51
|
Korologou-Linden R, Bhatta L, Brumpton BM, Howe LD, Millard LAC, Kolaric K, Ben-Shlomo Y, Williams DM, Smith GD, Anderson EL, Stergiakouli E, Davies NM. The causes and consequences of Alzheimer's disease: phenome-wide evidence from Mendelian randomization. Nat Commun 2022; 13:4726. [PMID: 35953482 PMCID: PMC9372151 DOI: 10.1038/s41467-022-32183-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/20/2022] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) has no proven causal and modifiable risk factors, or effective interventions. We report a phenome-wide association study (PheWAS) of genetic liability for AD in 334,968 participants of the UK Biobank study, stratified by age. We also examined the effects of AD genetic liability on previously implicated risk factors. We replicated these analyses in the HUNT study. PheWAS hits and previously implicated risk factors were followed up in a Mendelian randomization (MR) framework to identify the causal effect of each risk factor on AD risk. A higher genetic liability for AD was associated with medical history and cognitive, lifestyle, physical and blood-based measures as early as 39 years of age. These effects were largely driven by the APOE gene. The follow-up MR analyses were primarily null, implying that most of these associations are likely to be a consequence of prodromal disease or selection bias, rather than the risk factor causing the disease.
Collapse
Affiliation(s)
- Roxanna Korologou-Linden
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Laxmi Bhatta
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ben M Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Laura D Howe
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Louise A C Millard
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
- Intelligent Systems Laboratory, Department of Computer Science, University of Bristol, Bristol, UK
| | - Katarina Kolaric
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Emma L Anderson
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Evie Stergiakouli
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
52
|
Pagoni P, Korologou-Linden RS, Howe LD, Davey Smith G, Ben-Shlomo Y, Stergiakouli E, Anderson EL. Causal effects of circulating cytokine concentrations on risk of Alzheimer's disease and cognitive function. Brain Behav Immun 2022; 104:54-64. [PMID: 35580794 PMCID: PMC10391322 DOI: 10.1016/j.bbi.2022.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is considerable evidence suggesting a role of neuroinflammation in the pathogenesis of Alzheimer's disease. Establishing causality is challenging due to bias from reverse causation and residual confounding. METHODS We used two-sample MR to explore causal effects of circulating cytokine concentrations on Alzheimer's disease risk and cognitive function. We employed genetic variants from the largest publicly available genome-wide association studies (GWASs) of cytokine concentrations (N = 8,293), Alzheimer's disease (71,880 cases/383,378 controls), prospective memory (N = 152,605 to 462,302), reaction time (N = 454,157 to 459,523) and fluid intelligence (N = 149,051). RESULTS Evidence suggest that 1 standard deviation (SD) increase in levels of CTACK (CCL27) (OR = 1.09 95%CI: 1.01 to 1.19, p = 0.03) increased risk of Alzheimer's disease. There was weak evidence of a causal effect of MIP-1b (CCL4) (OR = 1.04 95% CI: 0.99 to 1.09, p = 0.08), Eotaxin (OR = 1.08 95% CI: 0.99 to 1.17, p = 0.10), GROa (CXCL1) (OR = 1.04 95% CI: 0.99 to 1.10, p = 0.15), MIG (CXCL9) (OR = 1.17 95% CI: 0.97 to 1.41, p = 0.10), IL-8 (Wald ratio: OR = 1.21 95% CI: 0.97 to 1.51, p = 0.09) and IL-2 (Wald Ratio: OR = 1.21 95% CI: 0.94 to 1.56, p = 0.14) on Alzheimer's disease risk. A 1 SD increase in concentration of Eotaxin (IVW: OR = 1.05 95% CI: 0.98 to 1.13, p = 0.14), IL-8 (OR = 1.21 95% CI: 1.07 to 1.37, p = 0.003) and MCP1 (OR = 1.07 95% CI: 1.03 to 1.13, p = 0.003) were associated with lower fluid intelligence, and IL-4 (OR = 0.86 95%CI: 0.79 to 0.98, p = 0.02) with higher. CONCLUSIONS Our findings suggest a causal role of cytokines in the pathogenesis of Alzheimer's disease and fluid intelligence.
Collapse
Affiliation(s)
- Panagiota Pagoni
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Roxanna S Korologou-Linden
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Evie Stergiakouli
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Anderson
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
53
|
Louca P, Nogal A, Moskal A, Goulding NJ, Shipley MJ, Alkis T, Lindbohm JV, Hu J, Kifer D, Wang N, Chawes B, Rexrode KM, Ben-Shlomo Y, Kivimaki M, Murphy RA, Yu B, Gunter MJ, Suhre K, Lawlor DA, Mangino M, Menni C. Cross-Sectional Blood Metabolite Markers of Hypertension: A Multicohort Analysis of 44,306 Individuals from the COnsortium of METabolomics Studies. Metabolites 2022; 12:601. [PMID: 35888725 PMCID: PMC9324896 DOI: 10.3390/metabo12070601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022] Open
Abstract
Hypertension is the main modifiable risk factor for cardiovascular morbidity and mortality but discovering molecular mechanisms for targeted treatment has been challenging. Here we investigate associations of blood metabolite markers with hypertension by integrating data from nine intercontinental cohorts from the COnsortium of METabolomics Studies. We included 44,306 individuals with circulating metabolites (up to 813). Metabolites were aligned and inverse normalised to allow intra-platform comparison. Logistic models adjusting for covariates were performed in each cohort and results were combined using random-effect inverse-variance meta-analyses adjusting for multiple testing. We further conducted canonical pathway analysis to investigate the pathways underlying the hypertension-associated metabolites. In 12,479 hypertensive cases and 31,827 controls without renal impairment, we identified 38 metabolites, associated with hypertension after adjusting for age, sex, body mass index, ethnicity, and multiple testing. Of these, 32 metabolite associations, predominantly lipid (steroids and fatty acyls) and organic acids (amino-, hydroxy-, and keto-acids) remained after further adjusting for comorbidities and dietary intake. Among the identified metabolites, 5 were novel, including 2 bile acids, 2 glycerophospholipids, and ketoleucine. Pathway analysis further implicates the role of the amino-acids, serine/glycine, and bile acids in hypertension regulation. In the largest cross-sectional hypertension-metabolomics study to date, we identify 32 circulating metabolites (of which 5 novel and 27 confirmed) that are potentially actionable targets for intervention. Further in-vivo studies are needed to identify their specific role in the aetiology or progression of hypertension.
Collapse
Affiliation(s)
- Panayiotis Louca
- Department of Twin Research, King’s College London, London SE1 7EH, UK; (P.L.); (A.N.); (M.M.)
| | - Ana Nogal
- Department of Twin Research, King’s College London, London SE1 7EH, UK; (P.L.); (A.N.); (M.M.)
| | - Aurélie Moskal
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France; (A.M.); (M.J.G.)
| | - Neil J. Goulding
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; (N.J.G.); (Y.B.-S.); (D.A.L.)
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
| | - Martin J. Shipley
- Department Epidemiology and Public Health, University College London, London WC1E 7HB, UK; (M.J.S.); (J.V.L.); (M.K.)
| | - Taryn Alkis
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center, Houston, TX 77030, USA; (T.A.); (B.Y.)
| | - Joni V. Lindbohm
- Department Epidemiology and Public Health, University College London, London WC1E 7HB, UK; (M.J.S.); (J.V.L.); (M.K.)
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 20 Helsinki, Finland
| | - Jie Hu
- Division of Women’s Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (J.H.); (K.M.R.)
| | - Domagoj Kifer
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia;
| | - Ni Wang
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark; (N.W.); (B.C.)
- Department of Biotechnology and Biomedicine, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, 2820 Gentofte, Denmark; (N.W.); (B.C.)
| | - Kathryn M. Rexrode
- Division of Women’s Health, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA; (J.H.); (K.M.R.)
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; (N.J.G.); (Y.B.-S.); (D.A.L.)
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol BS1 2NT, UK
| | - Mika Kivimaki
- Department Epidemiology and Public Health, University College London, London WC1E 7HB, UK; (M.J.S.); (J.V.L.); (M.K.)
| | - Rachel A. Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1G1, Canada
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center, Houston, TX 77030, USA; (T.A.); (B.Y.)
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France; (A.M.); (M.J.G.)
| | - Karsten Suhre
- Department of Biophysics and Physiology, Weill Cornell Medicine-Qatar, Doha 24144, Qatar;
| | - Deborah A. Lawlor
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; (N.J.G.); (Y.B.-S.); (D.A.L.)
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol BS8 2BN, UK
- Bristol NIHR Biomedical Research Centre, University of Bristol, Bristol BS1 2NT, UK
| | - Massimo Mangino
- Department of Twin Research, King’s College London, London SE1 7EH, UK; (P.L.); (A.N.); (M.M.)
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Foundation Trust, London SE1 9RT, UK
| | - Cristina Menni
- Department of Twin Research, King’s College London, London SE1 7EH, UK; (P.L.); (A.N.); (M.M.)
| |
Collapse
|
54
|
Caskey FJ, Procter S, MacNeill SJ, Wade J, Taylor J, Rooshenas L, Liu Y, Annaw A, Alloway K, Davenport A, Power A, Farrington K, Mitra S, Wheeler DC, Law K, Lewis-White H, Ben-Shlomo Y, Hollingworth W, Donovan J, Lane JA. The high-volume haemodiafiltration vs high-flux haemodialysis registry trial (H4RT): a multi-centre, unblinded, randomised, parallel-group, superiority study to compare the effectiveness and cost-effectiveness of high-volume haemodiafiltration and high-flux haemodialysis in people with kidney failure on maintenance dialysis using linkage to routine healthcare databases for outcomes. Trials 2022; 23:532. [PMID: 35761367 PMCID: PMC9235280 DOI: 10.1186/s13063-022-06357-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND More than a third of the 65,000 people living with kidney failure in the UK attend a dialysis unit 2-5 times a week to have their blood cleaned for 3-5 h. In haemodialysis (HD), toxins are removed by diffusion, which can be enhanced using a high-flux dialyser. This can be augmented with convection, as occurs in haemodiafiltration (HDF), and improved outcomes have been reported in people who are able to achieve high volumes of convection. This study compares the clinical- and cost-effectiveness of high-volume HDF compared with high-flux HD in the treatment of kidney failure. METHODS This is a UK-based, multi-centre, non-blinded randomised controlled trial. Adult patients already receiving HD or HDF will be randomised 1:1 to high-volume HDF (aiming for 21+ L of substitution fluid adjusted for body surface area) or high-flux HD. Exclusion criteria include lack of capacity to consent, life expectancy less than 3 months, on HD/HDF for less than 4 weeks, planned living kidney donor transplant or home dialysis scheduled within 3 months, prior intolerance of HDF and not suitable for high-volume HDF for other clinical reasons. The primary outcome is a composite of non-cancer mortality or hospital admission with a cardiovascular event or infection during follow-up (minimum 32 months, maximum 91 months) determined from routine data. Secondary outcomes include all-cause mortality, cardiovascular- and infection-related morbidity and mortality, health-related quality of life, cost-effectiveness and environmental impact. Baseline data will be collected by research personnel on-site. Follow-up data will be collected by linkage to routine healthcare databases - Hospital Episode Statistics, Civil Registration, Public Health England and the UK Renal Registry (UKRR) in England, and equivalent databases in Scotland and Wales, as necessary - and centrally administered patient-completed questionnaires. In addition, research personnel on-site will monitor for adverse events and collect data on adherence to the protocol (monthly during recruitment and quarterly during follow-up). DISCUSSION This study will provide evidence of the effectiveness and cost-effectiveness of HD as compared to HDF for adults with kidney failure in-centre HD or HDF. It will inform management for this patient group in the UK and internationally. TRIAL REGISTRATION ISRCTN10997319 . Registered on 10 October 2017.
Collapse
Affiliation(s)
- Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Renal unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
| | - Sunita Procter
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Stephanie J MacNeill
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Jodi Taylor
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Leila Rooshenas
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Yumeng Liu
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Ammar Annaw
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Karen Alloway
- Research and Innovation, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, England
| | - Albert Power
- Renal unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, East and North Hertfordshire NHS Trust, Coreys Mill Lane, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - Sandip Mitra
- Renal Unit, Manchester University Hospitals NHS Trust, Manchester, UK
| | - David C Wheeler
- UCL Department of Renal Medicine, Royal Free Hospital, University College London, London, England
- George Institute for Global Health, Sydney, Australia
| | - Kristian Law
- Public and patient involvement representative, Bristol, UK
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Will Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Jenny Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Trials Centre, 1-5 Whiteladies Road, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| |
Collapse
|
55
|
Lawton M, Tan MM, Ben-Shlomo Y, Baig F, Barber T, Klein JC, Evetts SG, Millin S, Malek N, Grosset K, Barker RA, Williams N, Burn DJ, Foltynie T, Morris HR, Wood N, Grosset DG, Hu MTM. Genetics of validated Parkinson's disease subtypes in the Oxford Discovery and Tracking Parkinson's cohorts. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-327376. [PMID: 35732412 PMCID: PMC9380504 DOI: 10.1136/jnnp-2021-327376] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 05/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the genetics of four Parkinson's disease (PD) subtypes that have been previously described in two large cohorts of patients with recently diagnosed PD. These subtypes came from a data-driven cluster analysis of phenotypic variables. METHODS We looked at the frequency of genetic mutations in glucocerebrosidase (GBA) and leucine-rich repeat kinase 2 against our subtypes. Then we calculated Genetic Risk Scores (GRS) for PD, multiple system atrophy, progressive supranuclear palsy, Lewy body dementia, and Alzheimer's disease. These GRSs were regressed against the probability of belonging to a subtype in the two independent cohorts and we calculated q-values as an adjustment for multiple testing across four subtypes. We also carried out a Genome-Wide Association Study (GWAS) of belonging to a subtype. RESULTS A severe disease subtype had the highest rates of patients carrying GBA mutations while the mild disease subtype had the lowest rates (p=0.009). Using the GRS, we found a severe disease subtype had a reduced genetic risk of PD (p=0.004 and q=0.015). In our GWAS no individual variants met genome wide significance (<5×10e-8) although four variants require further follow-up, meeting a threshold of <1×10e-6. CONCLUSIONS We have found that four previously defined PD subtypes have different genetic determinants which will help to inform future studies looking at underlying disease mechanisms and pathogenesis in these different subtypes of disease.
Collapse
Affiliation(s)
- Michael Lawton
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Manuela Mx Tan
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Fahd Baig
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Molecular and Clinical Sciences Institute, St. George's University of London, London, UK
| | - Thomas Barber
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Johannes C Klein
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Samuel G Evetts
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| | - Stephanie Millin
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Naveed Malek
- Department of Neurology, Queen's Hospital, Romford, Essex, UK
| | - Katherine Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital and University of Glasgow, Glasgow, UK
| | - Roger A Barker
- Cambridge Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Nigel Williams
- Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
- UCL Movement Disorders Centre, University College London, London, UK
| | - Nicholas Wood
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Donald G Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital and University of Glasgow, Glasgow, UK
| | - Michele Tao-Ming Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
| |
Collapse
|
56
|
Creavin ST, Noel-Storr AH, Langdon RJ, Richard E, Creavin AL, Cullum S, Purdy S, Ben-Shlomo Y. Clinical judgement by primary care physicians for the diagnosis of all-cause dementia or cognitive impairment in symptomatic people. Cochrane Database Syst Rev 2022; 6:CD012558. [PMID: 35709018 PMCID: PMC9202995 DOI: 10.1002/14651858.cd012558.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In primary care, general practitioners (GPs) unavoidably reach a clinical judgement about a patient as part of their encounter with patients, and so clinical judgement can be an important part of the diagnostic evaluation. Typically clinical decision making about what to do next for a patient incorporates clinical judgement about the diagnosis with severity of symptoms and patient factors, such as their ideas and expectations for treatment. When evaluating patients for dementia, many GPs report using their own judgement to evaluate cognition, using information that is immediately available at the point of care, to decide whether someone has or does not have dementia, rather than more formal tests. OBJECTIVES To determine the diagnostic accuracy of GPs' clinical judgement for diagnosing cognitive impairment and dementia in symptomatic people presenting to primary care. To investigate the heterogeneity of test accuracy in the included studies. SEARCH METHODS We searched MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), Web of Science Core Collection (ISI Web of Science), and LILACs (BIREME) on 16 September 2021. SELECTION CRITERIA We selected cross-sectional and cohort studies from primary care where clinical judgement was determined by a GP either prospectively (after consulting with a patient who has presented to a specific encounter with the doctor) or retrospectively (based on knowledge of the patient and review of the medical notes, but not relating to a specific encounter with the patient). The target conditions were dementia and cognitive impairment (mild cognitive impairment and dementia) and we included studies with any appropriate reference standard such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), International Classification of Diseases (ICD), aetiological definitions, or expert clinical diagnosis. DATA COLLECTION AND ANALYSIS Two review authors screened titles and abstracts for relevant articles and extracted data separately with differences resolved by consensus discussion. We used QUADAS-2 to evaluate the risk of bias and concerns about applicability in each study using anchoring statements. We performed meta-analysis using the bivariate method. MAIN RESULTS We identified 18,202 potentially relevant articles, of which 12,427 remained after de-duplication. We assessed 57 full-text articles and extracted data on 11 studies (17 papers), of which 10 studies had quantitative data. We included eight studies in the meta-analysis for the target condition dementia and four studies for the target condition cognitive impairment. Most studies were at low risk of bias as assessed with the QUADAS-2 tool, except for the flow and timing domain where four studies were at high risk of bias, and the reference standard domain where two studies were at high risk of bias. Most studies had low concern about applicability to the review question in all QUADAS-2 domains. Average age ranged from 73 years to 83 years (weighted average 77 years). The percentage of female participants in studies ranged from 47% to 100%. The percentage of people with a final diagnosis of dementia was between 2% and 56% across studies (a weighted average of 21%). For the target condition dementia, in individual studies sensitivity ranged from 34% to 91% and specificity ranged from 58% to 99%. In the meta-analysis for dementia as the target condition, in eight studies in which a total of 826 of 2790 participants had dementia, the summary diagnostic accuracy of clinical judgement of general practitioners was sensitivity 58% (95% confidence interval (CI) 43% to 72%), specificity 89% (95% CI 79% to 95%), positive likelihood ratio 5.3 (95% CI 2.4 to 8.2), and negative likelihood ratio 0.47 (95% CI 0.33 to 0.61). For the target condition cognitive impairment, in individual studies sensitivity ranged from 58% to 97% and specificity ranged from 40% to 88%. The summary diagnostic accuracy of clinical judgement of general practitioners in four studies in which a total of 594 of 1497 participants had cognitive impairment was sensitivity 84% (95% CI 60% to 95%), specificity 73% (95% CI 50% to 88%), positive likelihood ratio 3.1 (95% CI 1.4 to 4.7), and negative likelihood ratio 0.23 (95% CI 0.06 to 0.40). It was impossible to draw firm conclusions in the analysis of heterogeneity because there were small numbers of studies. For specificity we found the data were compatible with studies that used ICD-10, or applied retrospective judgement, had higher reported specificity compared to studies with DSM definitions or using prospective judgement. In contrast for sensitivity, we found studies that used a prospective index test may have had higher sensitivity than studies that used a retrospective index test. AUTHORS' CONCLUSIONS Clinical judgement of GPs is more specific than sensitive for the diagnosis of dementia. It would be necessary to use additional tests to confirm the diagnosis for either target condition, or to confirm the absence of the target conditions, but clinical judgement may inform the choice of further testing. Many people who a GP judges as having dementia will have the condition. People with false negative diagnoses are likely to have less severe disease and some could be identified by using more formal testing in people who GPs judge as not having dementia. Some false positives may require similar practical support to those with dementia, but some - such as some people with depression - may suffer delayed intervention for an alternative treatable pathology.
Collapse
Affiliation(s)
| | | | - Ryan J Langdon
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | | | - Sarah Cullum
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Sarah Purdy
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
57
|
Drew S, Fox F, Gregson CL, Patel R, Judge A, Johansen A, Marques EMR, Barbosa EC, Griffin J, Bradshaw M, Whale K, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gooberman-Hill R. 995 MULTIPLE ORGANISATIONAL FACTORS IMPROVE MULTI-DISCIPLINARY CARE DELIVERY TO PATIENTS WITH HIP FRACTURES: A QUALITATIVE STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Hip fractures are devastating injuries which incur high healthcare costs. Despite national standards and guidelines, there is substantial variation in hospital delivery of hip fracture care and in patient outcomes. This study aimed to understand organisational processes that facilitate successful delivery of hip fracture services.
Method
Forty qualitative interviews were conducted with healthcare professionals involved in delivering hip fracture care at four English hospitals. Interview data were supplemented with documentary analysis of 23 anonymised British Orthopaedic Association hospital-initiated peer-review reports of services. Data were analysed thematically, with themes transposed onto key components of the care pathway.
Results
We identified multiple aspects of service organisation that facilitated good care delivery. At admission, standardisation of training in nerve block administration impacted care delivery. During hospital stays, service delivery was improved by integrated, shared-care between orthopaedics and orthogeriatrics, and by strategies to improve trauma list efficiency. Adequately staffed orthogeriatric services and the ‘right’ skills and seniority mix were important to holistic care provision. Placing patients on designated hip fracture wards concentrated staff expertise. Collaborative working was achieved through multi-disciplinary team (MDT) meetings between key staff, protocols and care pathways that defined roles and responsibilities, MDT documentation, ‘joined-up’ IT systems within hospitals and with primary care, and shared working spaces such as shared offices and onwards. Trauma and hip fracture coordinators organised care processes and provided a valuable central point of contact within teams. Nominated leads, representing diverse specialties, worked together in MDT planning meetings to develop joint protocols, establish audit priorities, and agree shared goals. Routine, comprehensive monitoring and evaluation of service delivery, with findings shared throughout the MDT, was beneficial.
Conclusion
Our study has characterised potentially modifiable elements of successful hip fracture service delivery. Findings are intended to help services overcome organisational barriers towards delivery of high-quality hip fracture services.
Collapse
Affiliation(s)
| | | | | | | | | | - A Johansen
- Cardiff University and University Hospital of Wales
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
58
|
Patel R, Judge A, Johansen A, Marques EMR, Barbosa EC, Griffin J, Bhimjiyani A, Bradshaw M, Whale K, Drew, Gooberman-Hill R, Chesser T, Griffin XL, Javaid MK, Ben-Shlomo Y, Gregson CL. 946 MULTIPLE ORGANISATIONAL FACTORS ARE ASSOCIATED WITH ADVERSE PATIENT OUTCOMES POST HIP FRACTURE IN HOSPITALS IN ENGLAND & WALES. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Older adults who sustain a hip fracture require complex multidisciplinary care, which can challenge organisational structures within hospitals. Despite standards and guidelines, substantial variation remains in hip fracture care delivery across the UK. We aimed to determine which hospital-level organisational factors predict adverse patient outcomes in the post injury period.
Method
A cohort of 178,757 patients aged 60+ years in England and Wales (2016–19) who sustained a hip fracture was examined. Patient-level Hospital Episodes Statistics, National Hip Fracture Database, and mortality data were linked to metrics from 18 hospital-level organisational audits/reports/series. Multilevel models determined the organisational factors, independent of patient case-mix, associated with three patient outcomes: length of hospital stay (LOS), 30-day all-cause mortality, and emergency 30-day readmission.
Results
Overall LOS was mean 21 days (standard deviation, 20); 13,126 (7.3%) died within 30-days; and 25,239 (15.3%) were readmitted. 25 organisational factors independently predicted LOS: for example, a hospital’s ability to promptly mobilise ≥90% of patients was associated with a 2-day (95%CI:1.3–2.7) shorter LOS, and hospitals where all patients received orthogeriatric assessment within 72 hours of admission had mean 1.5-day (95%CI:0.6–2.3) shorter LOS. Ten organisational factors independently predicted 30-day mortality: providing prompt surgery (≤36 hours from admission) to >80% patients was associated with the same 10% reduction in mortality (95%CI:4–15%), as was discussion of ‘patient experience’ feedback at clinical governance meetings (95%CI:5–15%). Nine organisational factors independently predicted readmission: knowledge of time from discharge to start of community therapy was associated with 17% (95%CI:9–24%) lower readmission rates. Organisational delivery of clinical governance, surgery, and physiotherapy were associated with all outcomes.
Conclusion
Multiple, potentially modifiable, organisational factors are associated with important patient outcomes post-hip fracture. These factors, if causal, indicate auditable components of hospital care where interventions can be targeted to reduce variability in hip fracture care delivery, to improve patient outcomes.
Collapse
Affiliation(s)
| | | | - A Johansen
- Cardiff University and University Hospital of Wales
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
59
|
Lo C, Arora S, Lawton M, Barber T, Quinnell T, Dennis GJ, Ben-Shlomo Y, Hu MTM. A composite clinical motor score as a comprehensive and sensitive outcome measure for Parkinson's disease. J Neurol Neurosurg Psychiatry 2022; 93:617-624. [PMID: 35387867 PMCID: PMC9148987 DOI: 10.1136/jnnp-2021-327880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/04/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND An unmet need remains for sensitive outcome measures in neuroprotective trials. The study aims to determine whether a composite clinical motor score, combining the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III motor examination score, Purdue Pegboard Test, and Timed Up and Go, provides greater sensitivity in detecting motor change in early disease than the MDS-UPDRS III alone. METHODS The Oxford Discovery longitudinal cohort study involves individuals with isolated rapid eye movement sleep behaviour disorder (iRBD) (n=272, confirmed polysomnographically, median follow-up: 1.6 years), idiopathic Parkinson's disease (PD) (n=909, median follow-up: 3.5 years, baseline: <3.5 years disease duration) and controls (n=316, age-matched and sex-matched, without a first-degree family history of PD). Motor and non-motor assessments were performed at each in-person visit. RESULTS Compared with the MDS-UPDRS III, the composite clinical motor score demonstrated a wider score distribution in iRBD and controls, lower coefficient of variation (37% vs 67%), and higher correlation coefficients with self-reported measures of motor severity (0.65 vs 0.61) and overall health status (-0.40 vs -0.33). Greater score range in mild to moderate PD, higher magnitude of longitudinal change in iRBD and longitudinal score linearity suggest better sensitivity in detecting subtle motor change. The composite clinical motor score was more accurate than the MDS-UPDRS III in predicting clinical outcomes, requiring 64% fewer participants with PD and 51% fewer participants with iRBD in sample size estimations for a hypothetical 18-month placebo-controlled clinical trial. CONCLUSION The composite clinical motor score may offer greater consistency and sensitivity in detecting change than the MDS-UPDRS III.
Collapse
Affiliation(s)
- Christine Lo
- Department of Clinical Neurosciences, University of Oxford Nuffield, Oxford, UK .,Department of Clinical Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Siddharth Arora
- University of Oxford Somerville College, Oxford, UK.,University of Oxford Said Business School, Oxford, UK
| | - Michael Lawton
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Thomas Barber
- Department of Clinical Neurosciences, University of Oxford Nuffield, Oxford, UK
| | | | - Gary J Dennis
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michele Tao-Ming Hu
- Division of Neurology, Nuffield Department of Clinical Neurosciences, Oxford, UK
| |
Collapse
|
60
|
Auger S, Kanavou S, Lawton M, Ben-Shlomo Y, Hu M, Schrag A, Morris H, Grosset D, Noyce A. 228 Testing shortened versions of smell tests to screen for hyposmia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundHyposmia is an early feature in neurodegenerative diseases, most notably Parkinson’s Disease (PD). Using abbreviated smell tests could provide a cost-effective means for large-scale hyposmia screening. It is unclear whether short smell tests can effectively detect hyposmia in patient populations.ObjectivesTo test the ability of short smell combinations to ‘pre-screen’ for probable hyposmia in people with PD and target administration of more extensive tests, such as the University of Pennsylvania Smell Identification Test (UPSIT).MethodsWe assessed the screening performance of a short 4 smell combination previously derived from use of the 40-item UPSIT in healthy older people and its ability to detect hyposmia in a large cohort of PD patients.ResultsThe novel 4 smell combination included Menthol, Clove, Onion and Orange and had a sensitiv- ity of 87.1% (95% confidence interval: 84.9%-89.2%) and specificity of 69.7% (63.3%-75.5%) for detecting hyposmia in patients with PD. A different (also novel) 4-item combination developed using a data-driven approach in PD patients only achieved 81.3% (78.2%-84.4%) sensitivity for equivalent specificity.ConclusionsA short 4 smell combination derived from a healthy population demonstrated high sensitivity to detect those with hyposmia and PD.s.auger@outlook.com
Collapse
|
61
|
Vijiaratnam N, Lawton M, Heslegrave AJ, Guo T, Tan M, Jabbari E, Real R, Woodside J, Grosset K, Chelban V, Athauda D, Girges C, Barker RA, Hardy J, Wood N, Houlden H, Williams N, Ben-Shlomo Y, Zetterberg H, Grosset DG, Foltynie T, Morris HR. Combining biomarkers for prognostic modelling of Parkinson's disease. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328365. [PMID: 35577512 PMCID: PMC9279845 DOI: 10.1136/jnnp-2021-328365] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/14/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) have variable rates of progression. More accurate prediction of progression could improve selection for clinical trials. Although some variance in clinical progression can be predicted by age at onset and phenotype, we hypothesise that this can be further improved by blood biomarkers. OBJECTIVE To determine if blood biomarkers (serum neurofilament light (NfL) and genetic status (glucocerebrosidase, GBA and apolipoprotein E (APOE))) are useful in addition to clinical measures for prognostic modelling in PD. METHODS We evaluated the relationship between serum NfL and baseline and longitudinal clinical measures as well as patients' genetic (GBA and APOE) status. We classified patients as having a favourable or an unfavourable outcome based on a previously validated model, and explored how blood biomarkers compared with clinical variables in distinguishing prognostic phenotypes . RESULTS 291 patients were assessed in this study. Baseline serum NfL was associated with baseline cognitive status. Nfl predicted a shorter time to dementia, postural instability and death (dementia-HR 2.64; postural instability-HR 1.32; mortality-HR 1.89) whereas APOEe4 status was associated with progression to dementia (dementia-HR 3.12, 95% CI 1.63 to 6.00). NfL levels and genetic variables predicted unfavourable progression to a similar extent as clinical predictors. The combination of clinical, NfL and genetic data produced a stronger prediction of unfavourable outcomes compared with age and gender (area under the curve: 0.74-age/gender vs 0.84-ALL p=0.0103). CONCLUSIONS Clinical trials of disease-modifying therapies might usefully stratify patients using clinical, genetic and NfL status at the time of recruitment.
Collapse
Affiliation(s)
- Nirosen Vijiaratnam
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Michael Lawton
- Population Health Sciences, University of Bristol, Bristol, UK
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - Amanda J Heslegrave
- Dementia Research Institute, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Tong Guo
- Dementia Research Institute, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
| | - Manuela Tan
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Edwin Jabbari
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Raquel Real
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
| | - John Woodside
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Katherine Grosset
- Department of Neurology, Southern General Hospital, University of Glasgow and Institute of Neurological Sciences, Glasgow, UK
| | - Viorica Chelban
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Dilan Athauda
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Christine Girges
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Roger A Barker
- Cambridge Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - John Hardy
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
- Molecular Neuroscience, University College London Institute of Neurology, London, UK
| | - Nicholas Wood
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
| | - Henry Houlden
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Nigel Williams
- Cardiff University, Cardiff University Institute of Psychological Medicine and Clinical Neurosciences, Cardiff, UK
| | - Yoav Ben-Shlomo
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - Henrik Zetterberg
- Dementia Research Institute, University College London, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Hong Kong Center, for Neurodegenerative Diseases, Hong Kong, People's Republic of China
| | - Donald G Grosset
- Department of Neurology, Southern General Hospital, University of Glasgow and Institute of Neurological Sciences, Glasgow, UK
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - Huw R Morris
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
- Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD, 20815
| |
Collapse
|
62
|
Tenison E, Lithander FE, Smith MD, Pendry-Brazier D, Ben-Shlomo Y, Henderson EJ. Needs of patients with parkinsonism and their caregivers: a protocol for the PRIME-UK cross-sectional study. BMJ Open 2022; 12:e057947. [PMID: 35545401 PMCID: PMC9096540 DOI: 10.1136/bmjopen-2021-057947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION People with parkinsonism are a highly heterogeneous group and the disease encompasses a spectrum of motor and non-motor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. While parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe the broad range of health needs for people with parkinsonism and their carers in relation to their symptomatology, disability, disease stage, comorbidities and sociodemographic characteristics. METHODS AND ANALYSIS In this single site cross-sectional study, people with parkinsonism will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support, if required, to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes. Results will be displayed as descriptive statistics and regression models will be used to test simple associations and interactions. ETHICS AND DISSEMINATION This protocol was approved by the London-Brighton & Sussex Research Ethics Committee (REC reference 20/LO/0890). The results of this protocol will be disseminated through publication in an international peer-reviewed journal; presentation at academic meetings and conferences; and a lay summary uploaded to the PRIME-Parkinson website. TRIAL REGISTRATION NUMBER ISRCTN11452969; Pre-results.
Collapse
Affiliation(s)
- Emma Tenison
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Fiona E Lithander
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Matthew D Smith
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | | | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| |
Collapse
|
63
|
Poggiolini I, Gupta V, Lawton M, Lee S, El-Turabi A, Querejeta-Coma A, Trenkwalder C, Sixel-Döring F, Foubert-Samier A, Pavy-Le Traon A, Plazzi G, Biscarini F, Montplaisir J, Gagnon JF, Postuma RB, Antelmi E, Meissner WG, Mollenhauer B, Ben-Shlomo Y, Hu MT, Parkkinen L. Diagnostic value of cerebrospinal fluid alpha-synuclein seed quantification in synucleinopathies. Brain 2022; 145:584-595. [PMID: 34894214 PMCID: PMC9014737 DOI: 10.1093/brain/awab431] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022] Open
Abstract
Several studies have confirmed the α-synuclein real-time quaking-induced conversion (RT-QuIC) assay to have high sensitivity and specificity for Parkinson's disease. However, whether the assay can be used as a robust, quantitative measure to monitor disease progression, stratify different synucleinopathies and predict disease conversion in patients with idiopathic REM sleep behaviour disorder remains undetermined. The aim of this study was to assess the diagnostic value of CSF α-synuclein RT-QuIC quantitative parameters in regard to disease progression, stratification and conversion in synucleinopathies. We performed α-synuclein RT-QuIC in the CSF samples from 74 Parkinson's disease, 24 multiple system atrophy and 45 idiopathic REM sleep behaviour disorder patients alongside 55 healthy controls, analysing quantitative assay parameters in relation to clinical data. α-Synuclein RT-QuIC showed 89% sensitivity and 96% specificity for Parkinson's disease. There was no correlation between RT-QuIC quantitative parameters and Parkinson's disease clinical scores (e.g. Unified Parkinson's Disease Rating Scale motor), but RT-QuIC positivity and some quantitative parameters (e.g. Vmax) differed across the different phenotype clusters. RT-QuIC parameters also added value alongside standard clinical data in diagnosing Parkinson's disease. The sensitivity in multiple system atrophy was 75%, and CSF samples showed longer T50 and lower Vmax compared to Parkinson's disease. All RT-QuIC parameters correlated with worse clinical progression of multiple system atrophy (e.g. change in Unified Multiple System Atrophy Rating Scale). The overall sensitivity in idiopathic REM sleep behaviour disorder was 64%. In three of the four longitudinally followed idiopathic REM sleep behaviour disorder cohorts, we found around 90% sensitivity, but in one sample (DeNoPa) diagnosing idiopathic REM sleep behaviour disorder earlier from the community cases, this was much lower at 39%. During follow-up, 14 of 45 (31%) idiopathic REM sleep behaviour disorder patients converted to synucleinopathy with 9/14 (64%) of convertors showing baseline RT-QuIC positivity. In summary, our results showed that α-synuclein RT-QuIC adds value in diagnosing Parkinson's disease and may provide a way to distinguish variations within Parkinson's disease phenotype. However, the quantitative parameters did not correlate with disease severity in Parkinson's disease. The assay distinguished multiple system atrophy patients from Parkinson's disease patients and in contrast to Parkinson's disease, the quantitative parameters correlated with disease progression of multiple system atrophy. Our results also provided further evidence for α-synuclein RT-QuIC having potential as an early biomarker detecting synucleinopathy in idiopathic REM sleep behaviour disorder patients prior to conversion. Further analysis of longitudinally followed idiopathic REM sleep behaviour disorder patients is needed to better understand the relationship between α-synuclein RT-QuIC signature and the progression from prodromal to different synucleinopathies.
Collapse
Grants
- Wellcome Trust
- J-0901 Parkinson's UK
- MR/T046287/1 Medical Research Council
- EPSRC
- UKRI-MRC
- EU Horizon 2020 and Michael J. Fox Foundation
- IPMDS
- Canadian Institutes of Health Research and honoraria to serve on advisory boards for EISAI and JAZZ Pharma outside the present field of research
- Canadian Institutes in Health Research, Canada Research Chair, and National Institute on Aging
- Fonds de la Recherche en Sante
- Canadian Institute of Health Research
- The Parkinson Society of Canada
- Weston-Garfield Foundation
- Michael J. Fox Foundation and the Webster Foundation
- Takeda, Roche, Teva Neurosciences, Novartis Canada, Biogen, Boehringer Ingelheim, Theranexus, GE HealthCare, Jazz Pharmaceuticals, AbbVie, Jannsen, Otsuko, Phytopharmics and Inception Sciences
- Deutsche Forschungsgemeinschaft (DFG), EU (Horizon2020), Parkinson Fonds Deutschland, Deutsche Parkinson Vereinigung, Parkinson’s Foundation
- MRC, Wellcome Trust, NIHR and Parkinson’s UK
- Parkinson’s UK, NIHR Oxford Biomedical Research Centre, Cure Parkinson’s Trust, Lab10X, NIHR, Michael J Fox Foundation, H2020 European Union, GE Healthcare and PSP Association
- Parkinson’s UK, Weston Brain Institute and Michael J Fox Foundation
Collapse
Affiliation(s)
- Ilaria Poggiolini
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Vandana Gupta
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Michael Lawton
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, UK
| | - Seoyun Lee
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Aadil El-Turabi
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, UK
| | - Agustin Querejeta-Coma
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Claudia Trenkwalder
- Department of Neurosurgery, University Medical Center Goettingen, Göttingen, Germany
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
| | - Friederike Sixel-Döring
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
- Department of Neurology, Philipps-University Marburg, Germany
| | - Alexandra Foubert-Samier
- French Reference Centre for MSA, University Hospital Bordeaux, Bordeaux, France
- Institute des Maladies Neurodégénératives, CHU Bordeaux and Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
| | - Anne Pavy-Le Traon
- French Reference Centre for MSA, University Hospital of Toulouse, Toulouse, France
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- IRCCS—Institute of the Neurological Sciences of Bologna, Bologna, Italy
| | - Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Wassilios G Meissner
- Institute des Maladies Neurodégénératives, CHU Bordeaux and Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Brit Mollenhauer
- Department of Neurosurgery, University Medical Center Goettingen, Göttingen, Germany
- Paracelsus Elena Klinik, Centre for Movement Disorders, Kassel, Germany
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, UK
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| | - Laura Parkkinen
- Nuffield Department of Clinical Neurosciences, Oxford Parkinson’s Disease Centre, University of Oxford, UK
| |
Collapse
|
64
|
Zienius K, Ozawa M, Hamilton W, Hollingworth W, Weller D, Porteous L, Ben-Shlomo Y, Grant R, Brennan PM. Verbal fluency as a quick and simple tool to help in deciding when to refer patients with a possible brain tumour. BMC Neurol 2022; 22:127. [PMID: 35379182 PMCID: PMC8978365 DOI: 10.1186/s12883-022-02655-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
Background Patients with brain tumours often present with non-specific symptoms. Correctly identifying who to prioritise for urgent brain imaging is challenging. Brain tumours are amongst the commonest cancers diagnosed as an emergency presentation. A verbal fluency task (VFT) is a rapid triage test affected by disorders of executive function, language and processing speed. We tested whether a VFT could support identification of patients with a brain tumour. Methods This proof-of-concept study examined whether a VFT can help differentiate patients with a brain tumour from those with similar symptoms (i.e. headache) without a brain tumour. Two patient populations were recruited, (a) patients with known brain tumour, and (b) patients with headache referred for Direct-Access Computed-Tomography (DACT) from primary care with a suspicion of a brain tumour. Semantic and phonemic verbal fluency data were collected prospectively. Results 180 brain tumour patients and 90 DACT patients were recruited. Semantic verbal fluency score was significantly worse for patients with a brain tumour than those without (P < 0.001), whether comparing patients with headache, or patients without headache. Phonemic fluency showed a similar but weaker difference. Raw and incidence-weighted positive and negative predictive values were calculated. Conclusion We have demonstrated the potential role of adding semantic VFT score performance into clinical decision making to support triage of patients for urgent brain imaging. A relatively small improvement in the true positive rate in patients referred for DACT has the potential to increase the timeliness and efficiency of diagnosis and improve patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02655-9.
Collapse
Affiliation(s)
- Karolis Zienius
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mio Ozawa
- Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Willie Hamilton
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Will Hollingworth
- Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Lorna Porteous
- GP Lead for Cancer and Palliative Care, NHS Lothian, Edinburgh, UK
| | - Yoav Ben-Shlomo
- Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Robin Grant
- Department of Clinical Neurosciences, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,Department of Clinical Neurosciences, NHS Lothian, Western General Hospital, Edinburgh, UK. .,Centre for Clinical Brain Sciences, University of Edinburgh, Little France Crescent, Edinburgh, EH16, UK.
| |
Collapse
|
65
|
Tenison E, Lithander FE, Brazier D, Smith M, Ben-Shlomo Y, Henderson EJ. 697 PATIENTS WITH PARKINSONISM AND THEIR CAREGIVERS: A PROTOCOL FOR THE PRIME-UK CROSS-SECTIONAL STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
People with parkinsonism (PwP) are a highly heterogeneous group and the condition encompasses a spectrum of motor and nonmotor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. Whilst parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe a broad range of PwP in relation to their symptomatology, disability, health needs, disease stage, comorbidities and sociodemographics.
Methods
In this cross-sectional study, performed at one site, PwP (excluding those with drug-induced parkinsonism) will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support if required to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes.
Results
Our primary outcome is the frequency of various health outcomes (e.g. depression) and how they cluster together. Linear and logistic regression models will be used to test simple associations and interactions with gender, age group and socio-economic status.
Conclusion
It is necessary to consider the multifaceted problems that PwP experience, together with frailty and comorbidities, in order to fully appreciate the clinical complexity as well as the impact on caregiver well-being. This information is necessary to inform the development of a person-centered, individualised multicomponent intervention to target patients and caregivers most at risk of adverse outcomes. We hope that these findings will inform future intervention trials and improve accessibility to research participation.
Collapse
Affiliation(s)
- E Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - F E Lithander
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - D Brazier
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - M Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - Y Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
| | - E J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, United Kingdom
- Older People’s Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, United Kingdom
| |
Collapse
|
66
|
Smith MD, Tenison E, Hashim H, Ben-Shlomo Y, Henderson EJ. Neuromodulation for Storage Lower Urinary Tract Symptoms in Parkinson Disease: A Systematic Review. Neuromodulation 2022; 25:1076-1085. [PMID: 35300922 DOI: 10.1016/j.neurom.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/23/2021] [Accepted: 01/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bladder symptoms are common in Parkinson disease (PD), affecting quality of life. Medications commonly used such as antimuscarinics can cause frequently intolerable side effects, and therefore, new, better tolerated approaches are needed. Neuromodulation techniques have an established role in urologic disorders; these techniques include tibial nerve stimulation (TNS) and sacral neuromodulation (SNM), which are localized therapies lacking the side effects associated with medication. OBJECTIVES This study aimed to undertake a systematic review of the literature reporting the use of neuromodulation techniques for the treatment of bladder symptoms in PD and related conditions. MATERIALS AND METHODS A systematic search of data bases was conducted including MEDLINE, CENTRAL, and Web of Science. Studies were required to present specific outcomes for individuals with PD for neuromodulation interventions. RESULTS Ten primary studies were identified concerning detailed outcomes of neuromodulation on bladder symptoms in PD, including seven for TNS, one for SNM, and one using transcranial magnetic stimulation (TMS). Two further mixed cohort studies documented minimal data on individuals with PD. All studies demonstrated benefit in a range of outcome measures following neuromodulation. Two randomized sham-controlled studies were carried out using TNS, with one clearly demonstrating superiority over sham, although difficulties with achieving believable yet ineffective sham treatment are highlighted. Further studies reported limited, uncontrolled outcomes of SNM in patients with PD, demonstrating benefit. CONCLUSIONS Evidence from case series suggests benefit from TNS in PD, with limited literature on SNM or TMS. Placebo effect from neuromodulation is a concern, and only limited controlled data exist. Future well-designed and sham-controlled studies need to be completed to provide definitive data on the benefit of neuromodulation in PD. Definitively proving the utility of a neuromodulation modality will allow better treatment of bladder symptoms without the need for pharmacologic measures that cause side effects.
Collapse
|
67
|
Deere K, Matharu GS, Ben-Shlomo Y, Wilkinson JM, Blom AW, Sayers A, Whitehouse MR. The risk of all-cause mortality, heart outcomes, cancer, and neurodegenerative disorders with cobalt-chrome-containing total hip arthroplasty implants : an analysis of the National Joint Registry. Bone Joint J 2022; 104-B:359-367. [PMID: 35227088 DOI: 10.1302/0301-620x.104b3.bjj-2021-0397.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS A recent report from France suggested an association between the use of cobalt-chrome (CoCr) femoral heads in total hip arthroplasties (THAs) and an increased risk of dilated cardiomyopathy and heart failure. CoCr is a commonly used material in orthopaedic implants. If the reported association is causal, the consequences would be significant given the millions of joint arthroplasties and other orthopaedic procedures in which CoCr is used annually. We examined whether CoCr-containing THAs were associated with an increased risk of all-cause mortality, heart outcomes, cancer, and neurodegenerative disorders in a large national database. METHODS Data from the National Joint Registry was linked to NHS English hospital inpatient episodes for 374,359 primary THAs with up to 14.5 years' follow-up. We excluded any patients with bilateral THAs, knee arthroplasties, indications other than osteoarthritis, aged under 55 years, and diagnosis of one or more outcome of interest before THA. Implants were grouped as either containing CoCr or not containing CoCr. The association between implant construct and the risk of all-cause mortality and incident heart failure, cancer, and neurodegenerative disorders was examined. RESULTS There were 158,677 individuals (42.4%) with an implant containing CoCr. There were 47,963 deaths, 27,332 heart outcomes, 35,720 cancers, and 22,025 neurodegenerative disorders. There was no evidence of an association between patients with CoCr implants and higher rates of any of the outcomes. CONCLUSION CoCr-containing THAs did not have an increased risk of all-cause mortality, or clinically meaningful heart outcomes, cancer, or neurodegenerative disorders into the second decade post-implantation. Our findings will help reassure clinicians and the increasing number of patients receiving primary THA worldwide that the use of CoCr-containing implants is not associated with significant adverse systemic effects. Cite this article: Bone Joint J 2022;104-B(3):359-367.
Collapse
Affiliation(s)
- Kevin Deere
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| |
Collapse
|
68
|
Wong K, Caskey FJ, Casula A, Ben-Shlomo Y, Bailey P. The UK Chinese population with kidney failure: Clinical characteristics, management and access to kidney transplantation using 20 years of UK Renal Registry and NHS Blood and Transplant data. PLoS One 2022; 17:e0264313. [PMID: 35226673 PMCID: PMC8884499 DOI: 10.1371/journal.pone.0264313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the clinical demographics of and access to transplantation for Chinese diaspora populations with kidney disease. Methods The UK Renal Registry provided data on adults with ethnicity recorded as ‘Chinese’ or ‘White’ starting Kidney Replacement Therapy (KRT) 1/1/97-31/12/17. Baseline characteristics were compared between Chinese and White patients. Multivariable logistic regression models were used to investigate the relationships between Chinese ethnicity and i) being listed for deceased-donor transplantation at start of KRT, ii) being listed 2 years after start of KRT, iii) pre-emptive kidney transplantation, iv) kidney transplantation 3 years after start of KRT, and v) living-donor kidney transplantation (LDKT). Results UK Chinese patients were younger at start of KRT (61.6 vs 65.6 years, p <0.001) and had more diabetic kidney disease (29% vs 20%, p<0.001) and glomerulonephritis (21% vs 13%, p<0.001) than White patients. We found evidence of interaction between ethnicity and sex. Compared to UK White men, UK Chinese men had lower odds of pre-emptive transplant (aOR 0.28, 95% CI [0.10–0.76]) and transplant within 3 years of KRT start (aOR 0.65, [95% CI 0.49–0.87], P = 0.004). UK White women and Chinese women had the same likelihood of pre-emptive transplant (aOR 0.78, 95% CI [0.38–1.61]), or transplant within 3 years of KRT start (aOR 0.94, 95% CI [0.60–1.46]). Both UK Chinese men and women had markedly lower odds of LDKT compared to Whites aOR 0.34 [95% CI 0.21–0.53]. Conclusions UK Chinese are less likely to receive a LDKT. UK Chinese men have lower odds of accessing pre-emptive wait-listing and transplantation. Understanding whether these disparities reflect modifiable barriers will help ensure equitable access to transplantation.
Collapse
Affiliation(s)
- Katie Wong
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
- * E-mail:
| | - Fergus J. Caskey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | | | - Yoav Ben-Shlomo
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Pippa Bailey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| |
Collapse
|
69
|
Deere K, Matharu GS, Ben-Shlomo Y, Wilkinson JM, Blom AW, Sayers A, Whitehouse MR. The risk of all-cause mortality, heart outcomes, cancer, and neurodegenerative disorders with cobalt-chrome-containing total hip arthroplasty implants : an analysis of the National Joint Registry. Bone Joint J 2022:1-9. [PMID: 35018786 DOI: 10.1302/0301-620x.104b.bjj-2021-0397.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS A recent report from France suggested an association between the use of cobalt-chrome femoral heads in total hip arthroplasties (THAs) and an increased risk of dilated cardiomyopathy and heart failure. Cobalt-chrome is a commonly used material in orthopaedic implants. If the reported association is causal, the consequences would be significant given the millions of joint replacements and other orthopaedic procedures in which cobalt-chrome is used annually. We examined whether cobalt-chrome-containing THAs were associated with an increased risk of all-cause mortality, heart outcomes, cancer, and neurodegenerative disorders in a large national database. METHODS Data from the National Joint Registry was linked to NHS English hospital inpatient episodes for 374,359 primary THAs with up to 14.5 years follow-up. We excluded any patients with bilateral THAs, knee replacements, indications other than osteoarthritis, aged under 55 years, and diagnosis of one or more outcome of interest before THA. Implants were grouped as either containing cobalt-chrome or not containing cobalt-chrome. The association between implant construct and the risk of all-cause mortality and incident heart failure, cancer, and neurodegenerative disorders was examined. RESULTS There were 158,677 individuals (42.4%) with an implant containing cobalt-chrome. There were 47,963 deaths, 27,332 heart outcomes, 35,720 cancers, and 22,025 neurodegenerative disorders. There was no evidence of an association that patients with cobalt-chrome implants had higher rates of any of the outcomes. CONCLUSION Cobalt-chrome-containing THAs did not have an increased risk of all-cause mortality, or clinically meaningful heart outcomes, cancer or neurodegenerative disorders into the second decade post-implantation. Our findings will help reassure clinicians and the increasing number of patients receiving primary THA worldwide that the use of cobalt-chrome containing implants is not associated with significant adverse systemic effects.
Collapse
Affiliation(s)
- Kevin Deere
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| |
Collapse
|
70
|
Pearson GME, Welsh T, Pocock LV, Ben-Shlomo Y, Henderson EJ. Transforming undergraduate education in geriatric medicine: an innovative curriculum at Bristol Medical School. Eur Geriatr Med 2022; 13:1487-1491. [PMID: 36071347 PMCID: PMC9451112 DOI: 10.1007/s41999-022-00690-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/09/2022] [Indexed: 12/30/2022]
Abstract
The World Health Organization (WHO) advocates investment in high-quality undergraduate education in geriatric medicine as a means of meeting the future needs of the aging population. However, there is a lack of evidence for the optimal delivery of training in this area. Rigorous pedagogical research is required to determine the most effective way to equip tomorrow's doctors with the skills and knowledge to care for older adults with complex health and social care needs. The transition between two undergraduate medical curricula meant that Bristol Medical School (BMS) was uniquely positioned to innovate and evaluate undergraduate education in geriatric medicine. This transition marked BMS' departure from a 'traditional' curriculum to case-based learning. The outgoing curriculum included a 4-week unit in geriatrics, whilst the new programme includes an 18-week clerkship titled 'Complex Medicine in Older People' (CMOP). CMOP is a clinical clerkship with 18 cases at its core, covering the fundamental aspects of geriatric medicine. The core cases and clinical learning are enhanced with five expert lectures, six tutorials and three journal clubs. Reflective practice is modelled and promoted with Balint groups and a book club. Consolidative workplace-based assessments and clinical portfolio mirror those used in postgraduate training, preparing students for professional practice. CMOP is iteratively improved in real-time using staff and student feedback. This marked shift in mode and duration of teaching affords the opportunity to evaluate the impact of differing education in geriatrics, providing an evidence-based model for teaching on aging.
Collapse
Affiliation(s)
- Grace M E Pearson
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK.
- Royal United Hospitals NHS Foundation Trust, Bath, UK.
| | - Tomas Welsh
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
- Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Lucy V Pocock
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Emily J Henderson
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
- Royal United Hospitals NHS Foundation Trust, Bath, UK
| |
Collapse
|
71
|
Cauchi M, Ball H, Ben-Shlomo Y, Robertson N. Interpretation of vaccine associated neurological adverse events: a methodological and historical review. J Neurol 2022; 269:493-503. [PMID: 34398270 PMCID: PMC8366487 DOI: 10.1007/s00415-021-10747-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 12/18/2022]
Abstract
As a result of significant recent scientific investment, the range of vaccines available for COVID-19 prevention continues to expand and uptake is increasing globally. Although initial trial safety data have been generally reassuring, a number of adverse events, including vaccine induced thrombosis and thrombocytopenia (VITT), have come to light which have the potential to undermine the success of the vaccination program. However, it can be difficult to interpret available data and put these into context and to communicate this effectively. In this review, we discuss contemporary methodologies employed to investigate possible associations between vaccination and adverse neurological outcomes and why determining causality can be challenging. We demonstrate these issues by discussing relevant historical exemplars and explore the relevance for the current pandemic and vaccination program. We also discuss challenges in understanding and communicating such risks to clinicians and the general population within the context of the 'infodemic' facilitated by the Internet and other media.
Collapse
Affiliation(s)
- Marija Cauchi
- Division of Psychological Medicine and Clinical Neuroscience, Department of Neurology, University Hospital of Wales, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK.
| | - Harriet Ball
- Population Health Sciences, Bristol Medical School, Bristol, BS8 2PS UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, BS8 2PS UK
| | - Neil Robertson
- Division of Psychological Medicine and Clinical Neuroscience, Department of Neurology, University Hospital of Wales, Cardiff University, Heath Park, Cardiff, CF14 4XN UK
| |
Collapse
|
72
|
Spiga F, Lawton MA, Lightman SL, Smith GD, Ben-Shlomo Y. Socio-demographic and psychosocial predictors of salivary cortisol from older male participants in the Speedwell prospective cohort study. Psychoneuroendocrinology 2022; 135:105577. [PMID: 34823140 PMCID: PMC9972784 DOI: 10.1016/j.psyneuen.2021.105577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/24/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Associations between measures of socio-economic position and cortisol remain controversial. We examined the association between social class and cortisol reactivity in an aging male population. METHODS The Speedwell cohort study recruited 2348 men aged 45-59 years from primary care between 1979 and 1982 (phase I) where occupational social class was used to classify socioeconomic position. Men were seen on four more occasions, the last being between 1997 and 1999 (phase 5) when salivary samples were obtained capturing cortisol reactivity to stressors (cognitive test and venepuncture) and circadian variations (awakening and night-time cortisol levels, circadian slope and area under curve) at morning and afternoon clinic sessions. Longitudinal association between social class at phase 3 and log-transformed salivary cortisol measures at phase 5 was assessed using multivariable linear regression adjusted for variables associated with sampling time and age as a potential confounder, stratified by time of clinic session. We also explored possible mediation by psychosocial factors (e.g. work dislike) and health-related factors (e.g. waist-to-hip ratio and high-density lipoprotein cholesterol). RESULTS From 1768 living men, 1003 men (57%) attended a clinic at phase five, 854 participants (85% of attendees) returned home cortisol samples (mean age 71.7 years). We found little evidence of association between social class and baseline cortisol (i.e. prior to stress), cortisol response to stressors, and cortisol diurnal variation. However, we found lower social class was associated with higher and delayed post-stress recovery cortisol for participants that visited the clinic in the morning (adjusted β coefficient for manual versus non-manual 0.25 ng/ml; 95% CI: 0.06-0.48; P = 0.008). This association did not appear to be mediated by any of the measured psychosocial or health-related factors. CONCLUSION Our data did not show an overall association between social class and cortisol variability either diurnal or in response to a stressor. Lower social class was associated with a slower time to recover from exposure to stress in the morning, thereby increasing overall cortisol exposure. These findings provide some evidence for a mechanism that may contribute to the association between lower social class and a higher risk of adverse health outcomes.
Collapse
Affiliation(s)
- Francesca Spiga
- Population Health Sciences, University of Bristol Medical School, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
| | - Michael A. Lawton
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Stafford L. Lightman
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - George Davey Smith
- Population Health Sciences, University of Bristol Medical School, Bristol, UK,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| |
Collapse
|
73
|
Bailey PK, Lyons H, Caskey FJ, Ben-Shlomo Y, Al-Talib M, Babu A, Selman LE. Expectations of a new opt-out system of consent for deceased organ donation in England: A qualitative interview study. Health Expect 2021; 25:607-616. [PMID: 34951093 PMCID: PMC8957744 DOI: 10.1111/hex.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction In 2020 England moved to an opt‐out deceased donation law. We aimed to investigate the views of a mixed stakeholder group comprising people with kidney disease, family members and healthcare practitioners towards the change in legislation. We investigated the expected impacts of the new legislation on deceased‐donor and living‐donor transplantation, and views on media campaigns regarding the law change. Methods We undertook in‐depth qualitative interviews with people with kidney disease (n = 13), their family members (n = 4) and healthcare practitioners (n = 15). Purposive sampling was used to ensure diversity for patients and healthcare practitioners. Family members were recruited through snowball sampling and posters. Interviews were audio‐recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Results Three themes with six subthemes were identified: (i) Expectations of impact (Hopeful patients; Cautious healthcare professionals), (ii) Living‐donor transplantation (Divergent views; Unchanged clinical recommendations), (iii) Media campaigns (Single message; Highlighting recipient benefits). Patients expected the law change would result in more deceased‐donor transplant opportunities. Conclusions Clinicians should ensure patients and families are aware of the current evidence regarding the impact of opt‐out consent: expectations of an increased likelihood of receiving a deceased‐donor transplant are not currently supported by the evidence. This may help to prevent a decline in living‐donor transplantation seen in other countries with similar legislation. Media campaigns should include a focus on the impact of organ receipt. Patient or Public Contribution Two patient representatives from the Kidney Disease Health Integration Team, Primrose Granville and Soumeya Bouacida, contributed to the content and design of the study documents.
Collapse
Affiliation(s)
- Pippa K Bailey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Hannah Lyons
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Leeds School of Medicine, University of Leeds, Leeds, UK
| | - Fergus J Caskey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mohammed Al-Talib
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Adarsh Babu
- Department of Renal Medicine, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Lucy E Selman
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
74
|
Valentin G, Ravn MB, Jensen EK, Friis K, Bhimjiyani A, Ben-Shlomo Y, Hartley A, Nielsen CP, Langdahl B, Gregson CL. Socio-economic inequalities in fragility fracture incidence: a systematic review and meta-analysis of 61 observational studies. Osteoporos Int 2021; 32:2433-2448. [PMID: 34169346 DOI: 10.1007/s00198-021-06038-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022]
Abstract
UNLABELLED Individuals with low socio-economic status (SES) have a more than 25% higher risk of fragility fractures than individuals with high SES. Body mass index and lifestyle appear to mediate the effect of SES on fracture risk. Strategies to prevent fractures should aim to reduce unhealthy behaviours through tackling structural inequalities. INTRODUCTION This systematic review and meta-analysis aimed to evaluate the impact of socio-economic status (SES) on fragility fracture risk. METHODS Medline, Embase, and CINAHL databases were searched from inception to 28 April 2021 for studies reporting an association between SES and fragility fracture risk among individuals aged ≥50 years. Risk ratios (RR) were combined in meta-analyses using random restricted maximum likelihood models, for individual-based (education, income, occupation, cohabitation) and area-based (Index of Multiple Deprivation, area income) SES measures. RESULTS A total of 61 studies from 26 different countries including more than 19 million individuals were included. Individual-based low SES was associated with an increased risk of fragility fracture (RR 1.27 [95% CI 1.12, 1.44]), whilst no clear association was seen when area-based measures were used (RR 1.08 [0.91, 1.30]). The strength of associations was influenced by the type and number of covariates included in statistical models: RR 2.69 [1.60, 4.53] for individual-based studies adjusting for age, sex and BMI, compared with RR 1.06 [0.92, 1.22] when also adjusted for health behaviours (smoking, alcohol, and physical activity). Overall, the quality of the evidence was moderate. CONCLUSION Our results show that low SES, measured at the individual level, is a risk factor for fragility fracture. Low BMI and unhealthy behaviours are important mediators of the effect of SES on fracture risk. Strategies to prevent fractures and reduce unhealthy behaviours should aim to tackle structural inequalities in society thereby reducing health inequalities in fragility fracture incidence.
Collapse
Affiliation(s)
- G Valentin
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - M B Ravn
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - E K Jensen
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - K Friis
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - A Bhimjiyani
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK
| | - Y Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Hartley
- MRC Integrative Epidemiology Unit, Bristol Medical School, Oakfield House, Bristol, BS8 2BN, UK
| | - C P Nielsen
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - B Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - C L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
| |
Collapse
|
75
|
Sofianopoulou E, Kaptoge SK, Afzal S, Jiang T, Gill D, Gundersen TE, Bolton TR, Allara E, Arnold MG, Mason AM, Chung R, Pennells LAM, Shi F, Sun L, Willeit P, Forouhi NG, Langenberg C, Sharp SJ, Panico S, Engström G, Melander O, Tong TYN, Perez-Cornago A, Norberg M, Johansson I, Katzke V, Srour B, José Sánchez M, Redondo-Sánchez D, Olsen A, Dahm CC, Overvad K, Brustad M, Skeie G, Moreno-Iribas C, Onland-Moret NC, van der Schouw YT, Tsilidis KK, Heath AK, Agnoli C, Krogh V, de Boer IH, Kobylecki CJ, Çolak Y, Zittermann A, Sundström J, Welsh P, Weiderpass E, Aglago EK, Ferrari P, Clarke R, Boutron MC, Severi G, MacDonald C, Providencia R, Masala G, Zamora Ros R, Boer J, Verschuren WMM, Cawthon P, Schierbeck LL, Cooper C, Schulze MB, Bergmann MM, Hannemann A, Kiechl S, Brenner H, van Schoor NM, Albertorio JR, Sacerdote C, Linneberg A, Kårhus LL, Huerta JM, Imaz L, Joergensen C, Ben-Shlomo Y, Lundqvist A, Gallacher J, Sattar N, Wood AM, Wareham NJ, Nordestgaard BG, Di Angelantonio E, Danesh J, Butterworth AS, Burgess S. Estimating dose-response relationships for vitamin D with coronary heart disease, stroke, and all-cause mortality: observational and Mendelian randomisation analyses. Lancet Diabetes Endocrinol 2021; 9:837-846. [PMID: 34717822 PMCID: PMC8600124 DOI: 10.1016/s2213-8587(21)00263-1] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Randomised trials of vitamin D supplementation for cardiovascular disease and all-cause mortality have generally reported null findings. However, generalisability of results to individuals with low vitamin D status is unclear. We aimed to characterise dose-response relationships between 25-hydroxyvitamin D (25[OH]D) concentrations and risk of coronary heart disease, stroke, and all-cause mortality in observational and Mendelian randomisation frameworks. METHODS Observational analyses were undertaken using data from 33 prospective studies comprising 500 962 individuals with no known history of coronary heart disease or stroke at baseline. Mendelian randomisation analyses were performed in four population-based cohort studies (UK Biobank, EPIC-CVD, and two Copenhagen population-based studies) comprising 386 406 middle-aged individuals of European ancestries, including 33 546 people who developed coronary heart disease, 18 166 people who had a stroke, and 27 885 people who died. Primary outcomes were coronary heart disease, defined as fatal ischaemic heart disease (International Classification of Diseases 10th revision code I20-I25) or non-fatal myocardial infarction (I21-I23); stroke, defined as any cerebrovascular disease (I60-I69); and all-cause mortality. FINDINGS Observational analyses suggested inverse associations between incident coronary heart disease, stroke, and all-cause mortality outcomes with 25(OH)D concentration at low 25(OH)D concentrations. In population-wide genetic analyses, there were no associations of genetically-predicted 25(OH)D with coronary heart disease, stroke, or all-cause mortality. However, for the participants with vitamin D deficiency (25[OH]D concentration <25 nmol/L), genetic analyses provided strong evidence for an inverse association with all-cause mortality (odds ratio [OR] per 10 nmol/L increase in genetically-predicted 25[OH]D concentration 0·69 [95% CI 0·59-0·80]; p<0·0001) and non-significant inverse associations for stroke (0·85 [0·70-1·02], p=0·09) and coronary heart disease (0·89 [0·76-1·04]; p=0·14). A finer stratification of participants found inverse associations between genetically-predicted 25(OH)D concentrations and all-cause mortality up to around 40 nmol/L. INTERPRETATION Stratified Mendelian randomisation analyses suggest a causal relationship between 25(OH)D concentrations and mortality for individuals with low vitamin D status. Our findings have implications for the design of vitamin D supplementation trials, and potential disease prevention strategies. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health Research, Health Data Research UK, Cancer Research UK, and International Agency for Research on Cancer.
Collapse
|
76
|
Neumann S, Taylor J, Bamford A, Metcalfe C, Gaunt DM, Whone A, Steeds D, Emmett SR, Hollingworth W, Ben-Shlomo Y, Henderson EJ. Cholinesterase inhibitor to prevent falls in Parkinson's disease (CHIEF-PD) trial: a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson's disease. BMC Neurol 2021; 21:422. [PMID: 34715821 PMCID: PMC8556953 DOI: 10.1186/s12883-021-02430-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common complication of Parkinson's disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson's disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson's motor and non-motor symptoms, quality of life and cost-effectiveness. DISCUSSION This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson's disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population. TRIAL REGISTRATION REC reference: 19/SW/0043. EudraCT: 2018-003219-23. ISCRTN 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 PROTOCOL AT TIME OF PUBLICATION: Version 7.0, 20th January 2021.
Collapse
Affiliation(s)
- S Neumann
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - J Taylor
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Bamford
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - C Metcalfe
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - D M Gaunt
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Whone
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - D Steeds
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - S R Emmett
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - W Hollingworth
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - Y Ben-Shlomo
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - E J Henderson
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK.
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
| |
Collapse
|
77
|
Kehoe PG, Turner N, Howden B, Jarutyte L, Clegg SL, Malone IB, Barnes J, Nielsen C, Sudre CH, Wilson A, Thai NJ, Blair PS, Coulthard E, Lane JA, Passmore P, Taylor J, Mutsaerts HJ, Thomas DL, Fox NC, Wilkinson I, Ben-Shlomo Y. Safety and efficacy of losartan for the reduction of brain atrophy in clinically diagnosed Alzheimer's disease (the RADAR trial): a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2021; 20:895-906. [PMID: 34687634 PMCID: PMC8528717 DOI: 10.1016/s1474-4422(21)00263-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
Background Drugs modifying angiotensin II signalling could reduce Alzheimer's disease pathology, thus decreasing the rate of disease progression. We investigated whether the angiotensin II receptor antagonist losartan, compared with placebo, could reduce brain volume loss, as a measure of disease progression, in clinically diagnosed mild-to-moderate Alzheimer's disease. Methods In this double-blind, multicentre, randomised controlled trial, eligible patients aged 55 years or older, previously untreated with angiotensin II drugs and diagnosed (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria) with mild-to-moderate Alzheimer's disease, and who had capacity to consent, were recruited from 23 UK National Health Service hospital trusts. After undergoing a 4-week, open-label phase of active treatment then washout, participants were randomly assigned (1:1) oral over-encapsulated preparations of either 100 mg losartan (after an initial two-dose titration stage) or matched placebo daily for 12 months. Randomisation, minimised by age and baseline medial temporal lobe atrophy score, was undertaken online or via pin-access service by telephone. Participants, their study companions, and study personnel were masked to group assignment. The primary outcome, analysed by the intention-to-treat principle (ie, participants analysed in the group to which they were randomised, without imputation for missing data), was change in whole brain volume between baseline and 12 months, measured using volumetric MRI and determined by boundary shift interval (BSI) analysis. The trial is registered with the International Standard Randomised Controlled Trial Register (ISRCTN93682878) and the European Union Drug Regulating Authorities Clinical Trials Database (EudraCT 2012–003641–15), and is completed. Findings Between July 22, 2014, and May 17, 2018, 261 participants entered the open-label phase. 211 were randomly assigned losartan (n=105) or placebo (n=106). Of 197 (93%) participants who completed the study, 171 (81%) had complete primary outcome data. The mean brain volume (BSI) reduction was 19·1 mL (SD 10·3) in the losartan group and 20·0 mL (10·8) in the placebo group. The difference in total volume reduction between groups was –2·29 mL (95% CI –6·46 to 0·89; p=0·14). The number of adverse events was low (22 in the losartan group and 20 in the placebo group) with no differences between treatment groups. There was one treatment-related death per treatment group. Interpretation 12 months of treatment with losartan was well tolerated but was not effective in reducing the rate of brain atrophy in individuals with clinically diagnosed mild-to-moderate Alzheimer's disease. Further research is needed to assess the potential therapeutic benefit from earlier treatment in patients with milder cognitive impairment or from longer treatment periods. Funding Efficacy and Mechanism Evaluation Programme (UK Medical Research Council and National Institute for Health Research).
Collapse
Affiliation(s)
| | - Nicholas Turner
- Translational Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK; Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Beth Howden
- Translational Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK; Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Lina Jarutyte
- Dementia Neurology Research Group, University of Bristol, Bristol, UK
| | - Shona Louise Clegg
- Dementia Research Centre, University College London, London, UK; UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ian Brian Malone
- Dementia Research Centre, University College London, London, UK; UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Josephine Barnes
- Dementia Research Centre, University College London, London, UK; UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Casper Nielsen
- Dementia Research Centre, University College London, London, UK; UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Carole Hélène Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, and Centre for Medical Image Computing, University College London, London, UK; School of Biomedical Engineering and Imaging Sciences, Kings College London, UK
| | - Aileen Wilson
- Faculty of Health Sciences, Bristol Medical School, Clinical Research Imaging Centre, University of Bristol, Bristol, UK
| | - Ngoc Jade Thai
- Faculty of Health Sciences, Bristol Medical School, Clinical Research Imaging Centre, University of Bristol, Bristol, UK
| | - Peter Sinclair Blair
- Translational Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK; Bristol Trials Centre, University of Bristol, Bristol, UK
| | | | - Janet Athene Lane
- Translational Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK; Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Peter Passmore
- Institute of Clinical Sciences, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Jodi Taylor
- Translational Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK; Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Henk-Jan Mutsaerts
- Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - David Lee Thomas
- Dementia Research Centre, University College London, London, UK; UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Nick Charles Fox
- Dementia Research Centre, University College London, London, UK; UK Dementia Research Institute, University College London, London, UK; UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ian Wilkinson
- Clinical Pharmacology Unit, School of Clinical Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - Yoav Ben-Shlomo
- Translational Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK; Bristol Trials Centre, University of Bristol, Bristol, UK
| | | |
Collapse
|
78
|
Creavin ST, Haworth J, Fish M, Cullum S, Bayer A, Purdy S, Ben-Shlomo Y. Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study. BJGP Open 2021; 5:BJGPO.2021.0058. [PMID: 34315715 PMCID: PMC8596317 DOI: 10.3399/bjgpo.2021.0058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/01/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs often report using clinical judgment to diagnose dementia. AIM To investigate the accuracy of GPs' clinical judgment for the diagnosis of dementia. DESIGN & SETTING Diagnostic test accuracy study, recruiting from 21 practices around Bristol, UK. METHOD The clinical judgment of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged ≥70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to the 10th revision of the International Classification of Diseases (ICD-10) criteria for dementia. RESULTS A total of 240 people were recruited, with a median age of 80 years (interquartile range [IQR] 75-84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12-36 months) and the median Addenbrooke's Cognitive Examination III (ACE-III) score was 75 (IQR 65-87). GP clinical judgment had sensitivity 56% (95% confidence interval [CI] = 47% to 65%) and specificity 89% (95% CI = 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI = 2.9 to 15) compared with people aged ≥80 years (3.6, 95% CI = 1.7 to 7.6), and in women (10.4, 95% CI = 3.4 to 31.7) compared with men (3.2, 95% CI = 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. CONCLUSION A GP clinical judgment of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people whom GPs judge as not having dementia.
Collapse
Affiliation(s)
| | - Judy Haworth
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Mark Fish
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sarah Cullum
- Depatment of Psychological Medicine, School of Medicine, The University of Auckland, Grafton, New Zealand
| | | | - Sarah Purdy
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
79
|
Ali MS, Ernst M, Robinson DE, Caskey F, Arden NK, Ben-Shlomo Y, Nybo M, Rubin KH, Judge A, Cooper C, Javaid MK, Hermann AP, Prieto-Alhambra D. Correction to: Alendronate use and bone mineral density gains in women with moderate-severe (stages 3B-5) chronic kidney disease: an open cohort multivariable and propensity score analysis from Funen, Denmark. Arch Osteoporos 2021; 16:135. [PMID: 34533619 PMCID: PMC8448679 DOI: 10.1007/s11657-021-01001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Sanni Ali
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Public Health, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Martin Ernst
- OPEN, Department of Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Danielle E Robinson
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Fergus Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Katrine H Rubin
- OPEN, Department of Health, University of Southern Denmark, Odense, Denmark
| | - Andrew Judge
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, Southampton, UK
| | - Anne P Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Daniel Prieto-Alhambra
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- MRC Lifecourse Epidemiology Unit, Southampton, UK.
- GREMPAL Research Group (Idiap Jordi Gol Primary Care Research Institute) and CIBERFes, Universitat Autonoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
80
|
Liu Y, Lawton MA, Lo C, Bowring F, Klein JC, Querejeta-Coma A, Scotton S, Welch J, Razzaque J, Barber T, Ben-Shlomo Y, Hu MT. Longitudinal Changes in Parkinson's Disease Symptoms with and Without Rapid Eye Movement Sleep Behavior Disorder: The Oxford Discovery Cohort Study. Mov Disord 2021; 36:2821-2832. [PMID: 34448251 DOI: 10.1002/mds.28763] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) comorbid with rapid eye movement sleep behavior disorder (RBD) may show more severe motor and nonmotor symptoms, suggesting a distinct PD subtype. OBJECTIVE The aim of this study was to investigate the impact of RBD on the longitudinal change of motor and nonmotor symptoms in patients with PD. METHODS Patients with early PD (diagnosed within 3.5 years) recruited from 2010 to 2019 were followed every 18 months in the Oxford Parkinson's Disease Centre Discovery cohort. At each visit, we used standard questionnaires and measurements to assess demographic features and motor and nonmotor symptoms (including RBD, daytime sleepiness, mood, autonomic symptoms, cognition, and olfaction). Data were analyzed with linear mixed effects and Cox regression models. Possible RBD (pRBD) was longitudinally determined according to RBD Screening Questionnaire scores. RESULTS A total of 923 patients were recruited (mean age: 67.1 ± 9.59 years; 35.9% female), and 788 had follow-up assessment(s) (mean: 4.8 ± 1.98 years, range: 1.3-8.3). Among them, 33.3% were identified as pRBD (PD + pRBD). Patients with PD + pRBD had more severe baseline symptoms and showed faster progression on Movement Disorder Society-Unified Parkinson's Disease Rating Scale parts I and III, Purdue Pegboard test, and Beck Depression Inventory scores. Moreover, PD + pRBD was associated with an increased level of risk for mild cognitive impairment (hazard ratio [HR] = 1.36, 95% confidence interval [CI]: 1.01-1.83), freezing of gait (HR = 1.42, 95% CI: 1.10-1.86), and frequent falling (HR = 1.62, 95% CI: 1.02-2.60). CONCLUSIONS Patients with PD + pRBD progress faster on motor, mood, and cognitive symptoms, confirming a more aggressive PD subtype that can be identified at baseline and has major clinical implications. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Yaping Liu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael A Lawton
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Christine Lo
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Francesca Bowring
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom
| | - Johannes C Klein
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Agustin Querejeta-Coma
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom.,Department of Neurology, Infanta Elena University Hospital, Valdemoro, Spain.,Department of Neurology, Rey Juan Carlos University Hospital, Móstoles, Spain
| | - Sangeeta Scotton
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom
| | - Jessica Welch
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom
| | - Jamil Razzaque
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom
| | - Thomas Barber
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Yoav Ben-Shlomo
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
81
|
Ball HA, Bayer A, Coulthard E, Fish M, Gallacher J, Ben-Shlomo Y. #3122 Is subjective cognitive decline (SCD) a better marker of susceptibility to functional cognitive disorder (FCD) than to neurodegeneration?: The caerphilly prospective study. J Neurol Psychiatry 2021. [DOI: 10.1136/jnnp-2021-bnpa.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective/AimsDoes Subjective Cognitive Decline (SCD) indicate susceptibility to Functional Cognitive Disorder (FCD) more often than it indicates neurodegeneration? Prior research has focused on clinical populations where FCD is increasingly identified, but associations could differ at the community level. A clinical diagnosis of FCD requires cognitive symptoms, internal inconsistency, the absence of another explanatory disorder, and significant impairment; but we know little about its aetiology and prevalence. Cognitive internal inconsistency has not been systematically studied.Methods1,143 men were followed in the Caerphilly Prospective Study. Their subjective experience of cognitive change at average age 73 years was compared to their previous rate of objective cognitive change (using the Cambridge Cognition Examination). Logistic regression models examined potential predictors of SCD (measured in the preceding decade) including sociodemographic factors, vascular risk markers (ischaemic heart disease, vascular medications, smoking history), alcohol exposure, sleep problems, depression, anxiety trait, and objective cognition. We also looked for markers of cognitive internal inconsistency (delayed recall proportionately better than immediate recall, using the Rivermead Behavioural Memory Test). Finally, subjective and objective cognition at average age 73 were used to predict change in objective cognition nine years later.ResultsSCD was common (30%), and only weakly related to prior objective cognitive decline (sensitivity 36% [95% CI 30-42], specificity 72% [95% CI 68-75]). Longitudinal independent predictors of SCD were older age, poor sleep quality and higher trait anxiety: rate of decline in objective cognition did not independently predict subsequent SCD (adjusted OR 1.18 [95% CI 0.72 1.95]). Those with SCD (compared to those without) had mildly worse scores on immediate recall, but their delayed recall was in proportion to their immediate recall, i.e., there was no evidence of cognitive internal inconsistency. SCD did not predict future objective cognitive change (p=0.84). Important limitations include the male-only sample and the possibility of survivor bias.ConclusionsSCD is common, but is only weakly associated with prior objective cognitive decline, is not predicted by vascular risk markers (aside from age), and does not predict future objective cognitive decline. The high community prevalence of SCD is instead driven partly via sleep difficulties and anxiety. Our results suggest those with SCD may have a mild deficit in attentional processes but relatively intact memory for the items they do encode. Subjectively experiencing cognitive decline in the absence of an objective decline appears to be a highly prevalent example of poor meta-cognition, which could be a driver to later FCD.
Collapse
|
82
|
Robinson O, Carter AR, Ala-Korpela M, Casas JP, Chaturvedi N, Engmann J, Howe LD, Hughes AD, Järvelin MR, Kähönen M, Karhunen V, Kuh D, Shah T, Ben-Shlomo Y, Sofat R, Lau CHE, Lehtimäki T, Menon U, Raitakari O, Ryan A, Providencia R, Smith S, Taylor J, Tillin T, Viikari J, Wong A, Hingorani AD, Kivimäki M, Vineis P. Metabolic profiles of socio-economic position: a multi-cohort analysis. Int J Epidemiol 2021; 50:768-782. [PMID: 33221853 PMCID: PMC8271201 DOI: 10.1093/ije/dyaa188] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background Low socio-economic position (SEP) is a risk factor for multiple health outcomes, but its molecular imprints in the body remain unclear. Methods We examined SEP as a determinant of serum nuclear magnetic resonance metabolic profiles in ∼30 000 adults and 4000 children across 10 UK and Finnish cohort studies. Results In risk-factor-adjusted analysis of 233 metabolic measures, low educational attainment was associated with 37 measures including higher levels of triglycerides in small high-density lipoproteins (HDL) and lower levels of docosahexaenoic acid (DHA), omega-3 fatty acids, apolipoprotein A1, large and very large HDL particles (including levels of their respective lipid constituents) and cholesterol measures across different density lipoproteins. Among adults whose father worked in manual occupations, associations with apolipoprotein A1, large and very large HDL particles and HDL-2 cholesterol remained after adjustment for SEP in later life. Among manual workers, levels of glutamine were higher compared with non-manual workers. All three indicators of low SEP were associated with lower DHA, omega-3 fatty acids and HDL diameter. At all ages, children of manual workers had lower levels of DHA as a proportion of total fatty acids. Conclusions Our work indicates that social and economic factors have a measurable impact on human physiology. Lower SEP was independently associated with a generally unfavourable metabolic profile, consistent across ages and cohorts. The metabolites we found to be associated with SEP, including DHA, are known to predict cardiovascular disease and cognitive decline in later life and may contribute to health inequalities.
Collapse
Affiliation(s)
- Oliver Robinson
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Alice R Carter
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Mika Ala-Korpela
- Systems Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland.,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Juan P Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.,Division of Aging, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, UK
| | - Jorgen Engmann
- Institute of Cardiovascular Science, University College London, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, UK
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland.,Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Ville Karhunen
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, UK
| | - Tina Shah
- Institute of Cardiovascular Science, University College London, UK
| | - Yoav Ben-Shlomo
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Reecha Sofat
- Institute of Health Informatics, University College London, London, UK
| | - Chung-Ho E Lau
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.,Division of Computational and Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, University College London, UK
| | - Olli Raitakari
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Andy Ryan
- MRC Clinical Trials Unit at UCL, University College London, UK
| | - Rui Providencia
- Institute of Health Informatics, University College London, London, UK
| | - Stephanie Smith
- Department of Medicine, University of Turku, (and) Division of Medicine, Turku University Hospital, Turku, Finland
| | - Julie Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, UK
| | - Jorma Viikari
- Department of Medicine, University of Turku, (and) Division of Medicine, Turku University Hospital, Turku, Finland
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, UK.,Health Data Research UK, London, UK.,University College London British Heart Foundation Research Accelerator, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
83
|
Anderson EL, Richmond RC, Jones SE, Hemani G, Wade KH, Dashti HS, Lane JM, Wang H, Saxena R, Brumpton B, Korologou-Linden R, Nielsen JB, Åsvold BO, Abecasis G, Coulthard E, Kyle SD, Beaumont RN, Tyrrell J, Frayling TM, Munafò MR, Wood AR, Ben-Shlomo Y, Howe LD, Lawlor DA, Weedon MN, Davey Smith G. Is disrupted sleep a risk factor for Alzheimer's disease? Evidence from a two-sample Mendelian randomization analysis. Int J Epidemiol 2021; 50:817-828. [PMID: 33150399 PMCID: PMC8271193 DOI: 10.1093/ije/dyaa183] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background It is established that Alzheimer’s disease (AD) patients experience sleep disruption. However, it remains unknown whether disruption in the quantity, quality or timing of sleep is a risk factor for the onset of AD. Methods We used the largest published genome-wide association studies of self-reported and accelerometer-measured sleep traits (chronotype, duration, fragmentation, insomnia, daytime napping and daytime sleepiness), and AD. Mendelian randomization (MR) was used to estimate the causal effect of self-reported and accelerometer-measured sleep parameters on AD risk. Results Overall, there was little evidence to support a causal effect of sleep traits on AD risk. There was some suggestive evidence that self-reported daytime napping was associated with lower AD risk [odds ratio (OR): 0.70, 95% confidence interval (CI): 0.50–0.99). Some other sleep traits (accelerometer-measured ‘eveningness’ and sleep duration, and self-reported daytime sleepiness) had ORs of a similar magnitude to daytime napping, but were less precisely estimated. Conclusions Overall, we found very limited evidence to support a causal effect of sleep traits on AD risk. Our findings provide tentative evidence that daytime napping may reduce AD risk. Given that this is the first MR study of multiple self-report and objective sleep traits on AD risk, findings should be replicated using independent samples when such data become available.
Collapse
Affiliation(s)
- Emma L Anderson
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Samuel E Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Kaitlin H Wade
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Jacqueline M Lane
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Heming Wang
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ben Brumpton
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Roxanna Korologou-Linden
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Jonas B Nielsen
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gonçalo Abecasis
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Coulthard
- Translational Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Robin N Beaumont
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Jessica Tyrrell
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, at the University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol Medical School, Bristol, UK
| |
Collapse
|
84
|
Ypinga JHL, Van Halteren AD, Henderson EJ, Bloem BR, Smink AJ, Tenison E, Munneke M, Ben-Shlomo Y, Darweesh SKL. Rationale and design to evaluate the PRIME Parkinson care model: a prospective observational evaluation of proactive, integrated and patient-centred Parkinson care in The Netherlands (PRIME-NL). BMC Neurol 2021; 21:286. [PMID: 34294077 PMCID: PMC8298196 DOI: 10.1186/s12883-021-02308-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Culminating evidence shows that current care does not optimally meet the needs of persons with parkinsonism, their carers and healthcare professionals. Recently, a new model of care was developed to address the limitations of usual care: Proactive and Integrated Management and Empowerment in Parkinson's Disease (PRIME Parkinson). From 2021 onwards, PRIME Parkinson care will replace usual care in a well-defined region in The Netherlands. The utility of PRIME Parkinson care will be evaluated on a single primary endpoint (parkinsonism-related complications), which reflects the health of people with parkinsonism. Furthermore, several secondary endpoints will be measured for four dimensions: health, patient and carer experience, healthcare professional experience, and cost of healthcare. The reference will be usual care, which will be continued in other regions in The Netherlands. METHODS This is a prospective observational study which will run from January 1, 2020 until December 31, 2023. Before the new model of care will replace the usual care in the PRIME Parkinson care region all baseline assessments will take place. Outcomes will be informed by two data sources. We will use healthcare claims-based data to evaluate the primary endpoint, and costs of healthcare, in all persons with parkinsonism receiving PRIME Parkinson care (estimated number: 2,000) and all persons with parkinsonism receiving usual care in the other parts of The Netherlands (estimated number: 48,000). We will also evaluate secondary endpoints by performing annual questionnaire-based assessments. These assessments will be administered to a subsample across both regions (estimated numbers: 1,200 persons with parkinsonism, 600 carers and 250 healthcare professionals). DISCUSSION This prospective cohort study will evaluate the utility of a novel integrated model of care for persons with parkinsonism in The Netherlands. We anticipate that the results of this study will also provide insight for the delivery of care to persons with parkinsonism in other regions and may inform the design of a similar model for other chronic health conditions.
Collapse
Affiliation(s)
- Jan H L Ypinga
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Angelika D Van Halteren
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emily J Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
- Older People's Unit, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, UK
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Agnes J Smink
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Emma Tenison
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Marten Munneke
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1NU, UK
| | - Sirwan K L Darweesh
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
85
|
Eyles E, Redaniel MT, Purdy S, Tilling K, Ben-Shlomo Y. Associations of GP practice characteristics with the rate of ambulatory care sensitive conditions in people living with dementia in England: an ecological analysis of routine data. BMC Health Serv Res 2021; 21:613. [PMID: 34182996 PMCID: PMC8240405 DOI: 10.1186/s12913-021-06634-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital admissions for Ambulatory Care Sensitive Conditions (ACSCs) are potentially avoidable. Dementia is one of the leading chronic conditions in terms of variability in ACSC admissions by general practice, as well as accounting for around a third of UK emergency admissions. METHODS Using Bayesian multilevel linear regression models, we examined the ecological association of organizational characteristics of general practices (ACSC n=7076, non-ACSC n=7046 units) and Clinical Commissioning Groups (CCG n=212 units) in relation to ACSC and non-ACSC admissions for people with dementia in England. RESULTS The rate of hospital admissions are variable between GP practices, with deprivation and being admitted from home as risk factors for admission for ACSC and non-ACSC admissions. The budget allocated by the CCG to mental health shows diverging effects for ACSC versus non-ACSC admissions, so it is likely there is some geographic variation. CONCLUSIONS A variety of factors that could explain avoidable admissions for PWD at the practice level were examined; most were equally predictive for avoidable and non-avoidable admissions. However, a high amount of variation found at the practice level, in conjunction with the diverging effects of the CCG mental health budget, implies that guidance may be applied inconsistently, or local services may have differences in referral criteria. This indicates there is potential scope for improvement.
Collapse
Affiliation(s)
- Emily Eyles
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. .,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK.
| | - Maria Theresa Redaniel
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK
| | - Sarah Purdy
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK
| | - Kate Tilling
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK
| | - Yoav Ben-Shlomo
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK
| |
Collapse
|
86
|
Patel R, Bhimjiyani A, Ben-Shlomo Y, Gregson CL. Social deprivation predicts adverse health outcomes after hospital admission with hip fracture in England. Osteoporos Int 2021; 32:1129-1141. [PMID: 33399914 DOI: 10.1007/s00198-020-05768-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/26/2020] [Indexed: 12/22/2022]
Abstract
UNLABELLED We found social deprivation to be associated with higher mortality in the year following hip fracture among men and women aged 60 years and older in England. In those who did survive, deprivation was associated with longer hospital stays and greater risk of subsequent emergency readmission particularly for patients with dementia. INTRODUCTION Social deprivation predicts a range of adverse health outcomes; however, its impact on outcomes following hip fracture is not established. We examined the effect of area-level social deprivation on outcomes following hospital admission for hip fracture in England. METHODS We used English Hospital Episodes Statistics linked to the National Hip Fracture Database (April 2011-March 2015) and Office for National Statistics mortality database, to identify patients aged 60+ years admitted with hip fracture. Deprivation was measured using Index of Multiple Deprivation quintiles; Q1-least deprived; Q5-most deprived, and outcomes by mortality over 1-year, length-of-stay in NHS acute and rehabilitation hospitals ('superspell'), and emergency 30-day readmission. RESULTS We identified 218,907 admissions with an index hip fracture (mean age 82.8 [standard deviation, SD 8.4] years; 72.6% female). Each quintile of deprivation was associated with greater mortality; age-adjusted 30-day mortality odds ratio, OR 1.30 [95% confidence interval, CI: 1.24, 1.37], p < 0.001, equating to on average 1038 fewer deaths/year among those who are least deprived (Q1 versus 2-5). Similarly, at 365 days, those most deprived had 24% higher mortality (age-sex-comorbidity-adjusted OR:1.24 [1.20, 1.28], p < 0.001; Q5 versus Q1). Among survivors, mean superspell was longer in the most versus least deprived (Q5:24.4 [SD 21.7] days, Q1:23.3 [SD 22.1], p < 0.001). Readmission was more common in those most versus least deprived (age-sex-comorbidity-adjusted OR 1.27 [1.22, 1.32], p < 0.001). CONCLUSION Greater deprivation is associated with reduced survival at all timepoints in the year following hip fracture. Among survivors, hospital stay is increased as is readmission risk. The extent to which configuration of English hospital services, rather than patient case-mix, explains these apparent health inequalities remains to be determined.
Collapse
Affiliation(s)
- R Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - A Bhimjiyani
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK
| | - Y Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
87
|
Patel R, Drew S, Johansen A, Chesser T, Javaid MK, Griffin XL, Jones T, Griffin J, Bradshaw M, Whale K, Barbosa EC, Marques EMR, Ben-Shlomo Y, Gooberman-Hill R, Judge A, Gregson CL. REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study. BMJ Open 2021; 11:e049763. [PMID: 34011603 PMCID: PMC8137248 DOI: 10.1136/bmjopen-2021-049763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Substantial variation in the delivery of hip fracture care, and patient outcomes persists between hospitals, despite established UK national standards and guidelines. Patients' outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level factors account for the persistence of unwarranted variation in outcomes. The mixed-methods REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE) study, aims to determine key organisational factors to target to improve patient care. METHODS AND ANALYSIS Quantitative analysis will assess the outcomes of patients treated at 172 hospitals in England and Wales (2016-2019) using National Hip Fracture Database data combined with English Hospital Episodes Statistics; Patient Episode Database for Wales; Civil Registration (deaths) and multiple organisational-level audits to characterise each service provider. Statistical analyses will identify which organisational factors explain variation in patient outcomes, and typify care pathways with high-quality consistent patient outcomes. Documentary analysis of 20 anonymised British Orthopaedic Association hospital-initiated peer-review reports, and qualitative interviews with staff from four diverse UK hospitals providing hip fracture care, will identify barriers and facilitators to care delivery. The COVID-19 pandemic has posed a major challenge to the resilience of services and interviews will explore strategies used to adapt and innovate. This system-wide understanding will inform the development, in partnership with key national stakeholders, of an 'Implementation Toolkit' to inform and improve commissioning and delivery of hip fracture services. ETHICS AND DISSEMINATION This study was approved: quantitative study by London, City and East Research Ethics Committee (20/LO/0101); and qualitative study by Faculty of Health Sciences University of Bristol Research Ethics Committee (Ref: 108284), National Health Service (NHS) Health Research Authority (20/HRA/71) and each NHS Trust provided Research and Development approval. Findings will be disseminated through scientific conferences, peer-reviewed journals and online workshops.
Collapse
Affiliation(s)
- Rita Patel
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Drew
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Antony Johansen
- Division of Population Medicine, School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK
- National Hip Fracture Database, Royal College of Physicians, London, UK
| | - Tim Chesser
- Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Xavier L Griffin
- Division of Orthopaedics, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Tim Jones
- Clinical & Operations Directorate, Royal Osteoporosis Society, Bath, UK
| | - Jill Griffin
- Clinical & Operations Directorate, Royal Osteoporosis Society, Bath, UK
| | - Marianne Bradshaw
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katie Whale
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Estela Capelas Barbosa
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elsa M R Marques
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
88
|
Robinson DE, Ali MS, Pallares N, Tebé C, Elhussein L, Abrahamsen B, Arden NK, Ben-Shlomo Y, Caskey FJ, Cooper C, Dedman D, Delmestri A, Judge A, Pérez-Sáez MJ, Pascual J, Nogues X, Diez-Perez A, Strauss VY, Javaid MK, Prieto-Alhambra D. Safety of Oral Bisphosphonates in Moderate-to-Severe Chronic Kidney Disease: A Binational Cohort Analysis. J Bone Miner Res 2021; 36:820-832. [PMID: 33373491 DOI: 10.1002/jbmr.4235] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
Bisphosphonates are the first-line treatment for preventing fractures in osteoporosis patients. However, their use is contraindicated or to be used with caution in chronic kidney disease (CKD) patients, primarily because of a lack of information about their safety and effectiveness. We aimed to investigate the safety of oral bisphosphonates in patients with moderate to severe CKD, using primary-care electronic records from two cohorts, CPRD GOLD (1997-2016) and SIDIAP (2007-2015) in the UK and Catalonia, respectively. Both databases were linked to hospital records. SIDIAP was also linked to end-stage renal disease registry data. Patients with CKD stages 3b to 5, based on two or more estimated glomerular filtration rate measurements less than 45 mL/min/1.73 m2 , aged 40 years or older were identified. New bisphosphonate users were propensity score-matched with up to five non-users to minimize confounding within this population. Our primary outcome was CKD stage worsening (estimated glomerular filtration rate [eGFR] decline or renal replacement therapy). Secondary outcomes were acute kidney injury, gastrointestinal bleeding/ulcers, and severe hypocalcemia. Hazard ratios (HRs) were estimated using Cox regression and Fine and Gray sub-HRs were calculated for competing risks. We matched 2447 bisphosphonate users with 8931 non-users from CPRD and 1399 users with 6547 non-users from SIDIAP. Bisphosphonate use was associated with greater risk of CKD progression in CPRD (sub-HR [95% CI]: 1.14 [1.04, 1.26]) and SIDIAP (sub-HR: 1.15 [1.04, 1.27]). No risk differences were found for acute kidney injury, gastrointestinal bleeding/ulcers, or hypocalcemia. Hence, we can conclude a modest (15%) increased risk of CKD progression was identified in association with bisphosphonate use. No other safety concerns were identified. Our findings should be considered before prescribing bisphosphonates to patients with moderate to severe CKD. © 2020 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Danielle E Robinson
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - M Sanni Ali
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Natalia Pallares
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL) L'Hospitalet de Llobregat, Barcelona, Spain.,Basic Medical Sciences Department, Rovira Virgili University, Tarragona, Spain
| | - Leena Elhussein
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Bo Abrahamsen
- NDORMS, University of Oxford, Oxford, UK.,OPEN, Department of Health, University of Southern Denmark, Odense, Denmark.,Holbaek Hospital, Department of Medicine, Holbaek, Denmark
| | - Nigel K Arden
- Sport, Exercise and Arthritis Centre: Versus Arthritis, University of Oxford, Oxford, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - Cyrus Cooper
- NDORMS, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Daniel Dedman
- Clinical Practice Research Datalink (CPRD), London, UK
| | - Antonella Delmestri
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Andrew Judge
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Xavier Nogues
- Internal Medicine, IMIM (Hospital del Mar Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona, Spain.,Hospital del Mar Institute of Medical Research Autonomous University of Barcelona Research Network on Frailty and Healthy Aging (CIBERFES) Instituto Carlos III, Barcelona, Spain
| | - Adolfo Diez-Perez
- Internal Medicine, IMIM (Hospital del Mar Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona, Spain
| | - Victoria Y Strauss
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | | | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and CIBERFes, University Institute for Primary Care Research (IDIAP) Jordi Gol, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| |
Collapse
|
89
|
Ahluwalia TS, Prins BP, Abdollahi M, Armstrong NJ, Aslibekyan S, Bain L, Jefferis B, Baumert J, Beekman M, Ben-Shlomo Y, Bis JC, Mitchell BD, de Geus E, Delgado GE, Marek D, Eriksson J, Kajantie E, Kanoni S, Kemp JP, Lu C, Marioni RE, McLachlan S, Milaneschi Y, Nolte IM, Petrelis AM, Porcu E, Sabater-Lleal M, Naderi E, Seppälä I, Shah T, Singhal G, Standl M, Teumer A, Thalamuthu A, Thiering E, Trompet S, Ballantyne CM, Benjamin EJ, Casas JP, Toben C, Dedoussis G, Deelen J, Durda P, Engmann J, Feitosa MF, Grallert H, Hammarstedt A, Harris SE, Homuth G, Hottenga JJ, Jalkanen S, Jamshidi Y, Jawahar MC, Jess T, Kivimaki M, Kleber ME, Lahti J, Liu Y, Marques-Vidal P, Mellström D, Mooijaart SP, Müller-Nurasyid M, Penninx B, Revez JA, Rossing P, Räikkönen K, Sattar N, Scharnagl H, Sennblad B, Silveira A, Pourcain BS, Timpson NJ, Trollor J, van Dongen J, Van Heemst D, Visvikis-Siest S, Vollenweider P, Völker U, Waldenberger M, Willemsen G, Zabaneh D, Morris RW, Arnett DK, Baune BT, Boomsma DI, Chang YPC, Deary IJ, Deloukas P, Eriksson JG, Evans DM, Ferreira MA, Gaunt T, Gudnason V, Hamsten A, Heinrich J, Hingorani A, Humphries SE, Jukema JW, Koenig W, Kumari M, Kutalik Z, Lawlor DA, Lehtimäki T, März W, Mather KA, Naitza S, Nauck M, Ohlsson C, Price JF, Raitakari O, Rice K, Sachdev PS, Slagboom E, Sørensen TIA, Spector T, Stacey D, Stathopoulou MG, Tanaka T, Wannamethee SG, Whincup P, Rotter JI, Dehghan A, Boerwinkle E, Psaty BM, Snieder H, Alizadeh BZ. Genome-wide association study of circulating interleukin 6 levels identifies novel loci. Hum Mol Genet 2021; 30:393-409. [PMID: 33517400 PMCID: PMC8098112 DOI: 10.1093/hmg/ddab023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/02/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
Interleukin 6 (IL-6) is a multifunctional cytokine with both pro- and anti-inflammatory properties with a heritability estimate of up to 61%. The circulating levels of IL-6 in blood have been associated with an increased risk of complex disease pathogenesis. We conducted a two-staged, discovery and replication meta genome-wide association study (GWAS) of circulating serum IL-6 levels comprising up to 67 428 (ndiscovery = 52 654 and nreplication = 14 774) individuals of European ancestry. The inverse variance fixed effects based discovery meta-analysis, followed by replication led to the identification of two independent loci, IL1F10/IL1RN rs6734238 on chromosome (Chr) 2q14, (Pcombined = 1.8 × 10-11), HLA-DRB1/DRB5 rs660895 on Chr6p21 (Pcombined = 1.5 × 10-10) in the combined meta-analyses of all samples. We also replicated the IL6R rs4537545 locus on Chr1q21 (Pcombined = 1.2 × 10-122). Our study identifies novel loci for circulating IL-6 levels uncovering new immunological and inflammatory pathways that may influence IL-6 pathobiology.
Collapse
Affiliation(s)
- Tarunveer S Ahluwalia
- Steno Diabetes Center Copenhagen, Gentofte DK2820, Denmark.,Department of Biology, The Bioinformatics Center, University of Copenhagen, Copenhagen DK2200, Denmark
| | - Bram P Prins
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, The Netherlands
| | - Mohammadreza Abdollahi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, The Netherlands
| | | | - Stella Aslibekyan
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama 35233, USA
| | - Lisa Bain
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Barbara Jefferis
- Department of Primary Care & Population Health, UCL Institute of Epidemiology & Health Care, University College London, London NW3 2PF, UK
| | - Jens Baumert
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany
| | - Marian Beekman
- Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA
| | - Braxton D Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21202, USA
| | - Eco de Geus
- Department of Biological Psychology, Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam 1105 AZ, The Netherlands
| | - Graciela E Delgado
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim 68167, Germany
| | - Diana Marek
- SIB Swiss Institute of Bioinformatics, Lausanne 1015, Switzerland
| | - Joel Eriksson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Centre for Bone and Arthritis Research (CBAR), University of Gothenburg, Gothenburg 41345, Sweden
| | - Eero Kajantie
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, PO Box 30, Helsinki 00271, Finland.,Hospital for Children and Adolescents, Helsinki University Central Hospital and University of Helsinki, Helsinki 00014, Finland
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts & the London Medical School, Queen Mary University of London, London EC1M 6BQ, UK
| | - John P Kemp
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia.,MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol BS8 2BN, UK
| | - Chen Lu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Stela McLachlan
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam 1081 HJ, The Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, The Netherlands
| | | | - Eleonora Porcu
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato (CA) 09042, Italy
| | - Maria Sabater-Lleal
- Cardiovascular Medicine, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm 17176, Sweden.,Unit of Genomics of Complex Diseases, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona 08041, Spain
| | - Elnaz Naderi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, The Netherlands
| | - Ilkka Seppälä
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Tina Shah
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - Gaurav Singhal
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide 5005, Australia
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald 17475, Germany
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney 2052, Australia
| | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany.,Division of Metabolic Diseases and Nutritional Medicine, Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, Munich 80337, Germany
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands.,Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | | | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA.,Section of Cardiovascular Medicine and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Juan P Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA
| | - Catherine Toben
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide 5005, Australia
| | - George Dedoussis
- 44Department of Nutrition-Dietetics, Harokopio University, Athens 17671, Greece
| | - Joris Deelen
- Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands.,Max Planck Institute for Biology of Ageing, Cologne 50931, Germany
| | - Peter Durda
- Department of Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Jorgen Engmann
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110-1093, USA
| | - Harald Grallert
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany.,German Center for Diabetes Research (DZD), Neuherberg 85764, Germany
| | - Ann Hammarstedt
- The Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg SE-41345, Sweden
| | - Sarah E Harris
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh EH8 9JZ, UK.,Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald 17475, Germany
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam 1105 AZ, The Netherlands
| | - Sirpa Jalkanen
- MediCity Research Laboratory, University of Turku, Turku 20520, Finland.,Department of Medical Microbiology and Immunology, University of Turku, Turku 20520, Finland
| | - Yalda Jamshidi
- Genetics Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London SW17 0RE, UK
| | - Magdalene C Jawahar
- Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide 5005, Australia
| | - Tine Jess
- 55Department of Epidemiology Research, Statens Serum Institute, Copenhagen DK2300, Denmark
| | - Mika Kivimaki
- Department of Epidemiology & Public Health, UCL Institute of Epidemiology & Health Care, University College London, London WC1E 7HB, UK
| | - Marcus E Kleber
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim 68167, Germany
| | - Jari Lahti
- Turku Institute for Advanced Studies, University of Turku, Turku 20014, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki 00014, Finland
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Pedro Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne 1011, Switzerland.,University of Lausanne, Lausanne 1011, Switzerland
| | - Dan Mellström
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Centre for Bone and Arthritis Research (CBAR), University of Gothenburg, Gothenburg 41345, Sweden
| | - Simon P Mooijaart
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Martina Müller-Nurasyid
- IBE, Faculty of Medicine, Ludwig Maximilians University (LMU) Munich, Munich 81377, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johhanes Gutenberg University, Mainz 55101, Germany
| | - Brenda Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam 1081 HJ, The Netherlands
| | - Joana A Revez
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte DK2820, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen DK2200, Denmark
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki 00014, Finland
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine, Glasgow G12 8TA, UK
| | - Hubert Scharnagl
- 66Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz 8036, Austria
| | - Bengt Sennblad
- Cardiovascular Medicine, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm 17176, Sweden.,Department of Cell and Molecular Biology, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Uppsala University, Uppsala 75124, Sweden
| | - Angela Silveira
- Cardiovascular Medicine, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm 17176, Sweden
| | - Beate St Pourcain
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol BS8 2BN, UK.,Max Planck Institute for Psycholinguistics, Nijmegen XD 6525, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen 6525 AJ, The Netherlands
| | - Nicholas J Timpson
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol BS8 2BN, UK
| | - Julian Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney 2052, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney 2031, Australia
| | | | - Jenny van Dongen
- Department of Biological Psychology, Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam 1105 AZ, The Netherlands
| | | | | | - Peter Vollenweider
- Department of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne 1011, Switzerland.,University of Lausanne, Lausanne 1011, Switzerland
| | - Uwe Völker
- MediCity Research Laboratory, University of Turku, Turku 20520, Finland
| | - Melanie Waldenberger
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany
| | - Gonneke Willemsen
- Department of Biological Psychology, Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam 1105 AZ, The Netherlands
| | - Delilah Zabaneh
- Department of Genetics, Environment and Evolution, University College London Genetics Institute, London WC1E 6BT, UK
| | - Richard W Morris
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Donna K Arnett
- Dean's Office, College of Public Health, University of Kentucky, Lexington, KY 40536, USA
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Parkville 3000, Australia.,Department of Psychiatry and Psychotherapy, University of Muenster, Muenster 48149, Germany.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville 3000, Australia
| | - Dorret I Boomsma
- Department of Biological Psychology, Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam 1105 AZ, The Netherlands
| | - Yen-Pei C Chang
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21202, USA
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh EH8 9JZ, UK.,Department of Psychology, University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Panos Deloukas
- William Harvey Research Institute, Barts & the London Medical School, Queen Mary University of London, London EC1M 6BQ, UK.,77Centre for Genomic Health, Queen Mary University of London, London EC1M 6BQ, UK
| | - Johan G Eriksson
- National Institute for Health and Welfare, University of Helsinki, Helsinki 00014, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki 00014, Finland
| | - David M Evans
- The University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, Queensland 4102, Australia.,MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol BS8 2BN, UK
| | | | - Tom Gaunt
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol BS6 2BN, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kópavogur 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik 101, Iceland
| | - Anders Hamsten
- Cardiovascular Medicine, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm 17176, Sweden
| | - Joachim Heinrich
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg 85764, Germany.,Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich 81377, Germany.,Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia
| | - Aroon Hingorani
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - Steve E Humphries
- Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - J Wouter Jukema
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands.,Durrer Center for Cardiogenetic Research, Amsterdam 1105 AZ, The Netherlands
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich 80636, Germany.,88DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich 80336, Germany.,Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm 89081, Germany
| | - Meena Kumari
- Department of Epidemiology & Public Health, UCL Institute of Epidemiology & Health Care, University College London, London WC1E 7HB, UK.,Institute for Social and Economic Research, University of Essex, Colchester CO4 3SQ, Germany
| | - Zoltan Kutalik
- SIB Swiss Institute of Bioinformatics, Lausanne 1015, Switzerland.,University Center for Primary Care and Public Health, University of Lausanne, Lausanne 1010, Switzerland
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol BS6 2BN, UK.,Population Health Science, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33520, Finland
| | - Winfried März
- Vth Department of Medicine (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Mannheim 68167, Germany.,66Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz 8036, Austria.,SYNLAB Academy, SYNALB Holding Deutschland GmbH, Mannheim 68163, Germany
| | - Karen A Mather
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney 2052, Australia.,Neuroscience Research Australia, Sydney 2031, Australia
| | - Silvia Naitza
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato (CA) 09042, Italy
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald 17475, Germany.,DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald 17475, Germany
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Centre for Bone and Arthritis Research (CBAR), University of Gothenburg, Gothenburg 41345, Sweden
| | - Jackie F Price
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku, Turku University Hospital, Turku 20520, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20520, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku 20014, Finland
| | - Ken Rice
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney 2052, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney 2031, Australia
| | - Eline Slagboom
- Department of Biomedical Data Sciences, Section of Molecular Epidemiology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands.,Max Planck Institute for Biology of Ageing, Cologne 50931, Germany
| | - Thorkild I A Sørensen
- Novo Nordisk Foundation Center For Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK2200, Denmark.,Department of Public Health, Section on Epidemiology, University of Copenhagen, Copenhagen DK1014, Denmark
| | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - David Stacey
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | | | - Toshiko Tanaka
- Longitudinal Study Section, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD 21224, USA
| | - S Goya Wannamethee
- Department of Primary Care & Population Health, UCL Institute of Epidemiology & Health Care, University College London, London NW3 2PF, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Jerome I Rotter
- Department of Pediatrics, The Institute for Translational Genomics and Population Sciences, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus MC, Rotterdam 3000 CA, The Netherlands
| | - Eric Boerwinkle
- Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.,Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA.,Departments of Epidemiology and Health Services, University of Washington, Seattle, WA 98101, USA
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9700 RB, The Netherlands
| |
Collapse
|
90
|
Penfold CM, Whitehouse MR, Sayers A, Wilkinson JM, Hunt L, Ben-Shlomo Y, Judge A, Blom AW. A Comparison of the Surgical Practice of Potential Revision Outlier Joint Replacement Surgeons With Non-outliers: A Case Control Study From the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. J Arthroplasty 2021; 36:1239-1245.e6. [PMID: 33160808 DOI: 10.1016/j.arth.2020.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) has monitored the performance of consultant surgeons performing primary total hip (THR) or knee replacements (KR) since 2007. The aims of this study were: 1) To describe the surgical practice of consultant hip and knee replacement surgeons in the National Joint Registry for England and Wales (NJR), stratified by potential outlier status for revisions. 2) To compare the practice of revision outlier and non-outlier surgeons. METHODS We combined NJR primary THR and KR data from 2008-2017 separately with relevant anonymised NJR outlier notification records. We described the surgical practice of outliers and non-outliers by surgical workload, implant choice, and patients' clinical and demographic characteristics. We explored associations between surgeon-level factors and outlier status with conditional logistic regression models. RESULTS We included 764,888 primary THRs by 3213 surgeons and 889,954 primary KRs by 3084 surgeons performed between 2008-2017. One hundred and eleven (3.5%) THR and 114 (3.7%) KR consultant surgeons were potential revision outliers. Surgeons who used more types of implant had increased odds of being an outlier (KR: OR/additional implant = 1.35, 95%CI 1.17-1.55; THR: OR = 1.12, 95%CI 1.06-1.18). CONCLUSIONS The use of more types of implant is associated with increased risk of being a potential revision outlier. Further research is required to understand why surgeons use many different implants and to what extent this is responsible for the effects observed here.
Collapse
Affiliation(s)
- Chris M Penfold
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
| | - J Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sorby Wing, Northern General Hospital, Sheffield, UK; Centre for Integrated Research into Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
| | - Linda Hunt
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| |
Collapse
|
91
|
Abstract
Background Frailty and Parkinson’s disease (PD) are both highly prevalent in older people, but few studies have studied frailty in people with Parkinson’s. Identifying frailty in this population is vital, to target new interventions to those who would most benefit. Methods Data were collected as part of the double-blind randomised controlled rivastigmine to stabilise gait ReSPonD trial in 130 people with Hoehn and Yahr 2–3, idiopathic PD who had fallen in the year prior to enrolment. Individuals were assessed at baseline and followed up at eight months, including determination of frailty status. Results 120 patients attended for follow-up. At follow-up, the mean (SD) age was 70.2 years (8.0), MDS-UPDRS total score 91.5 (29.1), and MDS-UPDRS motor score (Part III) 42.7 (14.8). Median disease duration was 9.2 years (IQR 4.6 to 13.1), Geriatric Depression Score 4 (IQR 2 to 6). Using the Fried frailty criteria, 31 (26%) were frail and 70 (58%) pre-frail. In univariable analysis, being female, higher depression score, and MDS-UPDRS score were associated with greater frailty. Using ordinal regression, in the multivariable model, being female (odds ratio [OR] 3.10, 95%CI 1.53 to 6.26, p=.002), higher total MDS-UPDRS score (OR 2.02, 95%CI 1.42 to 2.87, p<.0001) and higher depression (OR 1.47, 95%CI 1.05 to 2.06, p=.03) were associated with higher number of frailty markers. Conclusion There was a high prevalence (84%) of pre-frail and frail individuals in patients participating in this RCT. Future research should determine the optimum tool to assess frailty in this at-risk population, and delineate the association between Parkinson’s, frailty, and health outcomes.
Collapse
Affiliation(s)
| | - Daisy M Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alan Whone
- Movement Disorders Group, Bristol Brain Centre, Southmead Hospital, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Royal United Hospitals Bath NHS Trust, Bath, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
92
|
Robinson DE, Ali MS, Strauss VY, Elhussein L, Abrahamsen B, Arden NK, Ben-Shlomo Y, Caskey F, Cooper C, Dedman D, Delmestri A, Judge A, Javaid MK, Prieto-Alhambra D. Bisphosphonates to reduce bone fractures in stage 3B+ chronic kidney disease: a propensity score-matched cohort study. Health Technol Assess 2021; 25:1-106. [PMID: 33739919 PMCID: PMC8020200 DOI: 10.3310/hta25170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bisphosphonates are contraindicated in patients with stage 4+ chronic kidney disease. However, they are widely used to prevent fragility fractures in stage 3 chronic kidney disease, despite a lack of good-quality data on their effects. OBJECTIVES The aims of each work package were as follows. Work package 1: to study the relationship between bisphosphonate use and chronic kidney disease progression. Work package 2: to study the association between using bisphosphonates and fracture risk. Work package 3: to determine the risks of hypocalcaemia, hypophosphataemia, acute kidney injury and upper gastrointestinal events associated with using bisphosphonates. Work package 4: to investigate the association between using bisphosphonates and changes in bone mineral density over time. DESIGN This was a new-user cohort study design with propensity score matching. SETTING AND DATA SOURCES Data were obtained from UK NHS primary care (Clinical Practice Research Datalink GOLD database) and linked hospital inpatient records (Hospital Episode Statistics) for work packages 1-3 and from the Danish Odense University Hospital Databases for work package 4. PARTICIPANTS Patients registered in the data sources who had at least one measurement of estimated glomerular filtration rate of < 45 ml/minute/1.73 m2 were eligible. A second estimated glomerular filtration rate value of < 45 ml/minute/1.73 m2 within 1 year after the first was requested for work packages 1 and 3. Patients with no Hospital Episode Statistics linkage were excluded from work packages 1-3. Patients with < 1 year of run-in data before index estimated glomerular filtration rate and previous users of anti-osteoporosis medications were excluded from work packages 1-4. INTERVENTIONS/EXPOSURE Bisphosphonate use, identified from primary care prescriptions (for work packages 1-3) or pharmacy dispensations (for work package 4), was the main exposure. MAIN OUTCOME MEASURES Work package 1: chronic kidney disease progression, defined as stage worsening or starting renal replacement. Work package 2: hip fracture. Work package 3: acute kidney injury, hypocalcaemia and hypophosphataemia identified from Hospital Episode Statistics, and gastrointestinal events identified from Clinical Practice Research Datalink or Hospital Episode Statistics. Work package 4: annualised femoral neck bone mineral density percentage change. RESULTS Bisphosphonate use was associated with an excess risk of chronic kidney disease progression (subdistribution hazard ratio 1.12, 95% confidence interval 1.02 to 1.24) in work package 1, but did not increase the probability of other safety outcomes in work package 3. The results from work package 2 suggested that bisphosphonate use increased fracture risk (hazard ratio 1.25, 95% confidence interval 1.13 to 1.39) for hip fractures, but sensitivity analyses suggested that this was related to unresolved confounding. Conversely, work package 4 suggested that bisphosphonates improved bone mineral density, with an average 2.65% (95% confidence interval 1.32% to 3.99%) greater gain in femoral neck bone mineral density per year in bisphosphonate users than in matched non-users. LIMITATIONS Confounding by indication was a concern for the clinical effectiveness (i.e. work package 2) data. Bias analyses suggested that these findings were due to inappropriate adjustment for pre-treatment risk. work packages 3 and 4 were based on small numbers of events and participants, respectively. CONCLUSIONS Bisphosphonates were associated with a 12% excess risk of chronic kidney disease progression in participants with stage 3B+ chronic kidney disease. No other safety concerns were identified. Bisphosphonate therapy increased bone mineral density, but the research team failed to demonstrate antifracture effectiveness. FUTURE WORK Randomised controlled trial data are needed to demonstrate antifracture efficacy in patients with stage 3B+ chronic kidney disease. More safety analyses are needed to characterise the renal toxicity of bisphosphonates in stage 3A chronic kidney disease, possibly using observational data. STUDY REGISTRATION This study is registered as EUPAS10029. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 17. See the NIHR Journals Library website for further project information. The project was also supported by the National Institute for Health Research Biomedical Research Centre, Oxford.
Collapse
Affiliation(s)
- Danielle E Robinson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - M Sanni Ali
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Victoria Y Strauss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Leena Elhussein
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Bo Abrahamsen
- Open Patient data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Nigel K Arden
- Arthritis Research UK Sports, Exercise and Osteoarthritis Centre, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Fergus Caskey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- UK Renal Registry, Bristol, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Daniel Dedman
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre (BRC), University Hospitals Bristol NHS Foundation Trust, University of Bristol, Southmead Hospital, Bristol, UK
| | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK
- Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFes), University Institute for Primary Care Research (IDIAP) Jordi Gol, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| |
Collapse
|
93
|
Lo C, Arora S, Ben-Shlomo Y, Barber TR, Lawton M, Klein JC, Kanavou S, Janzen A, Sittig E, Oertel WH, Grosset DG, Hu MT. Olfactory Testing in Parkinson Disease and REM Behavior Disorder: A Machine Learning Approach. Neurology 2021; 96:e2016-e2027. [PMID: 33627500 DOI: 10.1212/wnl.0000000000011743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/15/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We sought to identify an abbreviated test of impaired olfaction amenable for use in busy clinical environments in prodromal (isolated REM sleep behavior disorder [iRBD]) and manifest Parkinson disease (PD). METHODS Eight hundred ninety individuals with PD and 313 controls in the Discovery cohort study underwent Sniffin' Stick odor identification assessment. Random forests were initially trained to distinguish individuals with poor (functional anosmia/hyposmia) and good (normosmia/super-smeller) smell ability using all 16 Sniffin' Sticks. Models were retrained using the top 3 sticks ranked by order of predictor importance. One randomly selected 3-stick model was tested in a second independent PD dataset (n = 452) and in 2 iRBD datasets (Discovery n = 241, Marburg n = 37) before being compared to previously described abbreviated Sniffin' Stick combinations. RESULTS In differentiating poor from good smell ability, the overall area under the curve (AUC) value associated with the top 3 sticks (anise/licorice/banana) was 0.95 in the Development dataset (sensitivity 90%, specificity 92%, positive predictive value 92%, negative predictive value 90%). Internal and external validation confirmed AUCs ≥0.90. The combination of the 3-stick model determined poor smell, and an RBD screening questionnaire score of ≥5 separated those with iRBD from controls with a sensitivity, specificity, positive predictive value, and negative predictive value of 65%, 100%, 100%, and 30%. CONCLUSIONS Our 3-Sniffin'-Stick model holds potential utility as a brief screening test in the stratification of individuals with PD and iRBD according to olfactory dysfunction. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that a 3-Sniffin'-Stick model distinguishes individuals with poor and good smell ability and can be used to screen for individuals with iRBD.
Collapse
Affiliation(s)
- Christine Lo
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK.
| | - Siddharth Arora
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Yoav Ben-Shlomo
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Thomas R Barber
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Michael Lawton
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Johannes C Klein
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Sofia Kanavou
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Annette Janzen
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Elisabeth Sittig
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Wolfgang H Oertel
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Donald G Grosset
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Michele T Hu
- From the Oxford Parkinson's Disease Centre (C.L., S.A., T.R.B., J.C.K., M.T.H.), Nuffield Department of Clinical Neurosciences (C.L., T.R.B., J.C.K., M.T.H.), and Saïd Business School (S.A.), University of Oxford; Population Health Sciences (Y.B.-S., M.L., S.K.), University of Bristol, UK; Department of Neurology (A.J., E.S., W.H.O.), Philipps University Marburg; Institute for Neurogenomics (W.H.O.), München Helmholtz Center for Health and Environment, Neuherberg München, Germany; and Institute of Neurological Sciences (D.G.G.), Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
94
|
Plumb LA, Sinha MD, Casula A, Inward CD, Marks SD, Caskey FJ, Ben-Shlomo Y. Associations between Deprivation, Geographic Location, and Access to Pediatric Kidney Care in the United Kingdom. Clin J Am Soc Nephrol 2021; 16:194-203. [PMID: 33468533 PMCID: PMC7863652 DOI: 10.2215/cjn.11020720] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Pre-emptive kidney transplantation is advocated as best practice for children with kidney failure who are transplant eligible; however, it is limited by late presentation. We aimed to determine whether socioeconomic deprivation and/or geographic location (distance to the center and rural/urban residence) are associated with late presentation, and to what degree these factors could explain differences in accessing pre-emptive transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A cohort study using prospectively collected United Kingdom Renal Registry and National Health Service Blood and Transplant data from January 1, 1996 to December 31, 2016 was performed. We included children aged >3 months to ≤16 years at the start of KRT. Multivariable logistic regression models were used to determine associations between the above exposures and our outcomes: late presentation (defined as starting KRT within 90 days of first nephrology review) and pre-emptive transplantation, with a priori specified covariates. RESULTS Analysis was performed on 2160 children (41% females), with a median age of 3.8 years (interquartile range, 0.2-9.9 years) at first nephrology review. Excluding missing data, 478 were late presenters (24%); 565 (26%) underwent pre-emptive transplantation, none of whom were late presenting. No association was seen between distance or socioeconomic deprivation with late presentation, in crude or adjusted analyses. Excluding late presenters, greater area affluence was associated with higher odds of pre-emptive transplantation, (odds ratio, 1.20 per quintile greater affluence; 95% confidence interval, 1.10 to 1.31), with children of South Asian (odds ratio, 0.52; 95% confidence interval, 0.36 to 0.76) or Black ethnicity (odds ratio, 0.31; 95% confidence interval, 0.12 to 0.80) less likely to receive one. A longer distance to the center was associated with pre-emptive transplantation on crude analyses; however, this relationship was attenuated (odds ratio, 1.02 per 10 km; 95% confidence interval, 0.99 to 1.05) in the multivariable model. CONCLUSIONS Socioeconomic deprivation or geographic location are not associated with late presentation in children in the United Kingdom. Geographic location was not independently associated with pre-emptive transplantation; however, children from more affluent areas were more likely to receive a pre-emptive transplant.
Collapse
Affiliation(s)
- Lucy A. Plumb
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom,United Kingdom Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys and St Thomas’ National Health Service Foundation Trust, London, United Kingdom,King's British Heart Foundation Centre, King's College London, London, United Kingdom
| | - Anna Casula
- United Kingdom Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Carol D. Inward
- Department of Paediatric Nephrology, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Stephen D. Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom,Department of Renal Medicine, North Bristol National Health Service Trust, Bristol, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom,The National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| |
Collapse
|
95
|
Tan MM, Lawton MA, Jabbari E, Reynolds RH, Iwaki H, Blauwendraat C, Kanavou S, Pollard MI, Hubbard L, Malek N, Grosset KA, Marrinan SL, Bajaj N, Barker RA, Burn DJ, Bresner C, Foltynie T, Wood NW, Williams-Gray CH, Hardy J, Nalls MA, Singleton AB, Williams NM, Ben-Shlomo Y, Hu MT, Grosset DG, Shoai M, Morris HR. Genome-Wide Association Studies of Cognitive and Motor Progression in Parkinson's Disease. Mov Disord 2021; 36:424-433. [PMID: 33111402 PMCID: PMC9053517 DOI: 10.1002/mds.28342] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/10/2020] [Accepted: 10/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are currently no treatments that stop or slow the progression of Parkinson's disease (PD). Case-control genome-wide association studies have identified variants associated with disease risk, but not progression. The objective of the current study was to identify genetic variants associated with PD progression. METHODS We analyzed 3 large longitudinal cohorts: Tracking Parkinson's, Oxford Discovery, and the Parkinson's Progression Markers Initiative. We included clinical data for 3364 patients with 12,144 observations (mean follow-up 4.2 years). We used a new method in PD, following a similar approach in Huntington's disease, in which we combined multiple assessments using a principal components analysis to derive scores for composite, motor, and cognitive progression. These scores were analyzed in linear regression in genome-wide association studies. We also performed a targeted analysis of the 90 PD risk loci from the latest case-control meta-analysis. RESULTS There was no overlap between variants associated with PD risk, from case-control studies, and PD age at onset versus PD progression. The APOE ε4 tagging variant, rs429358, was significantly associated with composite and cognitive progression in PD. Conditional analysis revealed several independent signals in the APOE locus for cognitive progression. No single variants were associated with motor progression. However, in gene-based analysis, ATP8B2, a phospholipid transporter related to vesicle formation, was nominally associated with motor progression (P = 5.3 × 10-6 ). CONCLUSIONS We provide early evidence that this new method in PD improves measurement of symptom progression. We show that the APOE ε4 allele drives progressive cognitive impairment in PD. Replication of this method and results in independent cohorts are needed. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Manuela M.X. Tan
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK,UCL Movement Disorders Centre, University College London, London, UK,Correspondence to: Ms Manuela Tan and Prof. Huw Morris, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK; ;
| | - Michael A. Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edwin Jabbari
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK,UCL Movement Disorders Centre, University College London, London, UK
| | - Regina H. Reynolds
- Department of Neurodegenerative Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | - Hirotaka Iwaki
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA,Data Tecnica International, Glen Echo, Maryland, USA
| | - Cornelis Blauwendraat
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Sofia Kanavou
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Miriam I. Pollard
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK
| | - Leon Hubbard
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Naveed Malek
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Katherine A. Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sarah L. Marrinan
- Institute for Ageing and Health, Newcastle University, Newcastle Upon Tyne, UK
| | - Nin Bajaj
- Department of Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Roger A. Barker
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK,Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - David J. Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne. UK
| | - Catherine Bresner
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK,UCL Movement Disorders Centre, University College London, London, UK
| | - Nicholas W. Wood
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK,UCL Movement Disorders Centre, University College London, London, UK
| | - Caroline H. Williams-Gray
- Department of Clinical Neurosciences, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - John Hardy
- UCL Movement Disorders Centre, University College London, London, UK,Department of Neurodegenerative Diseases, Queen Square Institute of Neurology, University College London, London, UK,Reta Lila Weston Institute, UCL Queen Square Institute of Neurology, London, UK,UK Dementia Research Institute, University College London, London, UK,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, UK,Institute for Advanced Study, The Hong Kong University of Science and Technology, Hong Kong, SAR, China
| | - Michael A. Nalls
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA,Data Tecnica International, Glen Echo, Maryland, USA
| | - Andrew B. Singleton
- Molecular Genetics Section, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Nigel M. Williams
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michele T.M. Hu
- Nuffield Department of Clinical Neurosciences, Division of Clinical Neurology, University of Oxford, Oxford, UK,Oxford Parkinson’s Disease Centre, University of Oxford, Oxford, UK,Department of Clinical Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Donald G. Grosset
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Maryam Shoai
- Department of Neurodegenerative Diseases, Queen Square Institute of Neurology, University College London, London, UK,UK Dementia Research Institute, University College London, London, UK
| | - Huw R. Morris
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, UK,UCL Movement Disorders Centre, University College London, London, UK,Correspondence to: Ms Manuela Tan and Prof. Huw Morris, Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK; ;
| |
Collapse
|
96
|
Rao A, MacNeill SJ, van de Luijtgaarden MWM, Chesnaye NC, Drechsler C, Wanner C, Torino C, Postorino M, Szymczak M, Evans M, Dekker FW, Jager KJ, Ben-Shlomo Y, Caskey FJ. Using datasets to ascertain the generalisability of clinical cohorts: the example of European QUALity Study on the treatment of advanced chronic kidney disease (EQUAL). Nephrol Dial Transplant 2021; 37:540-547. [PMID: 33426560 DOI: 10.1093/ndt/gfab002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cohort studies are among the most robust of observational studies but have issues with external validity. This study assesses threats to external validity (generalisability) in the European QUALity (EQUAL) study, a cohort study of people over 65 years with stage 4/5 chronic kidney disease. METHODS Patients meeting the EQUAL inclusion criteria were identified in The Health Improvement Network database and stratified into those attending renal units (secondary care cohort-SCC) and not (primary care cohort-PCC). Survival, progression to renal replacement therapy (RRT), and hospitalisation were compared. RESULTS The analysis included 250, 633, and 2,464 patients in EQUAL, PCC, and SCC. EQUAL had a higher proportion of men in comparison to PCC and SCC (60.0% vs. 34.8% vs. 51.4%). Increasing age (≥85 years odds ratio (OR) 0.25 (95% confidence interval (CI) 0.15-0.40)) and comorbidity (Charlson Comorbidity Index ≥ 4 OR 0.69 (CI 0.52-0.91)) were associated with non-participation in EQUAL. EQUAL had a higher proportion of patients starting RRT at 1 year compared to SCC (8.1% vs. 2.1%%, p < 0.001). Patients in the PCC and SCC had increased risk of Hospitalisation (incidence rate ratio=1.76 (95% CI 1.27-2.47) & 2.13 (95% CI 1.59-2.86)) and mortality at one year (hazard ratio=3.48 (95% CI 2.1-5.7) & 1.7 (95% CI 1.1-2.7)) compared to EQUAL. CONCLUSIONS This study provides evidence of how participants in a cohort study can differ from the broader population of patients, which is essential when considering external validity and applying to local practice.
Collapse
Affiliation(s)
- Anirudh Rao
- Department of Nephrology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Moniek W M van de Luijtgaarden
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Christiane Drechsler
- Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Chistoph Wanner
- Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Torino
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Maurizio Postorino
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol.,North Bristol NHS Trust, Bristol
| | | |
Collapse
|
97
|
Plumb L, Boother EJ, Caskey FJ, Sinha MD, Ben-Shlomo Y. The incidence of and risk factors for late presentation of childhood chronic kidney disease: A systematic review and meta-analysis. PLoS One 2020; 15:e0244709. [PMID: 33382793 PMCID: PMC7774987 DOI: 10.1371/journal.pone.0244709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When detected early, inexpensive measures can slow chronic kidney disease progression to kidney failure which, for children, confers significant morbidity and impacts growth and development. Our objective was to determine the incidence of late presentation of childhood chronic kidney disease and its associated risk factors. METHODS We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library and CINAHL, grey literature and registry websites for observational data describing children <21 years presenting to nephrology services, with reference to late presentation (or synonyms thereof). Independent second review of eligibility, data extraction, and risk of bias was undertaken. Meta-analysis was used to generate pooled proportions for late presentation by definition and investigate risk factors. Meta-regression was undertaken to explore heterogeneity. RESULTS Forty-five sources containing data from 30 countries were included, comprising 19,339 children. Most studies (37, n = 15,772) described children first presenting in kidney failure as a proportion of the chronic kidney disease population (mean proportion 0.43, 95% CI 0.34-0.54). Using this definition, the median incidence was 2.1 (IQR 0.9-3.9) per million age-related population. Risk associations included non-congenital disease and older age. Studies of hospitalised patients, or from low- or middle-income countries, that had older study populations than high-income countries, had higher proportions of late presentation. CONCLUSIONS Late presentation is a global problem among children with chronic kidney disease, with higher proportions seen in studies of hospitalised children or from low/middle-income countries. Children presenting late are older and more likely to have non-congenital kidney disease than timely presenting children. A consensus definition is important to further our understanding and local populations should identify modifiable barriers beyond age and disease to improve access to care.
Collapse
Affiliation(s)
- Lucy Plumb
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- UK Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Emily J. Boother
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Department of Renal Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| |
Collapse
|
98
|
Keeney E, Mohiuddin S, Zienius K, Ben-Shlomo Y, Ozawa M, Grant R, Hamilton W, Weller D, Brennan PM, Hollingworth W. Economic evaluation of GPs' direct access to computed tomography for identification of brain tumours. Eur J Cancer Care (Engl) 2020; 30:e13345. [PMID: 33184924 DOI: 10.1111/ecc.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/18/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND When GPs suspect a brain tumour, a referral for specialist assessment and subsequent brain imaging is generally the first option. NICE has recommended that GPs have rapid direct access to brain imaging for adults with progressive sub-acute loss of central nervous function; however, no studies have evaluated the cost-effectiveness. METHODS We developed a cost-effectiveness model based on data from one region of the UK with direct access computed tomography (DACT), routine data from GP records and the literature, to explore whether unrestricted DACT for patients with suspected brain tumour might be more cost-effective than criteria-based DACT or no DACT. RESULTS Although criteria-based DACT allows some patients without brain tumour to avoid imaging, our model suggests this may increase costs of diagnosis due to non-specific risk criteria and high costs of diagnosing or 'ruling out' brain tumours by other pathways. For patients diagnosed with tumours, differences in outcomes between the three diagnostic strategies are small. CONCLUSIONS Unrestricted DACT may reduce diagnostic costs; however, the evidence is not strong and further controlled studies are required. Criteria-based access to CT for GPs might reduce demand for DACT, but imperfect sensitivity and specificity of current risk stratification mean that it will not necessarily be cost-effective.
Collapse
Affiliation(s)
- Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Syed Mohiuddin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Karolis Zienius
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mio Ozawa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robin Grant
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - William Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, College House, St Luke's Campus, University of Exeter, Exeter, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul M Brennan
- Translational Neurosurgery Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Brain Tumour Research Group, Institute of Clinical Neuroscience, Learning and Research Building, Southmead Hospital, University of Bristol, Bristol, UK
| | - William Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
99
|
Lloyd K, Gaunt D, Haunton V, Skelly R, Mann H, Ben-Shlomo Y, Henderson EJ. Driving in Parkinson's disease: a retrospective study of driving and mobility assessments. Age Ageing 2020; 49:1097-1101. [PMID: 32585014 DOI: 10.1093/ageing/afaa098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To guide decision-making about driving ability, some patients with Parkinson's disease (PD) undergo specialist driving assessment. However, decisions about driving safety in most patients need to be made without this definitive test. There is no consensus on what predicts unsafe driving in PD nor a validated prediction tool to guide clinician decision-making and the need to refer for further assessment. OBJECTIVES To describe the characteristics of patients with PD assessed at a Driving Mobility Centre and investigate factors that predict driving assessment outcome. METHODS Retrospective cohort study of patients with PD assessed between 2012 and 2016. Descriptive analyses and logistic models to determine factors predicting a negative outcome. RESULTS There were 86 assessments of patients with PD. The mean age was 70 years (±9.2), 86% were male, median disease duration 7 years (interquartile range 5-12.5 years) and 59% were referred by the Driver and Vehicle Licensing Agency. In total, 62% had a negative 'not drive' outcome. The Rookwood Driving Battery (RDB), depth of vision deficit, usual driving frequency, age, duration license held and response time were all predictors in univariable analysis. The RDB was the best predictor of assessment failure, conditional on other variables in a backward stepwise model (odds ratio 1.29; 95% confidence interval 1.05, 1.60; P = 0.015). CONCLUSIONS This is the first study to describe patients with PD undergoing driving assessments in the UK. In this population, RDB performance was the best predictor of outcome. Future prospective studies are required to better determine predictors of driving ability to guide development of prediction tools for implementation into clinical practice.
Collapse
Affiliation(s)
- Katherine Lloyd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Victoria Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Rob Skelly
- Department of Medicine for the Elderly, University Hospitals of Derby and Burton, Derby, UK
| | - Helen Mann
- Driving and Mobility Centre (West of England), The Vassal Centre, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol, Bristol, UK
| | | |
Collapse
|
100
|
Göttgens I, van Halteren AD, de Vries NM, Meinders MJ, Ben-Shlomo Y, Bloem BR, Darweesh SKL, Oertelt-Prigione S. The Impact of Sex and Gender on the Multidisciplinary Management of Care for Persons With Parkinson's Disease. Front Neurol 2020; 11:576121. [PMID: 33071952 PMCID: PMC7530641 DOI: 10.3389/fneur.2020.576121] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022] Open
Abstract
The impact of sex and gender on disease incidence, progression, and provision of care has gained increasing attention in many areas of medicine. Biological factors–sex–and sociocultural and behavioral factors–gender–greatly impact on health and disease. While sex can modulate disease progression and response to therapy, gender can influence patient-provider communication, non-pharmacological disease management, and need for assistance. Sex and gender issues are especially relevant in chronic progressive diseases, such as Parkinson's disease (PD), because affected patients require multidisciplinary care for prolonged periods of time. In this perspective paper, we draw from evidence in the field of PD and various other areas of medicine to address how sex and gender could impact PD care provision. We highlight examples for which differences have been reported and formulate research topics and considerations on how to optimize the multidisciplinary care of persons with PD.
Collapse
Affiliation(s)
- Irene Göttgens
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Angelika D van Halteren
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nienke M de Vries
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marjan J Meinders
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|