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Parallel changes in cognition, neuropsychiatric symptoms, and amyloid in cognitively unimpaired older adults and those with mild cognitive impairment

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ALZHEIMERS & DEMENTIA 2025年第2期21卷 e14568页

作者： De Vito, Alyssa N. Kunicki, Zachary J. Joyce, Hannah E. Huey, Edward D. Jones, Richard N. Alzheimers Dis Neuroimaging Initiative Brown Univ Dept Psychiat & Human Behav Warren Alpert Med Sch 345 Blackstone BlvdBox G-BH Providence RI 02906 USA Butler Hosp Memory & Aging Program Providence RI USA

INTRODUCTIONAlzheimer's disease (AD) diagnosis centers on cognitive impairment despite other early indicators like neuropsychiatric symptoms (NPSs) and amyloid beta (A beta) accumulation. This study examined how cognition, NPS, and A beta changes are interrelated over time in individuals without *** were 1247 individuals from the Alzheimer's Disease Neuroimaging Initiative (ADNI)-2 and -3 cohorts with at least 48 months of follow-up. Cognitive domains were assessed via ADNI composite measures, NPS via the neuropsychiatric inventory, and A beta via standardized uptake value ratio (SUVR) composite scores. Co-occurring changes were evaluated with parallel process *** was longitudinally associated with performance in each cognitive domain. Negative baseline A beta-cognition associations were observed in three cognitive domains. No A beta-NPS associations were *** study demonstrated strong longitudinal relationships between NPS and cognition in preclinical and prodromal stages of AD. Future studies should incorporate NPS into models of disease trajectories to improve early detection and prediction of disease *** Co-occurring changes in A beta, cognition, and neuropsychiatric symptoms are understudied. We found relationships between neuropsychiatric symptoms and cognition. We found baseline, but not longitudinal, A beta and cognition associations. Changes in neuropsychiatric symptoms should be included in early detection models of ADRD.

关键词： ADNI amyloid cognition longitudinal modeling neuropsychiatric symptoms

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Compensatory strategy use in diverse older adults with subjective cognitive complaints

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aging & MENTAL HEALTH 2025年第1期29卷 87-94页

作者： De Vito, Alyssa N. Emrani, Sheina Correia, Stephen Coutinho, Maria Teresa Lee, Athene Warren Alpert Med Sch Brown Univ Dept Psychiat & Human Behav Providence RI 02903 USA Butler Hosp Memory & Aging Program Providence RI 02906 USA Univ Georgia Inst Gerontol Athens GA USA Boston Univ Dept Counseling Psychol & Appl Human Dev Boston MA USA

ObjectivesThe current study aimed to evaluate the relationship between subjective cognitive complaints (SCC) and compensatory strategy (CS) use in a diverse sample of non-Latinx White (NLW), Black, and Latinx American older ***807 older adults (Mage = 65.38, 62.7% female) were recruited through Amazon's Mechanical Turk (MTurk) and Qualtrics Panel to complete questionnaires on SCC and CS use. Kruskall-Wallis tests were used to evaluate differences in SCC across groups given non-normal distributions. Analysis of variance (ANOVA) was used to evaluate group differences in CS use. The PROCESS macro for SPSS was used to examine whether demographic factors moderated the relationship between SCC and CS *** reported higher levels of SCC and greater overall use of CS in comparison to Latinx and Black individuals. Several demographic and psychosocial factors including age, ethno-racial group, education, and anxiety level were found to be associated with CS use. Education was found to moderate the association between SCC and CS *** with prior studies, our study found that NLWs reported the highest levels of SCC. CS were used across all racial/ethnic groups, but the frequency of CS use may be impacted by education level. While all education groups increased their CS in response to higher levels of SCC, this increase was more substantial for those with lower levels of education. Future work should consider individuals' cultural and educational background when examining SCC and/or developing CS-based intervention for the aging population.

关键词： Subjective cognitive complaints compensatory strategies aging Alzheimer's disease

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Associations between genetic variations in oxytocin pathway genes and hippocampal volume: Insights from the UK Biobank

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CORTEX 2025年 183卷 211-219页

作者： Xiao, Shanshan Ebner, Natalie C. Dang, Junhua Rukh, Gull Westberg, Lars Schioth, Helgi B. Fischer, Hakan Stockholm Univ Dept Psychol Albanovagen 12 SE-11419 Stockholm Sweden Uppsala Univ Dept Surg Sci Funct Pharmacol & Neurosci Uppsala Sweden Univ Florida Dept Psychol Gainesville FL USA Univ Florida Cognit Aging & Memory Program Clin Translat Res Program CAM CTRP Gainesville FL USA Univ Florida McKnight Brain Inst Gainesville FL USA Xi An Jiao Tong Univ Sch Humanities & Social Sci Inst Social Psychol Xian Shaanxi Peoples R China Univ Gothenburg Inst Neurosci & Physiol Sahlgrenska Acad Dept Pharmacol Gothenburg Sweden Stockholm Univ Brain Imaging Ctr SUBIC Stockholm Sweden Karolinska Inst Aging Res Ctr Stockholm Sweden Stockholm Univ Stockholm Sweden

The role of oxytocin-related genes in social-cognitive function has been previously established, but structural brain mechanisms underlying this link remain poorly understood. Utilizing a substantial dataset from the UK Biobank (N z 30,000), this research determined associations between variations in ten single nucleotide polymorphisms (SNPs) within three oxytocin pathway genes (i.e., the oxytocin/neurophysin I prepropetide gene, the cluster of differentiation 38 glycoprotein gene, the oxytocin receptor gene) and whole-brain gray matter volume. Carriers of the AA or AG genotypes of the oxytocin receptor gene rs237851 SNP exhibited significantly larger hippocampal volume than carriers of the GG genotype. These results support the link between variations in the oxytocin receptor gene and hippocampal structure, with possible impact on social-cognitive function such as social recognition memory. (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://***/licenses/by/4.0/).

关键词： Oxytocin pathway gene Oxytocin receptor Hippocampus Social recognition memory UK Biobank

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Clinical and Imaging Features of Sporadic and Genetic Frontotemporal Lobar Degeneration TDP-43 A and B

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ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY 2025年第5期12卷 947-957页

作者： Coulborn, Sean Schafer, Rhiana Roy, Ashlin R. K. Sokolowski, Andrzej Cryns, Noah G. Leichter, Dana Lago, Argentina Lario Ramos, Eliana Marisa Cobigo, Yann Spina, Salvatore Grinberg, Lea T. Geschwind, Daniel H. Gorno-Tempini, Maria L. Kramer, Joel H. Rosen, Howard J. Miller, Bruce L. Seeley, William W. Perry, David C. Univ Calif San Francisco UCSF Weill Inst Neurosci Memory & Aging Ctr Dept Neurol San Francisco CA 94143 USA Univ Calif Los Angeles Dept Neurol Los Angeles CA USA Univ Calif San Francisco Dept Pathol San Francisco CA USA Univ Calif Los Angeles Dept Human Genet Los Angeles CA USA Univ Calif Los Angeles David Geffen Sch Med Program Neurobehav Genet Semel Inst Los Angeles CA USA

Objective Certain frontotemporal lobar degeneration subtypes, including TDP-A and B, can either occur sporadically or in association with specific genetic mutations. It is uncertain whether syndromic or imaging features previously associated with these patient groups are subtype or genotype specific. Our study sought to discern the similarities and differences between sporadic and genetic TDP-A and TDP-B. Methods We generated individual atrophy maps and extracted mean atrophy scores for regions of interest-frontotemporal, occipitoparietal, thalamus, and cerebellum-in 54 patients with FTLD-TDP types A or B. We calculated asymmetry as the absolute difference in atrophy between right and left frontotemporal regions, and dorsality as the difference in atrophy between dorsal and ventral frontotemporal regions. We used ANCOVAs adjusted for disease severity to compare atrophy extent or imbalance, neuropsychological tests, and behavioral measures. Results For some regions, volumetric differences were found either between TDP subtypes (e.g., worse occipitoparietal and cerebellum atrophy in TDP-A than B), or within subtypes depending on genetic status (e.g., worse thalamic and occipitoparietal atrophy in C9orf72-associated TDP-B than sporadic TDP-B). While progranulin mutation-associated TDP-A and sporadic TDP-A cases can be strongly asymmetric, TDP-A and TDP-B associated with C9orf72 tended to be symmetric. TDP-A was more dorsal in atrophy than TDP-B, regardless of genetic status. Interpretation While some neuroimaging features are FTLD-TDP subtype-specific and do not significantly differ based on genotype, other features differ between sporadic and genetic forms within the same subtype and could decrease accuracy of classification algorithms that group genetic and sporadic cases.

关键词： c9orf72 frontotemporal dementia frontotemporal lobar degeneration progranulin

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Feasibility and acceptability of an online epilepsy stigma self-management program

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EPILEPSY & BEHAVIOR 2025年 165卷 110331-110331页

作者： Margolis, Seth A. Prieto, Sarah Goldstein, Allyson Kaden, Sarah Castillo, Elijah Sadhu, Shehjar Solanki, Dhaval Larracey, Emma T. Tremont, Geoffrey Mankodiya, Kunal Kiriakopoulos, Elaine T. Brown Univ Hlth Dept Psychiat Providence RI 02903 USA Brown Univ Dept Psychiat & Human Behav Warren Alpert Med Sch Providence RI USA Butler Hosp Memory & Aging Program Providence RI USA Univ Maine Psychol Dept Orono ME USA Dartmouth Hitchcock Med Ctr Dept Neurol Lebanon NH 03756 USA Univ Rhode Isl Dept Elect Comp & Biomed Engn Kingston RI USA Bridgewater State Univ Bridgewater MA USA Geisel Sch Med Hanover NH 03755 USA

Introduction: Stigma is a prevalent source of distress in people with epilepsy. We developed a self-paced online stigma self-management program for adults with epilepsy (Reducing Internalized Stigma in Epilepsy: A Behavioral Online Video Education, RISE ABOVE (TM)). Materials and Methods: Twenty socio-demographically diverse participants completed RISE ABOVE over an average of 3.5 weeks. Acceptability was determined by whether >= 80 % responded favorably to the Credibility and Expectancy Questionnaire and tailored surveys. Treatment Satisfaction was determined by whether mean Client Satisfaction Questionnaire responses was >= 80 %. Epilepsy Stigma, Perceived Stress, Perceived Rejection, Loneliness, Self-Efficacy, and Satisfaction with Social Roles and Activities were rated pre-post-intervention. Paired sample t-tests and Hedges' g effect sizes gauged improvements. Results: Most participants (>= 80 %) thought the intervention was logical and content was easy to understand/navigate, interesting/helpful, and planned on using learned skills. Mean satisfaction was 85.41 % +/- 14.43 %. There were large improvements in Epilepsy Stigma (p < 0.001;Hedge's g = 1.052), Perceived Stress (p < 0.001;Hedge's g = 0.887) and Satisfaction with Social Roles and Activities (p < 0.001;Hedge's g = -1.010), and medium improvements in Perceived Rejection (p = 0.004;Hedge's g = 0.634) and Self-Efficacy (p = 0.008;Hedge's g = -0.568). No significant differences were observed 6-months post-program completion, despite some attenuation. Conclusions: RISE ABOVE is a feasible and acceptable anti-stigma intervention. Markers of acceptability were evident in high rates of credibility and satisfaction. Sizable improvements in stigma and other psychosocial outcomes were seen. Future studies will establish RISE ABOVE's efficacy via a randomized controlled trial.

关键词： Perceived Stigma Discrimination Quality of Life Self-Management Behavioral Interventions

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Association and multimodal model of retinal and blood-based biomarkers for detection of preclinical Alzheimer's disease

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ALZHEIMERS RESEARCH & THERAPY 2025年第1期17卷 1-12页

作者： Ravichandran, Swetha Snyder, Peter J. Alber, Jessica Murchison, Charles F. Chaby, Lauren E. Jeromin, Andreas Arthur, Edmund Univ Alabama Birmingham Sch Optometry Birmingham AL 35294 USA Brown Univ Dept Neurol Alpert Med Sch Providence RI USA Univ Rhode Isl Dept Biomed & Pharmaceut Sci Kingston RI USA Univ Rhode Isl George & Anne Ryan Inst Neurosci Kingston RI USA Butler Hosp Memory & Aging Program Providence RI USA Univ Alabama Birmingham Alzheimers Dis Res Ctr Dept Neurol Birmingham AL USA Univ Alabama Birmingham Dept Biostat Birmingham AL USA Atlantic Biomarkers LLC Alachua FL USA

Background The potential diagnostic value of plasma amyloidogenic beta residue 42/40 ratio (A beta 42/A beta 40 ratio), neurofilament light (NfL), tau phosphorylated at threonine-181 (p-tau181), and threonine-217 (p-tau217) has been extensively discussed in the literature. We have also previously described the association between retinal biomarkers and preclinical Alzheimer's disease (AD). The goal of this study was to evaluate the association, and a multimodal model of, retinal and plasma biomarkers for detection of preclinical AD. Methods We included 82 cognitively unimpaired (CU) participants (141 eyes;mean age: 67 years;range: 56-80) from the Atlas of Retinal Imaging in Alzheimer's Study (ARIAS). Blood samples were assessed for concentrations of A beta 42/A beta 40 ratio, NfL, p-tau181, and p-tau217 (ALZpath, Inc.) using Single molecule array (SIMOA) technology. The Spectralis II system (Heidelberg Engineering) was used to acquire macular centered Spectral Domain Optical Coherence Tomography (SD-OCT) images for evaluation of putative retinal gliosis surface area and macular retinal nerve fiber layer (mRNFL) thickness. For all participants, correlations (adjusted for age and correlation between eyes) were assessed between retinal and blood-based biomarkers. A subgroup cohort of 57 eyes from 32 participants with recent A beta positron emission tomography (PET) results, comprising 18 preclinical patients (A beta PET + ve, 32 eyes) and 14 controls (A beta PET -ve, 25 eyes) with a mean age of 69 vs. 66, p = 0.06, was included for the assessment of a multimodal model to distinguish between the two groups. For this subgroup cohort, receiver operating characteristic (ROC) analysis was performed to compare the multimodal model of retinal and plasma biomarkers vs. each biomarker alone to distinguish between the two groups. Results Significant correlation was found between putative retinal gliosis and p-tau217 in the univariate mixed model (beta = 0.48, p = 0.007) but not

关键词： Putative retinal gliosis Plasma biomarkers Preclinical Alzheimer's disease Early detection Spectral domain optical coherence tomography

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A deep-learning retinal aging biomarker for cognitive decline and incident dementia

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ALZHEIMERS & DEMENTIA 2025年第3期21卷 e14601页

作者： Sim, Ming Ann Tham, Yih Chung Nusinovici, Simon Quek, Ten Cheer Yu, Marco Xue, Can Can Chee, Miao Li Peng, Qing Sheng Tan, Eugene S. J. Chan, Siew Pang Cai, Yuan Chong, Eddie Jun Yi Tan, Boon Yeow Venketasubramanian, Narayanaswamy Hilal, Saima Lai, Mitchell K. P. Choi, Hyungwon Richards, Arthur Mark Cheng, Ching-Yu Chen, Christopher L. H. Natl Univ Singapore Memory Aging & Cognit Ctr Dept Pharmacol Singapore Singapore Natl Univ Singapore Memory Aging & Cognit Ctr Dept Psychol Med Singapore Singapore Natl Univ Hlth Syst Dept Anaesthesia Singapore Singapore Natl Univ Singapore Yong Loo Lin Sch Med Singapore Singapore Natl Univ Singapore Ctr Innovat & Precis Eye Hlth Singapore Singapore Natl Univ Singapore Yong Loo Lin Sch Med Dept Ophthalmol Singapore Singapore Singapore Natl Eye Ctr Ocular Epidemiol Res Grp Singapore Eye Res Inst Singapore Singapore Duke NUS Med Sch Ophthalmol & Visual Sci Acad Clin Program Singapore Singapore Natl Univ Heart Ctr Dept Cardiac Thorac & Vasc Surg Singapore Singapore Chinese Univ Hong Kong Fac Med Dept Med & Therapeut Div Neurol Hong Kong Peoples R China St Lukes Hosp Singapore Singapore Raffles Hosp Raffles Neurosci Ctr Singapore Singapore Natl Univ Singapore Saw Swee Hock Sch Publ Hlth Singapore Singapore Natl Univ Singapore Cardiovasc Metab Dis Translat Res Program Singapore Singapore Univ Otago North Dunedin New Zealand

INTRODUCTION The utility of retinal photography-derived aging biomarkers for predicting cognitive decline remains under-explored. METHODS A memory-clinic cohort in Singapore was followed-up for 5 years. RetiPhenoAge, a retinal aging biomarker, was derived from retinal photographs using deep-learning. Using competing risk analysis, we determined the associations of RetiPhenoAge with cognitive decline and dementia, with the UK Biobank utilized as the replication cohort. The associations of RetiPhenoAge with MRI markers(cerebral small vessel disease [CSVD] and neurodegeneration) and its underlying plasma proteomic profile were evaluated. RESULTS Of 510 memory-clinic subjects(N = 155 cognitive decline), RetiPhenoAge associated with incident cognitive decline (subdistribution hazard ratio [SHR] 1.34, 95% confidence interval [CI] 1.10-1.64, p = 0.004), and incident dementia (SHR 1.43, 95% CI 1.02-2.01, p = 0.036). In the UK Biobank (N = 33 495), RetiPhenoAge similarly predicted incident dementia (SHR 1.25, 95% CI 1.09-1.41, p = 0.008). RetiPhenoAge significantly associated with CSVD, brain atrophy, and plasma proteomic signatures related to aging. DISCUSSION RetiPhenoAge may provide a non-invasive prognostic screening tool for cognitive decline and dementia.

关键词： biomarker cognitive decline deep-learning dementia prognostic retinal age retinal photography Southeast-Asian

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Social and health disparities associated with healthy brain ageing in Brazil and in other Latin American countries

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LANCET GLOBAL HEALTH 2025年第2期13卷 e277-e284页

作者： Da Ros, Lucas U. Borelli, Wyllians Vendramini Aguzzoli, Cristiano Schaffer De Bastiani, Marco Antonio Schilling, Lucas Porcello Santamaria-Garcia, Hernando Pascoal, Tharick A. Rosa-Neto, Pedro Souza, Diogo O. da Costa, Jaderson Costa Ibanez, Agustin Suemoto, Claudia Kimie Zimmer, Eduardo R. Univ Fed Rio Grande do Sul Grad Program Biol Sci Biochem Porto Alegre Brazil Univ Fed Rio Grande do Sul Grad Program Biol Sci Biochem Porto Alegre Brazil Univ Fed Rio Grande do Sul Dept Pharmacol BR-90035003 Porto Alegre Brazil Hosp Moinhos Vento Memory Ctr Porto Alegre RS Brazil Pontifical Univ Rio Grande do Sul Brain Inst Rio Grande do Sul Porto Alegre Brazil Pontifical Univ Rio Grande do Sul Sch Med Dept Pediat Tokat Brazil Pontifical Univ Rio Grande do Sul Grad Program Biomed Gerontol Porto Alegre Brazil Univ Calif San Francisco Hosp Univ San Ignacio Ctr Brain & Cognit Intellectus PhD Program NeurosciPontificia Univ Javeriana San Francisco CA USA Univ Calif San Francisco Gobal Brain Hlth Inst Memory & Aging Ctr Francisco CA USA Univ Pittsburgh Dept Psychiat & Neurol Pittsburgh PA USA McGill Ctr Studies Aging Montreal PQ Canada McGill Univ Montreal Neurol Inst Dept Neurol & Neurosurg Montreal PQ Canada Douglas Hosp Res Ctr Montreal PQ Canada Univ Sao Paulo Med Sch Dept Internal Med Div Geriatr Sao Paulo Brazil Univ Adolfo Ibanez Latin Amer Brain Hlth Inst BrainLat Santiago Chile Trinity Coll Dublin Global Brain Hlth Inst Dublin Ireland Univ San Andres Cognit Neurosience Ctr Buenos Aires Argentina

Background Latin American countries present major health-related inequities due to historical, cultural, and social aspects. Recent evidence highlights that factors related to social and health disparities outweigh classic demographic factors in determining healthy brain aging in these populations. However, these analyses have not been conducted with the Brazilian population, the largest and most ethnically diverse population in Latin America. Methods Here, we evaluated demographic, social, and health factors for healthy brain ageing using a machine learning model in a Brazilian population-based cohort (n=9412) and in additional cohorts from other Latin American countries, including Colombia (n=23 694), Chile (n=1301), Ecuador (n=5235), and Uruguay (n=1450). Findings In the Brazilian population and other Latin American countries, social and health disparities were more influential than demographic factors for cognition and functional ability. Uniquely in Brazil, education emerged as the primary risk factor impacting cognitive outcomes, diverging from other Latin American countries where mental health symptoms played more prominent roles. In terms of functional ability, Brazil displayed a distinct pattern, with mental health symptoms identified as the primary contributing factor. Interpretation Our findings indicate that Brazil converges with other Latin American countries to show that heterogeneous factors impacted more than demographic factors, but also showed a unique set of health factors when compared with other Latin American countries. Therefore, our study emphasises that social and health disparity factors are relevant predictors of healthy brain ageing in Latin America, but population-specific analyses are necessary to identify the specific risk profiles of each country.

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The interplay between age at menopause and synaptic integrity on Alzheimer's disease risk in women

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SCIENCE ADVANCES 2025年第10期11卷 eadt0757页

作者： Wood Alexander, Madeline Honer, William G. Saloner, Rowan Galea, Liisa A. M. Bennett, David A. Rabin, Jennifer S. Casaletto, Kaitlin B. Sunnybrook Res Inst Hurvitz Brain Sci Program Toronto ON Canada Univ Toronto Rehabil Sci Inst Temerty Fac Med Toronto ON Canada Univ British Columbia Dept Psychiat Vancouver BC Canada Univ Calif San Francisco Weill Inst Neurosci Memory & Aging Ctr Dept Neurol San Francisco CA USA Univ Toronto Dept Pharmacol & Toxicol Toronto ON Canada Campbell Family Mental Hlth Res Inst Ctr Addit & Mental Hlth Toronto ON Canada Univ Toronto Temerty Fac Med Dept Psychiat Toronto ON Canada Rush Univ Med Ctr Chicago IL 60612 USA Sunnybrook Res Inst Ctr Brain Resilience & Recovery Hurvitz Brain Sci Program Toronto ON Canada Univ Toronto Temerty Fac Med Sunnybrook Hlth Sci Ctr Div Neurol Toronto ON Canada Univ Toronto Harquail Ctr Neuromodulat Sunnybrook Hlth Sci Ctr Toronto ON Canada

Menopause is a major biological transition that may influence women's late-life brain health. Earlier estrogen depletion-via earlier menopause-has been associated with increased risk for Alzheimer's disease (AD). Synaptic dysfunction also incites and exacerbates AD progression. We investigated whether age at menopause and synaptic health together influence AD neuropathology and cognitive trajectories using clinical and autopsy data from 268 female decedents in the Rush memory and aging Project. We observed significant interactions between age at menopause and synaptic integrity on cognitive decline and tau tangles, such that earlier menopause strengthened the associations of reduced synaptic integrity with faster cognitive decline and elevated tau. Exploratory analyses showed that these relationships were attenuated in women who took menopausal hormone therapy. These findings suggest that midlife endocrine processes or their sequalae may influence synaptic vulnerability to AD. Interventions addressing both hormonal factors and synaptic health could enhance resilience to dementia in women.

关键词： Neurodegenerative diseases

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Discharge Disposition in Veterans with Heart Failure: Impact of Dementia and Severe Mental Illness

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JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION 2025年第5期26卷 105533-105533页

作者： Howe, Matthew D. Jiang, Lan Browne, Julia W. Bayer, Thomas A. Kunicki, Zachary J. De Vito, Alyssa N. Mcgeary, John E. Wu, Wen-Chih Lind, Jason D. Kelso, Catherine M. Rudolph, James L. VA Providence Healthcare Syst Ctr Innovat Transformat Hlth Syst Res Improve Vet Providence RI USA Brown Univ Dept Psychiat & Human Behav Alpert Med Sch Providence RI USA Brown Univ Alpert Med Sch Div Geriatr & Palliat Med Providence RI USA Butler Hosp Memory & Aging Program Providence RI USA Providence VA Med Ctr VA RR&D Ctr Neurorestorat & Neurotechnol Providence RI USA Vet Hlth Adm Off Patient Care Serv Geriatr & Extended Care Washington DC USA Brown Univ Dept Hlth Serv Policy & Practice Providence RI USA

Objectives: Post-acute heart failure (HF) care presents significant management challenges, particularly among veterans with cognitive and behavioral impairments due to Alzheimer disease and related dementias (AD/ADRD) or severe mental illness (SMI). We hypothesized that comorbid AD/ADRD and SMI would reduce the likelihood of discharge home following HF hospitalization. In addition, we explored how AD/ADRD and SMI influence discharge to Veterans Affairs (VA) Community Living Centers (CLCs) compared with Medicare Skilled Nursing Facilities (SNFs). Design: Retrospective cohort study spanning January 1, 2011, to September 30, 2019. Setting and Participants: Veterans hospitalized with acute HF at VA hospitals (n = 291,117). Methods: We examined VA administrative data from HF hospitalizations to assess how AD/ADRD and SMI impact post-hospital discharge location. Using diagnostic codes from the prior year, we stratified participants by the presence of AD/ADRD and/or SMI, then employed logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for discharge location, adjusted for demographics, comorbidities, and health care utilization. Results: Participants were predominantly older (mean age: 78.1 f 11.1 years), male (97.5%), and selfidentified as white (72.7%). Those with AD/ADRD alone (n = 16,212) or SMI alone (n = 33,194) outnumbered those with both conditions (n = 3612). Compared with neither condition, the presence of AD/ ADRD alone [adjusted OR (aOR), 0.523;95% CI, 0.505-0.542], SMI alone (aOR, 0.869;95% CI, 0.843 -0.896), and both conditions (aOR, 0.505;95% CI, 0.47-0.542) all reduced likelihood of discharge home. Participants with AD/ADRD and SMI were more likely to be discharged to a CLC than a SNF (aOR, 1.225;95% CI, 1.064-1.411). Conclusions and Implications: Our findings indicate that AD/ADRD and SMI are major barriers to discharge home for patients with HF, suggesting a need for enhanced supervision during health care trans

关键词： Alzheimer disease heart failure hospitalization mental disorders patient discharge skilled nursing facilities

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