·9 (95% UI 14 613·9 to 17 336·2) per 100 000 people in 2050, representing an average annual percentage change of 0·3% (95% UI 0·3-0·3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16·1% and approximately 1·3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.

The objective of this study was to examine the long-term perceptions of the value of receiving an amyloid PET scan, a test used to diagnose Alzheimer's disease, among Medicare beneficiaries with cognitive impairment and their care partners. An exploratory qualitative research design was used. A total of 100 in-depth semi-structured interviews were conducted with a purposeful sample of CARE-IDEAS participants two to three years post-scan. A team of coders applied qualitative content analysis to identify content about the value of the scan, which was then analyzed using thematic analysis, and stratified by diagnostic category (mild cognitive impairment vs. dementia) and scan results (elevated amyloid vs. not elevated). A majority of amyloid PET scan recipients and their care partners emphasized major benefits of receiving the scan including increased certainty about diagnosis, the ability to prepare for the future, potentially accessing treatment or trials, the ability to contribute to research, and limited procedural risks. Some participants also reported concerns about the cost of the scan, the lack of effective treatment options and clear prognostic information, the limited impact on their lives or treatment plans, and the emotional toll of living with the results. Their views and endorsements of the scan were shaped by their health and personal circumstances (e.g., seen as less relevant among those with rapidly declining health), and by their preference for more information and involvement in decision-making. The perspectives of persons living with cognitive impairment and their care partners about the value of amyloid PET scans differed across disease trajectories and personal circumstances. These experiences should be taken into consideration when advising symptomatic patients on the benefits and drawbacks of biomarkers for Alzheimer's disease.

Behavioral and psychological symptoms of dementia (BPSD) are critical aspects of the clinical presentation of dementia. There is no universally accepted approach for the managment of BPSD, currently based first on a non-pharmacological and subsequently on a pharmacological approach. We explored the potential effect of long-term treatment with acetylcholinesterase inhibitors (AChEI) on BPSD severity over time. The initial sample included 4032 older patients with mild-moderate dementia (Alzhemier's disease - AD, Lewy body dementia - LBD, or vascular dementias - VaD) from the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS). After propensity score matching, a cohort of 1408 patients (704 treated with AChEI&#xa0;=&#xa0;AChEI+ and 704 not treated&#xa0;=&#xa0;AChEI-) was generated. The mean age was 73.2&#xa0;years (females: 50.4%). The mean follow-up duration was 4.3&#xa0;&#xb1;&#xa0;1.6&#xa0;years (range: 2.2-8.3&#xa0;years). Patients were evaluated at baseline, T1 (2&#xa0;years), T2 (4&#xa0;years), T3 (6.2&#xa0;years), and T4 (8.1&#xa0;years). BPSD severity was assessed by Neuropsychiatric Inventory (NPI-Q). The baseline mean NPI-Q severity score was 1.33. At T4, the score increased to 1.41 in AChEI- patients (+6% from baseline), while it decreased to 1.26 in AChEI+ (-6%) (all p&#xa0;<&#xa0;0.01 from T1 to T4). As regards the NPI-Q sub-items, six of them (hallucinations, agitation/aggression, depression/dysphoria, anxiety, disinhibition and irritability/lability) exhibited significant differences over time (all p&#xa0;<&#xa0;0.01) in favor of the AChEI&#xa0;+&#xa0;group (stabilization or improvement). Similar trends were observed when LOAD, LBD and VaD were considered separately. In contrast, for five domains (delusions, elation/euphoria, motor disturbances, night-time behaviors, and appetite/eating changes) no differences were observed. Our study supports the potential role for AChEI in BPSD management, demonstrating a trend toward symptoms stabilization or improvement in patients with mild-moderate dementia. Although the effects were not uniform across all NPI-Q domains, and the limitations of the study, our results reinforces the relevance of AChEI in the comprehensive treatment of dementia.

The study was aimed to explore the effects of digital device use (digital use) on the psychological health and cognitive functions in Chinese older adults. Participants (n&#xa0;=&#xa0;1915) were extracted from the Chinese Longitudinal Aging Social Survey (CLASS) in 2018. The digital use was measured by the use of digital devices in different areas over the internet and their use proficiency. Cognitive functions (mainly orientation and calculation) were evaluated with items from the Mini-Mental State Examination (MMSE), while psychological health was measured by perceived loneliness and life satisfaction. Bayesian structural equation modeling was applied to examine the direct effects of digital device purposes and digital device proficiency on cognitive functions and psychological health (loneliness and life satisfaction) and the mediating effects of psychological health. Use purposes of digital devices positively influenced orientation (&#x3b2;&#xa0;=&#xa0;0.33, 95% CI: 0.09-0.57) and negatively influenced perceived loneliness (&#x3b2;&#xa0;=&#xa0;-0.41, 95% CI: -0.55 to -0.28); proficiency had positive effect on loneliness (&#x3b2;&#xa0;=&#xa0;0.24, 95% CI: 0.02-0.44) and negative effect on life satisfaction (&#x3b2;&#xa0;=&#xa0;-0.12, 95% CI: -0.22 to -0.03). Loneliness partially mediated the relationship between digital purposes and orientation (&#x3b2;&#xa0;=&#xa0;0.07, 95% CI: 0.00-0.15), accounting for only 20% of the total effect. Crucially, loneliness directly impaired cognition, reducing both orientation (&#x3b2;&#xa0;=&#xa0;-0.17, 95% CI: -0.33 to -0.01) and calculation (&#x3b2;&#xa0;=&#xa0;-0.18, 95% CI: -0.31 to -0.06). Purposeful digital engagement can improve orientation and alleviate loneliness in Chinese older adults. It also helps preserve orientation ability partly by reducing feelings of loneliness, whereas use proficiency may exacerbate loneliness and diminish life satisfaction.

To model scenarios exploring potential impacts of disease-modifying therapies (DMTs) for Alzheimer's disease (AD) dementia on future health and social care costs in the United Kingdom. A cohort Markov model was developed using population projections and published AD epidemiological data. Stage-specific transition rates (mild cognitive impairment due to AD and mild, moderate, severe AD dementia) and health and social care cost data were applied to estimate cost outcomes over 2020-2040. Potential proportion of eligible population receiving treatment (uptake) and follow-up care models (primary vs. specialist care) were elicited from expert opinion. Scenarios combined ranges of DMT efficacy estimates, uptake, and care model. DMT price was excluded due to no UK precedent. Without DMT access, 1,038,405 people (1.5%) were projected to have AD dementia by 2040. Under the various DMT treatment scenarios, the prevalence of AD dementia by 2040 was projected to be 34,000-98,000 cases lower. Associated cumulative cost offsets were higher, &#xa3;4.4-12.9billion over 2020-2040, in scenarios where most individuals received primary care follow-up, compared with majority specialist care follow-up (-&#xa3;2.3billion to +&#xa3;3.2billion). Assuming DMT efficacy of 25%, 58% uptake and majority primary care follow-up cumulative cost offsets increased from &#xa3;4.4billion to &#xa3;10.1billion by 2040 but the UK Health Service would need to diagnose and provide DMT for over a million individuals by 2030 and two million by 2040 to achieve this. Potential cost offset from DMT are large but highly dependent on the model of healthcare delivery and the ability of healthcare systems to scale up diagnosis and treatment services.

Late-life depression (LLD) is a heterogeneous psychiatric condition characterized by a wide range of psychopathological symptoms and associated with functional and structural abnormalities in brain networks implicated in mood and cognitive regulation. This cross-sectional study investigated the relationship between specific depressive symptom dimensions and cortical brain measures, as assessed by magnetic resonance imaging, in a sample of 87 community-dwelling older adults with depression. Significant associations were identified between the severity of sad mood and reduced cortical volume in the right medial orbitofrontal cortex (OFC) (p [FDR]&#xa0;=&#xa0;0.047), as well as reduced cortical thickness in the left OFC (p [FDR]&#xa0;=&#xa0;0.008), left ventrolateral prefrontal cortex (VLPFC) (p [FDR]&#xa0;=&#xa0;0.02), and right dorsolateral prefrontal cortex (DLPFC) (p [FDR]&#xa0;=&#xa0;0.054). Apathy/lassitude was also significantly associated with reduced thickness in the left OFC (p [FDR]&#xa0;=&#xa0;0.016) and left VLPFC (p [FDR]&#xa0;=&#xa0;0.046). Moreover, overall depression severity correlated with reduced thickness in the right middle temporal cortex (MTC) (p [FDR]&#xa0;=&#xa0;0.035). Our results suggest that feelings of low mood and lassitude in LLD are linked to structural changes in brain regions involved in emotion regulation, motivational drive, self-referential thinking, executive control, and decision-making. The findings contribute to the understanding of the neurobiological underpinnings of LLD and support the hypothesis that symptom-specific disruptions within mood and cognitive processing circuits are integral to its pathophysiology.

Psychiatric comorbidities are common in Alzheimer's disease (AD), and they have a negative impact on quality of life, but their impact on mortality remains unclear. This study examined mortality among persons with AD and psychiatric morbidity compared to persons with AD without psychiatric morbidity. This is the first study to analyze Alzheimer's disease mortality based on the timing of earlier psychiatric morbidity. We utilized the nationwide register-based MEDALZ cohort, including 70,718 Finnish individuals diagnosed with AD between 2005 and 2011. Individuals were categorized into four groups based on the occurrence of their hospital-treated psychiatric diagnosis before the diagnosis of AD. Mortality was assessed over an 8-year follow-up. Chi-square test was used to compare the differences between the four groups in terms of causes of death and annual cumulative mortality. We determined cumulative mortality curves and hazard ratios, stratified by age, gender, cardiovascular disease, and the year of AD diagnosis. During the 8-year follow-up, 70.4% of the AD cohort had died. Persons with earlier psychiatric morbidity had an AD diagnosis 1.4-4.3&#xa0;years earlier and died 1.4-4.1&#xa0;years younger. Mortality risk was slightly higher among those with psychiatric morbidity compared to those without (adjusted HRs 1.03-1.41), with the effect decreasing over the years of follow-up. Mortality risk was not affected by the timing of psychiatric morbidity. Psychiatric comorbidity is associated with earlier AD onset and reduced lifespan; however, post-diagnosis survival appears to be largely determined by AD progression itself.

Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259&#x2009;000 (95% uncertainty interval 202&#x2009;000-335&#x2009;000) global deaths and 2&#xb7;54 million (2&#xb7;20-2&#xb7;93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86&#x2009;600 [53&#x2009;300-149&#x2009;000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98&#x2009;700 deaths (77&#x2009;000-127&#x2009;000) and 594&#x2009;000 cases (514&#x2009;000-686&#x2009;000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.

To examine the longitudinal association between cognitive reserve (CR)-related proxies and episodic memory in older adults, and to explore the role of sociodemographic and clinical risk factors. Data were drawn from 2279 participants of the Survey of Health, Aging and Retirement in Europe (SHARE), with baseline in wave 5 (2013) and follow-up in wave 9 (2021-2022). A CR-proxy score was constructed using education, occupation, physical activity, social engagement, and loneliness. Logistic regression models were used to predict immediate and delayed recall performance at follow-up, adjusting for age, sex, depression, vascular risk factors, and sensory impairments. Higher levels of CR-related proxies significantly reduced the odds of impairment in both immediate recall (OR&#xa0;=&#xa0;0.55, p&#xa0;<&#xa0;0.001) and delayed recall (OR&#xa0;=&#xa0;0.46, p&#xa0;<&#xa0;0.001). Age was associated with poorer memory outcomes, while women showed better performance in delayed recall being female predicted lower odds of preserved delayed recall. Depression was significantly related to poorer immediate recall, but other health conditions and sensory factors were not significant predictors. CR-related proxies were strong predictors of memory performance over the 9-year period, particularly for delayed recall. These findings reflect sociobehavioural influences associated with CR development, rather than direct evidence of CR as a neurofunctional mechanism. Promoting cognitively, socially and physically enriching activities, together with addressing depression, may help preserve memory function in aging populations.

Self-perceived cognitive difficulties are a potential early marker of Alzheimer's disease (AD), frequently co-occur with depressive symptoms. This has hindered consideration of these subjective cognitive difficulties as a risk factor for AD. However, accumulating evidence points to dissociations between specific depressive symptoms (i.e., apathy, affective or mood symptoms, and others), with some suggestion that apathy is particularly predictive of and more proximate to AD and may drive the relationship between depressive symptomatology and AD. This study examines whether apathy drives the association between depressive symptoms and subjective cognitive complaints (SCC). 151 cognitively normal older adults (68% female, mean age 73&#xa0;&#xb1;&#xa0;7&#xa0;years) completed a 20-item SCC questionnaire, the Apathy Evaluation Scale, and the Geriatric Depression Scale (GDS). Depressive symptoms (per GDS) were significantly associated with SCC (p&#xa0;=&#xa0;0.008). However, affective symptoms (dysphoria, anxiety, hopelessness), were not statistically associated with SCC (p&#xa0;=&#xa0;0.100), while apathy symptoms were (p&#xa0;<&#xa0;0.001). In a mediation model, apathy mediated the relationship between depressive symptoms and SCC, accounting for 53% of the total effect, indicating that apathy may drive the relationship between depressive symptoms and SCC. When stratified by sex, the results remained significant for women only. These results underscore the relevance of apathy in pre-clinical stages of AD, such as SCC, particularly in women. Understanding the complex associations between SCC and depressive symptoms will help refine conceptualization of SCC as a risk factor for AD.

This study aims to evaluate the global burden of adverse effects of medical treatment (AEMT) using data from the Global Burden of Disease Study (GBD) 2021. Data were extracted from the GBD 2021, covering 204 countries/territories from 1990 to 2021. AEMT was defined using ICD-9 and ICD-10 codes, encompassing complications from medical procedures, treatments, or healthcare exposures. Estimates were categorized into fatal and non-fatal outcomes and stratified by age, sex, year, and covariates, including the Socio-demographic Index (SDI). Mortality-incidence ratios (MIRs), defined as the ratio of mortality calculated by dividing the number of deaths by the total incident cases, were analyzed. In 2021, the global age-standardized prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of AEMT were 11.48 (95% uncertainty interval [UI], 8.86-14.13), 150.44 (131.19-171.81), 64.19 (51.06-73.11), and 1.53 (1.29-1.68) per 100,000 population, respectively. DALY rates were highest in the early neonatal group (4,789.47 per 100,000 population [95% UI, 3,682.00-5,963.30]), while mortality rates followed a U-shaped pattern across age groups. In 2021, MIRs were highest at both ends of the age range: the early neonatal group (0.58 [95% UI, 0.55-0.58]) and the 95+ age group (0.05 [0.04-0.06]). This pattern was consistent across all SDI quintiles, with higher MIRs observed in lower SDI quintiles. The significantly higher prevalence and incidence rates of AEMT among the older population in high SDI quintiles, compared to lower SDI quintiles, could be attributed to the healthcare overutilization, highlighting the need for policy adjustments.

Anxiety disorders in older adults impose a markedly greater disease burden than in younger individuals. This study provides an overview and analysis of temporal trends in the prevalence of anxiety disorders in older adults over the past 30&#xa0;years, examining global, regional, and national patterns with a particular focus on age, period, and birth cohort effects. Estimates and 95% uncertainty intervals (UI) of anxiety disorder prevalence in older adults from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were analyzed. Age-period-cohort (APC) models were used to estimate the overall annual percentage change in prevalence (net drift), the annual percentage change within each age group (local drift), and longitudinal age-specific ratios adjusted for stage bias (age effect) and period/cohort relative risk (period/cohort effect) from 1992 to 2021 at global, regional, and national levels. Nordpred APC model was utilized for forecasting future epidemiological trajectories. From 1992 to 2021, the global prevalence of anxiety disorders in older adults increased markedly, with prevalence among women approximately double that among men. Age-standardized prevalence rates (ASPR) rose globally, particularly in low-middle socio-demographic index (SDI) regions, while high SDI regions saw smaller or even negative changes. In age groups, prevalence decreased in those aged 65-69 to 85-89, with little change in the 90+ group. High SDI regions exhibited stable or declining prevalence in younger age groups, whereas low SDI regions saw increased prevalence in older age groups. Gender differences were observed, with women showing higher and more consistent prevalence trends, while men exhibited rising rates in low SDI regions. Projections suggest that global cases of anxiety disorders among older adults will rise to 73.24 million by 2045, characterized by a higher prevalence in females and an increasing ASPR. This study highlights the complex epidemiology of anxiety disorders in older adults, with global prevalence and ASPR projected to rise, demonstrating regional and national heterogeneity. Anxiety disorders will remain a concern for older adults through 2045. Gender differences, especially the increasing prevalence among men, should be considered in intervention strategies.

To identify predictors of loneliness and social isolation experienced by people with dementia at baseline and over time. Using data from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort study (2014-2018), we examined the prevalence and predictors of loneliness and social isolation in 1547 people with mild-to-moderate dementia over 24&#xa0;months. Loneliness was measured using the six-item De Jong Gierveld Scale at baseline and 24&#xa0;months and social isolation by the six-item Lubben Social Network Scale at baseline, 12 and 24&#xa0;months. Generalised linear mixed effects models examined possible predictors of loneliness and social isolation including individual characteristics, depression, cognition, cultural participation, and neighbourhood characteristics. At baseline 35.4% of people with dementia were categorised as being lonely and 28.8% as socially isolated, increasing to 39.3% and 32.0% 2&#xa0;years later. Over the 24-month follow-up none of these predictors were associated with changes in social isolation scores. Only perceived neighbourhood trust was associated with change in loneliness longitudinally. At baseline, depressive symptoms, living alone, smaller social networks and lower neighbourhood trust were associated with greater loneliness. Cross-sectionally, loneliness and lower cognitive ability were associated with greater social isolation, and greater cultural participation, more green and blue spaces nearby and higher neighbourhood trust were associated with lower social isolation scores. The findings highlight the importance of the local environment and cultural participation for people with dementia. Enhancing interactions with the local neighbourhood through initiatives such as dementia friendly communities may help to reduce loneliness and social isolation.

Quality of life (QoL) captures objective life conditions, subjective wellbeing, and personal aspirations. Interest is growing in ability-based, patient-centered instruments, not confounded by health outcomes. The Quality of Life and Function Five Domain Scale (QFS-5) uses a multi-dimensional approach to measure QoL emphasizing abilities and life engagement. We describe the development and validation of the QFS-5 in a large sample of community-dwelling older adults. The validation sample comprised 1610 participants aged &#x2265; 50 from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behavior, Function, and Caregiving in Aging (CAN-PROTECT). Internal consistency was assessed using Cronbach's alpha and item-total correlations. Confirmatory factor analysis (CFA) evaluated domain structure. Criterion validity was tested through Pearson's correlation with the EuroQol-5D (EQ-5D). Convergent and discriminant validity were evaluated from associations with cognitive, mental health, and functional measures. Floor and ceiling effects were investigated. The QFS-5 demonstrated excellent internal consistency (&#x3b1;&#xa0;=&#xa0;0.92); CFA supported the proposed domain structure with strong item loadings. Criterion validity was confirmed with correlation of -0.61 against the EQ-5D; higher symptom burden on related scales were associated with lower QFS-5 scores. Floor effects were minimal, while modest ceiling effects were observed in some domains. No significant floor or ceiling effects were found in participants with frailty. Validity and reliability are established for this ability-based QoL scale, within a sample of mostly cognitively unimpaired, community-dwelling older adults. The QFS-5 aligns with EQ-5D, demonstrating potential clinical and research utility to measure relevant patient-reported QoL outcomes.

To identify distinct social isolation profiles and their associations, both direct and stress-moderating, with depressive symptoms using objective and subjective indicators of social isolation among older adults in a low-income community. Latent class analysis and multivariable regression were conducted with data from 881 individuals aged 60&#xa0;years or above residing in public rental housing in the Chin Swee area of Singapore. Four profiles emerged: "well-connected and less lonely" (27.9%), "structurally isolated but less lonely" (56.4%), "somewhat isolated and moderately lonely" (11.3%), and "severely isolated and highly lonely" (4.4%). The latter two profiles demonstrated significantly greater depressive symptoms than the former two. Additionally, the "somewhat isolated and moderately lonely" profile showed heightened vulnerability to stressors, exhibiting stronger associations between life stressors and depressive symptoms compared with the "well-connected and less lonely" profile. Subjective loneliness, more so than objective structural isolation, is pivotal in shaping older adults' mental health and stress vulnerability within low-income settings. Interventions should consider decoupling loneliness from social isolation, tailoring support to the specific needs associated with different social isolation profiles.

Accessing a diagnosis and receiving adequate care and support for dementia can often be subject to various inequalities. Personal-, community-, and infrastructure-level factors can contribute to and often intersect in causing unequal health and care outcomes. With a paucity of evidence to inform solutions for dementia inequalities, the aim of this public consultation exercise was to explore potential solutions to inequalities in dementia diagnosis and care with different dementia stakeholders. Utilising a future workshop approach, we conducted 11 in-person and remote consultation workshops to discuss experienced barriers of accessing diagnosis and care; discuss an ideal-world scenario where no barriers exist; and solutions to reach more equitable dementia diagnosis and care with people with dementia, unpaid carers, health and social care professionals, and third sector representatives. Discussions were synthesised by the research team and one public consultation group and mapped against the Dementia Inequalities model. A total of 131 different stakeholders in dementia attended 11 workshops across England. Solutions were identified across three layers of inequalities, with the majority of solutions proposed on a community and infrastructure level. Examples included link workers, a social care career pathway, Community Champions, adequate home equipment, and digital training. Some solutions require Governmental input, such as creating career pathways in the social care workforce, similar to the NHS, to train and maintain good paid carers, as well as a cross-UK national dementia strategy raising the priority of dementia and required changes. Dementia inequalities could be addressed via diverse and holistic approaches. With limited evidence to date on the impact of some of the proposed solutions, future research needs to build on these recommendations and design and test suitable interventions.