{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:50:00Z","timestamp":1789588200781,"version":"build-2803163510"},"reference-count":56,"publisher":"IMR Press","issue":"7","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Integr. Neurosci."],"abstract":"<jats:p>Background:Despite their negative effects on cognitive function and cognitive decline risk, drugs with anticholinergic properties are commonly prescribed, particularly in older individuals. In this observational study we aimed to shed light on the relationships between anticholinergic burden (ACB) and depressive symptoms and cognitive and functional performance in a real-world clinical setting. Methods:The study included individuals seeking care at the old-age psychiatry outpatient clinic of Patras University Mental Health Services. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale; cognitive function was tapped using the Cognitive Telephone Screening Instrument, the Montreal Cognitive Assessment, and the Mini-Mental State Examination; and functional performance was assessed using the Bristol Activities of Daily Living Scale. Differences in demographic and clinical variables across the four diagnostic groups were analyzed. Regression analyses were performed to examine the associations between ACB, cognitive and non-cognitive symptoms, and demographic variables. In addition, clustering analyses were conducted to identify distinct, naturally occurring examinee subgroups and to assess if ACB differed across them. Results:The study sample consisted of individuals without cognitive impairment (N = 301), people with mild neurocognitive disorder (MiND, N = 264), major neurocognitive disorder caused by Alzheimer\u2019s disease (ADMaND, N = 114), or other diseases (nonADMaND, N = 63). Significant associations were detected between ACB and depressive symptoms (0.72, p &lt; 0.001), short-term memory (\u20130.11, p = 0.017), long-term memory (\u20130.24, p &lt; 0.001), working memory (\u20130.24, p = 0.001), attention\/concentration (\u20130.13, p = 0.004), verbal fluency (\u20130.57, p = 0.003), inductive reasoning (\u20130.17, p = 0.002), basic activities of daily living (0.29, p = 0.001), and instrumental activities of daily living (0.58, p &lt; 0.001). The clustering analyses indicated that in the cluster including individuals with more advanced cognitive decline, poorer functional status, and more severe depressive symptoms, ACB was higher compared with the second group identified by the analyses (p &lt; 0.001). Conclusions:ACB is related to different aspects of the clinical phenotype of cognitive decline. Despite the lack of solid evidence regarding causal relationships and need for further research, minimizing ACB in clinical settings may embody a potential pragmatic strategy in managing cognitive decline in ageing.<\/jats:p>","DOI":"10.31083\/jin51135","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:01:26Z","timestamp":1785409286000},"source":"Crossref","is-referenced-by-count":2,"title":["Anticholinergic Burden and Cognitive Function, Depressive Symptoms, and Functional Performance in Individuals With Neurocognitive Disorders: Real-World Evidence"],"prefix":"10.31083","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3118-927X","authenticated-orcid":true,"given":"Maria","family":"Skondra","sequence":"first","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2639-9266","authenticated-orcid":true,"given":"Leonidas","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9202-6993","authenticated-orcid":true,"given":"Theodora","family":"Kougioumtzoglou","sequence":"additional","affiliation":[{"name":"Department of Civil Engineering (Statistics), School of Engineering, University of Patras, 26504 Patras, Greece"},{"name":"Department of Mathematics, School of Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9007-3770","authenticated-orcid":true,"given":"Charalampos L.","family":"Kandilakis","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2529-0069","authenticated-orcid":true,"given":"Eleni","family":"Konidari","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4875-728X","authenticated-orcid":true,"given":"Violeta","family":"Papalexiou","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4196-5789","authenticated-orcid":true,"given":"Ianthi","family":"Marouli","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5435-410X","authenticated-orcid":true,"given":"Loukia-Maria","family":"Malagkoniari","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2965-1996","authenticated-orcid":true,"given":"Andreas","family":"Kostakiotis","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8234-1355","authenticated-orcid":true,"given":"Theokritos","family":"Veskoukis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, LVR-Klinikum D\u00fcsseldorf, Heinrich-Heine-University D\u00fcsseldorf, 40629 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9825-154X","authenticated-orcid":true,"given":"Vaios","family":"Peritogiannis","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6452-5920","authenticated-orcid":true,"given":"Polychronis","family":"Economou","sequence":"additional","affiliation":[{"name":"Department of Civil Engineering (Statistics), School of Engineering, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Felemegkas","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9047-6365","authenticated-orcid":true,"given":"Panagiotis","family":"Alexopoulos","sequence":"additional","affiliation":[{"name":"Patras University Mental Health Services, Department of Medicine, School of Health Sciences, University of Patras, 26504 Patras, Greece"},{"name":"Global Brain Health Institute, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland"},{"name":"Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, 80333 M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Tetsuka S. Depression and Dementia in Older Adults: A Neuropsychological Review. Aging and Disease. 2021; 12: 1920\u20131934.","DOI":"10.14336\/AD.2021.0526"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Sabates J, Chiu WH, Loi S, Lampit A, Gavelin HM, Chong T, et al. The Associations Between Neuropsychiatric Symptoms and Cognition in People with Dementia: A Systematic Review and Meta-Analysis. Neuropsychology Review. 2024; 34: 581\u2013597.","DOI":"10.1007\/s11065-023-09608-0"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet (London, England). 2017; 390: 2673\u20132734.","DOI":"10.1016\/S0140-6736(17)31363-6"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Livingston G, Huntley J, Liu KY, Costafreda SG, Selb\u00e6k G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet (London, England). 2024; 404: 572\u2013628.","DOI":"10.1016\/S0140-6736(24)01296-0"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Zenebe Y, Akele B, W\/Selassie M, Necho M. Prevalence and determinants of depression among old age: a systematic review and meta-analysis. Annals of General Psychiatry. 2021; 20: 55.","DOI":"10.1186\/s12991-021-00375-x"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Eliza Georgiou EZ, Politis A, Kosmidis MH, Yannakoulia M, Dardiotis E, Hadjigeorgiou G, et al. Depressive symptoms in the entire spectrum of cognitive ageing in Greece: evidence from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). International Journal of Psychiatry in Clinical Practice. 2024; 28: 27\u201334.","DOI":"10.1080\/13651501.2023.2296889"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Taylor WD. Depression in the elderly. 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The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. 2018; 26: 280\u2013288.","DOI":"10.1016\/j.jagp.2017.08.005"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Taylor-Rowan M, Kraia O, Kolliopoulou C, Noel-Storr AH, Alharthi AA, Cross AJ, et al. Anticholinergic burden for prediction of cognitive decline or neuropsychiatric symptoms in older adults with mild cognitive impairment or dementia. Cochrane Database of Systematic Reviews. 2022; 8: CD015196.","DOI":"10.1002\/14651858.CD015196.pub2"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Reallon E, Gervais F, Moutet C, Dauphinot V, Desnavailles P, Novais T, et al. Impact of cumulative exposure to anticholinergic and sedative drugs on cognition in older adults: a memory clinic cohort study. Alzheimer's Research & Therapy. 2024; 16: 163.","DOI":"10.1186\/s13195-024-01530-8"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Robb C, Udeh-Momoh C, Wagenpfeil S, Sch\u00f6pe J, Alexopoulos P, Perneczky R, et al. Biomarkers and Functional Decline in Prodromal Alzheimer's Disease. Journal of Alzheimer's Disease : JAD. 2017; 58: 69\u201378.","DOI":"10.3233\/JAD-161162"},{"key":"ref19","unstructured":"Emmady PD, Schoo C, Tadi P. Major neurocognitive disorder (dementia). In StatPearls [Internet]. StatPearls Publishing: Treasure Island (FL). 2022."},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Alexopoulos P, Skondra M, Kontogianni E, Vratsista A, Frounta M, Konstantopoulou G, et al. Validation of the Cognitive Telephone Screening Instruments COGTEL and COGTEL+ in Identifying Clinically Diagnosed Neurocognitive Disorder Due to Alzheimer's Disease in a Naturalistic Clinical Setting. Journal of Alzheimer's Disease : JAD. 2021; 83: 259\u2013268.","DOI":"10.3233\/JAD-210477"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Fountoulakis KN, Tsolaki M, Iacovides A, Yesavage J, O'Hara R, Kazis A, et al. The validation of the short form of the Geriatric Depression Scale (GDS) in Greece. Aging (Milan, Italy). 1999; 11: 367\u2013372.","DOI":"10.1007\/BF03339814"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Li X, Dai J, Zhao S, Liu W, Li H. Comparison of the value of Mini-Cog and MMSE screening in the rapid identification of Chinese outpatients with mild cognitive impairment. Medicine. 2018; 97: e10966.","DOI":"10.1097\/MD.0000000000010966"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Alexopoulos P, Skondra M, Charalampopoulou M, Georgiou EEZ, Demertzis AA, Aligianni S\u0399, et al. Low cognitive functioning and depressive symptoms in patients with rheumatoid arthritis and systemic sclerosis: a clinical study. BMC Psychiatry. 2023; 23: 513.","DOI":"10.1186\/s12888-023-04995-3"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Poptsi E, Moraitou D, Eleftheriou M, Kounti-Zafeiropoulou F, Papasozomenou C, Agogiatou C, et al. Normative Data for the Montreal Cognitive Assessment in Greek Older Adults With Subjective Cognitive Decline, Mild Cognitive Impairment and Dementia. Journal of Geriatric Psychiatry and Neurology. 2019; 32: 265\u2013274.","DOI":"10.1177\/0891988719853046"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Kourtesis P, Margioti E, Demenega C, Christidi F, Abrahams S. A Comparison of the Greek ACE-III, M-ACE, ACE-R, MMSE, and ECAS in the Assessment and Identification of Alzheimer's Disease. Journal of the International Neuropsychological Society : JINS. 2020; 26: 825\u2013834.","DOI":"10.1017\/S1355617720000314"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Bucks RS, Ashworth DL, Wilcock GK, Siegfried K. Assessment of activities of daily living in dementia: development of the Bristol Activities of Daily Living Scale. Age and Ageing. 1996; 25: 113\u2013120.","DOI":"10.1093\/ageing\/25.2.113"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Acosta Quiroz CO, Garc\u00eda-Flores R, Echeverr\u00eda-Castro SB. The Geriatric Depression Scale (GDS-15): Validation in Mexico and Disorder in the State of Knowledge. International Journal of Aging & Human Development. 2021; 93: 854\u2013863.","DOI":"10.1177\/0091415020957387"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Kiesel EK, Hopf YM, Drey M. An anticholinergic burden score for German prescribers: score development. BMC Geriatrics. 2018; 18: 239.","DOI":"10.1186\/s12877-018-0929-6"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Modi AR, Casten R, Rovner BW. Relationship of anticholinergic drug burden on depression, engagement in activities, and perceived quality of life in older African-Americans. American Journal of Geriatric Psychiatry. 2015; 23: S109\u2013S110.","DOI":"10.1016\/j.jagp.2014.12.109"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Pistorio S, Scotto di Tella G, Canzanella V, Merenda R, Cuomo G, Iacotucci P, et al. Anticholinergic burden and behavioral and psychological symptoms in older patients with cognitive impairment. Frontiers in Medicine. 2025; 12: 1505007.","DOI":"10.3389\/fmed.2025.1505007"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Dagyt\u0117 G, Den Boer JA, Trentani A. The cholinergic system and depression. Behavioural Brain Research. 2011; 221: 574\u2013582.","DOI":"10.1016\/j.bbr.2010.02.023"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Corsonello A, Cozza A, D'Alia S, Onder G, Volpato S, Ruggiero C, et al. The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms. European Journal of Internal Medicine. 2019; 61: 69\u201374.","DOI":"10.1016\/j.ejim.2018.11.004"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Broder JC, Ryan J, Shah RC, Lockery JE, Orchard SG, Gilmartin-Thomas JFM, et al. Anticholinergic medication burden and cognitive function in participants of the ASPREE study. Pharmacotherapy. 2022; 42: 134\u2013144.","DOI":"10.1002\/phar.2652"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Bhatkhande G, Choudhry NK, Mahesri M, Haff N, Lauffenburger JC. Disentangling drug contributions: anticholinergic burden in older adults linked to individual medications: a cross-sectional population-based study. BMC Geriatrics. 2024; 24: 44.","DOI":"10.1186\/s12877-023-04640-4"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Naharci MI, Cintosun U, Ozturk A, Oztin H, Turker T, Bozoglu E, et al. Effect of anticholinergic burden on the development of dementia in older adults with subjective cognitive decline. Psychiatry and Clinical Psychopharmacology. 2017; 27: 263\u2013270.","DOI":"10.1080\/24750573.2017.1358130"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Pieper NT, Grossi CM, Chan WY, Loke YK, Savva GM, Haroulis C, et al. Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis. Age and Ageing. 2020; 49: 939\u2013947.","DOI":"10.1093\/ageing\/afaa090"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Coupland CAC, Hill T, Dening T, Morriss R, Moore M, Hippisley-Cox J. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Internal Medicine. 2019; 179: 1084\u20131093.","DOI":"10.1001\/jamainternmed.2019.0677"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Nishtala PS, Allore H, Han L, Jamieson HA, Hilmer SN, Chyou TY. Impact of Anticholinergic Burden on Cognitive Performance: A Cohort Study of Community-Dwelling Older Adults. Journal of the American Medical Directors Association. 2020; 21: 1357\u20131358.e3.","DOI":"10.1016\/j.jamda.2020.03.027"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Risacher SL, McDonald BC, Tallman EF, West JD, Farlow MR, Unverzagt FW, et al. Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults. JAMA Neurology. 2016; 73: 721\u2013732.","DOI":"10.1001\/jamaneurol.2016.0580"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Pantsiou K, Sfakianaki O, Papaliagkas V, Savvoulidou D, Costa V, Papantoniou G, et al. Inhibitory Control, Task\/Rule Switching, and Cognitive Planning in Vascular Dementia: Are There Any Differences From Vascular Aging? Frontiers in Aging Neuroscience. 2018; 10: 330.","DOI":"10.3389\/fnagi.2018.00330"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Dubois B, Villain N, Schneider L, Fox N, Campbell N, Galasko D, et al. Alzheimer Disease as a Clinical-Biological Construct-An International Working Group Recommendation. JAMA Neurology. 2024; 81: 1304\u20131311.","DOI":"10.1001\/jamaneurol.2024.3770"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Swallow J. Constructing classification boundaries in the memory clinic: negotiating risk and uncertainty in constituting mild cognitive impairment. Sociology of Health & Illness. 2020; 42: 99\u2013113.","DOI":"10.1111\/1467-9566.13016"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Pham Nguyen TP, Thibault D, Gray SL, Weintraub D, Willis AW. Impact of Anticholinergic Burden and Clinical-Demographic Characteristics on Incident Dementia in Parkinson Disease. Journal of Geriatric Psychiatry and Neurology. 2025; 38: 254\u2013263.","DOI":"10.1177\/08919887241313376"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Woodford HJ, Stevenson JM. Anticholinergic drugs and dementia: time for transparency in the face of uncertainty. The Cochrane Database of Systematic Reviews. 2021; 9: ED000154.","DOI":"10.1002\/14651858.ED000154"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Salet R, van der Velde N, Rhebergen D, van de Loo B, Seppala L, van Schoor NM, et al. The synergistic effect of anticholinergic burden and depression on fall risk in older persons. British Journal of Clinical Pharmacology. 2025; 91: 3082\u20133091.","DOI":"10.1002\/bcp.70148"},{"key":"ref46","unstructured":"Alexopoulos P, Canty AJ, Dasgupta J, Furlano JA, Haas AN. Re-centering precision medicine on the person: the potential role of values-based practice. Achaiki Iatriki. 2025; 44: 14\u201317."},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Vu HT, Nguyen HT, Nguyen AT. Effectiveness of Non-Pharmacological Interventions for Dementia among the Elderly: A Randomized Controlled Trial. Geriatrics (Basel, Switzerland). 2024; 9: 52.","DOI":"10.3390\/geriatrics9020052"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, et al. Anticholinergic drugs and risk of dementia: case-control study. BMJ (Clinical Research Ed.). 2018; 361: k1315.","DOI":"10.1136\/bmj.k1315"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Libon DJ, Emrani S, Matusz EF, Wasserman V, Perweiler E, Ginsberg TB, et al. Instrumental activities of daily living and mild cognitive impairment. Journal of Clinical and Experimental Neuropsychology. 2023; 45: 473\u2013481.","DOI":"10.1080\/13803395.2023.2249626"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Perneczky R, Pohl C, Sorg C, Hartmann J, Komossa K, Alexopoulos P, et al. Complex activities of daily living in mild cognitive impairment: conceptual and diagnostic issues. Age and Ageing. 2006; 35: 240\u2013245.","DOI":"10.1093\/ageing\/afj054"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Dafsari FS, Jessen F. Depression-an underrecognized target for prevention of dementia in Alzheimer's disease. Translational Psychiatry. 2020; 10: 160.","DOI":"10.1038\/s41398-020-0839-1"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"H\u00fcther J, von Wolff A, Stange D, H\u00e4rter M, Baehr M, Dartsch DC, et al. Incomplete medication adherence of chronically ill patients in German primary care. Patient Preference and Adherence. 2013; 7: 237\u2013244.","DOI":"10.2147\/PPA.S38373"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Chatterjee S, Bali V, Carnahan RM, Chen H, Johnson ML, Aparasu RR. Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression. Research in Social & Administrative Pharmacy : RSAP. 2020; 16: 329\u2013335.","DOI":"10.1016\/j.sapharm.2019.05.020"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Guerin JM, Copersino ML, Schretlen DJ. Clinical utility of the 15-item geriatric depression scale (GDS-15) for use with young and middle-aged adults. Journal of Affective Disorders. 2018; 241: 59\u201362.","DOI":"10.1016\/j.jad.2018.07.038"},{"key":"ref55","doi-asserted-by":"publisher","unstructured":"Georgiou EZ, Skondra M, Charalampopoulou M, Felemegkas P, Pachi A, Stafylidou G, et al. Validation of the test for finding word retrieval deficits (WoFi) in detecting Alzheimer's disease in a naturalistic clinical setting. European Journal of Ageing. 2023; 20: 29.","DOI":"10.1007\/s10433-023-00772-z"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Noguchi-Shinohara M, Domoto C, Yoshida T, Niwa K, Yuki-Nozaki S, Samuraki-Yokohama M, et al. A new computerized assessment battery for cognition (C-ABC) to detect mild cognitive impairment and dementia around 5 min. 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