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d’ Orsi E, Xavier AJ, Rafnsson SB, Steptoe A, Hogervorst E, Orrell M. Is use of the internet in midlife associated with lower dementia incidence? Results from the English Longitudinal Study of Ageing. Aging Ment Health 2018; 22:1525-1533. [PMID: 28795579 PMCID: PMC6127001 DOI: 10.1080/13607863.2017.1360840] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Dementia is expected to affect one million individuals in the United Kingdom by 2025; its prodromal phase may start decades before its clinical onset. The aim of this study is to investigate whether use of internet from 50 years of age is associated with a lower incidence of dementia over a ten-year follow-up. METHODS We analysed data based on 8,238 dementia free (at baseline in 2002-2004) core participants from the English Longitudinal Study of Ageing. Information on baseline use of internet was obtained through questionnaires; dementia casesness was based on participant (or informant) reported physician diagnosed dementia or overall score on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Cox proportional hazards regression analysis was used for examining the relationship between internet use and incident dementia. RESULTS There were 301 (5.01%) incident dementia cases during the follow-up. After full multivariable adjustment for potential confounding factors, baseline internet use was associated with a 40% reduction in dementia risk assessed between 2006-2012 (HR = 0.60 CI: 0.42-0.85; p < 0.05). CONCLUSION This study suggests that use of internet by individuals aged 50 years or older is associated with a reduced risk of dementia. Additional studies are needed to better understand the potential causal mechanisms underlying this association.
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Affiliation(s)
- Eleonora d’ Orsi
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Campus Universitário Trindade, Florianópolis, Brazil ZIP CODE: 88040-900; Tel: +55 48 37219388;
| | - Andre Junqueira Xavier
- Universidade do Sul de Santa Catarina, Av Pedra Branca, 25 - Cidade Universitária, ZIP CODE: 88137-270, Palhoça, Brazil; Tel: +55(48)91647539;
| | - Snorri Bjorn Rafnsson
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK. Tel: +44 (0)20 7679 2000;
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK WC1E 6BT, UK. Tel: +44 (0)20 7679 2000;
| | - Eef Hogervorst
- Applied Cognitive Research NCSEM, Loughborough University, LE11 3TU UK, Tel:+44 (0)1509 223020;
| | - Martin Orrell
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, NG7 2UH, UK; Tel: +441159515151;
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Debette S, Strbian D, Wardlaw JM, van der Worp HB, Rinkel GJE, Caso V, Dichgans M. Fourth European stroke science workshop. Eur Stroke J 2018; 3:206-219. [PMID: 31009021 PMCID: PMC6453207 DOI: 10.1177/2396987318774443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022] Open
Abstract
Lake Eibsee, Garmisch-Partenkirchen, 16 to 18 November, 2017: The European Stroke Organisation convened >120 stroke experts from 21 countries to discuss latest results and hot topics in clinical, translational and basic stroke research. Since its inception in 2011, the European Stroke Science Workshop has become a cornerstone of European Stroke Organisation's academic activities and a major highlight for researchers in the field. Participants include stroke researchers at all career stages and with different backgrounds, who convene for plenary lectures and discussions. The workshop was organised in seven scientific sessions focusing on the following topics: (1) acute stroke treatment and endovascular therapy; (2) small vessel disease; (3) opportunities for stroke research in the omics era; (4) vascular cognitive impairment; (5) intracerebral and subarachnoid haemorrhage; (6) alternative treatment concepts and (7) neural circuits, recovery and rehabilitation. All sessions started with a keynote lecture providing an overview on current developments, followed by focused talks on a timely topic with the most recent findings, including unpublished data. In the following, we summarise the key contents of the meeting. The program is provided in the online only Data Supplement. The workshop started with a key note lecture on how to improve the efficiency of clinical trial endpoints in stroke, which was delivered by Craig Anderson (Sydney, Australia) and set the scene for the following discussions.
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Affiliation(s)
- S Debette
- Inserm Centre Bordeaux Population Health (U1219), University of Bordeaux, Bordeaux, France
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - D Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - JM Wardlaw
- Centre for Clinical Brain Sciences, and UK Dementia Research Institute at the University of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - HB van der Worp
- Department of Neurology and neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - GJE Rinkel
- Department of Neurology and neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - V Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - M Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Palmer MJ, Barnard S, Perel P, Free C. Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database Syst Rev 2018; 6:CD012675. [PMID: 29932455 PMCID: PMC6513181 DOI: 10.1002/14651858.cd012675.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of disability and mortality globally. Premature fatal and non-fatal CVD is considered to be largely preventable through the control of risk factors via lifestyle modifications and preventive medication. Lipid-lowering and antihypertensive drug therapies for primary prevention are cost-effective in reducing CVD morbidity and mortality among high-risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor. Approximately 9% of CVD cases in the EU are attributed to poor adherence to vascular medications. Low-cost, scalable interventions to improve adherence to medications for the primary prevention of CVD have potential to reduce morbidity, mortality and healthcare costs associated with CVD. OBJECTIVES To establish the effectiveness of interventions delivered by mobile phone to improve adherence to medication prescribed for the primary prevention of CVD in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two other databases on 21 June 2017 and two clinical trial registries on 14 July 2017. We searched reference lists of relevant papers. We applied no language or date restrictions. SELECTION CRITERIA We included randomised controlled trials investigating interventions delivered wholly or partly by mobile phones to improve adherence to cardiovascular medications prescribed for the primary prevention of CVD. We only included trials with a minimum of one-year follow-up in order that the outcome measures related to longer-term, sustained medication adherence behaviours and outcomes. Eligible comparators were usual care or control groups receiving no mobile phone-delivered component of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. We contacted study authors for disaggregated data when trials included a subset of eligible participants. MAIN RESULTS We included four trials with 2429 randomised participants. Participants were recruited from community-based primary care or outpatient clinics in high-income (Canada, Spain) and upper- to middle-income countries (South Africa, China). The interventions received varied widely; one trial evaluated an intervention focused on blood pressure medication adherence delivered solely through short messaging service (SMS), and one intervention involved blood pressure monitoring combined with feedback delivered via smartphone. Two trials involved interventions which targeted a combination of lifestyle modifications, alongside CVD medication adherence, one of which was delivered through text messages, written information pamphlets and self-completion cards for participants, and the other through a multi-component intervention comprising of text messages, a computerised CVD risk evaluation and face-to-face counselling. Due to heterogeneity in the nature and delivery of the interventions, we did not conduct a meta-analysis, and therefore reported results narratively.We judged the body of evidence for the effect of mobile phone-based interventions on objective outcomes (blood pressure and cholesterol) of low quality due to all included trials being at high risk of bias, and inconsistency in outcome effects. Of two trials targeting medication adherence alongside other lifestyle modifications, one reported a small beneficial intervention effect in reducing low-density lipoprotein cholesterol (mean difference (MD) -9.2 mg/dL, 95% confidence interval (CI) -17.70 to -0.70; 304 participants), and the other found no benefit (MD 0.77 mg/dL, 95% CI -4.64 to 6.18; 589 participants). One trial (1372 participants) of a text messaging-based intervention targeting adherence showed a small reduction in systolic blood pressure (SBP) for the intervention arm which delivered information-only text messages (MD -2.2 mmHg, 95% CI -4.4 to -0.04), but uncertain evidence of benefit for the second intervention arm that provided additional interactivity (MD -1.6 mmHg, 95% CI -3.7 to 0.5). One study examined the effect of blood pressure monitoring combined with smartphone messaging, and reported moderate intervention benefits on SBP and diastolic blood pressure (DBP) (SBP: MD -7.10 mmHg, 95% CI -11.61 to -2.59; DBP: -3.90 mmHg, 95% CI -6.45 to -1.35; 105 participants). There was mixed evidence from trials targeting medication adherence alongside lifestyle advice using multi-component interventions. One trial found large benefits for SBP and DBP (SBP: MD -12.45 mmHg, 95% CI -15.02 to -9.88; DBP: MD -12.23 mmHg, 95% CI -14.03 to -10.43; 589 participants), whereas the other trial demonstrated no beneficial effects on SBP or DBP (SBP: MD 0.83 mmHg, 95% CI -2.67 to 4.33; DBP: MD 1.64 mmHg, 95% CI -0.55 to 3.83; 304 participants).Two trials reported on adverse events and provided low-quality evidence that the interventions did not cause harm. One study provided low-quality evidence that there was no intervention effect on reported satisfaction with treatment.Two trials were conducted in high-income countries, and two in upper- to middle-income countries. The interventions evaluated employed between three and 16 behaviour change techniques according to coding using Michie's taxonomic method. Two trials evaluated interventions that involved potential users in their development. AUTHORS' CONCLUSIONS There is low-quality evidence relating to the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD; some trials reported small benefits while others found no effect. There is low-quality evidence that these interventions do not result in harm. On the basis of this review, there is currently uncertainty around the effectiveness of these interventions. We identified six ongoing trials being conducted in a range of contexts including low-income settings with potential to generate more precise estimates of the effect of primary prevention medication adherence interventions delivered by mobile phone.
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Affiliation(s)
- Melissa J Palmer
- London School of Hygiene and Tropical MedicineDepartment of Population HealthLondonUK
| | | | - Pablo Perel
- London School of Hygiene and Tropical MedicineDepartment of Population HealthLondonUK
| | - Caroline Free
- London School of Hygiene & Tropical MedicineClinical Trials Unit, Department of Population HealthKeppel StreetLondonUKWC1E 7HT
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Robbins TD, Lim Choi Keung SN, Arvanitis TN. E-health for active ageing; A systematic review. Maturitas 2018; 114:34-40. [PMID: 29907244 DOI: 10.1016/j.maturitas.2018.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
Enabling successful active ageing is an international priority to meet the challenges of increasing life expectancy. Digital strategies, such as telemedicine and e-health, offer the potential to deliver active ageing in a cost-effective manner at scale. This article aims to establish the extent to which the research literature considers e-health-based and telemedicine-based active ageing interventions. A systematic review was conducted according to PRISMA standards. Independently, two authors searched the Cochrane, EMBASE & CINAHL databases, with subsequent independent extraction and semi-quantitative analysis. We report a considerable breadth in digital active ageing research, which is truly international in its scope. There is a diverse range of both interventions and technologies, including a reassuring focus on community-based interventions. Whilst there are a number of quantitative studies, sample sizes are small, with a limited amount of statistical testing of the results. There is significant variation in the outcome measures reported and little consensus as to the most effective intervention strategies. Overall, whilst there is considerable breadth to the research published in the literature, there is a clear restriction in the depth of this research. There is little overall consensus. This lack of depth and consensus may be due to the need to recognize the important role of technical research elements alongside more traditional research methodologies, such as randomized controlled trials. Enabling both technical and clinical research methods to be recognized, in tandem, has enormous potential to support individuals, communities, clinicians and policy makers to make more informed decisions in relation to active ageing.
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Affiliation(s)
- Timothy David Robbins
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, United Kingdom; University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Sarah N Lim Choi Keung
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Theodoros N Arvanitis
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, United Kingdom.
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van Middelaar T, Beishuizen CRL, Guillemont J, Barbera M, Richard E, Moll van Charante EP. Engaging older people in an internet platform for cardiovascular risk self-management: a qualitative study among Dutch HATICE participants. BMJ Open 2018; 8:e019683. [PMID: 29358447 PMCID: PMC5781010 DOI: 10.1136/bmjopen-2017-019683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To study older peoples' experiences with an interactive internet platform for cardiovascular self-management, to assess which factors influence initial and sustained engagement. To assess their views on future use within primary care. DESIGN Qualitative semistructured interview study, with thematic analysis. SETTING Primary care in the Netherlands. PARTICIPANTS People ≥65 years with an increased risk of cardiovascular disease who used the 'Healthy Ageing Through Internet Counselling in the Elderly' internet platform with remote support of a coach. Participants were selected using a purposive sampling method based on gender, age, level of education, cardiovascular history, diabetes, duration of participation and login frequency. RESULTS We performed 17 interviews with 20 participants, including three couples. In the initial phase, platform engagement was influenced by perceived computer literacy of the participants, user-friendliness, acceptability and appropriateness of the intervention and the initial interaction with the coach. Sustained platform use was mainly facilitated by a relationship of trust with the coach. Other facilitating factors were regular automatic and personal reminders, clear expectations of the platform, incorporation into daily routine, social support and a loyal and persistent attitude. Perceived lack of change in content of the platform could work both stimulating and discouraging. Participants supported the idea of embedding the platform into the primary care setting. CONCLUSIONS Human support is crucial to initial and sustained engagement of older people in using an interactive internet platform for cardiovascular self-management. Regular reminders further facilitate sustained use, and increased tailoring to personal preference is recommended. Embedding the platform in primary healthcare may enhance future adoption. TRIAL REGISTRATION NUMBER ISRCTN48151589; Pre-results.
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Affiliation(s)
- Tessa van Middelaar
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Mariagnese Barbera
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Edo Richard
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
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Marengoni A, Rizzuto D, Fratiglioni L, Antikainen R, Laatikainen T, Lehtisalo J, Peltonen M, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M, Ngandu T. The Effect of a 2-Year Intervention Consisting of Diet, Physical Exercise, Cognitive Training, and Monitoring of Vascular Risk on Chronic Morbidity-the FINGER Randomized Controlled Trial. J Am Med Dir Assoc 2017; 19:355-360.e1. [PMID: 29108888 DOI: 10.1016/j.jamda.2017.09.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To verify whether a multidomain intervention lowers the risk of developing new chronic diseases in older adults. METHODS Multicenter, double-blind randomized controlled trial started in October 2009, with 2-year follow-up. A total of 1260 people aged 60 to 77 years were enrolled in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Participants were randomly assigned in a 1:1 ratio to a 2-year multidomain intervention (n = 631) (nutritional guidance, exercise, cognitive training, and management of metabolic and vascular risk factors) or a control group (n = 629) (general health advice). Data on most common chronic diseases were collected by a physician at baseline and 2 years later. RESULTS At 2-year follow-up, the average number of new chronic diseases was 0.47 [standard deviation (SD) 0.7] in the intervention group and 0.58 (SD 0.8) in the control group (P < .01). The incidence rate per 100 person-years for developing 1+ new disease(s) was 17.4 [95% confidence interval (CI) = 15.1-20.1] in the intervention group and 20.5 (95% CI = 18.0-23.4) in the control group; for developing 2+ new diseases, 4.9 (95% CI = 3.7-6.4) and 6.1 (95% CI = 4.8-7.8); and for 3+ new diseases, 0.7 (95% CI = 0.4-1.5) and 1.8 (95% CI = 1.1-2.8), respectively. After adjustment for age, sex, education, current smoking, alcohol intake, and the number of chronic diseases at baseline, the intervention group had a hazard ratio ranging from 0.80 (0.66-0.98) for developing 1+ new chronic disease(s) to 0.38 (0.16-0.88) for developing 3+ new chronic diseases compared to the control group. CONCLUSIONS Findings from this randomized controlled trial suggest that a multidomain intervention could reduce the risk of developing new chronic diseases in older people.
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Affiliation(s)
- Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Riitta Antikainen
- Center for Life Course Health Research/Geriatrics, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland; Oulu City Hospital, Oulu, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Joint municipal authority for North Karelia social and health services, Joensuu, Finland
| | - Jenni Lehtisalo
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Markku Peltonen
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Timo Strandberg
- Center for Life Course Health Research/Geriatrics, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland; University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Tuomilehto
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; South Ostrobothnia Central Hospital, Seinäjoki, Finland; Dasman Diabetes Institute, Dasman, Kuwait; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Miia Kivipelto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden; Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholms Sjukhem, Research & Development unit, Stockholm, Sweden
| | - Tiia Ngandu
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Crous-Bou M, Minguillón C, Gramunt N, Molinuevo JL. Alzheimer's disease prevention: from risk factors to early intervention. ALZHEIMERS RESEARCH & THERAPY 2017; 9:71. [PMID: 28899416 PMCID: PMC5596480 DOI: 10.1186/s13195-017-0297-z] [Citation(s) in RCA: 352] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Due to the progressive aging of the population, Alzheimer’s disease (AD) is becoming a healthcare burden of epidemic proportions for which there is currently no cure. Disappointing results from clinical trials performed in mild–moderate AD dementia combined with clear epidemiological evidence on AD risk factors are contributing to the development of primary prevention initiatives. In addition, the characterization of the long asymptomatic stage of AD is allowing the development of intervention studies and secondary prevention programmes on asymptomatic at-risk individuals, before substantial irreversible neuronal dysfunction and loss have occurred, an approach that emerges as highly relevant. In this manuscript, we review current strategies for AD prevention, from primary prevention strategies based on identifying risk factors and risk reduction, to secondary prevention initiatives based on the early detection of the pathophysiological hallmarks and intervention at the preclinical stage of the disease. Firstly, we summarize the evidence on several AD risk factors, which are the rationale for the establishment of primary prevention programmes as well as revising current primary prevention strategies. Secondly, we review the development of public–private partnerships for disease prevention that aim to characterize the AD continuum as well as serving as platforms for secondary prevention trials. Finally, we summarize currently ongoing clinical trials recruiting participants with preclinical AD or a higher risk for the onset of AD-related cognitive impairment. The growing body of research on the risk factors for AD and its preclinical stage is favouring the development of AD prevention programmes that, by delaying the onset of Alzheimer’s dementia for only a few years, would have a huge impact on public health.
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Affiliation(s)
- Marta Crous-Bou
- Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain
| | - Carolina Minguillón
- Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain
| | - Nina Gramunt
- Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain.,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain. .,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
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Hoevenaar-Blom MP, Guillemont J, Ngandu T, Beishuizen CRL, Coley N, Moll van Charante EP, Andrieu S, Kivipelto M, Soininen H, Brayne C, Meiller Y, Richard E. Improving data sharing in research with context-free encoded missing data. PLoS One 2017; 12:e0182362. [PMID: 28898245 PMCID: PMC5595279 DOI: 10.1371/journal.pone.0182362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/17/2017] [Indexed: 11/19/2022] Open
Abstract
Lack of attention to missing data in research may result in biased results, loss of power and reduced generalizability. Registering reasons for missing values at the time of data collection, or—in the case of sharing existing data—before making data available to other teams, can save time and efforts, improve scientific value and help to prevent erroneous assumptions and biased results. To ensure that encoding of missing data is sufficient to understand the reason why data are missing, it should ideally be context-free. Therefore, 11 context-free codes of missing data were carefully designed based on three completed randomized controlled clinical trials and tested in a new randomized controlled clinical trial by an international team consisting of clinical researchers and epidemiologists with extended experience in designing and conducting trials and an Information System expert. These codes can be divided into missing due to participant and/or participation characteristics (n = 6), missing by design (n = 4), and due to a procedural error (n = 1). Broad implementation of context-free missing data encoding may enhance the possibilities of data sharing and pooling, thus allowing more powerful analyses using existing data.
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Affiliation(s)
- Marieke P. Hoevenaar-Blom
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | | | - Tiia Ngandu
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Cathrien R. L. Beishuizen
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicola Coley
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
- INSERM, University of Toulouse UMR1027, Toulouse, France
| | - Eric P. Moll van Charante
- Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sandrine Andrieu
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
- INSERM, University of Toulouse UMR1027, Toulouse, France
| | - Miia Kivipelto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
- Aging Research Center, Karolinska Institutet/ Stockholm University, Stockholm, Sweden
- Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
- Neurocenter, neurology, Kuopio University Hospital, Kuopio, Finland
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, United Kingdom
| | - Yannick Meiller
- Department of Information and Operations Management, ESCP Europe, Paris, France
| | - Edo Richard
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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Tariq S, Barber PA. Dementia risk and prevention by targeting modifiable vascular risk factors. J Neurochem 2017; 144:565-581. [PMID: 28734089 DOI: 10.1111/jnc.14132] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/23/2017] [Accepted: 07/15/2017] [Indexed: 01/04/2023]
Abstract
The incidence of dementia is expected to double in the next 20 years and will contribute to heavy social and economic burden. Dementia is caused by neuronal loss that leads to brain atrophy years before symptoms manifest. Currently, no cure exists and extensive efforts are being made to mitigate cognitive impairment in late life in order to reduce the burden on patients, caregivers, and society. The most common type of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) often co-exists in the brain and shares common, modifiable risk factors, which are targeted in numerous secondary prevention trials. There is a growing need for non-pharmacological interventions and infrastructural support from governments to encourage psychosocial and behavioral interventions. Secondary prevention trials need to be redesigned based on the risk profile of individual subjects, which require the use of validated and standardized clinical, biological, and neuroimaging biomarkers. Multi-domain approaches have been proposed in high-risk populations that target optimal treatment; clinical trials need to recruit individuals at the highest risk of dementia before symptoms develop, thereby identifying an enriched disease group to test preventative and disease modifying strategies. The underlying aim should be to reduce microscopic brain tissue loss by modifying vascular and lifestyle risk factors over a relatively short period of time, thus optimizing the opportunity for preventing dementia in the future. Collaboration between international research groups is of key importance to the optimal use and allocation of existing resources, and the development of new techniques in preventing dementia. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Sana Tariq
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada.,Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
| | - Philip A Barber
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada.,Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
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Resende APGDL, Barbieri AR. INTERNAÇÕES POR CONDIÇÕES SENSÍVEIS À ATENÇÃO PRIMÁRIA À SAÚDE DECORRENTES DAS DOENÇAS CARDIOVASCULARES. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017006570015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar as internações por condições sensíveis à atenção primária decorrentes das doenças cardiovasculares, correlacionando-as com o número de pessoas com hipertensão estimadas e acompanhadas e com a cobertura da Estratégia Saúde da Família nos 78 municípios de Mato Grosso do Sul, no período 2009 a 2012. Método: estudo ecológico, com análise estatística a partir da composição de agrupamentos (clusters) que foram formados, considerando as internações por condições cardiovasculares, sensíveis à atenção primária, associadas às internações gerais dos municípios e demais internações por condições sensíveis. Associações também foram estatisticamente realizadas entre a proporção de pessoas com hipertensão acompanhadas e cobertura da Estratégia Saúde da Família. Resultados: evidenciou-se associação entre cobertura da Estratégia Saúde da Família e internações decorrentes de doenças cardiovasculares. Embora tenha aumento no registro de pessoas com hipertensão cadastradas e acompanhadas. Não foi observada redução no número de internações e na mortalidade pelas causas analisadas. Conclusão: a saúde da família como estratégia de intervenção na atenção primária em geral contribuiu para a redução das internações por doenças cardiovasculares. No entanto, o baixo número de pacientes cadastrados e acompanhados indica problemas nos mecanismos de implantação da estratégia e processos de trabalho.
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Rohde D, Williams D, Gaynor E, Bennett K, Dolan E, Callaly E, Large M, Hickey A. Secondary prevention and cognitive function after stroke: a study protocol for a 5-year follow-up of the ASPIRE-S cohort. BMJ Open 2017; 7:e014819. [PMID: 28348196 PMCID: PMC5372058 DOI: 10.1136/bmjopen-2016-014819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/22/2016] [Accepted: 01/06/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Cognitive impairment is common following stroke and can increase disability and levels of dependency of patients, potentially leading to greater burden on carers and the healthcare system. Effective cardiovascular risk factor control through secondary preventive medications may reduce the risk of cognitive decline. However, adherence to medications is often poor and can be adversely affected by cognitive deficits. Suboptimal medication adherence negatively impacts secondary prevention targets, increasing the risk of recurrent stroke and further cognitive decline. The aim of this study is to profile cognitive function and secondary prevention, including adherence to secondary preventive medications and healthcare usage, 5 years post-stroke. The prospective associations between cognition, cardiovascular risk factors, adherence to secondary preventive medications, and rates of recurrent stroke or other cardiovascular events will also be explored. METHODS AND ANALYSIS This is a 5-year follow-up of a prospective study of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort of patients with stroke. This cohort will have a detailed assessment of cognitive function, adherence to secondary preventive medications and cardiovascular risk factor control. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the Research Ethics Committees at Beaumont Hospital, Dublin and Connolly Hospital, Dublin, Mater Misericordiae University Hospital, Dublin, and the Royal College of Surgeons in Ireland. Findings will be disseminated through presentations and peer-reviewed publications.
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Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Eva Gaynor
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eamon Dolan
- Department of Geriatric Medicine, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Elizabeth Callaly
- Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Margaret Large
- Clinical Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Editorial: no health without cognitive health. Curr Opin Psychiatry 2017; 30:123-127. [PMID: 27997453 DOI: 10.1097/yco.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jongstra S, Beishuizen C, Andrieu S, Barbera M, van Dorp M, van de Groep B, Guillemont J, Mangialasche F, van Middelaar T, Moll van Charante E, Soininen H, Kivipelto M, Richard E. Development and Validation of an Interactive Internet Platform for Older People: The Healthy Ageing Through Internet Counselling in the Elderly Study. Telemed J E Health 2016; 23:96-104. [PMID: 27463120 DOI: 10.1089/tmj.2016.0066] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A myriad of Web-based applications on self-management have been developed, but few focus on older people. In the face of global aging, older people form an important target population for cardiovascular prevention. This article describes the full development of an interactive Internet platform for older people, which was designed for the Healthy Ageing Through Internet Counselling in the Elderly (HATICE) study. We provide recommendations to design senior-friendly Web-based applications for a new approach to multicomponent cardiovascular prevention. METHODS The development of the platform followed five phases: (1) conceptual framework; (2) platform concept and functional design; (3) platform building (software and content); (4) testing and pilot study; and (5) final product. RESULTS We performed a meta-analysis, reviewed guidelines for cardiovascular diseases, and consulted end users, experts, and software developers to create the platform concept and content. The software was built in iterative cycles. In the pilot study, 41 people aged ≥65 years used the platform for 8 weeks. Participants used the interactive features of the platform and appreciated the coach support. During all phases adjustments were made to incorporate all improvements from the previous phases. The final platform is a personal, secured, and interactive platform supported by a coach. DISCUSSION When carefully designed, an interactive Internet platform is acceptable and feasible for use by older people with basic computer skills. To improve acceptability by older people, we recommend involving the end users in the process of development, to personalize the platform and to combine the application with human support. The interactive HATICE platform will be tested for efficacy in a multinational randomized controlled trial (ISRCTN48151589).
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Affiliation(s)
- Susan Jongstra
- 1 Department of Neurology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Cathrien Beishuizen
- 1 Department of Neurology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands
| | - Sandrine Andrieu
- 2 INSERM, University of Toulouse , Toulouse, France .,3 Department of Epidemiology and Public Health, Toulouse University Hospital , Toulouse, France
| | - Mariagnese Barbera
- 4 Institute of Clinical Medicine/Neurology, University of Eastern Finland , Kuopio, Finland
| | | | | | | | - Francesca Mangialasche
- 6 Ageing Research Center, Karolinska Institutet/Stockholm University , Stockholm, Sweden
| | - Tessa van Middelaar
- 1 Department of Neurology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands .,7 Department of Neurology, Radboud University Medical Center , Nijmegen, The Netherlands
| | - Eric Moll van Charante
- 8 Department of General Practice, Academic Medical Centre, University of Amsterdam , Amsterdam, The Netherlands
| | - Hilkka Soininen
- 4 Institute of Clinical Medicine/Neurology, University of Eastern Finland , Kuopio, Finland
| | - Miia Kivipelto
- 4 Institute of Clinical Medicine/Neurology, University of Eastern Finland , Kuopio, Finland .,6 Ageing Research Center, Karolinska Institutet/Stockholm University , Stockholm, Sweden .,9 Chronic Disease Prevention Unit, National Institute for Health and Welfare , Helsinki, Finland
| | - Edo Richard
- 1 Department of Neurology, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands .,7 Department of Neurology, Radboud University Medical Center , Nijmegen, The Netherlands
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