The Memory Clinic

Background: Up to 30% of hospital admissions in older adults may be attributed to drug-related problems (DRPs). DRPs encompass adverse drug reactions, interaction between medications, the use of potentially inappropriate medications, and non-adherence to prescribed medications. Objective: To evaluate and compare the average number of DRPs identified in older adults with cognitive impairment or dementia using the Medication Review in Cognitive Impairment and Dementia (MedRevCiD) checklist compared to the Medication Appropriateness Index (MAI) criteria. Methods: Forty-four participants from the Multi-specialty Interprofessional Team-based Memory Clinic were included in the study. The researcher used 2 distinct tools, the MAI criteria and MedRevCiD checklist, to perform a medication review. The Wilcoxon signed-rank test was applied to evaluate if a significant difference exists in the average number of DRPs identified by the MedRevCiD compared to the MAI. Bivariate logistic regression analysis was conducted to explore potential factors associated with the DRPs use. Results: In the study, a total of 134 DRPs were identified in 44 participants using the MedRevCiD checklist, averaging 3.05 DRPs per person ± standard deviation (SD) of 4.0. In comparison, 81 DRPs were identified with the use of the MAI in the same group of 44 participants, resulting in an average of 1.84 DRPs per person (SD ± 2.9). A significant difference was found in the average number of DRPs identified by the 2 instruments (Z = –4.8, p-value <0.001). Conclusion: The MedRevCiD Checklist demonstrated a heightened ability to uncover DRPs in this population.

BackgroundAs dementia progresses, individuals with Alzheimer’s disease and related forms of dementia often lose decision-making capacity, raising complex ethical challenges related to autonomy, surrogate decision-making, dignity, privacy, and justice. This review examines the dilemmas in caring for patients who are no longer capable of providing informed consent, comparing Lebanon’s situation with those of countries across the Global North and South, and proposes practical, culturally grounded recommendations for improvement.ObjectiveTo conduct a comprehensive thematic review comparing international practices with Lebanon’s ethical, legal, and institutional approaches to caring for individuals with advanced dementia who lack capacity.MethodsA systematic yet flexible review approach, guided by the PRISMA framework, was applied. Studies focusing on Alzheimer’s disease and other related dementias were retrieved from PubMed, Scopus, PsycINFO, Web of Science, and the Cochrane Library up to April 2025. A total of 121 studies, including 112 international and 9 from Lebanon, met the inclusion criteria. These included qualitative, quantitative, and policy sources. Studies were thematically analyzed for ethical relevance across five themes.ResultsFive major ethical themes emerged: surrogate decision-making, patient autonomy, surveillance and technology, legal frameworks, and cultural and economic factors. A clear North–South divide was observed, with countries in the Global North generally relying on formal legal safeguards, advance directives, and structured institutional ethics oversight. In contrast, Lebanon and comparable countries in the Global South often operated with informal, family-centered models, limited legal clarity, and minimal institutional ethics support.ConclusionLebanon reflects broader Global South patterns: strong familial caregiving traditions, but inadequate legal and institutional frameworks to ensure dignity-based, ethically consistent care. This review proposes culturally sensitive reforms in law, public education, and ethics infrastructure to better protect the rights and dignity of individuals with advanced dementia.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12910-025-01277-3.

This article explores the application of convolutional neural networks (CNNs), specifically the UNet1D architecture, for filtering M-response signals − an essential component of electromyographic (EMG) diagnostics used to assess the functional state of the peripheral neuromuscular system. The goal of the study is to improve signal quality by effectively removing artifacts while preserving the amplitude-frequency characteristics critical for clinical interpretation. The model was trained on real biomedical data containing various types of noise and artifacts. Results show that the proposed model achieves high filtering accuracy with minimal deviation from the original signals (a mean amplitude deviation of only −0.04%, and a 20.75% increase in signal-to-noise ratio, SNR). The CNN-based approach demonstrated strong potential for preserving diagnostically significant features and can be effectively integrated into clinical EMG workflows to enhance diagnostic precision and reduce the impact of external interference.

This study examines the anomalous Hall effect (AHE) in the Heusler series ${\mathrm{Mn}}_{3}Z$ ($Z$=Ga, Ge, Sn), with a particular emphasis on the manipulation of noncollinear antiferromagnetic structures to enhance the AHE. By employing density-functional theory and first-principles calculations, we demonstrate that the anomalous Hall conductivity is markedly responsive to electron filling. By strategically doping Ga into ${\mathrm{Mn}}_{3}\mathrm{Sn}$ and ${\mathrm{Mn}}_{3}\mathrm{Ge}$ in order to modulate the electron density, a significant increase in anomalous Hall conductivity (AHC) is achieved. It is noteworthy that a Ga:Sn ratio of 1:5 yields peak AHC values exceeding $700\phantom{\rule{0.16em}{0ex}}{(\mathrm{\ensuremath{\Omega}}\phantom{\rule{0.16em}{0ex}}\mathrm{cm})}^{\ensuremath{-}1}$, while 3:7 Ga-Ge ratios can result in AHC values surpassing $600\phantom{\rule{0.16em}{0ex}}{(\mathrm{\ensuremath{\Omega}}\phantom{\rule{0.16em}{0ex}}\mathrm{cm})}^{\ensuremath{-}1}$. A comparison between the virtual crystal approximation and supercell construction methods for doping has revealed consistent trends. The results of this study pave the way for optimizing the AHE in noncollinear antiferromagnetic materials.

OBJECTIVE AND SCOPEA panel of clinicians, subject‐matter experts, and guideline methodologists convened by the Alzheimer's Association conducted a systematic review and formulated evidence‐based recommendations for using blood‐based biomarkers (BBMs) in the diagnostic workup of suspected Alzheimer's disease (AD) within specialized care settings. The scope focuses on individuals with objective cognitive impairment, including those with mild cognitive impairment (MCI) or dementia, who are undergoing evaluation by providers trained and experienced in memory disorders, where AD is the suspected underlying etiology.METHODSThe panel conducted a systematic review to assess the diagnostic accuracy of BBMs in detecting AD pathology. The BBMs of interest included plasma phosphorylated‐tau (p‐tau) and amyloid‐beta (Aβ) tests measuring the following analytes: p‐tau217, ratio of p‐tau217 to non‐p‐tau217 ×100 (%p‐tau17), p‐tau181, p‐tau231, and ratio of Aβ42 to Aβ40. The reference standard tests included cerebrospinal fluid (CSF) AD biomarkers, amyloid positron emission tomography (PET), or neuropathology. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of the evidence and the GRADE evidence‐to‐decision (EtD) Framework to develop its recommendations.RECOMMENDATIONSThe key recommendations in this Clinical Practice Guideline (CPG) are: (1) BBM tests with ≥90% sensitivity and ≥75% specificity can be used as a triaging test and (2) BBM tests with ≥90% sensitivity and specificity can serve as a substitute for amyloid PET imaging or CSF AD biomarker testing in patients with cognitive impairment presenting to specialized care for memory disorders. The panel cautions users of this guideline that there is significant variability in diagnostic test accuracy and many commercially available BBM tests do not meet these thresholds, especially using a single cutoff. Additionally, these tests do not serve as a substitute for comprehensive clinical evaluation by a healthcare professional and should be used only as part of a full diagnostic workup of patients with cognitive impairment presenting to specialized care settings, and with careful consideration of pretest probability of AD pathology.CONCLUSIONS AND PRACTICAL IMPLICATIONSThis CPG provides performance‐based, brand‐agnostic recommendations for the use of BBMs in the diagnostic workup of suspected AD within specialized care settings. By linking recommendations to a systematic review and associated living updates, and using a robust and transparent methodology, the guideline ensures scientific rigor, adaptability, and sustained relevance as evidence evolves. Clinicians are encouraged to stay informed about emerging paradigms—such as biomarker combinations or ratios and multi‐threshold testing—that may further refine the diagnostic accuracy of BBMs as the field evolves.

The Apollo study was designed to support the clinical performance verification of the adjusted cutoffs ofthe Elecsys® β-Amyloid(1-42) (Aβ42) cerebrospinal fluid (CSF) II, β-Amyloid(1-40) (Aβ40) CSF, Phospho-Tau (181P) (pTau) CSF and Total-Tau (tTau) CSF immunoassays (Roche Diagnostics International Ltd) for measuring fresh CSF samples, and assess the concordance of the Elecsys CSF pTau/Aβ42, tTau/Aβ42 and Aβ42/Aβ40 ratios, as well as Aβ42 alone, with amyloid positron emission tomography (PET) visual read status. The primary study endpoint was to assess the concordance of the Elecsys CSF ratios and Aβ42 alone with amyloid PET visual read status using fresh CSF samples collected from individuals with subjective cognitive decline or mild cognitive impairment, handled with a new routine-use pre-analytical procedure and measured with the Elecsys CSF immunoassays. The sample stability after 1- to 13-week storage at-20 °C was also investigated in an exploratory analysis. Of 108 screened individuals, 91 met the eligibility criteria, of whom 44.0 % were amyloid PET-positive and 56.0 % amyloid PET-negative. Positive percent agreement (PPA) and negative percent agreement, respectively, were 0.800 and 0.882 for pTau/Aβ42, 0.775 and 0.902 for tTau/Aβ42, and 0.950 and 0.824 for Aβ42/Aβ40. For Aβ42, PPA was 0.975 and negative likelihood ratio was 0.039. Overall, 33 samples (36.3 %) were frozen at-20 °C for 1-13weeks. All concentration recoveries were within 100±10 % when stored at-20 °C for≤8weeks. Elecsys CSF ratios and Aβ42 alone may be reliable alternatives to amyloid PET for identifying amyloid positivity in clinical practice.

Abstract BackgroundNew disease modifying treatments (DMTs) offer a new treatment paradigm in mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s disease (AD). This likely requires significant changes in patient management and need for added capacity for diagnosis, treatment and monitoring.MethodWe surveyed eight selected memory clinics in the three largest and two smaller regions of Sweden, plus one in each of Denmark, Finland and Norway on their current practice, number of patients by diagnosis and available resources. Findings were compared to clinic assumptions on a future scenario where eligible patients with MCI or mild dementia due to AD are offered DMT.ResultUp to 3, but most often less than 1, incident patients in 1000 inhabitants per year are seen at surveyed memory clinics, of which on average about 40% have MCI or mild dementia due to AD. This constitutes not more than a few percent of the 10‐30 persons in 1000 inhabitants expected to have AD at this stage in the Nordics today. Most patients get amyloid biomarker confirmation as part of their diagnosis, while there are long wait times for radiology, in particular magnetic resonance imaging.ConclusionMost patients expected to be eligible for DMTs in AD are not referred to memory clinics today, but are managed in primary care or are not presenting with cognitive complaints to health care at all. Therefore, the main challenge is likely not to treat patients already seen at memory clinics, but to manage a potential increase in patients that would benefit from DMTs. New referral patterns and health care seeking behaviors are therefore expected to determine the need for investments in additional capacity to diagnose and treat eligible patients.

BackgroundOlder adults with chronic or acute cognitive impairment, such as dementia or delirium, who are hospitalized face unique barriers to person-centered care and a higher risk for negative outcomes stemming from hospitalizations. There is a need for co-designed interventions adapted for these patients to the hospital setting to improve care and outcomes. Patient life storytelling interventions have demonstrated promise in enhancing person-centered care by improving patient–care team relationships and providing information to enable care tailored to individual needs and values.ObjectiveThis study aims to engage patients, care partners, and clinical stakeholders in a co-design process to adapt an existing life storytelling model for use with older adults with dementia and at risk of delirium in the acute care hospital setting.MethodsWe recruited patients with dementia or at risk of delirium who were hospitalized, their care partners, clinicians, and informaticists. A 3-stage co-design process that used a mixed methods data collection approach including in-depth interviews and surveys was completed. We used content analysis to analyze qualitative data and descriptive statistics to summarize quantitative data.ResultsIn total, 27 stakeholder informants (ie, patients, care partners, and interdisciplinary care team [IDT] members) participated. Stakeholders were unanimously interested in using patient life stories as a tool for hospital care through electronic health record (EHR) integration. Stakeholders shared potential topics for life stories to cover, including social support, information on patients’ key life events, and favorite activities. Participants provided insights into the logistics of integrating life stories into acute care, including interview arrangement, story-sharing methods, and barriers and facilitators. IDT members shared preferences on EHR integration, resulting in 3 co-designed mock-ups of EHR integration options. Stakeholders shared ways to optimize future acceptability and uptake, including engaging with the care team and promoting awareness of life stories, ensuring suitability to the acute environment (eg, distilling information in an easily digestible way), and addressing concerns for patient capacity and privacy (eg, engaging care partners when appropriate). Thoughts on potential impacts of life stories were also elicited, including improving patient- and care partner–IDT member relationships; humanizing patients; increasing clinical team, patient, and caregiver satisfaction; and enabling more specific, tailored care for patients with dementia and at risk of delirium.ConclusionsThis study resulted in a co-designed life storytelling intervention for patients with dementia and at risk for delirium in an acute care hospital setting. Stakeholders provided valuable information to ensure future intervention acceptability and uptake, including potential benefits, facilitators, and challenges in the acute care setting.

Identifying and validating a biomarker with high specificity in early-stage dementia with Lewy bodies (DLB) using a feasible method is crucial to enhance the current suboptimal diagnostic procedure. Previous research revealed abnormalities, including hypoperfusion in the right anterior insular cortex at group level, in prodromal DLB. Exploring hypoperfusion of the right anterior insula, at an individual-level and assessing its relevance as a potential imaging biomarker in early DLB, has, to our knowledge, not been investigated. Our preliminary study aims to assess the feasibility of the technique and to provide a methodological framework for further investigation. We assessed the feasibility and accuracy of the hypoperfusion of the right anterior insula per arterial spin labelling magnetic resonance imaging (ASL-MRI) as a diagnostic biomarker in early DLB and provided rough estimates of its sensitivity and specificity. Defining the region of interest based on previous research, we established the biomarker as the hypoperfusion of the right anterior insula. Discriminative and analytical performances were assessed in comparison to a control group of treatment-resistant depression patients. Bayesian diagnostic reasoning was employed to assess the biomarker diagnostic usability in early DLB in two scenarios: healthy elderly controls and mild cognitive impairment. Additionally, we updated probabilities by integrating data from the Mayo-clinic cognitive fluctuations scale and real-time quaking-induced conversion (RT-QuIC) α-synuclein data. Lastly, a whole-brain perfusion analysis of DLB patients was conducted to identify further brain regions with discriminative abilities. We successfully replicated the right anterior insular hypoperfusion (RAI-Hypo) in all DLB patients at the individual level. The overall sensitivity of the biomarker was 96%, and the specificity was 92%. Bayesian testing revealed the biomarker's highest performance in early-stage DLB with cognitive fluctuations, showcasing a diagnostic potential associated with a high precision and moderate accuracy. In a cognitively non-impaired population, the RAI-Hypo showed a limited usability and lacked in selectivity to qualify as a screening tool. The exploratory whole-brain analysis revealed perfect discriminative capacities in the bilateral anterior insulae and the left inferior parietal lobule. Further studies are needed to confirm our preliminary results. If performance is maintained in subsequent studies and is compared to a more suitable control population, the proposed biomarker may be eventually sufficient to discriminate early-stage DLB from non-DLB.