Associations between specific autoimmune diseases and subsequent dementia: retrospective record-linkage cohort study, UK

The Functional Roles and Applications of Immunoglobulins in Neurodegenerative Disease

Natural autoantibodies, immunoglobulins (Igs) that target self-proteins, are common in the plasma of healthy individuals; some of the autoantibodies play pathogenic roles in systemic or tissue-specific autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Recently, the field of autoantibody-associated diseases has expanded to encompass neurodegenerative diseases such as Alzheimer's disease (AD) and Parkinson's disease (PD), with related studies examining the functions of Igs in the central nervous system (CNS). Recent evidence suggests that Igs have various effects in the CNS; these effects are associated with the prevention of neurodegeneration, as well as induction. Here, we summarize the functional roles of Igs with respect to neurodegenerative disease (AD and PD), focusing on the target antigens and effector cell types. In addition, we review the current knowledge about the roles of these antibodies as diagnostic markers and immunotherapies.

Towards an understanding of women's brain aging: the immunology of pregnancy and menopause

Women are at significantly greater risk of developing Alzheimer's disease and show higher prevalence of autoimmune conditions relative to men. Women's brain health is historically understudied, and little is therefore known about the mechanisms underlying epidemiological sex differences in neurodegenerative diseases, and how female-specific factors may influence women's brain health across the lifespan. In this review, we summarize recent studies on the immunology of pregnancy and menopause, emphasizing that these major immunoendocrine transition phases may play a critical part in women's brain aging trajectories.

Summary-Based Methylome-Wide Association Analyses Suggest Potential Genetically Driven Epigenetic Heterogeneity of Alzheimer's Disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder with no curative treatment available. Exploring the genetic and non-genetic contributors to AD pathogenesis is essential to better understand its underlying biological mechanisms, and to develop novel preventive and therapeutic strategies. We investigated potential genetically driven epigenetic heterogeneity of AD through summary data-based Mendelian randomization (SMR), which combined results from our previous genome-wide association analyses with those from two publicly available methylation quantitative trait loci studies of blood and brain tissue samples. We found that 152 probes corresponding to 113 genes were epigenetically associated with AD at a Bonferroni-adjusted significance level of 5.49E-07. Of these, 10 genes had significant probes in both brain-specific and blood-based analyses. Comparing males vs. females and hypertensive vs. non-hypertensive subjects, we found that 22 and 79 probes had group-specific associations with AD, respectively, suggesting a potential role for such epigenetic modifications in the heterogeneous nature of AD. Our analyses provided stronger evidence for possible roles of four genes (i.e., AIM2, C16orf80, DGUOK, and ST14) in AD pathogenesis as they were also transcriptionally associated with AD. The identified associations suggest a list of prioritized genes for follow-up functional studies and advance our understanding of AD pathogenesis.

Is psoriasis associated with dementia or cognitive impairment? A Critically Appraised Topic

CLINICAL QUESTION

Is psoriasis associated with dementia or cognitive impairment?

BACKGROUND

Psoriasis is a multisystemic inflammatory disorder that has an unclear association with cognitive dysfunction.

OBJECTIVES

To conduct a Critically Appraised Topic that synthesizes the results from relevant observational studies.

METHODS

A systematic literature search of PubMed and Embase was conducted on 12 July 2019 to identify case-control, cross-sectional or cohort studies that investigated the association between psoriasis and cognitive impairment or dementia. Risk of bias was assessed for each study, and the results presented in a narrative synthesis.

RESULTS

Eleven studies were included for critical appraisal. Of the 11 studies, 10 compared a total of 16 574 psoriasis cases with over 45 078 controls for risk of dementia or cognitive impairment. One of the 11 studies evaluated 7118 patients with dementia for odds of psoriasis compared with 21 354 controls. Six studies were assessed to have higher risk of bias. Nine of the 11 included studies found a significant positive association between the two diseases, one study a null association, and one study an inverse association.

DISCUSSION AND RECOMMENDATION

Most of the 11 included studies found a positive association between psoriasis and either mild cognitive impairment or dementia. Brief cognitive assessments have been suggested to screen older patients with psoriasis who present with subjective cognitive complaints.

Neuronal surface autoantibodies in dementia: a systematic review and meta-analysis

INTRODUCTION

Neuronal antibodies can cause encephalopathy syndromes often presenting with subacute cognitive impairment, sometimes resembling neurodegenerative dementias.

METHODS

We searched Medline and Embase for studies reporting associations between neuronal surface antibodies in all-cause dementia versus controls. Random-effects meta-analysis was used to pool adjusted estimates across studies.

RESULTS

Six studies were included, all reporting frequency of serum NMDAR antibodies in dementia with four also reporting frequency in atypical dementias. Both IgG [OR = 8.09 (1.51; 56.85), p = 0.036] and IgA/IgM NMDAR antibodies [OR = 42.48 (11.39; 158.52), p < 0.001] were associated with atypical dementia, but neither were associated with all-cause dementia.

DISCUSSION

In the first meta-analysis to explore this literature, serum IgG and IgA/IgM NMDAR antibodies were significantly more common in atypical dementias. However, methodological issues and small-sample sizes necessitate caution interpreting this result. Further studies measuring both serum and CSF antibodies are needed to investigate the role of neuronal antibodies in dementia, since evidence of pathogenicity in even a subset of patients could pave the way for novel treatment options.

Psoriasis is not a risk factor for dementia: a 12-year nationwide population-based cohort study

Studies investigating the risk for dementia in psoriatic patients remain inconclusive. There are a limited number of population-based studies on the association between psoriasis and dementia. This study aims to investigate the risk for dementia in psoriatic patients. This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Research Database between 2000 and 2012. A total of 111,825 patients with psoriasis and 111,825 age-, sex-, and index date-matched controls were recruited. The hazard ratio (HR) for subsequent dementia in patients with psoriasis was analyzed using a Cox model and a Fine-Gray competing risk model. During 1,358,774 person-years of follow-up, 2688 patients developed dementia in the psoriatic cohort, and 2062 developed dementia in the control cohort. In the multivariate adjusted Cox model, the hazard ratio (HR) of psoriatic patients for dementia was 1.02 [95% confidence interval (CI) 0.96-1.09] relative to the controls. Psoriasis did not increase the risk for dementia (both vascular dementia and degenerative dementia). In the competing risk model, the HR of dementia was 0.96 (95% CI 0.90-1.02) for psoriatic patients. Compared to psoriatic patients who had not received phototherapy or systemic treatment, those psoriatic patients receiving phototherapy or systemic treatment had a lower risk for dementia. However, this phenomenon was not observed in psoriatic patients who were observed for longer than 6 years. Psoriasis was not found to be a risk factor for dementia. Phototherapy and systemic treatment might not have a protective effect against dementia in psoriatic patients.

Framework of treating Alzheimer’s dementia

Current treatment paradigm in Alzheimer’s disease (AD) involves multiple approaches combining pharmacological and nonpharmacological intervention to mitigate the clinical symptoms, slow the progressive loss of cognitive and functional abilities, or modify the disease course. So far, beyond anti-cholinesterase inhibitors (AChEIs), donepezil, rivastigmine, galantamine, and antagonist of N-methyl-D-aspartic acid (NMDA) receptor, there are no newly approved medicines to treat AD. Under pharmacological treatment, the personal characteristic and the intra-individual therapeutic evaluations to examine various cognitive domains, behavioral and psychological problems, and global function should be considered when choosing any of AChEIs. The use of optimal dosage referring to the expected clinical outcomes and currently reported deficits from patient with AD has become an important issue in clinical treatment. Establishing and maintaining a strong therapeutic alliance to physician, patient, and caregiver is crucial and central to the comprehensive care in AD.

The Impact of Exercise, Lifestyle, and Clinical Factors on Perceived Cognitive Function in Patients with Rheumatoid Arthritis: Results from a Prospective Cohort Study

Objective

Lifestyle factors, such as inactivity and obesity, contribute to cognitive decline in the general population, but little is known about how these factors may affect individuals with a chronic inflammatory condition such as rheumatoid arthritis (RA). We studied the clinical and functional risk factors related to a worsening of perceived cognitive function in patients with RA.

Methods

We collected clinical and functional questionnaire data over 10 years in a prospective RA cohort including yearly self‐reported memory, concentration, and word‐finding difficulties graded from “never” to “often.” Generalized estimating equation models examined the role of exercise (defined as those meeting the Department of Health and Human Services physical activity guidelines of 75 minutes of vigorous or 150 minutes of moderate aerobic activity per week), body mass index (BMI), sleep, depression (Mental Health Index‐Depression), Disease Activity Score (DAS)28–c‐reactive protein (CRP)3 score, disease‐modifying antirheumatic drug, and corticosteroid use from the previous year as predictors of cognitive complaints that progressed to “often” compared with the previous year (the first year (T_i) progressed to “often” 1 year later (T_i+1)).

Results

Of 1219 RA subjects, 127 (10.4%) described either poor memory, concentration, or word‐finding difficulties as affecting them “often” at study entry. RA patients (n = 1092, mean age = 56.5 years, 82% female, 58% college educated) were less likely to report word‐finding difficulties, poor memory, and concentration as “often” if they were physically active (p = 0.0001, P = 0.01, P < 0.0001, respectively). Female RA patients developed more concentration complaints compared with males (P = 0.03); patients taking an anti–tumor necrosis factor therapy were less likely to complain of poor memory (P = 0.01). Sleep, BMI, fatigue, depression, DAS28‐CRP3, methotrexate, and corticosteroid use were not independently associated with a worsening of any cognitive complaints.

Conclusion

RA patients who are physically active are less likely to report cognitive difficulties. Our study suggests potential modifiable risk factors for the prevention of cognitive dysfunction in RA.

Can Disease-Modifying Anti-Rheumatic Drugs Reduce the Risk of Developing Dementia in Patients with Rheumatoid Arthritis?

Disease-modifying anti-rheumatic drugs (DMARDs) can reduce inflammation and slow progression of rheumatoid arthritis (RA). It remains unknown what impact DMARDs may have on dementia, where inflammation also plays a critical role in pathogenesis. Patients without a prior history of dementia who were newly diagnosed with RA between 2000 and 2005 were identified from Taiwan's National Health Insurance Research Database. The participants were stratified by age and gender. The outcome of interest was all-cause dementia, and Cox regression models were used to estimate the hazard ratio (HR) of dementia. The cumulative DMARD dosage was stratified by quartiles of defined daily doses. A total of 20,707 patients were diagnosed with RA, and 62,121 non-RA individuals aged 20 years or older were included. Cox proportional hazard regression analysis revealed that the RA cohort was 37% less likely to develop dementia compared with the non-RA cohort [adjusted HR 0.63, 95% confidence interval (CI) 0.55-0.72]. Further decreased risk was noted in DMARD users (adjusted HR 0.48, 95% CI 0.39-0.58) with dose-dependent effect. Subgroup analysis identified DMARD use as having a protective effect against developing dementia in female and younger patients. Also, in male and older patients, DMARD use further reduced the risk. These observations suggest that DMARDs may reduce the risk of developing dementia, and its effect is further increased at high cumulative dosages. These findings warrant further examination in randomized control trials.

Association Between Psoriasis and Dementia: A Population-Based Case-Control Study

BACKGROUND

Dementia is a syndrome that involves the deterioration of several higher mental functions in advanced age, and psoriasis is an autoimmune disease characterized by skin plaque. Epidemiological studies have indicated an association between dementia and psoriasis; however, to date, no studies in Asia have reported this association.

OBJECTIVE

This study used a population-based medical dataset to explore the association between previously diagnosed psoriasis and dementia in Taiwan.

METHODS

Using the Taiwan Longitudinal Health Insurance Database 2000, we identified 7118 individuals with a diagnosis of dementia; a further 21,354 sex- and aged-matched individuals were randomly extracted as controls. Patients with bullous pemphigoid, which is characterized by inflammatory phenomena similar to that evident in psoriasis, were chosen as a control group. Conditional logistic regression was performed to evaluate the association between dementia and prior psoriasis or bullous pemphigoid among the sampled patients.

RESULTS

Of the 28,472 individuals, 2.2, 3.0, and 1.5% of the total, case, and control groups, respectively, had been diagnosed with psoriasis. After adjustments were made for patients' monthly income, region, urbanization level, diabetes, hyperlipidemia, hypertension, and coronary heart disease, the odds ratio (OR) of diagnosed psoriasis for the case group was 1.46 (95% confidence interval [CI] 1.23-1.73; p < 0.001) compared with the control group. The ORs of a previous psoriasis diagnosis with arthritis and without arthritis in the case group were, respectively, 1.95 and 1.44 times (95% CI 1.03-3.89 and 1.21-1.72, respectively) those of the control group after adjustments for socioeconomic variables, diabetes, hyperlipidemia, hypertension, and coronary heart disease. However, no significant differences in prior bullous pemphigoid were observed between the dementia and control groups (0.5% and 0.4%, respectively).

CONCLUSIONS

More patients with dementia had prior psoriasis than did patients in the control group. Additional research is required to confirm our results and clarify the relationship.

Pregnancy loss and risk of later dementia: A nationwide cohort study, Denmark, 1977-2017

INTRODUCTION

Pregnancy losses may be associated with increased risks of dementia.

METHODS

We conducted a register-based cohort study in 1,243,957 women with ≥1 pregnancy in Denmark in the period 1977-2015. Using Cox regression, we estimated hazard ratios (HRs) comparing risks of dementia in women with and without pregnancy losses.

RESULTS

During 21,672,433 person-years of follow-up, 261,279 women experienced a pregnancy loss, and 2188 women were diagnosed with dementia. Stillbirth was associated with an 86% increased risk of dementia overall (HR 1.86, 95% confidence interval [CI] 1.28-2.71). By contrast, miscarriage was not associated with later risk of dementia overall (single miscarriage, HR 0.99, 95% CI 0.87-1.12; recurrent miscarriages, HR 1.06, 95% CI 0.84-1.35). Adjustment for cardiovascular disease, hypertension, and diabetes did not meaningfully alter the association magnitudes.

DISCUSSION

Stillbirth and dementia may share underlying mechanisms, suggesting that a history of stillbirth should be considered when assessing dementia risk in women.

Neuroimmune nexus of depression and dementia: Shared mechanisms and therapeutic targets

Dysfunctional immune activity is a physiological component of both Alzheimer's disease (AD) and major depressive disorder (MDD). The extent to which altered immune activity influences the development of their respective cognitive symptoms and neuropathologies remains under investigation. It is evident, however, that immune activity affects neuronal function and circuit integrity. In both disorders, alterations are present in similar immune networks and neuroendocrine signalling pathways, immune responses persist in overlapping neuroanatomical locations, and morphological and structural irregularities are noted in similar domains. Epidemiological studies have also linked the two disorders, and their genetic and environmental risk factors intersect along immune-activating pathways and can be synonymous with one another. While each of these disorders individually contains a large degree of heterogeneity, their shared immunological components may link distinct phenotypes within each disorder. This review will therefore highlight the shared immune pathways of AD and MDD, their overlapping neuroanatomical features, and previously applied, as well as novel, approaches to pharmacologically manipulate immune pathways, in each neurological condition. LINKED ARTICLES: This article is part of a themed section on Therapeutics for Dementia and Alzheimer's Disease: New Directions for Precision Medicine. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.18/issuetoc.

Prediction of Alzheimer's Disease-Associated Genes by Integration of GWAS Summary Data and Expression Data

Alzheimer's disease (AD) is the most common cause of dementia. It is the fifth leading cause of death among elderly people. With high genetic heritability (79%), finding the disease's causal genes is a crucial step in finding a treatment for AD. Following the International Genomics of Alzheimer's Project (IGAP), many disease-associated genes have been identified; however, we do not have enough knowledge about how those disease-associated genes affect gene expression and disease-related pathways. We integrated GWAS summary data from IGAP and five different expression-level data by using the transcriptome-wide association study method and identified 15 disease-causal genes under strict multiple testing (α < 0.05), and four genes are newly identified. We identified an additional 29 potential disease-causal genes under a false discovery rate (α < 0.05), and 21 of them are newly identified. Many genes we identified are also associated with an autoimmune disorder.

Risk factors of hippocampal sclerosis in the oldest old: The 90+ Study

OBJECTIVE

To examine the risk factors and comorbidities of hippocampal sclerosis (HS) in the oldest-old.

METHODS

A total of 134 participants with dementia from The 90+ Study with longitudinal evaluations and autopsy were included in this investigation. Participants were divided into 2 groups, one with and one without HS pathology, and differences in clinical and pathologic characteristics were compared.

RESULTS

Persons with HS tended to have a longer duration of dementia compared to participants without HS (mean 4.0 years vs 6.7 years, odds ratio [OR] 1.26; 95% confidence interval [CI] 1.11-1.42; p < 0.001). HS was more likely in participants with a history of autoimmune diseases (rheumatoid arthritis or thyroid disease, OR 3.15; 95% CI 1.30-7.62; p = 0.011), high thyroid-stimulating hormone (OR 4.94; 95% CI 1.40-17.46; p = 0.013), or high thyroid antibodies (OR 3.45; 95% CI 1.09-10.88; p = 0.035). Lewy body disease (LBD) pathology was also associated with an increased likelihood of HS (OR 5.70; 95% CI 1.22-26.4; p = 0.027).

CONCLUSION

We identified autoimmune conditions (rheumatoid arthritis and thyroid disease) as potential risk factors for HS in our cohort. LBD was the only pathology that was associated with increased odds of HS and those harboring HS pathology had a longer duration of dementia. This suggests multiple pathways of HS pathology among the oldest-old.

Inflammation: Bridging Age, Menopause and APOEε4 Genotype to Alzheimer's Disease

Neuro-inflammatory processes that contribute to development of Alzheimer’s are evident early in the latent prodromal phase and worsen during the course of the disease. Despite substantial mechanistic and clinical evidence of inflammation, therapeutic approaches targeting inflammation have failed to alter the course of the disease. Disparate results from epidemiological and clinical trials targeting inflammation, highlight the complexity of the inflammatory process. Herein we review the dynamics of the inflammatory process across aging, midlife endocrine transitions, and the APOEε4 genotype and their contribution to progression of Alzheimer’s disease (AD). We discuss the chronic inflammatory processes that are activated during midlife chronological and endocrine aging, which ultimately limit the clearance capacity of microglia and lead to immune senescence. Aging, menopause, and APOEε4 combine the three hits of a compromised bioenergetic system of menopause with the chronic low grade innate inflammation of aging with the APOEε4 dyslipidemia and adaptive immune response. The inflammatory immune response is the unifying factor that bridges across each of the risk factors for AD. Immune system regulators that are specific to stage of disease and inflammatory phenotype would provide a therapeutic strategy to disconnect the bridge that drives disease. Outcomes of this analysis provide plausible mechanisms underlying failed clinical trials of anti-inflammatory agents in Alzheimer’s patients. Further, they highlight the need for stratifying AD clinical trial cohorts based on inflammatory phenotype. Combination therapies that include targeted use of anti-inflammatory agent’s specific to the immune phenotype are considered.

Accuracy of general hospital dementia diagnoses in England: Sensitivity, specificity, and predictors of diagnostic accuracy 2008-2016

INTRODUCTION

Recognizing dementia in general hospitals allows for tailored care. We aimed to assess hospital dementia diagnosis accuracy, changes over time, and predictors of correct identification.

METHOD

Retrospective cohort study of people over 65 years, using data from a large mental health care database as gold standard, linked to 2008-2016 English hospital data.

RESULTS

In 21,387 people who had 138,455 admissions, we found sensitivity and specificity of dementia recording, respectively, to be 78.0% and 92.0% for each person's complete records, and 63.3% and 96.6% for each nonelective admission. Diagnostic sensitivity increased between 2008 and 16. Accurate general hospital recording of the presence of dementia was lower in ethnic minority groups, younger, single people, and those with physical illness.

DISCUSSION

Dementia diagnosis recording in general hospitals is increasing but remains less likely in some groups. Clinicians should be aware of this inequity and have a higher index of clinical suspicion in these groups.

Risk of dementia among patients with Sjogren's syndrome: A nationwide population-based cohort study in Taiwan

OBJECTIVE

Autoimmunity may play a role in early-stage dementia. The association between Sjogren's syndrome (SS) and dementia remains unknown. This study was conducted to provide epidemiologic evidence for this relationship.

METHODS

This 12-year, nationwide, population-based, retrospective cohort study analyzed the risk of dementia in the SS cohort. We also investigated the incidence of dementia among patients with SS by using data from the Longitudinal Health Insurance Database 2000, maintained by the Taiwan National Health Research Institutes. To balance the prevalence of characteristics in the cohorts, we used the propensity score to match selected comorbidities in the two cohorts. We also analyzed the association between SS and dementia among patients with different potential risks by using a Cox proportional hazard model.

RESULTS

According to the analysis of data obtained from follow-up conducted during 2000-2012, the incidence of dementia in the SS cohort was 1.21-fold that in the control cohort (95% confidence interval [CI] = 1.02-1.45, p < 0.05). In the group older than 65years, the incidence of dementia was significantly high (adjusted hazard ratio [aHR] = 5.30, 95% CI = 4.26-6.60, p < 0.01). After adjustment for comorbidities, including Parkinson's disease (aHR = 2.98, 95% CI = 1.80-4.94), insomnia (aHR = 1.45, 95% CI = 1.14-1.85), and hypertension (aHR = 1.43, 95% CI = 1.19-1.71), the association between SS and dementia was still significant.

CONCLUSION

This 13-year, nationwide, population-based retrospective cohort study revealed patients with SS to have a higher risk of dementia.

The association between systemic lupus erythematosus and dementia A meta-analysis

A growing body of evidence indicates that systemic lupus erythematosus (SLE) is associated with increased risk of cognitive impairment and dementia. However, to date, no studies have been conducted to quantitatively summarize and evaluate the consistency of data.

Prevalence of immunological diseases in a Finnish frontotemporal lobar degeneration cohort with the C9orf72 repeat expansion carriers and non-carriers

Recent studies have suggested a role for immune dysregulation behind the etiology of frontotemporal lobar degeneration (FTLD). Here, we have investigated the prevalence of immunological diseases in FTLD (N = 196) with and without the C9orf72 repeat expansion, Alzheimer's disease (AD) (N = 193) and not cognitively impaired (NCI) subjects (N = 92). The prevalence was 16.3% in FTLD, 13.5% in AD and 15.2% in NCI. Although differences between the groups did not reach statistical significance, the frequency of immunological diseases was the highest in FTLD without the C9orf72 expansion (22/117, 18.8%) and the lowest in FTLD with the expansion (6/56, 10.7%), suggesting that the C9orf72 expansion possibly influences immunological pathways in FTLD.

The role of ophthalmic imaging in central nervous system degeneration in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that can involve any organ system. Central nervous system involvement can be a severe life threatening complication, ultimately resulting in severe neurodegenerative changes. Magnetic resonance imaging suggests that neurodegeneration, which may have deleterious effects on brain function, may occur early in SLE and experimental models suggest that neuroprotection may be feasible and beneficial. The retina is an extension of the brain. Recent ophthalmic imaging technologies are capable of identifying early changes in retinal and choroidal morphology and circulation that may reflect CNS degeneration. However, their utility in monitoring CNS involvement in SLE has been poorly studied as these have only been performed in small cohorts, in a cross-sectional design, non-quantitatively and without correlation to disease activity. The authors aim to review the current understanding of neurodegeneration associated with SLE, with particular focus on the visual pathway. We describe the neuropathology of the visual system in SLE and the evidence for retinal and choroidal neurodegenerative and microvascular changes using optical coherence tomography technology. We aim to describe the potential role of optical imaging modalities in NPSLE diagnosis and their likely impact on the study of neuronal function.

Presence of Anticardiolipin Antibodies in Patients with Dementia: A Systematic Review and Meta-Analysis

Growing evidences are supporting towards the involvement of antiphospholipid antibodies [aPLs e.g., lupus anticoagulant (LA), anticardiolipin (aCL) and anti-β2-glycoprotein I (anti-β2-GPI) antibodies] in various neurological manifestations including migraine, epilepsy and dementia in the presence or absence of autoimmune diseases such as antiphospholipid syndrome or systemic lupus erythematosus. The aim of this systematic review and meta-analysis was to assess the presence of aPLs in dementia patients without a diagnosis of any autoimmune disease. Electronic databases (e.g., PubMed, Web of Science, Scopus, ScienceDirect and Google Scholar) were searched without any year or language restrictions and based on the inclusion criteria, nine prospective case-control studies assessing only aCL were included involving 372 dementia patients and 337 healthy controls. No studies were found to assess the presence of both LA or anti-β2-GPI. The study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects model. We observed the prevalence of aCL in dementia was higher (32.80%) than that of controls (9.50%) e.g., 3.45 times higher risk of presenting with dementia than the controls, and significant presence of aCL antibodies was detected in dementia patients compared to controls (OR: 4.94, 95% CI: 2.66 - 9.16, p < 0.00001; I² = 32%, p = 0.16). Publication bias was not observed from Egger's (p = 0.081) and Begg's tests (p = 0.180). Based on the study quality assessment using modified Newcastle-Ottawa Scale for case-control studies, seven of nine studies were of high methodological quality scoring ≥ 7 (median value). In summary, aCL antibodies were significantly present in dementia patients suggesting that aCL antibodies are generated due to the autoimmune-derived effects of dementia or there might be a potential causative role of this autoantibody in dementia pathogenesis.

ALZHEIMER'S DISEASE - ESTROGENS AND SELECTIVE ESTROGEN RECEPTOR MODULATORS, FRIENDS OR FOES?

Alzheimer's disease(AD) is the leading cause of dementia and is characterized by the presence of extensive plaque deposition and neurofibrillary pathology. The aim of the present study was to make an update regarding the influence of estrogens and SERMs on inflammation and on the resolution of inflammation, respectively, focusing on these most important features implicated in the pathophysiology of AD. Several hypothesised mechanisms of action of estrogens and SERM are exposed and also some relevant clinical studies on this subject are analysed. The analyzed studies have a high heterogeneity of preparations used, of administration routes, of the female population included and of the periods of time from the appearance/induction of menopause to the therapeutic intervention and also of follow-up periods of patients and of the means of evaluating their cognitive decline. One can say that all the ways of pharmacological influence on the membrane or intracellular signalling system associated to estrogens that may have clinical importance in the prevention and possibly in the treatment of AD have not been exhausted. Estrogens with selective ERα or G protein-coupled estrogen receptors (GPER1 or GqMER) effects could be used to influence the resolution of inflammation process, with positive effects on AD evolution.