{"title":"Neuroimaging of psychosis, agitation, and affective disturbance in Alzheimer's disease, dementia with Lewy bodies, and mild cognitive impairment.","authors":"Hideki Kanemoto, Tetsuo Kashibayashi, Ryuichi Takahashi, Takashi Suehiro, Yuto Satake, Daiki Taomoto, Yoshihiro Chadani, Kenji Tagai, Shunichiro Shinagawa, Kazunari Ishii, Kenji Yoshiyama, Manabu Ikeda, Hiroaki Kazui","doi":"10.1016/j.inpsyc.2025.100059","DOIUrl":"10.1016/j.inpsyc.2025.100059","url":null,"abstract":"<p><strong>Objectives: </strong>This study identifies neuropsychiatric syndromes and investigates their relationship with neuroimaging in Alzheimer's disease dementia (AD), dementia with Lewy bodies (DLB), and mild cognitive impairment (MCI).</p><p><strong>Methods: </strong>Magnetic resonance imaging and perfusion single-photon emission computed tomography data were collected for 281, 68, and 180 patients with AD, DLB, and MCI, respectively, from three Japanese institutions. Neuropsychiatric Inventory was used for exploratory factor analysis in each group. Statistical Parametric Mapping was exploited to reveal the relationships between each factor score and cerebral volume or perfusion with age, sex, dementia severity, and the other factor scores as covariates.</p><p><strong>Results: </strong>Three factors (psychosis, agitation, and affective disturbance) were extracted for AD. For DLB, nighttime behavior and aberrant motor behavior were extracted as independent symptoms with the same three factors. Four factors (psychosis, agitation, anxiety, and apathy) were extracted for MCI. A positive relationship between agitation and cerebral volume in the left middle frontal gyri and left caudate was observed in AD. In DLB, agitation was positively correlated with cerebral perfusion in the left dominant regions, including the middle frontal gyri and caudate. Psychosis and perfusion were negatively correlated in the left extent regions, including the temporo-parieto-occipital lobe, insula, and inferior frontal gyri in DLB. Psychosis was significantly associated with lower perfusion in the bilateral occipital lobes, whereas apathy was significantly correlated with a lower volume of the right dominant bilateral frontal lobes in MCI.</p><p><strong>Conclusions: </strong>Three neuropsychiatric syndromes - psychosis, agitation, and affective disturbance - may heterogeneously associate with AD, DLB, and MCI.</p>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":" ","pages":"100059"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Philip D Harvey, Anna Strassnig, Martin T Strassnig, Andrea Rivera-Molina, Annalee Mueller, Colin A Depp, Raeanne C Moore, Peter Kallestrup, Sara J Czaja
{"title":"Awareness of baseline functioning and sensitivity to improvement in older people with and without mild cognitive impairment receiving a computerized functional skills training program.","authors":"Philip D Harvey, Anna Strassnig, Martin T Strassnig, Andrea Rivera-Molina, Annalee Mueller, Colin A Depp, Raeanne C Moore, Peter Kallestrup, Sara J Czaja","doi":"10.1016/j.inpsyc.2024.100025","DOIUrl":"https://doi.org/10.1016/j.inpsyc.2024.100025","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the relative ability of participants with Mild Cognitive Impairment (MCI) to self-assess their cognitive performance and training gains.</p><p><strong>Design: </strong>Randomized clinical trial with baseline and post treatment objective and self -report assessments.</p><p><strong>Setting: </strong>Multiple community centers in New York City and South Florida.</p><p><strong>Participants: </strong>MCI (n = 84) participants and individuals with normal cognition NC (n = 68).</p><p><strong>Intervention: </strong>MCI participants were randomized to receive fully remote functional skills training (FUNSAT) alone or with Computerized Cognitive Training (CCT), while NC participants received FUNSAT alone twice a week for up to 12 weeks.</p><p><strong>Measurements: </strong>Gains in performance of trained functional skills, performance-based assessments of cognition and functional capacity, and global and specific self-reports of functional abilities.</p><p><strong>Results: </strong>Baseline performance for all performance-based variables was significantly worse in the MCI participants, all p < .001, all d> .77. Training-related Improvements were found for all variables for both groups, all p < .001, all d> .54. However, baseline group differences in global and specific self-reports were smaller all p > .02, d< .44, than objective performance differences. Baseline reports of global functioning were correlated with baseline performance variables in both groups, although no self-reported changes in either global or specific self-reports were significant for either sample.</p><p><strong>Conclusions: </strong>Participants with MCI underestimated their performance deficits at baseline. Self-reports of changes in everyday functioning do not track the substantial objective changes. Previous studies have reported a lack of sensitivity to training gains in several different conditions. Strategies to increase awareness of training gains may be required to sustain treatment benefits.</p>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"37 3","pages":"100025"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suzanne B Hendrix, Mary Sano, Constantine Lyketsos, Paul B Rosenberg, Anton P Porsteinsson, Bruce L Brown, Dawson Hedges, Jeffrey L Cummings
{"title":"Cohen-mansfield agitation inventory total score as a measure of agitation and aggression in Alzheimer's disease: A factor analysis.","authors":"Suzanne B Hendrix, Mary Sano, Constantine Lyketsos, Paul B Rosenberg, Anton P Porsteinsson, Bruce L Brown, Dawson Hedges, Jeffrey L Cummings","doi":"10.1016/j.inpsyc.2025.100056","DOIUrl":"10.1016/j.inpsyc.2025.100056","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer's disease (AD) is often associated with agitation and aggression, which may impair function, impede care, and be a major source of stress for caregivers. The Cohen-Mansfield Agitation Inventory (CMAI) is often used to assess agitation and aggression. In its original, nursing-home version, it is a 29-item, caregiver-informed, clinician-administered 7-point scale that assesses the frequency of various agitation or aggressive behaviors. However, the instruction manual advises against the use of the total score in favor of a domain-based analysis. This recommendation has been followed in both clinical trials and practice. Because the CMAI is comprehensive and easy to administer, we sought to determine the validity of its total score as a single construct for assessing agitation and aggression in patients with AD.</p><p><strong>Methods: </strong>We used a previously conducted factor analysis of the CMAI scores from two risperidone trials in patients with dementia (N = 648), and a follow-up analysis of the subset of patients with psychosis of AD (N = 479), to examine, using vector analysis and an effect-size-versus-signal-to-noise ratio analysis, whether the total CMAI score could confidently be used as a global measure of agitation and aggression in AD.</p><p><strong>Results: </strong>Our findings suggest that the CMAI items from the dataset analyzed load into 4 clusters, which cover about 50 % of the total data variance. Surprisingly, items with the lowest signal-to-noise ratio (hitting, performing repetitious mannerisms, aimless pacing or wandering) had the strongest response to treatment (and vice versa), and belonged to different factors. The further observation that many items were spread among the factors, instead of primarily measuring a single factor or domain, suggests that there is a continuum of symptoms, and separating them into domains requires separating very similar items that measure two or more domains.</p><p><strong>Conclusions: </strong>These findings suggest that assessing agitation and aggression via CMAI domains instead of the total score is likely to miss important behavioral signals. Using total CMAI score in clinical trials and practice, along with the assessment of individual items, is warranted.</p>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":" ","pages":"100056"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Myrra Vernooij-Dassen, Isabelle F van der Velpen, Suzanne D Lanooij, Eddy A van der Zee, M Arfan Ikram, Wilhelmus H I M Drinkenburg, Andrea Costanzo, Meike W Vernooij, Ulrich L M Eisel, René Melis, Martien J H Kas, Marieke Perry
{"title":"Social health and prevention of dementia: Integration of human and mice studies.","authors":"Myrra Vernooij-Dassen, Isabelle F van der Velpen, Suzanne D Lanooij, Eddy A van der Zee, M Arfan Ikram, Wilhelmus H I M Drinkenburg, Andrea Costanzo, Meike W Vernooij, Ulrich L M Eisel, René Melis, Martien J H Kas, Marieke Perry","doi":"10.1016/j.inpsyc.2025.100054","DOIUrl":"10.1016/j.inpsyc.2025.100054","url":null,"abstract":"<p><strong>Objectives: </strong>Prevention of dementia is considered a healthcare priority. We aimed to identify potentially modifiable risk factors and mechanisms within the social health domain to find novel avenues to prevent cognitive decline and dementia.</p><p><strong>Design: </strong>We integrated the results of eight sub-studies of the Social Health in Mice and Men (SHiMMy) project that were separately published in specialized journals, but not yet jointly considered. We followed the integrative methodology of Whittemore and Knafl, using the conceptual framework for social health to structure and integrate the results of human epidemiological and qualitative studies and experimental mice studies. This is a novel multi-method approach.</p><p><strong>Participants: </strong>Participants of the population-based longitudinal cohort Rotterdam study were included in the epidemiolocal studies (ranging from N = 1259 to N = 3.720) and in the qualitative study (n = 17). Mice intervention studies were performed using a transgenic mouse model for Alzheimer's pathology and matched controls, under group and single housed conditions.</p><p><strong>Measurements: </strong>Epidemiological studies include social health markers (loneliness, perceived social support, marital status) and magnetic resonance imaging of the brain. The semi-structured qualitative study used an interview guide. The mice study assessed behavioral and histological markers.</p><p><strong>Results: </strong>In human and mice studies, we identified several similar potentially modifiable risk (e.g. marital status, social group size) and protective (e.g. perceived social support, behavioral responses) factors. This alignment of findings showing that social health may impact brain health lend further support to our social health hypothesis.</p><p><strong>Conclusion: </strong>These results allow us to propose evidence-based social health targets for preventive interventions.</p>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":" ","pages":"100054"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francisco Javier Álvaro-Afonso, Esther García-Morales, Mateo López-Moral, Luis Alou-Cervera, Raúl Molines-Barroso, José Luis Lázaro-Martínez
{"title":"Comparative Clinical Outcomes of Patients with Diabetic Foot Infection Caused by Methicillin-Resistant <i>Staphylococcus Aureus</i> (MRSA) or Methicillin-Sensitive <i>Staphylococcus Aureus</i> (MSSA).","authors":"Francisco Javier Álvaro-Afonso, Esther García-Morales, Mateo López-Moral, Luis Alou-Cervera, Raúl Molines-Barroso, José Luis Lázaro-Martínez","doi":"10.1177/15347346221094994","DOIUrl":"10.1177/15347346221094994","url":null,"abstract":"<p><p>Few studies have addressed the interaction of specific pathogens with clinical outcomes in patients with diabetic foot infection (DFI). Our study aim was to compare the clinical outcomes among patients with DFI caused by methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) with cases caused by methicillin-sensitive <i>Staphylococcus aureus</i> (MSSA). We gathered the data of 75 consecutive patients admitted at specialized outpatients diabetic with mild or moderate DFI in which <i>S. aureus</i> was isolated from bone or soft tissue specimens in pure or as a part of the polymicrobial culture. Patients were divided into two groups: those with MRSA infection and those with MSSA infection. Patients with MRSA diabetic foot infections were significantly associated with male gender (86% vs. 64%, <i>P</i> = .029), higher SINBAD Classification Score (3.6 ± 0.99 points vs. 2.8 ± 1.06 points, <i>P</i> = .001), longer mean wound evolution [17.8 (3;29.5) weeks versus 9.1 (1;12) weeks, <i>P</i> = .008], bone involvement [18 (50%) versus 9 (23.1%), <i>P</i> = .015] and longer mean healing time [18.2(8;28) weeks versus 9.1 (1;12) weeks, <i>P</i> = .008]. In addition, male gender (OR 8.81, 95% CI 2.00-38.84) and SINBAD Classification Score (OR 2.70, 1.46-5.00) were identified as independent risk factors for MRSA DFI. Significant differences in the number of surgical procedures to resolve infection [15 (41.7%) versus 13 (33.3%), <i>P</i> = .456] or in the mean healing time after surgical treatment [10.5 weeks (6.7;16.5) versus 6.1 weeks (3;8.7), <i>P</i> = .068] were not observed among groups, suggesting that when treatment is based on early and surgical debridement, MRSA infections are not associated with worse prognosis. In conclusion MRSA DFI has importance in clinical outcomes such as time to healing. We propose that recent lines of research regarding the genetic virulence of strains of <i>S. aureus</i> could provide new insights into our results.</p>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":"14 1","pages":"392-401"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79103733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natasha Z Anita, Roberto Gonzalez-Prado, Alejandra Morlett Paredes, Wassim Tarraf, Sayaka Kuwayama, Ariana M Stickel, Daniela Sotres-Alvarez, Linda C Gallo, Frank J Pendedo, Martha Daviglus, Fernando D Testai, Hector M González
{"title":"Associations between anxious-depression and cognitive change and mild cognitive impairment: HCHS/SOL Study of Latinos-Investigation of Neurocognitive Aging.","authors":"Natasha Z Anita, Roberto Gonzalez-Prado, Alejandra Morlett Paredes, Wassim Tarraf, Sayaka Kuwayama, Ariana M Stickel, Daniela Sotres-Alvarez, Linda C Gallo, Frank J Pendedo, Martha Daviglus, Fernando D Testai, Hector M González","doi":"10.1016/j.inpsyc.2025.100058","DOIUrl":"10.1016/j.inpsyc.2025.100058","url":null,"abstract":"<p><strong>Objectives: </strong>This study examined the associations between anxious-depression symptoms with cognitive change and prevalent mild cognitive impairment (MCI) in middle-aged and older Hispanics/Latinos.</p><p><strong>Methods: </strong>Participants were enrolled in the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA) and the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Anxiety and depression were measured at Visit 1 using the 10-item Spielberger State-Trait Anxiety Inventory and the 10-item Center for Epidemiologic Studies Depression Scale, with latent class analysis applied to derive anxious-depression phenotypes based on items from both scales. Cognitive tests were completed at Visits 1 and 2 (average 7-years follow-up), where change was assessed using a change index between Visit 1 and 2, and function was assessed at Visit 2. Prevalent MCI was assessed using National Institute on Aging diagnostic criteria. Regression models were used to investigate the association of anxious-depression phenotypes with cognitive function, change, and MCI.</p><p><strong>Results: </strong>In 6140 participants (mean age = 56.5 ± 8.1-years), three anxious-depression profiles were identified: low (62 %), moderate (30 %), and high (8 %). All three profiles were associated with cognitive function at Visit 2, where high and moderate phenotypes were associated with lower cognitive scores compared to low. Moderate and high anxious-depression phenotypes were associated with greater prevalence of MCI compared to low (OR [95 % CI] = 1.64 [1.25; 2.16] and OR = 1.62 [1.12; 2.33], respectively). We found no associations between cognitive change and anxious-depression phenotype.</p><p><strong>Discussion: </strong>Co-occurring elevated anxiety and depression symptoms were associated with lower cognitive function and increased prevalence MCI 7-years later, but not overall changes in cognitive function between Visit 1 and Visit 2.</p>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":" ","pages":"100058"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Interpreting self-report measures about cognition: What matters and what to do with the data: A commentary on \"Awareness of baseline functioning and sensitivity to improvement in older people with and without mild cognitive impairment receiving a computerized functional skills training program\".","authors":"Henry W Mahncke","doi":"10.1016/j.inpsyc.2025.100082","DOIUrl":"10.1016/j.inpsyc.2025.100082","url":null,"abstract":"","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":" ","pages":"100082"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lloyd L Y Chan, Maria Teresa Espinoza Cerda, Matthew A Brodie, Stephen R Lord, Morag E Taylor
{"title":"Daily-life walking speed, running duration and bedtime from wrist-worn sensors predict incident dementia: A watch walk - UK biobank study.","authors":"Lloyd L Y Chan, Maria Teresa Espinoza Cerda, Matthew A Brodie, Stephen R Lord, Morag E Taylor","doi":"10.1016/j.inpsyc.2024.100031","DOIUrl":"10.1016/j.inpsyc.2024.100031","url":null,"abstract":"<p><strong>Objective: </strong>To determine if wrist-worn sensor parameters can predict incident dementia in individuals aged 60 + years and to compare prediction with other tools.</p><p><strong>Design: </strong>Observational cohort study.</p><p><strong>Setting: </strong>Community PARTICIPANTS: The cohort comprised 47,371 participants without dementia, aged 60 + years, who participated in the UK Biobank study (mean age=67 ± 4 years; 52 % female).</p><p><strong>Measurements: </strong>Nineteen digital biomarkers were extracted from up-to-7-day wrist-worn sensor accelerometry data at baseline. Univariable and multivariable Cox proportional hazard models examined associations between sensor parameters and prospectively diagnosed dementia.</p><p><strong>Results: </strong>Median follow-up was 7.5 years (interquartile range: 7.0 to 9.0 years), during this time 387 participants (0.8 %) were diagnosed with dementia. Among the gait parameters, slower maximal walking speed had the strongest association with incident dementia (32 % decrease in hazard for each standard deviation increase) followed by lower daily step counts (30 % decrease) and increased step-time variability (17 % increase). While adjusting for age and sex, running duration, maximal walking speed and early bedtime were identified as independent and significant predictors of dementia. The multivariable prediction model performed comparably to the ANU-ADRI and UKB-Dementia Risk Score models in the UK Biobank cohort.</p><p><strong>Conclusions: </strong>The study findings indicate that remotely acquired parameters from wrist-worn sensors can predict incident dementia. Since wrist-worn sensors are highly acceptable for long-term use, wrist-worn sensor parameters have the potential to be incorporated into dementia screening programs.</p>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":" ","pages":"100031"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clarissa Giebel, Megan Rose Readman, Abigail Godfrey, Annabel Gray, Joan Carton, Megan Polden
{"title":"Geographical inequalities in dementia diagnosis and care: A systematic review.","authors":"Clarissa Giebel, Megan Rose Readman, Abigail Godfrey, Annabel Gray, Joan Carton, Megan Polden","doi":"10.1016/j.inpsyc.2025.100051","DOIUrl":"10.1016/j.inpsyc.2025.100051","url":null,"abstract":"<p><strong>Background: </strong>People with dementia can be disadvantaged in accessing health and social care services for diagnosis and care depending on where they live (including rural vs suburban vs. urban; postcode; country). Without an existing comprehensive synthesis of the evidence to date, the aim of this systematic review was to explore the evidence on geographical inequalities in accessing services for dementia diagnosis and care.</p><p><strong>Methods: </strong>Five databases were searched in June 2024, including studies conducted in any country, published from 2010 onwards, and in English or German. Titles and abstracts, and then full texts, were screened by at least two reviewers each. Any discrepancies were resolved in discussion with a third reviewer. Data were extracted by two researchers and synthesised narratively.</p><p><strong>Results: </strong>From 1321 studies screened and 49 full texts read, 32 studies were included in the final review. Most studies were conducted in the US, followed by the UK. Geographical inequalities in dementia are most often evidenced in relation to availability and suitability of services in different regions within a country, or a lack thereof. People with dementia residing in rural areas often experience challenges in receiving a timely diagnosis and accessing health and social care. No research has addressed geographical inequalities in accessing residential care. Innovative models on improving efficiency and quantity of diagnosis rates in rural Canada and Australia emerged.</p><p><strong>Conclusions: </strong>Health and social care services in rural areas need to be increased and made more suitable to the needs of people with dementia. More research needs to explore inequalities experienced by people with rarer forms of dementia. National strategies to overhaul the health and social care system need to focus on the rurality issue and recommend strategies to improve service access.</p>","PeriodicalId":14368,"journal":{"name":"International psychogeriatrics","volume":" ","pages":"100051"},"PeriodicalIF":4.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}