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Dementia incidence is rising in low-middle-income countries (LMIC), majority of economic burden is indirect cost. In the Philippines, informal care by family members is the cornerstone of dementia care, yet programs for dementia education and training are lacking. The Institute for Dementia Care Asia (IDCA) formally initiated a partnership with the Technical Education and Skills Development Authority (TESDA) to create local Dementia Care Competency Standards (CS). Functional analysis was done to define the primary purpose, function, and required skills aligned with industry standards. Key steps were undertaken: a) Industry and Job Analysis to define roles and competencies care workers, focusing on technical, behavioral, and communication skills. b) Development of Units of Competencies (UCs), and c) External Validation. Twenty industry stakeholders including health and allied health professionals, therapists, educators, environmental design, community workers, and family members with knowledge and experience in dementia care underwent orientation in CS development by TESDA. Since there is a CS on general care for the elderly, skills mapping identified core competencies critical for dementia care which were discussed in bi-weekly consensus meetings from February to December 2024. Six competencies were derived: 1. Perform Health Assessment on People Living with Dementia (PLwD), 2. Apply Treatment Plan Based on the Determined Level of dementia care 3. Respond to and Manage Behavioral and Psychological Symptoms of Dementia (BPSD), 4. Facilitate Engagement in Recreational and Therapeutic Activities, 5. Facilitate End-of-Life Care Planning, and 6. Perform Self-Care. Descriptors for the work performance such as elements, functions, performance criteria, required knowledge and required skills under each UC were prescribed to ensure standards in training and assessment. The UCs were then presented to experts for external validation. In conclusion, we have created the first Dementia Care Competency Standard in the Philippines. A competency-based training program will be part of TESDA course offering. Given the constraints of economic its resources but wealth of human resource in the country, this partnership is a big step towards improving dementia care, and the competency standards and qualification is an opportunity for middle-skilled workers to upskill or reskill for an occupation in the fast-growing global dementia care industry.

Older adults experience less anxiety. We examined how memory of negative emotional images varied with age and may reflect age-related differences in anxiety. Fifty-one adults, age 22-80 years, underwent imaging with a memory task where negative and neutral images were displayed pseudo-randomly. They were queried post-scan about the images inter-mixed with an equal number of images never displayed. Sensitivity ( ) and reporting bias (Z-score of false alarm rate; Z[FAR]) were quantified with signal detection theory. Age was negatively correlated with both Spielberg State Trait Anxiety Inventory (STAI) state score and (negative - neutral) and positively with Z[FAR] (negative - neutral). However, STAI score and or Z[FAR] (negative - neutral) were not significantly correlated. In whole-brain regression, STAI score was correlated with higher activity of the right middle/superior temporal gyri/temporal parietal junction (MTG/STG/TPJ) for \"negative correct - incorrect\" - \"neutral correct - incorrect\" trials. Further, the MTG/STG/TPJ activity (β) was also negatively correlated with age. Mediation analyses supported a complete mediation model of age → less anxiety → less MTG/STG/TPJ β. Together, the findings demonstrated age-related changes in negative emotional memory and how age-related reduction in anxiety is reflected in diminished temporoparietal cortical activities during encoding of negative emotional memory.

Introduction Oligomeric amyloid-ß is a major toxic species associated with Alzheimer’s disease pathogenesis. Methods used to measure oligomeric amyloid-β in the blood have increased in number in recent years. The Multimer Detection System-Oligomeric Amyloid-β (MDS-OAβ) is a specific method to measure oligomerization tendencies in the blood. The objective of this study was to determine the association between amyloid-ß oligomerization in the plasma and structural changes of the brain. Methods We studied 162 subjects composed of 92 community-based normal healthy subjects, 17 with subjective cognitive decline, 14 with mild cognitive impairment and 39 with Alzheimer’s disease dementia. All subjects underwent MDS-OAβ and three-dimensional T1 magnetic resonance imaging. To determine the structural changes of the brain that are statistically correlated with MDS-OAβ level, we used voxel-based morphometry with corrections for age and total intracranial volume covariates. Results We found brain volume reduction in the bilateral temporal, amygdala, parahippocampal and lower parietal lobe and left cingulate and precuneus regions (family-wise error, p  < 0.05). Reduction was also found in white matter in proximity to the left temporal and bilateral lower parietal lobes and posterior corpus callosum (family-wise error, p  < 0.05). Brain volume increment was not observed in any regions within grey or white matter. Discussion Findings suggest that substantial correlation exists between amyloid ß oligomerization in the blood and brain volume reduction in the form of Alzheimer’s disease despite of uncertainty in the casual relationship.

Background This study investigated the differences in caregiver activity, caregiver burden, and awareness of both caregivers and patients with Alzheimer’s disease (AD) across different Asian locations. Methods This was a secondary analysis of a multi-national cohort study that aimed to assess caregiver activity and caregiver burden using the Caregiver Activity Scale (CAS) and Zarit Burden Interview (ZBI), respectively. Patients’ awareness of their dementia diagnosis was assessed by asking the following yes/no question: “Do you have dementia?” Caregivers’ awareness of the patient’s dementia diagnosis was assessed by asking the following yes/no question: “Does your patient have dementia?” Results In total, 524 caregivers of patients with AD from China, Hong Kong, South Korea, the Philippines, Singapore, Thailand, and Taiwan participated. The CAS and ZBI score were significantly different across most locations ( p  < 0.001 and p  = 0.033, respectively). Overall, 56.6% of caregivers and 37.5% of patients had awareness of the dementia diagnosis, and the proportion of patients and caregivers with awareness were also different between each location (all, p  < 0.001). Conclusions Caregiving, caregiver burden, and the awareness of caregivers and patients were different across many Asian locations. With understanding of cultural differences, further public education on dementia could help increase the awareness of patients and caregivers and reduce caregiver burden. Trial registration ClinicalTrials.gov , NCT02262975 . Registered 13 October 2014,

Introduction Oligomeric amyloid-ss is a major toxic species associated with Alzheimer's disease pathogenesis. Methods used to measure oligomeric amyloid-[beta] in the blood have increased in number in recent years. The Multimer Detection System-Oligomeric Amyloid-[beta] (MDS-OA[beta]) is a specific method to measure oligomerization tendencies in the blood. The objective of this study was to determine the association between amyloid-ss oligomerization in the plasma and structural changes of the brain. Methods We studied 162 subjects composed of 92 community-based normal healthy subjects, 17 with subjective cognitive decline, 14 with mild cognitive impairment and 39 with Alzheimer's disease dementia. All subjects underwent MDS-OA[beta] and three-dimensional T1 magnetic resonance imaging. To determine the structural changes of the brain that are statistically correlated with MDS-OA[beta] level, we used voxel-based morphometry with corrections for age and total intracranial volume covariates. Results We found brain volume reduction in the bilateral temporal, amygdala, parahippocampal and lower parietal lobe and left cingulate and precuneus regions (family-wise error, p < 0.05). Reduction was also found in white matter in proximity to the left temporal and bilateral lower parietal lobes and posterior corpus callosum (family-wise error, p < 0.05). Brain volume increment was not observed in any regions within grey or white matter. Discussion Findings suggest that substantial correlation exists between amyloid ss oligomerization in the blood and brain volume reduction in the form of Alzheimer's disease despite of uncertainty in the casual relationship. Keywords: Oligomerization, Blood-based biomarker, Amyloid [beta], Oligomer, Multimer detection system, Voxel-based morphometry, Multimer detection system-oligomeric A[beta]

Realistic single-cell neuronal dynamics are typically obtained by solving models that involve solving a set of differential equations similar to the Hodgkin-Huxley(HH) system. However, realistic simulations of neuronal tissue dynamics —especially at the organ level, the brain— can become intractable due to an explosion in the number of equations to be solved simultaneously. Consequently, such efforts of modeling tissue- or organ-level systems require a lot of computational time and the need for large computational resources. Here, we propose to utilize a cellular automata(CA) model as an efficient way of modeling a large number of neurons reducing both the computational time and memory requirement. First, a first-order approximation of the response function of each HH neuron is obtained and used as the response- curve automaton rule. We then considered a system where an external input is in a few cells. We utilize a Moore neighborhood (both totalistic and outer-totalistic rules) for the CA-system used. The resulting steady-state dynamics of a two-dimensional(2D) neuronal patch of size 1024×1024 cells can be classified into three classes: (1) Class 0–inactive, (2) Class 1–spiking, and (3) Class 2–oscillatory. We also present results for different quasi-3D configurations starting from the 2D lattice and show that this classification is robust. The numerical modeling approach can find applications in the analysis of neuronal dynamics in mesoscopic scales in the brain (patch or regional). The method is applied to compare the dynamical properties of the young and aged population of neurons. The resulting dynamics of the aged population shows higher average steady-state activity ⟨a(t→∞)⟩ than the younger population. The average steady-state activity ⟨a(t→∞)⟩ is significantly simplified when the aged population is subjected to external input. The result conforms to the empirical data with aged neurons exhibiting higher firing rates as well as the presence of firing activity for aged neurons stimulated with lower external current.

Background Mild cognitive impairment (MCI) is a neurocognitive state between normal cognitive aging and dementia, with evidence of neuropsychological changes but insufficient functional decline to warrant a diagnosis of dementia. Individuals with MCI are at increased risk for progression to dementia; and an appreciable proportion display neuropsychiatric symptoms (NPS), also a known risk factor for dementia. Cerebrovascular disease (CVD) is thought to be an underdiagnosed contributor to MCI/dementia. The Ginkgo biloba extract, EGb 761®, is increasingly being used for the symptomatic treatment of cognitive disorders with/without CVD, due to its known neuroprotective effects and cerebrovascular benefits. Aims To present consensus opinion from the ASian Clinical Expert group on Neurocognitive Disorders (ASCEND) regarding the role of EGb 761® in MCI. Materials & Methods The ASCEND Group reconvened in September 2019 to present and critically assess the current evidence on the general management of MCI, including the efficacy and safety of EGb 761® as a treatment option. Results EGb 761® has demonstrated symptomatic improvement in at least four randomized trials, in terms of cognitive performance, memory, recall and recognition, attention and concentration, anxiety, and NPS. There is also evidence that EGb 761® may help delay progression from MCI to dementia in some individuals. Discussion EGb 761® is currently recommended in multiple guidelines for the symptomatic treatment of MCI. Due to its beneficial effects on cerebrovascular blood flow, it is reasonable to expect that EGb 761® may benefit MCI patients with underlying CVD. Conclusion As an expert group, we suggest it is clinically appropriate to incorporate EGb 761® as part of the multidomain intervention for MCI. EGb 761® has demonstrated improvement in mild cognitive impairment (MCI) symptoms in at least four randomized trails, and is currently recommended for MCI in multiple clinical guidelines. The ASian clinical expert group on Neurocognitive Disorders (ASCEND) suggests that it is clinically appropriate to incorporate EGb 761® as part of the multidomain intervention for MCI, including cases with underlying CVD.

Aim. This study was aimed at validating the Filipino version of AD8 (AD8-P). Methods. Community-dwelling Filipino older persons aged ≥60 years, together with their informants, participated in this study. Psychologists independently interviewed the informants with AD8-P and administered the Filipino-validated Mini-Mental State Examination (MMSE-P) and Montreal Cognitive Assessment (MoCA-P) to the older persons. Neurologists and geriatrician conducted physical and neurological examination and Clinical Dementia Rating™ (CDR™) to determine cognitive diagnosis and were blinded with the results of AD8-P. Dementia was diagnosed based on DSM-IV-TR criteria. AD8-P discriminatory ability to screen for dementia was evaluated according to DSM-IV-TR diagnostic criteria for dementia. Results. A total of 366 community-dwelling Filipino older persons aged ≥60 years, 213 with normal cognition and 153 with dementia, and their informants were included in this study. Majority (90%) were at the mildest stage of dementia. Area under the receiver-operating-characteristic curve (AUROC) for AD8-P was 0.94 (95% CI 0.92 to 0.96), demonstrating excellent overall predictive power to screen for dementia. The optimal AD8-P cut-off score with best balance sensitivity (91.5%) and specificity (77.9%) was ≥3. Conclusion. AD8-P demonstrated good psychometric properties to screen for dementia, even at the earliest stage of cognitive decline.

The primary objective of this trial (SP1042; NCT02582866) was to assess long‐term safety and tolerability of lacosamide monotherapy (200‐600 mg/day) in adults with focal (partial‐onset) seizures or generalized tonic‐clonic seizures (without clear focal origin). This Phase III, long‐term, open‐label, multicenter, follow‐up trial enrolled patients with epilepsy who were taking lacosamide in, and completed, the previous double‐blind trial (SP0994; NCT01465997). Primary safety outcomes were treatment‐emergent adverse events (TEAEs), discontinuations due to TEAEs, and serious TEAEs. One hundred and six patients were enrolled and received lacosamide: 84 (79.2%) completed the trial and 22 (20.8%) discontinued. The median duration of exposure was 854.0 days, with a median modal dose of 200 mg/day. Ninety‐six (90.6%), 64 (60.4%), and 44 (41.5%) patients had ≥12, ≥24, and ≥36 months of lacosamide exposure, respectively. At least one TEAE was reported by 61 (57.5%) patients. The most common (≥4%) TEAEs were headache (10 [9.4%]), nasopharyngitis (eight [7.5%]), and back pain (five [4.7%]). One (0.9%) patient discontinued due to a TEAE (sudden unexpected death in epilepsy; not considered drug‐related), 14 (13.2%) patients reported serious TEAEs, and seven (6.6%) patients reported TEAEs that were considered drug‐related. Overall, long‐term lacosamide monotherapy was generally well tolerated up to 600 mg/day, with no new safety signals identified.

Background: Filipino normative data for neuropsychological tests are lacking. Objectives: This study aimed to determine the Filipino normative data for the Filipino Norming Project (FNP) Neuropsychological Battery, combining the Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-Cog) and the Neuropsychological Test Battery from the Uniform Dataset of Alzheimer’s Disease Center (UDS-ADC). Methods: We recruited participants 60 years and older with normal cognition (MMSE score of 25 and above and did not fulfill criteria for dementia according to DSM-IV criteria). Psychologists administered the tests to the study participants. We conducted multivariate analyses to study the effect of age, gender, and education on test performance. Results: A total of 191 participants underwent the FNP Neuropsychological Test Battery. The mean age was 68.8 years (SD 5.4). The majority were female (84.1%). The mean score of ADAS-Cog was 9.98 (SD 4.74). The effect of education was prominent throughout the cognitive domains tested while the effect of age was limited to a few cognitive domains. The mean ADAS-Cog scores were 11.80 ± 4.40 for primary education, 9.93 ± 5.08 for secondary, and 8.15 ± 3.95 for tertiary. On average, women scored 2.75 points lower than men and performed better on the verbal components. Men performed better on the constructional praxis component. The same effect of education and gender was observed for the UDS-ADC. Conclusion: For the first time, normative data are available for the ADAS-Cog and UDS-ADC for a Filipino older population. This study stresses the importance of establishing population-specific normative data, taking into account the specific sociocultural and linguistic context of that population.