Journal of Alzheimer's Disease最新文献

{"title":"White matter hyperintensities moderate neuropsychiatric response to N-acetylcysteine and exercise therapy in vascular mild cognitive impairment.","authors":"Ethan Mah, Damien Gallagher, Yejin Kang, Fuqiang Gao, Joel Ramirez, Zahinoor Ismail, Sandra E Black, Xingshan Cao, Nathan Herrmann, Susan Marzolini, Paul Oh, Jinghan Jenny Chen, Kate Survilla, Walter Swardfager, Danielle Vieira, Mark J Rapoport, Krista L Lanctôt","doi":"10.1177/13872877261490542","DOIUrl":"https://doi.org/10.1177/13872877261490542","url":null,"abstract":"<p><p>BackgroundVascular mild cognitive impairment (vaMCI) is frequently accompanied by neuropsychiatric symptoms (NPS), particularly apathy, which are associated with white matter hyperintensities (WMH). N-acetylcysteine (NAC) combined with exercise may provide neuroprotective benefits.ObjectiveWe hypothesized that baseline frontal and global WMH burden would moderate the neuropsychiatric response to NAC plus exercise. We further hypothesized that the strongest domain-specific effects would be observed for apathy and affective dysregulation.MethodsParticipants with vaMCI were randomized to NAC (2400 mg daily) or placebo plus exercise for 6 months. WMH volumes were quantified using structural MRI. NPS were assessed using the Mild Behavioral Impairment Checklist (MBI-C) at baseline, 3 months, and 6 months. Negative binomial generalized linear mixed models examined WMH × time × treatment interactions. False discovery rate (FDR) correction was applied.ResultsFifty-one participants were included. Lower baseline frontal (<i>β</i> = 0.229, SE = 0.070, FDR-adjusted <i>p</i> = 0.007) and global (<i>β</i> = 0.258, SE = 0.080, FDR-adjusted <i>p</i> = 0.007) WMH volume was associated with greater reductions in NPS over 6 months in the NAC plus exercise group. This effect was driven by improvements in apathy (frontal: <i>β</i> = 0.186, SE = 0.076, FDR-adjusted <i>p</i> = 0.048; global: <i>β</i> = 0.207, SE = 0.089, FDR-adjusted <i>p</i> = 0.049).ConclusionsBaseline WMH burden moderates neuropsychiatric treatment response in vaMCI. These findings support the importance of optimizing care for cerebrovascular risk factors in this vulnerable population.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"13872877261490542"},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreased cerebrospinal fluid NDRG2 is associated with non-Alzheimer's disease derived mild cognitive impairment.","authors":"Qing-Ning Zhang, Wei Wu, Yong-Ming Zhou, Lan-Ke Yu, Xin-Yuan Zhang, Jia-Lin Wu, Si-Yuan Song, Zhao-Hui Yao","doi":"10.1177/13872877261477113","DOIUrl":"10.1177/13872877261477113","url":null,"abstract":"<p><p>BackgroundMild cognitive impairment (MCI) lacks clear clinical biomarkers. N-Myc downstream-regulated gene 2 (NDRG2) is predominantly localized in astrocytes and is implicated in cognitive function.ObjectiveThis study aims to explore whether cerebrospinal fluid (CSF) NDRG2 could predict MCI and investigate its underlying mechanisms of cognitive decline.MethodsA total of 650 CSF samples were collected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database, comprising 157 normal individuals, 366 MCI patients, and 127 Alzheimer's disease (AD) patients. One-way analysis of covariance (ANCOVA) was employed to assess differences in CSF NDRG2 levels among groups. Linear regression was used to analyze the correlation between NDRG2 and amyloid-β (Aβ), phosphorylated tau (p-tau), ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET), albumin quotient (Qalb), and growth-associated protein 43 (GAP43). Receiver operating characteristic (ROC) curves were used to examine the diagnostic performance of NDRG2 for MCI.ResultsCSF NDRG2 levels were significantly reduced in MCI, most prominently in non-Aβ and non-tau subgroups. NDRG2 discriminated Aβ-negative MCI with an area under the curve (AUC) of 0.719, but showed limited discriminatory capacity in Aβ+, tau+, and apolipoprotein E ε4 (<i>APOE</i> ε4) carrier groups. Furthermore, CSF NDRG2 levels were positively correlated with GAP-43, a marker of synaptic plasticity.ConclusionsThe present study demonstrates that NDRG2 is a potential biomarker for non-AD derived MCI and suggests its involvement in synaptic plasticity impairment.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1420-1439"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between higher-order executive planning and subjective cognitive decline in middle-aged individuals.","authors":"Miguel Ramos-Henderson, Paulina Aliaga-Gallardo, Camila Aguilar-Riveros, Loreto Fuentes, Carlos Calderón, Marcos Domic-Siede","doi":"10.1177/13872877261470712","DOIUrl":"10.1177/13872877261470712","url":null,"abstract":"<p><p>BackgroundSubjective cognitive decline (SCD) is a recognized risk factor for future objective cognitive impairment and dementia. Although widely studied in older adults, SCD during midlife remains underexplored, despite this period representing a critical window for early detection. Higher-order executive functions, particularly cognitive planning, may be especially sensitive to subtle cognitive changes at this stage.ObjectiveTo examine the association between higher-order executive function performance and subjective cognitive decline in middle-aged individuals.MethodsThis cross-sectional study included 167 community-dwelling middle-aged adults (45-60 years) with SCD and normal global cognition. Participants completed the Subjective Cognitive Decline Questionnaire (SCDq), mood and sleepiness measures, structured executive function tests, and the Zoo Map Test (ZMT) to assess higher-order executive planning. Group comparisons, correlation analyses, and hierarchical linear regressions were performed.ResultsHigher SCD levels were associated with longer planning times and more planning errors on the ZMT. No associations were observed between SCD and global cognitive performance or structured executive function measures. In the hierarchical regression model, mood symptoms and daytime sleepiness explained 23% of SCD variance, while higher-order executive planning measures accounted for an additional 8.4%, yielding a final hierarchical model explaining 33.6% of the variance. Fully adjusted simultaneous model showed the same pattern.ConclusionsSCD in midlife is associated with subtle differences in higher-order executive functioning that emerge under high cognitive demand. Ecologically valid executive tasks may improve early detection of individuals at risk for future objective cognitive decline beyond traditional neuropsychological measures.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1084-1098"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of psychosocial factors on neurocognitive functioning in family caregivers of persons with Alzheimer's disease and related dementias.","authors":"Lauren Elliott, Emily Post, Anna McClendon, Jonathan Singer","doi":"10.1177/13872877261476965","DOIUrl":"10.1177/13872877261476965","url":null,"abstract":"<p><p>BackgroundLimited research has examined neurocognitive decline in family caregivers of persons with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD), despite most caregivers being over 65 and more susceptible to age-related declines due to increased stressors. The lack of insight into how psychosocial factors interact with caregivers' neurocognitive functioning limits our ability to identify targets for reducing neurocognitive risk.ObjectiveInvestigate the effects of psychosocial factors on neurocognitive functioning of AD/ADRD caregivers.MethodsThe caregiver sample (<i>n</i> = 42) consisted predominantly of older adults (<i>M</i>_age = 69.40, <i>SD</i>_age = 11.58) who were caring for a spouse (64.3%). On average, caregivers provided 99 h of care per week for several years (<i>M</i> = 3.42, <i>SD</i> = 2.39). Multiple linear regressions were conducted to examine the effects of psychological (i.e., depression, anxiety, pre-death grief, perceived stress) and social (i.e., social support, social network) factors on caregivers' neurocognitive functioning (i.e., visuospatial memory, verbal memory, processing speed, intelligence, executive functioning).ResultsSocial support significantly predicted visuospatial memory and processing speed. As social support increased, delayed visuospatial memory and processing speed improved when controlling for social network size.ConclusionsCaregivers may face additional stressors and have limited time or opportunities for social engagement. Social support may be especially important for spousal caregivers losing a primary support source (i.e., spouse). Findings suggest social support is a potential intervention target for reducing caregivers' risk of neurocognitive decline.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1357-1369"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between body composition and mortality in older patients with mild cognitive impairment and Alzheimer's disease: NCGG-STORIES.","authors":"Kazuaki Uchida, Taiki Sugimoto, Takeshi Nakagawa, Taiji Noguchi, Ayane Komatsu, Rei Ono, Yoko Yokoyama, Ayaka Onoyama, Takashi Sakurai, Tami Saito","doi":"10.1177/13872877261476079","DOIUrl":"10.1177/13872877261476079","url":null,"abstract":"<p><p>BackgroundAlthough a lower body mass index (BMI) has been identified as a prognostic risk factor among older adults with cognitive impairment, it remains unclear which body composition are associated with prognosis.ObjectiveThis study investigated the relationship between body composition and mortality in older adults with mild cognitive impairment (MCI) and Alzheimer's disease (AD).MethodsThis longitudinal study, using data from a memory clinic in Japan, included patients aged ≥65 years who were clinically diagnosed with MCI or AD. Mortality data (date and cause of death) were obtained using a proxy questionnaire. Body composition (muscle mass, fat-free mass, fat mass, %FM) was measured using bioelectrical impedance analysis, and muscle mass index (MMI), fat-free mass index (FFMI) and fat mass index (FMI) were calculated. Body composition index was divided into tertiles (lowest, middle, and highest). To evaluate associations between body composition and mortality, we conducted survival analyses using Cox proportional hazards model (ref. lowest group).ResultsA total of 1575 patients were included in the analysis (mean age, 78.2 years; 63.2% women). The highest FMI and %FM groups had a lower risk of mortality than that in the lowest group (hazard ratio [95% confidence interval]: FMI, 0.55 [0.37-0.81]; %FM, 0.49 [0.33-0.71]), and this association was significant in women with MCI and AD. No significant associations were observed between MMI, FFMI, and mortality.ConclusionsLower FM may be a potential risk factor for poor prognosis, emphasizing the need to monitor it from an early stage of cognitive decline.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1182-1191"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progression from mild cognitive impairment to dementia in Alzheimer's disease: Whole cortex voxelwise functional connectivity analysis with multivariate distance matrix regression.","authors":"Luiz Kobuti Ferreira, Eric Westman, Lars-Olof Wahlund, Rosaleena Mohanty","doi":"10.1177/13872877261477016","DOIUrl":"10.1177/13872877261477016","url":null,"abstract":"<p><p>BackgroundDifferentiating individuals with mild cognitive impairment who convert to dementia due to Alzheimer's disease (MCI-C) from those who do not convert (MCI-NC) is increasingly important. Functional connectivity (FC) derived from resting state functional MRI (rs-fMRI) has been investigated as a potential biomarker. However, improved data analysis strategies are needed. One underexplored approach is pairwise voxel-to-voxel analysis.ObjectiveTo describe differences in FC between amyloid positive MCI-C and MCI-NC using a whole-cortex voxel-to-voxel pairwise approach.MethodsBaseline rs-fMRI from the Alzheimer's Disease Neuroimaging Initiative was retrieved for amyloid positive MCI participants. Voxel-to-voxel, pairwise, cortical FC was computed. Multivariate distance matrix regression was used to identify voxels presenting FC patterns that were significantly different between MCI-C and MCI-NC.Results21 MCI-C and 28 MCI-NC were included. The primary analysis with voxel-level threshold at p < 0.001 combined with cluster-level p < 0.05 yielded no significant results. At voxel-level p < 0.01 and the same cluster-level threshold, three significant clusters on the right visual cortex were found. These clusters, however, were not robust to head motion, fMRI protocol and additionally clinical or biological severity.ConclusionsProgression from Alzheimer-related MCI to dementia was not significantly associated with FC in the primary analysis. However, a less stringent threshold yielded FC differences in the occipital lobe in alignment with previous studies but were not robust to methodological and biological covariates between groups. Our findings highlight the need for larger samples and careful control of covariates to identify robust FC alterations related to dementia conversion.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1384-1395"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depressive symptoms and low cognitive performance in Chinese older adults: A severity-graded epidemiological analysis and a BARNN-inspired prospective risk-prediction framework with strict participant-level temporal validation.","authors":"Qiang Zhang, Xiao Cai, Yifan Zhao, Xinsong Ren, Dongwei Yan","doi":"10.1177/13872877261482053","DOIUrl":"10.1177/13872877261482053","url":null,"abstract":"<p><p>BackgroundLate-life depression is robustly associated with subsequent cognitive impairment, yet the dose-response gradient and temporally validated, uncertainty-aware prediction tools remain understudied in Chinese older adults.ObjectiveTo characterize the severity-graded epidemiological association between depressive symptoms and low cognitive performance, and to develop and validate a prospective risk-prediction framework with explicit uncertainty estimation.MethodsWe analyzed 31,570 observations from 12,494 participants aged ≥45 years in the China Health and Retirement Longitudinal Study (2011-2020). Depressive symptoms were measured with the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10); low cognitive performance was defined as total cognition score < 10. Layer 1 reported severity-graded prevalence and adjusted odds ratios. Layer 2 implemented a BARNN-inspired prospective state-transition predictor via a diverse tree ensemble, yielding predictive probability and epistemic uncertainty. Both layers used strict participant-level temporal validation.ResultsClinically significant depressive symptoms (CESD-10 ≥ 10) were associated with twofold higher odds of low cognitive performance (OR = 2.07, 95% CI 1.97-2.18), with a monotonic dose-response gradient across severity tiers (20.8% to 46.0%, p < 0.001). In prospective validation, the ensemble achieved comparable discrimination (AUC-ROC 0.838 versus 0.839 for logistic regression, P = 0.85) but superior calibration (Brier score 0.099 versus 0.126), plus per-sample uncertainty estimates and an explicit algorithmic deferral tier. The frozen four-tier rule produced a steep risk gradient (Low 5.8%, Moderate 24.9%, High 63.0%; OR high versus low=27.8).ConclusionsDepressive symptom severity shows a robust graded association with low cognitive performance in Chinese older adults. The framework supports reliable ordinal risk stratification with algorithmic deferral, providing a transferable template for population-level cognitive monitoring.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1797-1809"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-life candidate vascular plasma biomarkers are associated with MRI markers of vascular brain injury and amyloid- and tau-PET in cognitively healthy adults.","authors":"Martin D Mulligan, Ruiqi Wang, Qiong Yang, Alexa S Beiser, Pauline Maillard, Claudia Satizabal, Saptaparni Ghosh, Jeremy Tanner, Keith A Johnson, Charles DeCarli, Russell P Tracy, Daniel Levy, Emelia J Benjamin, Georges El Fakhri, Ramachandran S Vasan, Sudha Seshadri, Emer R McGrath","doi":"10.1177/13872877261480733","DOIUrl":"10.1177/13872877261480733","url":null,"abstract":"<p><p>BackgroundIdentifying candidate biomarkers for preclinical dementia could improve our understanding of underlying biological pathways leading to vascular brain injury (VBI) and neurodegeneration.ObjectiveTo identify plasma protein markers of MRI markers of VBI and amyloid- and tau-PET burden in cognitively healthy adults.Methods125 plasma proteins were measured in dementia-free Framingham third Generation cohort participants between 2002-2005 (mean age 46 [SD 8]) with available MRI brain (n = 1039), ¹¹C-Pittsburgh Compound-B (PiB)- (n = 279), and/or ¹⁸F-Flortaucipir (FTP)-PET (n = 239) performed ∼13-15 years after blood sampling. Outcomes included white matter hyperintensities, peak width of skeletonized mean diffusivity, and free water); precuneus-, posterior cingulate- and frontal, lateral and retrosplenial cortices-Aβ deposition; and global- and entorhinal cortex-tau.ResultsGrowth differentiation factor-15 (GDF-15) was associated with increased VBI (p ≤ 0.02), while soluble receptor for advanced glycation end products (sRAGE) and insulin-like growth factor 1 (IGF-1) were associated with reduced VBI (p ≤ 0.04). Plasma tau, renin, and ApoB were associated with increased Aβ deposition (p ≤ 0.02), while sRAGE was associated with reduced Aβ deposition in all regions (p ≤ 0.03). Brain natriuretic peptide (NT-proBNP) and purine nucleoside phosphorylase (PNP) were associated with increased tau deposition (p ≤ 0.02), while low density lipoprotein cholesterol (LDL-C) and GDF-15 were associated with reduced tau deposition (p ≤ 0.04).ConclusionsCandidate vascular plasma proteins measured in dementia-free, asymptomatic adults at late mid-life were associated with subsequent neuroimaging markers of VBI and tau and amyloid deposition. Our findings highlight potential novel candidate vascular biomarkers for preclinical dementia but will require validation.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1674-1699"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation analysis between complement proteins and Alzheimer's disease.","authors":"Ying-Tong Lu, Zi-Ming Guo, Meng-Yuan Liu, Cheng-Hong Ji, Yu-Ting Luo, Shu-Yun Zhou, Tao Ma, Xi-Chen Zhu","doi":"10.1177/13872877261475358","DOIUrl":"10.1177/13872877261475358","url":null,"abstract":"<p><p>BackgroundThe prominent pathological features of Alzheimer's disease (AD) are amyloid-β (Aβ) plaques and tau pathology. The complement cascade is closely related to AD-associated pathological processes; however, the precise mechanisms underlying its contributions remain incompletely elucidated.ObjectiveWe aim to investigate the changes in complement protein expression during AD progression.MethodsThis study enrolled 285 participants from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Participants were classified into biomarker-defined groups based on predefined cutoff values for Aβ₄₂ and phosphorylated tau (P-tau). We compared cerebrospinal fluid (CSF) levels of complement proteins (C1q, C2, C3, C4a, C5, C6, C8b, and factor B) across these subgroups. Furthermore, we explored their associations with core AD biomarkers (Aβ₄₂, P-tau, and T-tau) and clinical characteristics. Additionally, we investigated age-related changes in complement gene expression within the cerebral cortex of 3xTg mice using single-nucleus RNA sequencing.ResultsComplement protein levels in the CSF of A + subjects were significantly lower than those in A- subjects, and complement protein levels were positively correlated with Aβ pathology. Complement protein levels were influenced by factors such as age, gender, body mass index, <i>APOE</i> genotype, and hypertension. Compared with control mice, the complement gene C1qa in microglia was upregulated throughout the entire pathological cycle in 3xTg AD mice.ConclusionsComplement proteins undergo significant changes during the pathogenesis of AD, and alterations in their levels may reflect early pathological changes in AD and warrant further investigation. Notably, our findings suggest that microglia may contribute to complement-mediated pathological processes associated with AD.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1119-1136"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual eligibility and neuropsychiatric symptoms and treatment disparities among Medicare Part D beneficiaries with Alzheimer's disease and related dementias.","authors":"Sara Alsharayri, Sara Knox, Maxwell Cutty, Abe Mollalo","doi":"10.1177/13872877261478140","DOIUrl":"10.1177/13872877261478140","url":null,"abstract":"<p><p>BackgroundNeuropsychiatric symptoms (NPS) are common and clinically consequential in Alzheimer's disease and related dementias (ADRD), yet their recognition and treatment may vary across socioeconomic groups. Dual-eligible Medicare-Medicaid beneficiaries represent a vulnerable population, but differences in NPS documentation and management remain unclear.ObjectiveTo examine whether dual eligibility is associated with differences in (1) documented NPS and (2) prescription fills among Medicare beneficiaries with ADRD who received home health (HH) care.MethodsWe conducted a cross-sectional study of 167,484 Medicare Part D beneficiaries with ADRD who received HH care and were identified using the Chronic Conditions Warehouse flag. Dual eligibility was the primary exposure. NPS were identified using diagnosis codes from medical claims. Prescription fills for NPS-related medications were identified using Medicare Part D prescription drug event data (≥2 prescription fills for anxiety-related medications and antidepressants). Logistic regression models estimated associations of dual eligibility with NPS documentation and prescription fills, adjusting for demographic characteristics, original Medicare entitlement, and comorbidity burden.ResultsDual-eligible beneficiaries comprised 30.7% of the cohort. Documented confusion and anxiety were the most prevalent symptoms. Dual-eligible beneficiaries had a higher prevalence of confusion (83.5% versus 82.0%) and anxiety (57.0% versus 53.2%) compared with Medicare-only beneficiaries. After adjustment, dual eligibility was associated with higher odds of documented confusion (aOR 1.18, 95% CI 1.14-1.22) and anxiety (aOR 1.19, 95% CI 1.15-1.22). Dual eligibility was also associated with slightly higher odds of anxiety-related prescription fills (aOR 1.21, 95% CI 1.17-1.26), whereas antidepressant prescription fills did not differ (aOR 1.00, 95% CI 0.95-1.05).ConclusionsDual eligibility was associated with modest differences in NPS documentation and prescription fills, suggesting differences in recognition and management of NPS among beneficiaries with ADRD.</p>","PeriodicalId":14929,"journal":{"name":"Journal of Alzheimer's Disease","volume":" ","pages":"1449-1457"},"PeriodicalIF":3.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}