Agitation is a common and distressing phenomenon across neurocognitive disorders (NCD). It is linked to decreased quality of life of the person with NCD, cognitive and functional decline, increased health-care utilization and institutionalization rates, and substantial burden for family carers and care professionals. Its management is particularly challenging. The objective of this International Psychogeriatric Association's (IPA) task force was to synthesize recent advances in nomenclature and assessment, epidemiology, progression, etiology, detection, impact, approaches to managing agitation; and to make recommendations to guide IPA's next 10-year strategy. A multidisciplinary expert workgroup met multiple times virtually and during the 2024 IPA Congress in person to discuss the current scientific and clinical practice landscape for agitation in NCD. The group integrated evidence about validated behavioral measures, biomarkers, digital monitoring, psychosocial and environmental interventions, and pharmacological options. Agitation is attributed to disruptions in fronto-limbic circuitry with contributions from neuroimmune dysregulation, neurotransmitter alterations, and mitochondrial dysfunction, and various psychosocial and environmental factors. Psychosocial and environmental strategies can reduce agitation, though magnitude and durability of responses vary. Pharmacological options can have short-term benefits but carry risks that require strict patient selection, counseling, monitoring and medication stewardship. Approved medications based on controlled clinical trials remain limited. Care and support in agitation in NCD should involve the implementation of person-centered, rights-based psychosocial and environmental approaches, with time-limited pharmacological adjuncts as second-line. Key evidence gaps include head-to-head and longer-term trials, active safety surveillance, validated agitation measures, and equity-focused implementation across settings and cultures.
Apathy, defined as a significant and sustained reduction in goal-directed behavior associated with impaired daily functioning, is a common and clinically important syndrome in mild and major neurocognitive disorders (NCDs) and is associated with poorer outcomes for patients and carers. Despite growing research, important gaps in knowledge continue to hinder accurate recognition and effective treatment. This International Psychogeriatric Association (IPA) white paper summarizes key scientific and clinical insights from a multidisciplinary Apathy Task Force, with the aim of providing a narrative overview of current knowledge on nomenclature, biomarkers, treatments, and prevention, and of identifying gaps to inform global priorities in research and clinical care, and inform policy. The IPA convened a multidisciplinary task force of apathy researchers during the 2024 and 2025 IPA Congress meetings. Through structured discussions informed by targeted literature review, the group identified key themes and critical gaps across domains relevant to apathy in NCDs. Apathy is highly prevalent across NCDs and evidence demonstrates that it has substantial functional, emotional, and societal impact. Although diagnostic criteria have recently been refined, clinical identification remains challenging. Multiple scales exist to assess apathy, yet inconsistent use across settings and misalignment with updated diagnostic criteria limit comparability. Neuroimaging studies consistently implicate fronto-subcortical network involvement, but no reliable peripheral biomarkers have been established. While select non-pharmacological, pharmacological and neuromodulatory interventions show promising evidence, non-pharmacological are considered central to current management. Clinical guidelines and policy efforts remain limited despite the substantial burden of apathy. Emerging evidence highlights opportunities to improve diagnosis, deepen mechanistic understanding, and develop more treatments that are targeted and scalable. Key priorities identified include increasing awareness of and education around apathy, incorporating apathy into national dementia strategies, improving implementation of effective non-pharmacological interventions, and advancing the development of interventions and biomarkers aligned with contemporary diagnostic criteria. By integrating evidence across clinical, biological, and care domains, this white paper provides a structured framework to guide future research, clinical practice, and policy.
Depression and mood dysregulation are among the most prevalent and clinically consequential neuropsychiatric symptoms (NCD-NPS) across the spectrum of neurocognitive disorders (NCD). These symptoms impair quality of life, increase carer burden, and are associated with accelerated functional and cognitive decline. At the same time, major depressive disorder across the lifespan represents a potentially modifiable risk factor for later-life dementia, while late-onset depressive symptoms may signal prodromal neurodegeneration. This dual role positions depression at a critical intersection between symptom management and dementia prevention. This International Psychogeriatric Association (IPA) white paper was developed through expert consensus meetings held in Buenos Aires (2024) and Kanazawa (2025) to identify key knowledge gaps and define global priorities in nomenclature, biomarkers, treatment, and prevention. Current diagnostic frameworks inadequately capture dementia-specific depressive phenotypes and the marked heterogeneity of depression in NCD, including variation by disease stage, dementia subtype, symptom profile, apathy overlap, sleep and circadian disruption, exposomic risk, caregiver context, and treatment response. Although advances in neuroimaging, inflammatory markers, molecular biomarkers, digital phenotyping, and life-course risk assessment offer promise, none are yet validated for routine diagnostic stratification or treatment selection. Pharmacologic therapies demonstrate modest and inconsistent efficacy, and no agent is specifically approved for depression comorbid with dementia. Psychosocial, behavioral, caregiver-inclusive, sleep-focused, and multimodal interventions remain essential but require greater scalability and integration into care systems. The IPA Depression Workgroup proposes a next-decade roadmap emphasizing NCD-specific diagnostic criteria, biomarker-informed and exposome-aware subtyping, development of targeted and scalable interventions, routine attention to sleep health and caregiver context, and integration of depression prevention into brain health and NCD care frameworks to advance precision psychiatry and dementia risk reduction.
To assess the prevalence, characteristics, and associated factors of research waste among randomized controlled trials (RCTs) of delirium. Cross-sectional study. Data derived from ClinicalTrials.gov. 126 phase III/IV delirium RCTs registered between 2000 and 2024. Publication status was determined via PubMed and Google Scholar. Reporting adequacy was evaluated using the CONSORT reporting guideline checklist, and methodological flaws were assessed using the Cochrane Risk of Bias tool. Research waste was defined as meeting any of the following criteria: non-publication, inadequate reporting (CONSORT compliance <75%), or avoidable design flaws (high/unclear risk per Cochrane criteria). Research waste was highly prevalent, affecting 92.9% of RCTs. Only 22.2% of trials were fully published. Among published trials, reporting rates for key methodological details (allocation concealment, blinding) were below 80%, and 67.9% had avoidable design flaws. A large sample size (≥100 participants) was independently associated with a higher likelihood of publication (adjusted OR=4.23, 95% CI: 1.43-14.41, P = 0.013), whereas industry or other external funding was associated with a lower likelihood (adjusted OR=0.05, 95% CI: 0.00-0.53, P = 0.027). International and multicenter designs showed a trend toward reducing research waste but were not statistically significant in the multivariate model. Phase III/IV delirium RCTs exhibit severe research waste, highlighting a critical gap in evidence generation for this geriatric syndrome. Mandating disclosure of results, enhancing reporting transparency, and prioritizing high-quality, large-scale collaborative research are urgently needed to optimize resource allocation and improve outcomes for this vulnerable population.
Sandtray therapy is a non-pharmacological expressive intervention that enables individuals to communicate inner experiences through symbolic and metaphorical representation. Unlike traditional non-directive sandplay therapy, sandtray therapy is more structured and may include facilitator prompts. It has been associated with psychosocial benefits across diverse age groups experiencing psychological or behavioral challenges. This study examined the effects of sandtray therapy on cognition, mood, self-efficacy, life satisfaction, and gerotranscendence among community-dwelling older adults in Taiwan, and further explored participants' lived experiences. A mixed-methods design was employed. A total of 140 participants were randomly assigned to an intervention or control group. The intervention group attended weekly 30-40-minute sandtray sessions for four weeks, while the control group received no intervention. Outcomes were assessed pre- and post-intervention using the Mini-Mental State Examination (MMSE), Geriatric Depression Scale-Short Form (GDS-SF), General Self-Efficacy Scale (GSES), Satisfaction with Life Scale (SWLS), and Gerotranscendence Scale (GS). Semi-structured interviews were conducted following the intervention. A one-way analysis of covariance analyses revealed significant between-group differences in self-efficacy (p < .001), life satisfaction (p < .001), and gerotranscendence (p < .001). No significant effects were observed for cognitive function or depressive symptoms. Qualitative analysis identified three overarching themes: building social connectedness, the essential role of play in later life, and engagement in cognitively demanding processes. Sandtray therapy appeared feasible and well-tolerated within this study sample. The findings suggest that sandtray therapy may serve as a beneficial non-pharmacological intervention for promoting positive aging, particularly through improvements in self-efficacy, life satisfaction, and psychosocial growth among older adults.
This scoping review provides an overview of factors influencing family members' involvement with older adults in Long Term Care Facilities (LTCFs). Included factors are organized into resident-, family member-, and organizational level categories. A literature search (in PubMed, Embase, PsycInfo and CINAHL) was performed up to May 15, 2023, in collaboration with a medical information specialist. Long Term Care Facilities. Family members of older adults residing in LTCFs. Family involvement, conceptualized as visit frequency and visit duration. Ten studies were eligible for inclusion. Only a limited number of factors were examined across most studies, and these showed consistent associations with family involvement: residents' duration of stay in the facility, their physical health and their cognitive functioning, and family members' kinship and emotional closeness and physical proximity to the LTCF. These findings highlight that family involvement in LTCFs does not solely depend on older adults' characteristics, but is also shaped by relationship quality as well as emotional and physical proximity. Recognizing families as essential care partners, and embedding this perspective into policies, training, and care routines, may enhance residents' quality of life and support family well-being.
Verbal fluency is a core marker for early cognitive decline in older adults. This study aimed to compare the relative efficacy of different digital cognitive training (DCT) regimens on verbal fluency in older adults, and identify the optimal intervention and moderators. A search was conducted across PubMed, Web of Science, PsycINFO and IEEE Xplore from January 2015 to November 2025, and included randomized controlled trials (RCTs) of DCT for verbal fluency in adults aged ≥ 65 years. We conducted pairwise meta-analysis and frequentist network meta-analysis (NMA), with Bayesian model validation, subgroup analysis and meta-regression. Risk of bias was assessed with RoB 2.0, and evidence quality with GRADE. 20 RCTs with 1358 participants were included. Compared with passive control, computerized cognitive training (CCT) combined with social/language activities had the optimal efficacy (SMD=0.47, 95%CI [0.02, 0.93], SUCRA=0.84), with greater benefits in older adults with cognitive impairment and lower education level. Furthermore, optimal therapeutic gains were observed following an initial acclimation period (i.e., >20 h of intervention duration). CCT combined with social/language activities is the most effective DCT regimen to improve verbal fluency in older adults, especially for those with cognitive impairment and lower education level.The research protocol has been pre-registered on the Open Science Framework (OSF)( Registration DOI: 10.17605/OSF.IO/UGR7Y).This work was supported by the National Natural Science Foundation (NNSF) of China under Grant Nos. 32371132.
Prevention of cognitive decline in older adults is a critical public health issue in rapidly ageing societies. Studies indicate that engagement in instrumental activities of daily living (IADL) and social participation is associated with better cognitive function. Employment incorporates elements of IADL and social participation; however, longitudinal evidence describing cognitive and brain function changes in older adults who continue working is scarce. Hence, this study aimed to longitudinally examine changes in cognitive and brain functions over a three-year period among older adults who continued working. The participants were 23 community-dwelling older adults aged 65 years and older who completed baseline and follow-up assessments. Cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J), Trail Making Test Parts A and B (TMT-A and TMT-B) and behavioural performance on a Go/No-go task. Brain function was evaluated using event-related potentials (ERPs), focusing on the No-go P3 component as an index of inhibitory control. The baseline and follow-up data were compared using paired statistical analyses. The MoCA-J scores significantly improved at follow-up compared with those of baseline (p < 0.001). In the Go/No-go task, No-go accuracy significantly increased (p = 0.017). ERP analyses revealed that the No-go P3 amplitude significantly increased at follow-up at the Fz (p < 0.001), Cz (p = 0.002) and Pz (p = 0.004) electrodes, whereas the No-go P3 latency showed no significant change. Older adults who continued working displayed improvements in global cognitive function, behavioural measures of inhibitory control and associated neural activity over a three-year period. Although causal relationships cannot be established in the absence of a non-working comparison group, our study provides longitudinal descriptive evidence of cognitive and neural changes in older adults who remain employed.
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To describe caregiver reports of delirium superimposed on dementia (DSD) and lucid episodes (LEs), and to examine their associations with anticipatory grief (AG) and caregiver stressors. Cross-sectional analysis of survey data. Online survey of caregivers of persons living with dementia (PLWD). Current caregivers of PLWD (N = 434). DSD and LEs were assessed using caregiver-reported survey data. Caregiver outcomes included AG, role overload, and role captivity. DSD was consistently associated with higher AG, role overload, and role captivity. LEs were associated with lower AG but were not associated with role overload or role captivity. DSD and LEs are acute phenomena that may be associated with caregiver outcomes in different ways. While DSD shows robust associations with AG and caregiver stressors, LEs were specifically associated with AG.
Collateral histories from carers are central to dementia diagnosis but are often collected inconsistently and variably documented. With rising demand on memory services and the emergence of disease-modifying therapies requiring timely diagnosis, there is increasing need for structured and efficient assessment approaches. Conversational AI powered by large language models (LLMs) may support standardised collateral history acquisition while maintaining clinician oversight. We developed LUMEN, a stakeholder-informed prototype designed to generate structured collateral summaries for clinical review. A five-stage patient, public and professional involvement programme (approximately 232 participants) co-designed the question set, interface and outputs. Seven open-source LLMs were benchmarked; Qwen3-30B-A3B was selected to generate structured summaries from interview transcripts. Six clinician-authored vignettes representing Alzheimer's disease, dementia with Lewy bodies, vascular dementia, frontotemporal dementia, mild cognitive impairment and normal cognition were used to generate 54 synthetic dialogues (27 clinician role-played, 27 GPT-4 generated). Diagnostic categories were assigned using a deterministic rule-based rubric applied to structured summaries. Two clinicians independently rated each dialogue. Outcomes included exploratory evaluation of alignment with diagnostic categories measured by area under the receiver operating characteristic curve (AUROC) and Cohen's κ, and System Usability Scale (SUS) scores. In this small synthetic vignette-based dataset, macro-average AUROC was 0.95; these values reflect performance under closed-loop proof-of-concept conditions rather than real-world diagnostic accuracy. Discrimination was highest for Alzheimer's disease and vascular dementia (AUROC = 1.00 in this synthetic dataset) and lowest for mild cognitive impairment (AUROC = 0.77). Agreement between categories assigned by the rule-based rubric and averaged clinician ratings was κ = 0.88 (95% CI 0.83-0.93). Mean SUS score was 78.1/100. In a small, closed-loop synthetic proof-of-concept dataset, this LLM-assisted, rubric-based pipeline showed that structured summaries could be processed reproducibly by the rubric and separated diagnostic categories under controlled conditions. These findings do not show real-world diagnostic performance. Further evaluation is required to determine clinical usefulness, robustness and workflow impact.
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Missed and late diagnoses of dementia are frequent in underserved populations and impact the implementation of dementia interventions. Twenty dyads of persons living with dementia and comorbidity, new to the principal investigator's panel at a Geriatrics Clinic, and their caregivers. Quantitative Assessment: geriatric assessment, cognitive and staging scales, review of all medical records. Qualitative analysis: interviews with the dyad, coding for factors for late diagnosis and impact of the non-diagnosis. Ninety percent women, mean age: 78 years (range 65-96), all African- American. Diagnosis distribution: Alzheimer's disease (11), mixed dementia (7), vascular dementia (1), Lewy Body Disease (1). Calculated mean time from the first symptom of dementia to diagnosis: 3.3 years (range: 1-10). Of the 20 cases, 15 did not have a prior formal diagnosis of dementia; their staging at diagnosis was: severe dementia: 5, moderate dementia: 4, mild dementia: 6. Eight cases had a delay in diagnosis of at least 4 years. We estimated the impact on health outcomes of years of living with undiagnosed dementia and found a high frequency of non-compliance with medications, uncontrolled comorbid conditions, weight loss, and multiple health transitions. We observed a significant time delay in the diagnosis of dementia, while many participants had moderate to severe dementia when diagnosed. Strategies to improve screening and dementia diagnosis in primary care settings are needed to increase access to dementia-specific services and improve care and well-being in this vulnerable African American population and their caregivers.
Augmented reality (AR) has gained significant attention in recent years due to a myriad of innovations and the milestones achieved by virtual reality. We conducted a systematic review of the literature on the current use of AR technology in older adults and how their applications may improve care. We searched PubMed, Ovid MEDLINE, and ScienceDirect from inception to April 2026 for peer-reviewed articles. Primary studies using AR interventions in older adults (≥65 years) and with empirical data analysis were included. The search yielded 540 records, of which 409 were excluded after title/abstract screening, and 27 after full-text screening. A total of 41 articles were included in this review. Across the included studies, several themes of AR use with older adults emerged: foundations of AR use for older adults (n = 11), exercise and movement (n = 14), cognitive functioning (n = 12), education/activities of daily living (ADL) support (n = 9). AR-enhanced care in older adults is a rapidly emerging field. Most studies reported positive feedback for AR technology and high motivation to use it among older adults. The use of AR with older adults has proved to be feasible and effective for gait/balance, exercise, ADL-support, and education applications. There was mixed feedback on the physical and technical aspects of the AR headset, with common concerns including weight of the device, difficulty controlling it, and challenges with calibration. Using this technology successfully with older adults is dependent on ensuring accessibility which requires user-friendly designs.
Loneliness is a major concern in later life, yet disparities between heterosexual and LGBTQ+ older adults remain insufficiently understood. This study examined how families of origin and families of choice relate to loneliness among adults aged 50 +, and whether these associations differ by sexual orientation. Data were collected via online surveys in Israel and compared two groups: LGBTQ+ and heterosexual adults aged 50 +. The analytic sample included 948 participants. Loneliness was assessed using the brief UCLA Loneliness Scale. Participants identified close members of their family of origin and family of choice, and rated relationship commitment\stability and negativity. Hiererchical regression analyses examined the predictors of loneliness and the interactions of social relationships with sexual orientation group. LGBTQ+ participants reported fewer traditional family ties (e.g., children, partners) but more siblings and friends in their close networks. Overall, having a partner, a close sibling, and reporting higher commitment and stability in both family types were associated with lower loneliness, whereas greater negativity in family of choice relationships was associated with higher loneliness. Interaction analyses showed that the protective effects of partnership and high commitment\stability within families of choice were stronger for LGBTQ+ aging adults. The findings highlight the central role of chosen family, particularly committed, stable partnerships, in buffering loneliness among LGBTQ+ older adults. Practice and policy in relation to later life should recognize diverse kinship structures and address inequities that shape relational resources in later life, especially among LGBTQ+ aging adults.
Domain-level ADL and IADL independence across MMSE score ranges has been less well described in Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). This study described the observed proportions of basic ADL and IADL independence across MMSE score ranges in these three neurodegenerative dementias. In a cohort of 650 patients (524 AD, 90 DLB, 36 FTD), cognitive function was assessed with the Mini-Mental State Examination (MMSE), and daily function was evaluated using the Physical Self-Maintenance Scale and the Lawton IADL scale. Patients were grouped into MMSE score ranges. For each diagnosis and MMSE score range, we calculated the observed proportion of participants rated as independent in each ADL/IADL domain and Wilson score 95% confidence intervals. Because the FTD sample was small (n = 36), with only 1-11 participants in individual five-point MMSE score ranges, and several MMSE-specific subgroup counts were sparse, the analyses were descriptive. Observed independence proportions varied across ADL/IADL domains, MMSE score ranges, and diagnostic groups. In AD and DLB, shopping, food preparation, and medication management had low observed independence proportions even in higher MMSE ranges. In the MMSE 21-30 stratum, selected absolute numerical contrasts between DLB and AD ranged from 7.2 percentage points for feeding to 18.4 percentage points for bathing. Estimates for FTD, which were based on only 1-11 participants per five-point MMSE score range, and for DLB in the MMSE 0-10 stratum were based on small denominators and were therefore imprecise. This study provides descriptive estimates of domain-level ADL and IADL independence across MMSE score strata in AD, DLB, and FTD. The results may contribute to domain-specific assessment and support planning for people living at home with MCI or dementia. These findings should be regarded as hypothesis-generating for future studies.
Electroconvulsive therapy (ECT) is widely used for severe depression. Dementia with Lewy bodies (DLB) may initially present with depressive symptoms, and ECT may be administered in some patients during the course of the disease. However, the timing of DLB diagnosis in relation to ECT treatment has not been well characterized. We conducted a retrospective cohort study using a nationwide administrative claims database in Japan, including records from 564 acute care hospitals between April 2008 and March 2025. Analyses were restricted to patients with a mood disorder diagnosis (ICD-10 F30-F39) recorded in the same month as the first ECT session, and patients with both DLB and Alzheimer disease (AD) diagnostic codes were excluded. The primary analysis examined the timing of recorded DLB diagnostic labels relative to ECT initiation, with AD diagnoses analyzed as a comparator. Among 3733 patients who underwent ECT, 71 met the analytic criteria for DLB. The median interval between ECT initiation and the first DLB diagnosis was 8 days prior to ECT initiation. Recorded DLB diagnostic labels occurred significantly more often within ±90 and ±180 days of ECT initiation than AD diagnoses, whereas AD diagnoses were distributed more broadly across the observation period. Recorded DLB diagnostic labels showed a distinct temporal pattern around ECT initiation. Clinical evaluation associated with ECT may facilitate recognition of underlying DLB in patients presenting with severe psychiatric symptoms. Clinicians should remain attentive to evolving DLB when treating late-life treatment-resistant mood disorders with ECT, as recognition of DLB may occur several years after treatment initiation.
Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) share overlapping cognitive and neuropsychiatric symptoms, complicating early differential diagnosis. This study aimed to compare multidimensional impairment patterns in AD and DLB and develop a simple, interpretable classification model based on clinical scales. A total of 249 participants were included: 84 patients with AD, 82 with DLB, and 83 participants with normal cognition (NC). Participants completed assessments covering global cognition, six cognitive domains, neuropsychiatric and depressive symptoms. Missing values in cognitive scales were handled using multiple imputation, and results were pooled across all imputations. Then, Least Absolute Shrinkage and Selection Operator (LASSO), Support Vector Machine (SVM), and Random Forest (RF) were used to identify key variables. A final set of six scales was selected to build a logistic regression model distinguishing DLB from AD. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) in the entire cohort, mild stage and dementia stage. DLB patients showed greater deficits in attention, visuospatial processing, and neuropsychiatric symptoms; AD patients exhibited more pronounced memory impairment. At mild stage, DLB displayed more depressive symptoms and attention deficits but milder memory decline than AD. At dementia stage, DLB presented broader impairments in executive, visuospatial, attentional, with similar global cognition. The six-feature model achieved high diagnostic accuracy in the entire cohort (AUC=0.879, 95%CI: 0.802-0.957), mild stage (AUC=0.866, 95% CI: 0.788-0.943) and dementia stage (AUC=0.939, 95% CI: 0.839-0.999). The study identified distinct cognitive profiles of DLB and AD, and developed a concise, clinically practical model with robust diagnostic utility across disease stages, supporting its use in outpatient and resource-limited settings.
Social frailty is characterised by a decline in social resources, engagement in social activities and self-management capacity. Reduced subjective satisfaction with the outcomes of social activities is associated with social frailty. However, existing instruments do not adequately capture this dimension, and few studies have reported differences in satisfaction by severity of social frailty. The Social Activities-Related Daily Life Satisfaction Scale (SARDLSS) provides a more comprehensive measure. We investigated the association between social frailty and satisfaction with the outcomes of social activities among community-dwelling older adults in Japan. This cross-sectional analysis included community-dwelling adults aged ≥ 65 years who participated in a community health survey. Social frailty was assessed using the Makizako Social Frailty Index and stratified into robust, pre-social frailty and social frailty. Satisfaction with the outcomes of social activities was quantified using the SARDLSS. Group differences were examined, and ordinal logistic regression models were fitted to estimate the association between social frailty status and satisfaction with the outcomes of social activities, adjusting for confounding factors, including age, walking speed and cognitive function. A total of 141 participants were included in the analysis; 27.7% were robust, 36.9% had pre-social frailty and 35.4% had social frailty. Ordinal logistic regression analyses indicated that higher satisfaction was independently associated with lower odds of belonging to a more severe social frailty category after adjusting for potential confounders (odds ratio = 0.95, 95% confidence interval: 0.91-0.98, p = 0.004). Domain-level analyses corroborated this pattern, with satisfaction with friendships, health and physical fitness and contributions to others and society showing significant associations with social frailty status. Social frailty among community-dwelling older adults was associated with their satisfaction with the outcomes of social activities. Addressing both quantitative and qualitative aspects of social engagement is warranted for preventing or mitigating social frailty.
Loneliness is an epidemic affecting mental health across all demographics. It is linked to mental disorders, such as anxiety and depression, and despair, highlighting a significant public health issue as persons feel more disconnected in a connected world. This study aims to investigate the relationship between loneliness, Alzheimer's disease and suicidal behaviour. This review was systematised in a dichotomous manner. Therefore, two systematic reviews were initially carried out following the PRISMA statement. The loneliness was understood as feeling lonely. One group searched for associations between loneliness and Alzheimer's disease and the other between loneliness and suicidal behaviour, with a consecutive meta-analysis. After that, it was searched for between the two groups to seek loneliness, such as an interface in meta-analytic factor analysis. Depression is the most studied and cited factor associated with loneliness as a link between Alzheimer's disease and suicide. Loneliness demonstrated association with Alzheimer's disease (OR = 1.89, 95% CI 1.57-2.28; p < 0.001); suicidal ideation (OR = 2.17, 95% CI 1.88-2.51; p < 0.001); suicidal planning (OR = 2.36, 95% CI 1.91-2.92; p < 0.001); suicide attempt (OR = 2.54, 95% CI 2.13-3.04; p < 0.001); and suicide (OR = 4.9, 95% CI 4.4-5.5; p < 0.001). Entrapment, hopelessness, insomnia and stress demonstrated significative correlation (r > 0.40; p < 0.001) with loneliness in the interface between AD and suicidal behaviour. Loneliness has been identified as a comorbid factor between AD and suicide. To prevent both AD and suicide, it is essential to monitor levels of stress, insomnia, feelings of entrapment and hopelessness. The triad of loneliness, hopelessness and insomnia seems to represent the greatest risk profile.