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Major depressive disorder (MDD) is a complex mental illness with unmet therapeutic needs. The antidepressant effects of ω–3 polyunsaturated fatty acids (n–3 PUFAs) have been widely reported. The subcommittee of the International Society for Nutritional Psychiatry Research organized an expert panel and conducted a literature review and a Delphi process to develop a consensus-based practice guideline for clinical use of n–3 PUFAs in MDD. The guideline focuses on 5 thematic areas: general concepts, acute treatment strategy, depression recurrence monitoring and prevention, use in special populations, and potential safety issues. The key practice guidelines contend that: (1) clinicians and other practitioners are advised to conduct a clinical interview to validate clinical diagnoses, physical conditions, and measurement-based psychopathological assessments in the therapeutic settings when recommending n–3 PUFAs in depression treatment; (2) with respect to formulation and dosage, both pure eicosapentaenoic acid (EPA) or an EPA/docosahexaenoic acid (DHA) combination of a ratio higher than 2 (EPA/DHA >2) are considered effective, and the recommended dosages should be 1–2 g of net EPA daily, from either pure EPA or an EPA/DHA (> 2:1) formula; (3) the quality of n–3 PUFAs may affect therapeutic activity; and (4) potential adverse effects, such as gastrointestinal and dermatological conditions, should be monitored, as well as obtaining comprehensive metabolic panels. The expert consensus panel has agreed on using n–3 PUFAs in MDD treatment for pregnant women, children, and the elderly, and prevention in high-risk populations. Personalizing the clinical application of n-3 PUFAs in subgroups of MDD with a low Omega-3 Index or high levels of inflammatory markers might be regarded as areas that deserve future research.

IntroductionRetinal neurodegeneration has recently been shown to occur in tandem with neurodegenerative disease. In the expectation that disease-modifying treatments for Alzheimer’s disease (AD) and Parkinson’s disease (PD) will soon become available, it will be important to have clinically useful biomarkers for neurodegenerative disease subtyping to guide early diagnosis, inform on prognosis and stratify subgroups for treatment. Understanding differences in detectable retina changes in individuals with different neurodegenerative disease subtypes is therefore fundamental. The emerging field of oculomics posits that systemic and neurodegenerative disease can be characterised using detectable ocular biomarkers within retinal diagnostics. The aim of this review is to compare the performance of common retinal imaging modalities in neurodegenerative disease detection and subtyping.Methods and analysisThis protocol has been reported in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. A comprehensive literature search will be conducted in PubMed, Web of Science and Scopus. Eligible studies will have reported using retinal diagnostic tools defined as optical coherence tomography (OCT), OCT angiography (OCTA), colour fundus photography (CFP) and electroretinography (ERG) in individuals with neurodegenerative diseases, including AD, PD, dementia with Lewy bodies, frontotemporal dementia, vascular dementia and mild cognitive impairment. There will be no time restrictions placed in these searches. Studies not written in English, not peer-reviewed and grey literature will be excluded. Screening for eligible studies and data extraction will be conducted by two independent reviewers, using predefined inclusion criteria. Any disagreements between the reviewers will be settled by discussion, and if required, third senior reviewer arbitration. The systematic review primary outcome is the performance of retinal diagnostics, namely OCT, OCTA, CFP and ERG in the detection and subtyping of aforementioned neurodegenerative diseases. The secondary outcome is to evaluate the association between changes in retinal diagnostic features (eg, retinal layer thicknesses) and neurodegenerative disease subtypes. The quality of the included studies will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) tool. A narrative synthesis approach will be used to analyse the results, with meta-analysis performed if there is sufficient data.Ethics and disseminationEthical approval for this manuscript is not required, as this is a protocol for a systematic review and therefore no data are to be collected. Findings for this systematic review will be disseminated as a peer-reviewed publication and presentations at national and international symposiums including International Lewy Body Dementia Conference, International Congress of Parkinson’s Disease and Movement Disorders, The Association for Research in Vision and Ophthalmology.PROSPERO registration numberCRD42023434024.

BACKGROUND Wrist‐worn actigraphy can be an objective tool to assess sleep and other behavioral and psychological symptoms in dementia (BPSD). We investigated the feasibility of using wearable actigraphy in agitated late‐stage dementia patients. METHODS Agitated, late‐stage Alzheimer's dementia care home residents in Greater London area (n = 29; 14 females, mean age ± SD: 80.8 ± 8.2; 93.1% White) were recruited to wear an actigraphy watch for 4 weeks. Wearing time was extracted to evaluate compliance, and factors influencing compliance were explored. RESULTS A high watch‐acceptance (96.6%) and compliance rate (88.0%) was noted. Non‐compliance was not associated with age or BPSD symptomatology. However, participants with “better” cognitive function (R = 0.42, p = 0.022) and during nightshift (F1.240, 33.475 = 8.075, p = 0.005) were less compliant. Female participants were also marginally less compliant (F1, 26 = 3.790, p = 0.062). DISCUSSIONS Wrist‐worn actigraphy appears acceptable and feasible in late‐stage agitated dementia patients. Accommodating the needs of both the patients and their carers may further improve compliance.

Sleep disturbances are common in dementia patients, and nocturnal behavioural and psychological symptoms of dementia (BPSD) are particularly challenging to caregivers. Measuring them currently relies on carer-rated questionnaires, which can be imprecise. We explore the use of a validated research-grade actigraphy (Geneactiv Original) and an open-sourced R-package GGIR to measure the sleep of care home residents living with late-stage Alzheimer's disease (AD) and agitation from the Sativex® for the treatment of Agitation & Aggression in Alzheimer's Dementia (STAND) trial (ISRCTN registry: 97163562). Out of 29 participants from STAND trial, 28 (14 female) accepted wearing the device were included. The participants' BPSD were assessed with caregiver-rated Neuropsychiatry Inventory-Nursing Home version (NPI-NH) and Pittsburgh Sleep Quality Index (PSQI) at baseline, week 2 and week 4. Sleep-related variables, including sleep duration, onset and offset time, efficiency, Wake-After-Sleep-Onset (WASO) duration and the Sleep Regularity Index, were calculated using GGIR and then correlated with the NPI and PSQI items of the corresponding period. Spearman correlation and linear regression to analyse questionnaires and device-based results were undertaken, and a two-tailed alpha of 0.05 with a p-value < .05 were applied and considered statistically significant. The prevalence of sleep problem was high, regardless of the measuring tool (62.1% NPI-sleep item ≥ 4, 72.4% PSQI > 5, and 51.9% actigraphy-derived sleep efficiency < 85%) and the trial group assigned. Overall, participants' average sleep regularity index was very low (26.4 ± 15.0 during week 1-2, and 25.7 ± 16.9 during week 3-4). Questionnaires and actigraphy results averaged across multiple days had good correlations in qualitative variables, but wearables appeared more sensitive in measuring time-dependent variables and reflecting the sleep regularity. Using a data-driven approach, a moderate degree of correlation was found between WASO duration and irritability throughout the trial period (R = 0.43 and 0.44 over week 1-2 and week 3-4, respectively, both p <0.05). Nocturnal sleep appeared commonly poor and irregular in this population, and the irregularity may not be captured by questionnaires. Clinical trials could consider applying wearables as alternative measurements, which might be able to offer information to complement questionnaire-based results and to explore novel therapeutic targets.

The co-occurrence of depression and obesity has become a significant public health concern worldwide. Recent studies have shown that metabolic dysfunction, which is commonly observed in obese individuals and is characterized by inflammation, insulin resistance, leptin resistance, and hypertension, is a critical risk factor for depression. This dysfunction may induce structural and functional changes in the brain, ultimately contributing to depression’s development. Given that obesity and depression mutually increase each other’s risk of development by 50–60%, there is a need for effective interventions that address both conditions. The comorbidity of depression with obesity and metabolic dysregulation is thought to be related to chronic low-grade inflammation, characterized by increased circulating levels of pro-inflammatory cytokines and C-reactive protein (CRP). As pharmacotherapy fails in at least 30–40% of cases to adequately treat major depressive disorder, a nutritional approach is emerging as a promising alternative. Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are a promising dietary intervention that can reduce inflammatory biomarkers, particularly in patients with high levels of inflammation, including pregnant women with gestational diabetes, patients with type 2 diabetes mellitus, and overweight individuals with major depressive disorder. Further efforts directed at implementing these strategies in clinical practice could contribute to improved outcomes in patients with depression, comorbid obesity, and/or metabolic dysregulation.

PurposeInsomnia is a prevalent sleep disorder among patients undergoing hemodialysis for chronic kidney disease. This study aimed to translate the sleep condition indicator (SCI), an insomnia screening tool based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), into a traditional Chinese version (SCI-TC) and evaluate the reliability and validity of this version for patients undergoing hemodialysis.MethodsThis cross-sectional study conducted from November 2022 to June 2023 involved 200 patients on hemodialysis (mean age, 65.56 years; 61.5% men). Participants completed a series of questionnaires, with insomnia diagnosed according to DSM-5 criteria as the gold standard. A receiver operating characteristic (ROC) curve analysis was conducted to examine the sensitivity and specificity of the SCI-TC.ResultsAccording to the DSM-5 criteria, 38% of the participants had insomnia. Cronbach’s alpha for the SCI-TC was 0.92. The SCI-TC exhibited a good fit as a two-factor model, and its scores were significantly associated with those of the traditional Chinese versions of the Insomnia Severity Index, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, EuroQol 5-Dimensions scale, and EuroQol Visual Analogue Scale (r =  − 0.94, − 0.53, − 0.38, 0.27, and 0.30, respectively; all p < 0.05). The ROC curve analysis revealed an optimal cutoff of 16 points, with the sensitivity, specificity, and area under curve of 88.2%, 84.7%, and 0.91(95% confidence interval, 0.87–0.95), respectively.ConclusionThe SCI-TC demonstrates robust reliability and validity in detecting insomnia among patients undergoing hemodialysis. These findings suggest that health-care providers should considering using the SCI as an easy-to-use tool for the timely detection of insomnia in this population.

Background Sleep disturbances are common in dementia patients, and nocturnal behavioural and psychological symptoms of dementia (BPSD) are particularly challenging to caregivers. Measuring them currently relies on carer‐rated questionnaires, which can be imprecise. We explore the use of a validated research‐grade actigraphy (Geneactiv Original) and an open‐sourced R‐package GGIR to measure the sleep of care home residents living with late‐stage Alzheimer's disease (AD) and agitation from the Sativex® for the treatment of Agitation & Aggression in Alzheimer's Dementia (STAND) trial (ISRCTN registry: 97163562). Method Out of 29 participants from STAND trial, 28 (14 female) accepted wearing the device were included. The participants’ BPSD were assessed with caregiver‐rated Neuropsychiatry Inventory‐Nursing Home version (NPI‐NH) and Pittsburgh Sleep Quality Index (PSQI) at baseline, week 2 and week 4. Sleep‐related variables, including sleep duration, onset and offset time, efficiency, Wake‐After‐Sleep‐Onset (WASO) duration and the Sleep Regularity Index, were calculated using GGIR and then correlated with the NPI and PSQI items of the corresponding period. Spearman correlation and linear regression to analyse questionnaires and device‐based results were undertaken, and a two‐tailed alpha of 0.05 with a p‐value < .05 were applied and considered statistically significant. Result The prevalence of sleep problem was high, regardless of the measuring tool (62.1% NPI‐sleep item ≥ 4, 72.4% PSQI > 5, and 51.9% actigraphy‐derived sleep efficiency < 85%) and the trial group assigned. Overall, participants' average sleep regularity index was very low (26.4 ± 15.0 during week 1‐2, and 25.7 ± 16.9 during week 3‐4). Questionnaires and actigraphy results averaged across multiple days had good correlations in qualitative variables, but wearables appeared more sensitive in measuring time‐dependent variables and reflecting the sleep regularity. Using a data‐driven approach, a moderate degree of correlation was found between WASO duration and irritability throughout the trial period (R = 0.43 and 0.44 over week 1‐2 and week 3‐4, respectively, both p <0.05). Conclusion Nocturnal sleep appeared commonly poor and irregular in this population, and the irregularity may not be captured by questionnaires. Clinical trials could consider applying wearables as alternative measurements, which might be able to offer information to complement questionnaire‐based results and to explore novel therapeutic targets.