Subjective cognitive decline (SCD) is considered a pre-symptomatic stage of dementia characterized by cognitive complaints. The ability of education to reduce the risk of dementia is well known. Our objective is to investigate the influence of education on the risk of progression from SCD to MCI or dementia. Prospective longitudinal studies of adults (≥50 years) with SCD evaluating progression to objective cognitive decline, MCI, or dementia were selected. Pooled estimates (random effects model) and 95 % confidence intervals were calculated, exploring heterogeneity. Standardized education differences, Odds Ratio, or Hazard Ratio between converters and non-converters were estimated. The systematic review carried out showed that high education, as well as other cognitive reserve proxies, delays cognitive decline. The first meta-analysis showed a significant association of SCD with conversion in both high and low education strata. A second meta-analysis considering education as a continuous variable found that SCD converters showed two years less education than non-converters. Our results suggest that education has a delaying effect against cognitive decline progression. The presumed improvement in accurately detecting cognitive decline associated with better metacognitive skills in higher-educated SCD participants does not seem to neutralize the incremental risk of objective cognitive decline associated with lower educational attainment.

Digital therapeutics (DTx) are transforming healthcare delivery through personalised, evidence-based interventions that offer a cost-effective approach to health management. However, their widespread adoption faces significant barriers including privacy concerns, usability issues, and integration challenges within healthcare systems. This review assesses the current evidence on DTx, with a particular focus on the role of co-creation in enhancing design and usability. A narrative review was conducted to identify studies exploring co-creation in DTx development. Three studies were selected for in-depth analysis, demonstrating that co-creation processes significantly improve the usability and effectiveness of DTx interventions. Findings underscore challenges in DTx implementation, including complex regulatory processes, digital inequality, high development costs, and difficulties in integrating with existing healthcare systems. Despite the existence of discrete examples of co-creation in DTx and its acknowledged value in the healthcare domain, systematic research in this field remains markedly limited. Future studies should prioritise establishing best practises for co-creation, with particular emphasis on methods to enhance data privacy and security, standardisation protocols, and patient engagement strategies to optimise DTx adoption and effectiveness. This review contributes to the growing body of literature on DTx by highlighting the potential of co-creation while also identifying critical areas for future research.

Objectives: To analyze the impacts of the restrictions implemented in LTCF during the COVID-19 pandemic on the psychological and functional status of older adults. Design: A retrospective multicentre study is designed. We hypothesize that the negative effects of the restrictions will lead to a higher rate of decline between the measures taken immediately before and after the lockdown than between the two measures taken before the lockdown. Setting and participants: 365 participants recruited in four Spanish LTCFs in Galicia and Valencia. Methods: Impacts of restrictions on cognitive (MMSE), affective (GDS) and functional status (Barthel index, Tinetti) were analyzed by Linear Mixed Models with random intercepts, random slopes, and personal and contextual factors as covariates. Results: Social measures covaried significantly with the cognitive and functional status but did not predict longitudinal change. MMSE, Barthel index and Tinetti scores decreased significantly across pre- and post-lockdown measurement times, but only the Tinetti scores showed a specific impact of the restrictions. Conclusions: Only performance-based functional measures showed the real impact of restrictions. The findings highlight the importance of having data from several pre-lockdown measurements to enable identification of changes that can be causally attributed to the restrictions. The findings also support the resilience of older adults in mitigating the effect of the restrictions.